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I’m worried my daughter has eating disorder

Mom notices that her daughter heads to the bathroom after meals. Dr. Judith Reichman suspects bulimia — and urges intervention.

Q: My daughter is extremely body-conscious and always seems to be struggling to lose weight. Of late, I’ve noticed that she heads for the bathroom as soon as she’s finished eating. Should I be concerned?

A: Absolutely. It’s very possible that your daughter has an eating disorder. And it’s most probably bulimia.

One out of four women suffers from bulimia at some time in their lives, and over fifty percent of adolescent girls will overeat and then vomit to control their weight.

She probably thinks it’s no big deal. After all, she most likely has friends who “do the same thing.” But it is a big deal  one that can lead to serious health problems and even death.

I know the case of Terri Schiavo has been reviewed extensively both in the judicial courts and in the court of public opinion, but one aspect of her situation that was often overlooked was the underlying disorder that caused her heart attack: bulimia.

Schiavo’s purging led to a severe electrolyte imbalance, which in turn caused the heart attack that left her brain-damaged and in a vegetative state.

Bulimia literally means “ox hunger” and is usually accompanied by recurrent binge eating and subsequent attempts to control weight gain by vomiting, use of laxatives or diuretics, extreme dieting, or over-vigorous exercise.

As in Schiavo’s case, all of this can lead to a dangerous electrolyte imbalance and dehydration. A heart attack is obviously the most severe consequence of bulimia, but other serious repercussions can occur. These include severe fatigue, heart palpitations, muscle spasms and numbness in the extremities.

Unfortunately, this disorder is usually hidden from friends and loved ones. For instance, bulimics are not necessarily underweight (though they may be). So as a concerned parent you have to be on the lookout for warning signs. According to the American Psychiatric Association, these include:

  • Frequent trips to bathroom during or after meals
  • Laxatives or diuretics lying around in hidden and not-so-hidden places
  • Excessive exercise after meals
  • The smell of vomit on your daughter’s breath or clothes
  • Signs of vomit in or around the toilet or shower
  • Unusual tooth decay
  • Expressing guilt about eating or self-criticism about weight
  • Mood swings
  • Depression or withdrawal from social activities

Why does bulimia happen? Most experts believe that societal pressure is to blame. Girls and women so often feel they have to look like the models and celebrities that they see in magazines, television shows and movies. In their attempts to reach an often unrealistic body size they develop eating disorders that can be severely dangerous to their health.

Because bulimia can be life-threatening, you can’t pretend not to notice or hope it will pass on its own. Your daughter may be in immediate danger, and you need to address the situation.

If your suspicion level is high and/or you confirm that she is engaging in bulimic behavior, seek professional help. (Parental expressions of disapproval alone do not usually suffice.)

Have her see a physician and, if necessary, a therapist who specializes in the treatment of eating disorders. Ultimately, she may need a combination of psychotherapy, nutritional counseling, behavioral modification and participation in a self-help group. Doctors often prescribe anti-depressants as part of the process.

Dr. Reichman’s Bottom Line: We have to pay attention to the eating habits and after-eating habits of our children, both male and female. An eating disorder you detect in time can be treated and the precious, long-term health of your child protected.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of .

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.