Knowing that someone you love struggles with bulimia is deeply upsetting. For many, it is also baffling. But bulimia can be a serious condition – sometimes even a fatal one.
Begin by finding out all you can about the disorder. The more you know, the more help you will be. You will also avoid saying something foolish or insensitive. As soon as someone realizes you don’t know what you are talking about, they stop listening.
Bulimia is both an eating disorder and a form of mental illness. Indeed, it has little to do with food itself – food is simply the way the problem manifests. It can affect anyone at any age, but it is most common among young women and teenage girls.
First, the bulimic binges. When they do, they may enjoy it, but more often they do not. Some even binge on food they dislike, feeling detached or disconnected the whole time. Once finished, they usually feel a mixture of shame and self-loathing. Some literally hit themselves, others look into the bathroom mirror and yell insults (“you disgusting pig”, etc). Then comes the purging. This can take many forms. Some vomit, others use laxatives. Whatever method they choose, the aim is to get rid of food before the body has a chance to digest it.
Those who know little about the disorder sometimes regard it as harmless – even healthy. They may, for example, think of it as a detox, or even an alternative to dieting. In fact, bulimia seriously hurts the body. The constant vomiting damages one’s teeth, eroding the enamel and causing decay. As if that were not bad enough, it can also turn them yellow. Excessive use of laxatives, on the other hand, affects the heart and digestive system. The individual risks arrhythmia, heart palpitations and even heart attacks. Binging causes problems of its own, stretching the stomach and, in extreme cases, ripping the lining. Once that happens, acid spills over into other parts of the body. At the very least, the bulimic usually develops stomach pain and gastric reflux. Inflammation is also common, especially around the esophagus.
The causes vary from person to person, but in essence the bulimic uses food as a substitute. Some lack affection, others intimacy or self-esteem. Hot food, especially fatty or sugary food, comforts us, just as warm milk soothes a crying baby. For the average person, a hot meal fills an actual emptiness; for bulimics, it fills an emotional or psychological one. Once full up, self-loathing sets in and they want to be rid of both the feeling and the food.
Such a negative self-image is common among bulimics. The individual feels ugly and unloveable, or they despise their body. When they binge, it can thus be an aggressive, self-punishing act. There is also an element of masochism, as the individual thinks horrible things like, “you are greedy and disgusting…you look like a pig so you may as well eat like one.”
The simple wish to lose weight is another motive. For example, a teenage girl is slightly larger than her friends. She also has a big appetite and loves food. As she reaches puberty and becomes more self-conscious, her relationship with food changes. She longs to be like her favorite pop stars, begins to dislike gym class and refuses to wear a bikini on the family vacation. And yet she doesn’t want to give up ice cream and potato chips. The obvious answer is to eat the potato chips, enjoy them, and then expel them from the body immediately. Being young and naive she assumes no one else has ever thought of this.
Control also plays a part in bulimia. People who develop a troubled relationship with food often feel powerless in other areas of their life. They cannot control their depression or unfaithful partner, but they can control how much they eat. This is often true of anorexics, and it is even true of many healthy eaters. The need for control also explains why teenage girls are more likely to do it; young people generally feel less in control of their lives. For example, to a 16-year-old, navigating her way through exams, bullying and arguing parents, life seems overwhelming. She feels helpless – at the mercy of the cool girls, or her parents’ selfishness, or the school authorities, and so on.
But it must be stressed that bulimia isn’t only experienced by young girls. Even middle-aged men develop this problem. Imagine a 35-year-old man whose wife leaves him for somebody younger, fitter and stronger. He feels humiliated and rejected. He tries to win her back, but he cannot. Feeling empty, alone and unloved he starts to loathe his body. “If only I was thin and muscular like her new lover,” he thinks, “she would never have left me.” And yet, because he feels lonely and empty, he craves hot, fatty food more than ever. The obvious answer is to eat, fill the emotional hole and then use the laxatives in the medicine cabinet to flush it away. He cannot control his wife, but he can control this. As his depression and loneliness worsen, the binging and purging become the norm.
