So what if you throw up a little after eating?

Well, it's a serious problem if you are female, 13 to 20 years of age and it happens consistently over the course of a couple of months. You could be bulimic and end up in the hospital with esophageal bleeding, infected glands, cardiac arrhythmias and electrolyte imbalances.

And this isn't just a "big city" problem. It can take place right here in our small community. That's what happened to Jennifer's high school friend, Allie (not their real names). "Allie was beautiful, one of the prettiest girls I've ever known, absolutely gorgeous," says Jennifer. And over the course of a year or so of covert binge eating, vomiting and laxative abuse, Allie was reduced to a bag of bones with terrible teeth. "I remember her saying it was triggered by a boyfriend who said she was fat, then she started doing some modeling and everything all together triggered it she was 5 feet 7 inches and 90 pounds."

Eating disorders, including bulimia and anorexia, are mysterious diseases. The reasons why some women are more susceptible to eating disorders than others are not fully known, but may have to do with self-esteem, feelings of self-worth and coping skills. "There's a feeling of being out of control, of needing to be nurtured, reassured," notes Providence Medical Group pediatrician, Dr. Lisa Miller. "There's poor self-esteem and there's often some kind of dysfunctional family environment. There's usually some kind of extra stress on the person."

The bulimic's vomiting and/or laxative use is a consequence of binging, her way of avoiding the weight gained by compulsive eating. Jennifer saw this when Allie stayed the night: "I remember waking up and oh my god, everything was gone," she recalls. "The whole chocolate cake was gone, the whole bag of Doritos was gone and all the milk was gone." And, Jennifer says, the bathroom needed a good cleaning.

The typical bulimic has a normal body type, perhaps slightly overweight, at least in the early stages of the disease. As the bulimia progresses, her hair becomes brittle, her skin gets dry and flaky and her knuckles are red and scarred from forced vomiting.

"She's usually a depressed person, has a very reserved affect and a sad appearance," explains Dr. Miller. "The parents will bring them in because they're sleeping all the time or they were dizzy and fainted at school or they've got muscle aches." It can take up to three months to test for medical problems that mimic bulimia and just as much time to gain the young woman's trust.

Eating disorders can be deeply rooted and are not easily resolved. Effective treatment will involve a multidisciplinary team that includes the physician, psychotherapist and nutritionist who work with the young woman and her family. Frequently, antidepressants are prescribed to relieve anxiety and help manage the harmful behavior.

Loren Fogelman is a therapist with Kolpia Counseling of Ashland and Medford and has experience treating women with eating disorders. "Part of what I do is to increase their motivation to want to look at a behavior that is a problem for them," says Fogelman. "I help to reaffirm the healthy aspects of what they're doing well, focus on positives and really listen to what they want to do, and support the healthy decisions that they feel ready to make."

Healing can be a very long journey. "People are always recovering, so if they're not practicing good self care they can relapse into bulimia again," Fogelman explains. "Progress is based on having longer periods of time without a bulimic episode and if they do have it, it is shorter in duration."

Today, almost 10 years later, Jennifer and Allie have grown apart, but Allie's still around and has gained some weight back.

Jennifer learned a lot about bulimia from her high school friend. She saw that often people don't know what to make of someone's changing appearance or eating patterns. "Usually people deal with it by making little jokes," says Jennifer. "They kind of make light of it [your appearance or behavior] and it's not helpful." More than anything, Jennifer saw that ignoring unhealthy behaviors won't make them go away.

What does help? Jennifer's quiet for a long while, and then says softly, "People being there, kind of surrounding you. Loving you and accepting you and just acknowledging that you're there."