Princess Diana may be history's most famous victim of bulimia nervosa, a disorder that was officially defined only in 1980. But it is a condition that afflicts millions of women the world over. Below, three ordinary women tell how they were overtaken by bulimia and how they have worked to conquer it.

When just wanting to be thin becomes a tyrant's command

By the age of 20, Johanna Prudden had been through three therapists and two hospitalizations in an effort to overcome her bulimia, all to no avail. "I could only see darkness," she says. "I knew I was going to die, and I was scared."

Prudden, the product of a privileged upbringing in Tulsa, had been self-conscious about her weight since she was a child. "I was kind of a chunky kid, and all my friends were bone-thin," she says. "It really bothered me." When she was 15, a friend showed her how to use laxatives to keep her weight down. "It was great. You could eat what you wanted, wake up every three hours and get rid of it. And your stomach would be flat." Then Prudden discovered she could achieve the same results by vomiting. "I knew I was in trouble during my senior year of high school, when I couldn't keep anything down. But I didn't want to give up what I had: to be thin and in control of my life."

When Prudden went off to Mary Baldwin College in Staunton, Va., in 1988, she was bingeing and purging on a daily basis. She had learned which foods to avoid—peanut butter, nachos and chocolate were difficult to regurgitate, but "ice cream was a breeze." She often would lock her roommate out so she could purge. After a while, she would only have to lean over for the gag reflex to take over. By Christmas, Prudden's weight had fallen from 110 to 84 lbs. Her concerned friends alerted the college administration, which urged her to seek help. Prudden agreed to enter a hospital back in Tulsa. "All I did was learn tricks from other patients there, like drinking ipecac [a vomit-inducing syrup] and using diuretics," she says. "It just got worse."

Prudden was sent home after 30 days. Aware that her parents were watching her, she would sneak off and purge in the shower after family meals, spraying air freshener to hide the smell. "I remember throwing up in Dumpsters. I was so out of control, yet I felt so in control because I thought I was hiding it. I know my parents knew, but I think they were just too scared."

In 1989, Prudden made another try at college, this time at the University of Kansas, but she relapsed and was hospitalized again. She failed to improve, and by March 1990, her weight had dropped to 92 lbs. Unable to keep food in her stomach, Prudden committed herself to the Laureate Psychiatric Clinic, a hospital in Tulsa that specializes in eating disorders. "I couldn't do it anymore," she says. "I had ruined everything. My sisters hated me, my parents had had it. I felt I should be buried, but I was still alive." The nonprofit hospital, which requires a two-year commitment to its program, uses individual psychotherapy as well as a 12-step approach to break bulimic behavior.

Prudden's breakthrough came five months later. "I was in the bathroom and wanted to throw up so bad," she says. "One of the counselors and two patients came in and sat with me for nearly two hours while I cried and literally inched my way out of the bathroom. I realized that these people cared, that this was a place I didn't have to be perfect."

Prudden successfully completed 18 months of daily treatment last October and still has individual therapy every week. She is now a junior at the University of Tulsa and pursues her recovery day by day. "If I say I'll never purge again, I'm just selling myself up to fail," she says. "So I tell myself, 'Today there'll be no monkeying around with food.' If I keep to that, I'm doing well. I never, ever want to lean over a toilet again."

An illusion of control that signals surrender to a high-risk obsession

Marie Bair began to worry about her weight after the birth of her third child in 1971. Seven years later she was still depressed about how her body looked. A junior high school teacher, she was 5'2" and weighed 128 lbs. "To me that was a lot," she says. "In my family I was raised to be perfect. I expected it of myself, physically as well as intellectually."

Bair, now 41, started to go on a diet. But then she happened to see a group of fashion models on television talking about how they maintained their weight by bingeing and pinging. and she decided to give it a try. "I started experimenting, doing it once a day," she says. "Then it escalated to four and five times a day. Il became addictive. I couldn't break it.

Within eight months, Bair was out of control. "A typical binge for me was a two-liter bottle of soda, a box of cupcakes, a box of cookies, a gallon of ice cream, four or five hamburgers and french fries. If I couldn't consume it all at once, I would purge, then finish it." she says. "I couldn't get the food in my mouth fast enough."

