With indications that the `affluent' disease of food addiction is reaching unprecedented heights in the US, Bermuda has not yet officially recognised the extreme forms -- bulimia nervosa and anorexia nervosa -- as illnesses.

Pauline Greenham, who suffers from bulimia, has decided to return home to the UK in order to obtain treatment for her condition. She agreed to talk to Living because "I want Bermuda to understand there are far more people suffering from these diseases than might ever be imagined and if this interview brings the problem out into the open, I would be very happy.

"I am fortunate, because I have somewhere to go -- most Bermudians don't have that option -- and I think people need to realise that, although there are some very effective rehabilitation programmes in the US, insurance companies here do not cover the costs for people to go away for treatment. I find this rather ironic -- if I were a drug addict or an alcoholic, I would qualify for treatment. I am also hoping that other sufferers will be encouraged to get together and form a therapy or support group and that affordable help will be made available in Bermuda. I got to the point some months ago,'' she reveals, "when I thought I was going to die. I was promised help to go to a 28-day programme in the States but, in the end, I was turned down by the insurance company. People,'' she adds grimly, "should understand both bulimia and anorexia can be fatal.'' According to the US's Rader Institute, one-quarter of all US women aged from 19-39 have periodically `binged' on food. Half resort to fasting (anorexia) or practise self-induced vomitting to prevent weight gain (bulimia).

Forty percent of all US citizens compulsively overeat. Far outnumbering those who receive treatment, says the Institute, are those who have the disease, are not being treated and, in many cases, conceal their condition.

Dr. Mary Pipher in her book `Hunger Pains: The Modern Woman's Tragic Quest for Thinness,' points out bulimia is an epidemic that surfaced in the 1980's.

Currently, between eight to 20 percent of all high school girls are bulimic while rates for college-age women are estimated at one in every four or five.

This is hardly surprising in a society where TV, movies and magazines perpetuate the idea that `thin is beautiful', and `thin is successful' -- whether it's in pursuit of a man, or that top job. For some people, bulimia is seen as a way of keeping them from dreaded obesity.

According to Kate Williams, clinical psychologist at St. Brendan's Hospital, Bermuda does not, at present, appear to be following US and European trends.

Noting bulimia is often difficult to detect and that sufferers do tend to keep their condition secret, she says, "I have been here for 18 months and, fortunately, it seems to be relatively infrequent and seems mostly to affect expatriates.

A possible explanation for this could be genetic. In the UK, I always had half a dozen clients at any one time. The worrying thing there is that bulimia is developing in much younger people -- sometimes as young as ten and 11 years of age.'' Ms Williams adds St. Brendan's is awaiting the results of a survey undertaken recently by a former psychiatric resident at the hospital.

Among the famous people who have suffered from bulimia are Jane Fonda and the late Princess Diana -- the latter having brought the disease into high profile when she spoke frankly and openly about the debilitating effects of bulimia on her life.

Among the many who have fought anorexia was the late Karen Carpenter and this `slimmer's disease' is known to be especially prevalent among dancers, models and athletes, for whom a reed-thin body is a `must'. There are signs, too, that a surprising number of males suffer from bulimia -- and they are even more reluctant to seek help.

If some of those sufferers lead superficially `glamorous' lives, the details of the illnesses are far from glamorous. Anorectics -- around 25% of whom `progress' to bulimia -- develop wildly distorted body images and, in extreme cases, starve themselves to death. Bulimics are compulsive eaters who binge on food (often `junk food') and then force themselves to vomit to maintain an acceptable body weight.

Pauline Greenham who, incidentally, has never missed a day's work due to her illness, says her problems began as a teenager when she sought self-nurture through food: "I was about 16 when I became anorexic and a compulsive exerciser. I was clever at school, good at sport and everybody saw me as a happy person, a joker and an extrovert. But there were alcohol problems in my family and, at any early age I became the `care-giver' in the family.'' Noting that while some bulimics are also alcoholic, Ms Greenham points out that alcohol takes away a person's control, "whereas bulimia gives you total control over something as no one else can -- your own body! It gets very expensive as you literally waste so much money on food!'' When she did her `A' levels with a brighter, competitive group of students, she hid her lack of confidence through anorexic behaviour. Training as a radiographer, she became bulimic and, in spite of stable periods, has remained so ever since.

She is perhaps fortunate in that her job is a stabilising influence. Even so, she says that occasionally, she has to live from hour to hour.

"Sometimes I binge three or four times a day. I read somewhere that three or four times a week is considered bad. It's very exhausting. I went to see a doctor here and even he didn't really take me seriously.'' Like Princess Diana, who spoke publicly about the sense of shame and self-disgust, Ms Greenham says that one of the worst aspects is the general ignorance about the illness. "I have three or four friends who have done a lot of research about bulimia and so I know they really care about me and don't consider me a bad person. A lot of the time, I hide my condition because I hate to offend anyone, I like to keep the peace and avoid confrontation of any kind.'' Although she is critical about her appearance -- but not as drastically as a severe anorectic, she spends a lot of time exercising in the gym: "It's an outlet for me and I've always been keen on athletics, horse-riding and ice-skating. Even when I am on a `bout,' I force myself to exercise. As I get older, I'm more aware of the stress on the heart -- one of the common causes of death for a bulimic is a heart attack.'' Ironically, her first confidante was her best friend who ranked 13th among England's gymnasts. "She was very petite and when she stopped her gymnastics and exercising five days a week, she became bulimic and, of course, recognised what was wrong with me. She had extreme pressure to stay `tiny' and it became a constant battle for her.'' Well aware alcoholics and drug addicts can only recover through complete abstention, Ms Greenham says that recovery is more complicated for bulimics: "I have to eat in order to stay alive, so it's a balancing act, learning how to eat appropriate portions of appropriate foods.'' Pipher calls bulimia alcoholism's `sister disease,' with some people suffering from both. Certain aspects are shared in that both experience remorse, guilt, `hangover' headaches and sleepiness after a binge, and the use of a substance to cope with unhappiness or stress. Most importantly, bulimia, like alcoholism, becomes a way of life.

"Bulimia is an intensely private thing,'' says Pauline Greenham. "I hope that my speaking out about this disease will help others feel less alone and encourage them to demand professional help.'' Jane Fonda waged a silent war with bulimia.

SPEAKING OUT -- The late Princess Diana spoke publicly about the devastating effects of bulimia.