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My 19-year-old daughter is obsessed with dieting. She is slim and attractive but her weight has been worrying her for the past two years. Two weeks ago, I caught her vomiting in the toilet after we had come back home following a meal in a restaurant. When confronted, she admitted that she has been vomiting on a regular basis after meals to keep her weight down. She also admitted that periodically she cannot resist her urges to eat and consumes large quantities of chocolates and biscuits. She feels she is fat and ugly. She has now become very morose and suffers from low self-esteem. I will be grateful for your advice.

Name and address withheld

It seems your daughter has symptoms suggestive of Bulimia Nervosa, a form of eating disorder. Bulimia Nervosa affects three out of every 100 women at some time in their lives in Western countries. It is thought to be much less common in our country but the incidence is increasing. Like anorexics, people with bulimia suffer from an exaggerated fear of becoming fat. Unlike women with anorexia, the bulimic woman usually manages to keep her weight within normal limits. She can do this because, although she tries to lose weight by making herself sick or taking laxatives, she also ‘binge eats’. This involves eating, in a very short time, large quantities of fattening foods that she would not normally allow herself. Afterwards she will make herself vomit and feel very guilty. Your daughter, like other sufferers with bulimia, is in a no-win situation. She has two conflicting desires, i.e. to binge and to vomit. It is a highly distressing psychiatric illness.

Bulimia Nervosa has effective treatment. Psychotherapy and drug treatment is effective in controlling not only the symptoms of bulimia but also addresses the deeper underlying conflicts, which cause the condition. I will request you to get in touch with a psychiatrist who has experience in dealing with eating disorders.

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