The cause of BN is unknown, but bulimia is generally attributed to a combination of psychological, genetic, and physiological causes. The onset occurs in late adolescence when the individual has left or is preparing to leave home. Experts suggest that the stress and depression that accompany this transition lead to binging and purging as a way of coping with these changes. Obesity usually precedes the onset of bulimia, and strict dieting usually triggers the binge-purge cycling. Changes in neurotransmitter metabolism, and in particular serotonin, and response to antide-pressants suggest a biochemical component to the condition. Cultural pressures toward thinness may also contribute to the onset of bulimia.

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