As part of their training outline, ECHO counselors receive psychological profiles of bulimics that outline the importance of cultural factors, such as the notions that "beating the system is good" and "major transgressions require major atonement." For these women, bulimia is a way to repent for what they believe to be their sins, for them to accept roles as penitents for success and the ways in which the think they fall short of society's expectations.

"I really think guilt is at the heart of [bulimia]," says ECHO counselor Andrea Schwartz '91.

To protect the identity of the counselors and the students they help, the names of all ECHO staff quoted in this article have been changed.

But instead of comfort, bulimia brings with it more guilt.

Says Associate Professor of Psychology Penelope J. Davis, who teaches a psychology class entitled "Eating Disorders," "Bulimia becomes a vicious cycle so it gets out of control almost once it's started."

Not all the effects of bulimia are psychological. Vomiting damages the digestive track, tears the esophagus, erodes tooth enamel and can lead to anemia.

Most bulimics induce vomiting by gagging themselves with their fingers, but some estimate that about one-third of all bulimics use a toothbrush or other instrument to make themselves throw-up.

Regular consumption of laxatives causes abdominal complications and malabsorption of fat, protein and calcium. In extreme cases, bulimia may even cause an irregular heartbeat and sudden death.

Davis says there are signs she looks for to find people in her class who binge and purge.

Bulimics have teeth that are decayed, and sometimes their voices are hoarse, Davis says. Most noticeable of all, she adds, are swollen glands and puffed face.

"I could tell in class when people were having bulimic episodes because of the puffy face," Davis says. "In a few days, the faces would return to normal."

But bulimics often go to great lengths to keep their disorder a secret.

"If they're extreme bulimics, it's harder to hide it, but they're good at it because it's an obsession," Schwartz said.

Although Davis says she recognize the symptoms of bulimics in her class, she says she cannot even begin to speculate on the number.

"I don't think we can have a number for Harvard, but my hunch is that eating disorders are alive and well among undergraduates," she says.