Sometimes after I eat, I feel that I've eaten too much, so I make a stop at the bathroom and make myself throw up. I know that this is bad for me, and I really don't want to have an eating disorder. But I also don't want to become fat either, and that seems to be the winning situation. How can I stop this before it's too late?

-- Katie

You are wise to recognize the danger of your purging and its relationship to your fear of becoming fat. I know that it won't do much good for me to let you know that gaining weight is actually not as harmful to your health as an eating disorder. Many women say they diet for reasons of health, rather than appearance, but as Boston Globe columnist Ellen Goodman once said, "Show me a woman who wants to lose weight for her health, and I'll show you a man who reads Playboy for the interview."

I don't know whether you actually would gain weight if you stopped purging. But it may benefit you to know that vomiting is not an effective weight-loss strategy, as prolonged and repeated purging can lower the body's metabolism.

Ultimately, it comes down to what you fear would happen if you became fat. Most of the eating disordered clients I've worked with feel they are unacceptable or unlovable unless they are thin or look or act a certain way. They also tend to have trouble recognizing and expressing their feelings. It's as if all negative feelings get channeled into the feeling or sensation of "fat," which they then try to exorcise.
Some things you can do to change this pattern: Learn to tolerate feelings of fullness after eating and recognize that they will pass. If you delay acting on the urge to purge, that, too, will peak and pass. Make sure you are eating adequately throughout the day -- a common pattern is for people to restrict what they eat in attempts to lose weight and then binge in response to that restriction. Increase your awareness of what may trigger your negative feelings about your body and about eating. (Keeping a journal can help.) Learn how to recognize and appropriately express the full range of feelings, from sadness to anger to joy. Work on accepting and loving your body as it is. Combat prejudice against fat, in yourself and others.

Some books you might check out: Jane Hirschmann and Carol Munter's When Women Stop Hating Their Bodies: Freeing Yourself from Food and Weight Obsession, Susan Kano's Making Peace With Food, and Nan Allison and Carol Beck's Full & Fulfilled: The Science of Eating to Your Soul's Satisfaction. The Something Fishy website is also an excellent resource.