In a study of the family environments and psychiatric histories of 35 bulimic women, the authors found that 12 (34.3%) of the 35 women had been sexually abused or had a sister who had been sexually abused. That rate is comparable to estimates from other studies of women with eating disorders and of female psychiatric patients, but is apparently higher than the rate found in the general population. Bulimic women from families in which sexual abuse occurred were more likely than bulimic women with no personal or family history of sexual abuse to have a personal history of major depression, relatives who abused drugs, and a disturbed family environment. The presence of bulimia should alert clinicians to screen for concomitant depression, suicidality, and substance abuse as well as the possibility of severe, if hidden, familial pathology and environmental disruption including sexual abuse, parental psychopathology, and character deficits.