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They always have to try. Some use their fingers, some can just push it out using stomach muscles, and some use ipacec syrup. At any rate it's not pretty and it's not tasty. Some binge on foods that are easier to purge such as ice cream. Some drink a lot of water to help them throwup... or chew any food more throuroly so it comes out easier.

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Q: How long do bulimics have to throw up before they start doing it without trying?
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