fter midnight a silent woman carefully opens the fridge door. She sits alone and stuffs food into herself without pleasure. She gorges on enough for five full meals. She tiptoes to the bathroom, closes the door and puts her fingers down her throat.

Bulimics are trapped in a cycle of binge eating, guilt and purging. Figures vary as to how many bulimics there are. Most doctors believe that the problem is much more widespread than anorexia.

Bulimia is known to be far more common among teenagers and young women, and more likely in women whose weight is deemed relevant to work or to other pursuits such as ballet, acting, and modelling.

Bulimics can eat like everybody else but take lots of laxatives to ‘purge’ the food. They can only do so after kilojoules have been absorbed anyway: most bulimics don’t know that the weight loss after laxatives and diuretics is not the food but water loss. Bulimics can seem overweight or underweight.

Their condition is characterised by binge eating and then purging the food through vomiting, or laxative and diuretic abuse, exercising, dieting, abuse of diet pills and fasting. Binge eating is the fast eating of a large amount of food or almost constant nibbling, associated with a sense of being out of control. Food restriction and dieting are also common and so is depression.

Bulimics can display many of the symptoms of anorexia but while anorexics feel in control of their eating and not much else, bulimics feel totally out of control with eating, in contrast to their high-achieving, well-regulated life. They tend to do their bingeing in secret. Some food is chewed and then spat out. A bulimic often diets, and then has to succumb to the body screaming for carbohydrates, and binges. Then the guilt begins and the cycle continues.

The horrible turmoil is a hidden one. Bulimics tend to be passive people who want attention and approval (who doesn’t?). Generally speaking, they have some difficulty in being honest about their needs, and they hide their insecurity and self-doubt behind a busy social life.

Apart from misery, physical consequences can include gastrointestinal damage, iron deficiency and poor nutrition, diarrhoea, kidney damage from the diuretic pills, a swollen face, calluses on the hand used to induce vomiting, damage to teeth, mouth and gullet from stomach acids, fatal stomach rupture or heart attack. The director of a Sydney eating disorders clinic says up to half the patients she has seen with bulimia have previously had anorexia.

Many bulimics can learn how to express their feelings in ways other than those involving food. They learn that they have needs and wants that cannot be met with food, but can be identified and met by other ‘rewards’ in life.

There are organisations across Australia that can help. Find the closest one at www.uq.net.au/eda/ documents/start.html