Alice, 37

Bulimia nervosa is more common in women. It has been called the secret eating disorder because unless sufferers seek treatment it is difficult to detect, unlike other eating disorders such as anorexia nervosa where there is significant weight loss.

This condition is a combination of excessive binge eating, usually on highly calorific foods that are eaten at speed, followed by immediate vomiting as well as use of laxatives, diuretics and obsessional exercise. There may also be associated impulsive risk- taking behaviour such as self-harm and substance abuse. Side-effects can include renal problems and decayed tooth enamel.

Why would anyone find themselves caught in such a painful and difficult cycle of behaviour? Your honesty and insight illustrate a core issue that I think many people, especially women (eating disordered or not), will relate to — the link between outward appearance and inner happiness. You talk about self-esteem and you clearly understand the connection between your feelings about yourself and your desire to attain a perfect body. However, it runs deeper than that — it is about feeling emotionally empty inside (and so filling up with food) and then experiencing deep discomfort and self-loathing and so purging.

If we live our lives via an external appraisal of ourselves, we set ourselves up to fail, because self-esteem is linked to internal belief systems. Our core beliefs are laid down in childhood when we experience our most powerful early attachments and emotional experiences — those who have childhoods marked by abuse and neglect will often develop very negative belief systems about themselves and the world and can go on, via behaviour and relationships, to repeat difficult experiences and so reinforce the negative beliefs. You clearly have concerns about your daughter and the way you manage her relationship with food and her body. Her beliefs about herself will be very much determined by how you deal with these issues. Your daughter may be slightly overweight but equally she may be happy within herself with a confident and positive self-image. Don’t pollute her experiences of herself with yours. I also suggest a strong word with her brother.

Please contact the Eating Disorders Association, as they can recommend treatment and helpful reading. Also ask your GP to refer you for cognitive behaviour therapy so that you can finish your journey out of bulimia — a journey in which you have already made some impressive strides.

Eating Disorders Association: 0845 6341414; www.edauk.com

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E-mail drtanyabyron@thetimes.co.uk or write to her at: times2, 1 Pennington Street, London E98 1TT. Include your name, age, address and telephone number. Dr Byron cannot enter into personal correspondence