Data concerning the longitudinal course of illness and associated problems reported by a series of 275 female patients with bulimia are presented. Eighty-five percent of these patients indicated that they had started binge-eating during a period of voluntary dieting, and the majority indicated that they had perceived pressure from family members and/or friends to lose weight in association with this dieting episode. Although the development of binge-eating usually preceded or coincided with the development of self-induced vomiting behavior, a pattern of habitual self-induced vomiting developed prior to the onset of binge-eating in 44 (18.4%) patients. Most patients reported having experienced several periods of abstinence from bulimic behavior during the course of the illness, with the majority indicating periods of abstinence of at least two weeks in duration, suggesting that the symptoms of bulimia may wax and wane over time. Several problems were reported at high frequencies by this patient group including a history of self-injurious behavior (34.4%) and a history of at least one suicide attempt (18.8%).