I am a college student, and I think I have a problem. Every day, I eat and then I go and throw it up by forcing my finger down my mouth. I have lost almost 20 pounds in two weeks. I am an athlete, and I get really lightheaded and dizzy, and I have terrible stomach cramps and sores in my mouth. I am afraid to talk to anyone because I am afraid that they won't believe me. My mom would kill me if she knew. What should I do?

-- Allison

You definitely have a problem and it is called bulimia. And as for your mother killing you if she finds out, you may save her the trouble -- bulimia (and the related eating disorder anorexia nervosa) do lead to death sometimes. This is a serious problem, for which you need immediate professional help. Many colleges, through their student health services, can refer you for treatment. DO NOT DELAY -- CALL NOW!!!

Anorexia nervosa is characterized by an intense fear of gaining weight. Body image is distorted, so that a normal-sized young woman feels she is fat, and even very thin women feel they are overweight. An anorexic woman may exercise excessively and compulsively. Many women with anorexia have disturbances in menstrual function, including lack of periods. Bulimia is characterized by episodes of bingeing on food and then purging the food from your system -- either by inducing vomiting or using laxatives. As with anorexia, bulimia typically involves a distorted body image and low self-esteem.

Either of these behaviors may lead to extremely serious medical complications. Dehydration and disturbances in blood chemistry may cause low blood pressure, episodes of fainting with resultant injuries, muscle weakness and even disturbances in the heart's rhythm and function -- which can kill you. You may notice extremely dry skin, constipation, bruising at the slightest bump, and trouble tolerating cold temperatures. Your periods may stop. The lack of proper nutrients may increase your risk of developing osteoporosis later in life, and you may even have stress fractures now. Bulimia that involves vomiting can lead to cavities and erosion of teeth from contact with stomach acids. It may also cause tears in the esophagus and bleeding -- sometimes severe enough to require medical intervention and blood transfusion.

Anorexia nervosa and bulimia are serious public health problems in the United States. Peak rates of both occur at times of transition for young women -- age 13, with puberty, and age 18, with graduation from high school and starting college or a job. Because they are pretty common among college-age women, many colleges and universities have programs in place to help. Local mental health departments are another option. Looking in the Yellow Pages under "psychologists" for those who treat eating disorders is another avenue. Help is available. For your sake, please seek it now, before you get any sicker.