Bair began ordering her life around her binges and prided herself on keeping them a secret. A single mother who has been briefly married twice, she had little trouble hiding her disorder from her young children. Bair patronized different stores because she was afraid shopkeepers might pick up on what she was doing. During a binge, she would take the telephone off the hook. "If anyone rang the doorbell, I didn't answer. I was very secretive. The fact that people were interrupting me made me angry. I felt ashamed and isolated. I didn't know how to change."

By the end of 1978, Bail's weight had plummeted to 79 lbs. She was get-ling dizzy in her classroom. When she started lo throw up blood, Bair finally realized that she needed help. She was hospitalized by her therapist and placed in a psychiatric ward. "I was put in confinement for two hours after each meal to make sure I kept my food down," she says. "I fell like I was being penalized for this disorder.

But the hospitalization seemed to work. Bair gained 30 lbs. and was discharged after two months. Within a week after she was released, however, she plunged back into her bulimia. "No one picked up on it," she says. "When I would go out to dinner, I would get up during the meal, go to the bathroom and vomit. It became involuntary. I didn't even have to use a finger." Still worried about gaining weight, Bair also took laxatives and fasted for a day between binges. "Because I was still working and functioning, I thought I was able to handle it," she says. "I didn't want to accept the fact I couldn't do it on my own."

During the next decade, Bair's health continued to deteriorate. She lost additional weight and was hospitalized two more times. Only recently did she acknowledge that she needed a different kind of help. On the advice of a therapist, she entered the Renfrew Center in Philadelphia, a specialized residential treatment facility for women with eating disorders. Now in the fourth week of a seven-week program, Bair is undergoing intensive individual, group and family therapy. Patients discuss self-esteem, body image, sexuality, addictions, assertiveness and nutrition. "Our job is to enable women to feel safe enough to begin to let go of their eating disorder and feel strong enough to go back to their initial problems," says William Davis, a psychologist who is the center's clinical director.

Bair is now eating three well-balanced meals a day. She has gotten over the compulsive need to binge and purge, and she says she is beginning to deal with the causes of her illness instead of the symptoms. "For years I thought the issue was to lose weight, to be in control, to look good," she says. "Now I'm finding out that food isn't the issue, that there are a lot of issues from my childhood I never dealt with. There are things I completely repressed, things I fell I couldn't say without hurting the people close to me. For the first time, I've found a safe place to say what I have to say."

A teen's desperate desire to purge herself of rape's trauma

Bonnie Booz was just a ninth grader in Jupiter, Fla., when she was raped by an upperclassman four years ago. A few months later Booz, who kept the rape secret from everyone, began eating huge quantities of junk food, then forcing herself to throw up. "I felt so horrible after what happened," she says. "The purging helped relieve those feelings."

During the next four years, Booz, now 18, engaged in a frequent ritual: On her way home from school, she would stop by a fast-food restaurant or grocery store and buy about $30 worth of food, using money she had earned baby-sitting. "When I got home, I'd sneak into my bedroom." Booz would gorge herself on potato chips, ice cream and cupcakes for an hour and then return to her supply of snacks two or three times during the afternoon and evening. Each binge would be followed by a purge. Then she would compulsively exercise until 2 A.M. "It consumed my life," she says, looking back. "I wouldn't go out with friends very much. I'd swallow pills, take laxatives—even ipecac.

For years Booz's parents, an engineer and a housewife, had known their daughter ate very little. Then, gradually, they became more suspicious—and concerned. Her grades slipped, and she was having trouble concentrating. When they confronted Bonnie, she broke down and told them the truth. "I knew I needed treatment to stop," she says.

Last spring, Booz's parents persuaded her to enroll in the Renfrew Center in Coconut Creek, Fla., the southern branch of the Philadelphia-based eating disorder clinic. Having recently completed the seven-week program, Booz says she feels immense relief at finally dealing with her bulimia and is planning to attend Wingate College, in North Carolina, in the fall. "Everyone has been open and honest. They accept me. I'm a lot better at managing myself, dealing with urges. I don't think I'll ever go back to how I was. I hope to God I don't."

SUSAN REED
BONNIE BELL in Tulsa, ANDREA FINE in Philadelphia and JOE VIDUEIRA in Coconut Creek

  • Contributors:
  • Bonnie Bell,
  • Andrea Fine,
  • Joe Vidueira,
  • Maria Spiedel.