Neurotics and perfectionists are also prone to eating disorders. Again, they want control. The same is true of those who’ve undergone a trauma of some kind. They couldn’t stop that drunk driver from nearly killing them, but they can stop themselves becoming fat.
Spotting the Signs
If you suspect that someone you love is developing bulimia, look out for the following. First, do they regularly binge eat? This trait often surprises people. After all, the bulimic dislikes their body, so why would they gorge themselves on unhealthy food? In fact, the gorging and purging go together, forming a kind of perverse ritual.
Next time they finish a big meal, watch their behavior. Do they excuse themselves after they eat? Do they look troubled? Maybe they go strangely quiet. Note if they disappear to their room, or into the lavatory. When they do, also note their expression when they return. Do they avoid eye contact? Maybe their face is flushed red, or they seem elated and happy. Others will do a ridiculous amount of exercise after they eat – disappearing for hours and then returning pale and drenched in sweat.
Also, note the comments they make about food and about their body. Maybe they speak with contempt of an overweight friend or work colleague. And when they binge, note whether they hide away. Remember, bulimics have a love-hate relationship with food. Often, they love the sense of warmth and comfort, but they loathe their greed and their chubby body. Maybe they hide food in their room. If they become furious when you remark on this, you know there is a problem.
Then of course there will be the physical signs, weight loss being the most obvious. They may, for example, be tired all the time. Or maybe they complain of a sore throat (a consequence of the vomiting). Bloating, stomach pains and a puffy face are also common. Some will even self-harm in addition to the binging and purging.
How to Help
First, be careful never to patronize a bulimic. Bulimia is a very serious condition. A teenage girl is not being melodramatic or attention-seeking. If she has settled into a routine of binging and purging, something serious is troubling her.
Tough love will not work either. Telling someone to grow up and stop being selfish will just deepen self-loathing and entrench the damaging behavior. Neither will you help by controlling what they eat. If someone has mental health problems, you won’t solve those problems by rationing food or removing locks from the bathroom. By doing so you treat the symptoms not the cause. You must get at the root of the problem instead. Look at their life and try to work out what could be troubling them. Are they having problems at work? Maybe there is something they haven’t told you, either because they feel embarrassed or because they do not want to worry you.
When it is your teenage child, finding out may be even harder: as every parent knows, teenagers can be very secretive. If your 15-year-old daughter refuses to talk, you must piece together what is happening from comments she makes about unrelated issues, even from her reactions to TV shows or news events. You could also try talking to her friends when she isn’t there. Be careful how you do this. Do not ask them explicitly; nothing enrages a teenager more than discovering their parents have been asking personal questions about them. Just chat to them about school, hobbies, boys in their class, etc., and see if they let something slip.
Remember, a bulimic may feel dirty, guilty and embarrassed. At all costs avoid deepening those feelings. Make it clear that you take their problem seriously and do not find it shocking or ridiculous. Assure them that most people struggle with mental ill-health at some point. Just as our physical health is constantly undermined by viruses and bacteria, so our mental health is affected by stress, relationships or simple biochemistry. The bulimic isn’t weird or freakish. They simply react to stress or pain in their own way.
CBT, or “Cognitive Behavioral Therapy,” is particularly helpful for bulimics. The patient learns to recognize self-destructive patterns of thought. Next, they learn to challenge and ultimately replace them. The bulimic also needs to deal with painful emotions in a healthier way, to learn not to run away but accept them as part of life. Indeed, schools ought to teach students to see loneliness and bereavement as a natural part of life.
Of course, mental illness can only be understood within a broader cultural and social context. In the USA, and those cultures most influenced by it, pursuing happiness has become the purpose of life. Failure to achieve it means failure as a human being. In other words, to be lonely or sad is to be a loser. People seem almost ashamed of negative emotions. The photos on Facebook, for example, seem at times like a frantic effort to assure others “I’m having a great time all the time.”
Do not underestimate bulimia. Regardless of the physical effects, it is a sign of deep emotional pain. Nevertheless, much can be done. Indeed, the simple fact that you are there and want to help is a start.