I'm concerned that my wife is bulimic since she has some of the following signs:

• Buys large amounts of food that disappear
• Can't explain missing food
• Skips meals
• Always excuses self from table before others are finished
• Eats only a particular food or food group (e.g., condiments)
• Drinks excessive amounts of liquids
• Isolates self from interactions with family and friends
• Uses excessive amounts of mouthwash, mints, and gum
• Excessive exercise regimens
• I've also seen vomit a few times that she denies will come from her.

She will eat 3/4 of a pan of brownies, a whole bag of Reese's cups, a whole box of cookies, 1/2 a bowl of cookie dough (without baking the cookies), a whole pan of fudge, etc. On Christmas Eve I counted the calories in junk food that she consumed and it was at least 4,000. She spends a ton of time in the bathroom, and has red marks all over her face which I used to think were zits but I'm wondering if they are related to burst blood vessels.

She was bulimic before we were married and had significant weight as a teen, and was sexually abused as a child.

She is always tired, has headaches frequently, and drinks TONS of coffee.

We've been married for 10 years, and now we're going through a tough time in marriage. Since we are not close due to our marriage difficulties, I doubt she will listen to me. We have four young kids and I am deeply concerned for her health with the stresses of being a mom and working an early morning fitness-related job. She seems depressed and most days has difficulty making meals.

I would appreciate any ideas on how to approach this with her.