In 1914, the first chronicle of a bulimic woman, Ellen West, was published. Her poignant description of her bulimia rings true one century later: “My life is filled with dread,” she said. “Dread of eating, dread of hunger, dread of the dread.” Bulimia nervosa is both a biological and emotional illness. Some bulimics are fat and some are thin; some binge and purge; some starve along with bingeing and purging; others purge without bingeing. Some spit out the food before they swallow. Some swallow, bring up the food, and re-swallow repeatedly. Some use laxatives or diuretics. Some cut themselves. Some exercise compulsively and some take drugs or drink alcoholically.