Bulimia Nervosa occurs when an adolescent has repeated episodes of binge eating and purging. Binges are characterized by eating large quantities of food in a discrete period of time. The teen also has feelings of being unable to stop eating and loss of control over the amount of food being eaten. Usually, after binge eating, they attempt to prevent weight gain by self-induced vomiting, laxative use, diuretics, enemas, medications, fasting, or excessive exercise. These teen's self-esteem is strongly affected by weight and body shape. Serious medical problems can occur with Bulimia Nervosa (e.g. esophageal or gastric rupture, cardiac arrhythmias, kidney failure, and seizures). Other psychological problems such as depression, intense moods, and low self-esteem are common. Early diagnosis and treatment can improve outcome and decrease the risk of worsening depression, shame, and harmful weight fluctuations.