Many women may fail to recognize bulimia symptoms in themselves, particularly if they don’t go to the extremes of self-induced vomiting, new research suggests.

In a study of 158 women with bulimia-type eating disorders, Australian researchers found that nearly half did not acknowledge a problem with their eating. This was particularly true of those who did not vomit to control their weight.

Bulimia is widely known as a “binge-purge” eating disorder, in which a person goes through cycles of excessive eating followed by purging - through either vomiting or abusing laxatives and diuretics.

But there are also non-purging forms of bulimia, where tactics like excessive exercise or strict dieting are used to counter binge-eating episodes.

Still other people have certain symptoms of bulimia but fall short of all the criteria used to diagnose the disorder; they may fall into the category of “eating disorder not otherwise specified,” or EDNOS.

The new study, published in the International Journal of Eating Disorders, focused on women with “bulimic-type” eating disorders. This included those with purging or non-purging bulimia, as well as women with EDNOS. Some women in the latter group were diagnosed with binge-eating disorder, which involves excessive eating but no purging to compensate]

The researchers presented the women with a vignette about a woman with bulimia, and then asked the women if they might have a problem similar to that of the character. In all, 52 percent said they might, while 48 percent denied that they did.

Women who used self-induced vomiting were nearly six times more likely than other women to recognize that they had a problem, the study found.

“Our research suggests that, when it comes to bulimia-type eating disorders, women tend to think that if there is not vomiting involved, then it’s not a problem,” said lead study author Dr. Jonathan Mond, a senior research scientist at James Cook University in Townsville, Australia.

This is partly due to media portrayals of eating disorders, which typically highlight anorexia and purging-type bulimia, Mond told Reuters Health.

But there’s also a general perception that excessive exercise and strict calorie-cutting are acceptable, or even “desirable,” behaviors, he added.

What’s needed, Mond said, is greater awareness of the nopurging forms of bulimia, as well as other bulimia-type eating problems - including binge-eating disorder and “compensatory” disorder, where a person purges or exercises excessively, for example, but does not binge.

And that awareness needs to spread not only in the general public, Mond noted, but among doctors and other health professionals.

In some cases where a woman with one of these eating disorders does seek treatment, he explained, the doctor may treat what’s seen as the “true” problem - such as depression or anxiety - leaving the eating disorder inadequately addressed.

SOURCE: International Journal of Eating Disorders, December 2006.