given individual. Binge eating appears to be characterized more by an abnormality in the
amount of food consumed than by a craving for a specific nutrient. However, during binges,
individuals tend to eat foods they would otherwise avoid. 
Individuals with bulimia nervosa are typica lly ashamed of their eating problems and
attempt to conceal their symptoms. Binge eating  usually occurs in secrecy or as inconspic-
uously as possible. The binge eating often cont inues until the individual is uncomfortably,
or even painfully, full. The most common antecedent of binge eating is negative affect.
Other triggers include interpersonal stressors; dietary restraint; negative feelings related
to body weight, body shape, and food; and boredom. Binge eating may minimize or mit-
igate factors that precipitated  the episode in the short-term, but negative self-evaluation
and dysphoria often are the delayed consequences.
Another essential feature of bulimia nervosa is the recurrent use of inappropriate com-
pensatory behaviors to prevent weight gain, collectively referred to as purge behaviors or
purging  (Criterion B). Many individuals with bulimia nervosa employ  several methods to
compensate for binge eating. Vomiting is the most common inappropriate compensatory
behavior. The immediate effects of vomiting include relief from physical discomfort and re-
duction of fear of gaining weight. In some cases, vomiting becomes a goal in itself, and the
individual will binge eat in orde r to vomit or will vomit after eating a small amount of food.
Individuals with bulimia nervosa may use a vari ety of methods to induce vomiting, includ-
ing the use of fingers or instruments to stimulate the gag reflex. Individuals generally
become adept at inducing vomit ing and are eventually able to  vomit at will. Rarely, indi-