My sister has a problem with bulimia. She has had this since she was about 15, and she is now 44. She has been to a doctor and tried to get help. Now she says she is doing it again and has no control. I have tried to talk to her about it. What should I do? What causes this problem?

Gail

Your sister needs counseling. Bulimia, like anorexia nervosa, is an eating disorder mostly affecting women. These women have a distorted body image and often low self-esteem. They may feel out of control in many areas of their lives, and try to exert control where they can -- in controlling what they eat and trying to become thinner and thinner.

Bulimia is characterized by episodes of binge eating, followed by activities such as purging (self-induced vomiting or use of laxatives), excessive exercise or fasting in order to not gain weight. Eating disorders can lead to dehydration and an imbalance in blood chemistry, which can in turn adversely affect organs such as the kidneys, liver and heart. When vomiting is used over and over again to ride the body of food eaten during a binge, the stomach acid that comes up can injure the esophagus. This can result in tears or rupture, which can be life-threatening.

You should tell your sister you are concerned about her. You should encourage her to seek counseling. Many large cities have special eating disorder clinics, while smaller communities will probably have a psychologist who is well versed in treating eating disorders.