Up to two percent of Americans have bulimia, the seemingly “invisible” eating disorder that often lurks in its anorectic sister shadow. Bulimia recovery, like any mental health illness recovery, is hard to quantify. It’s even harder to conceptualize. We still need to do a better job of understanding it.
1. It’s Not About the Vomiting
Imagine the quintessential person living with bulimia. Where does your bias lie? Do you picture an underweight female gorging herself with sweets, only to secretly purge in the toilet immediately afterward? A dancer or gymnast, perhaps? Wealthy?
We all have biases, and they aren’t inherently right or wrong, good or bad: but it’s essential to keep them in check. That’s because bulimia isn’t always about the vomiting, just like eating disorders aren’t just about eating. In fact, bulimia can be in the form of many different types of compensatory behaviors including:
periods of fasting/restriction
Professionals can easily miss the mark when it comes to diagnosing or even engaging a client in bulimia recovery. If they’re only looking for the cliches, they risk overlooking many telling clues. They may miss the health-obsessed male talking about relationship issues. They may miss the mother who gets so stressed with her children that she “forgets to eat.” It’s easy to make assumptions, but eating disorders are cunning, manipulative and insidious. They flourish in being hidden.
2. It’s Always About Body Image
I can dispel this one quickly. It’s not. In fact, in all the work I’ve done with eating disorder and bulimia recovery, body image just represents a piece of the proverbial shame puzzle.
While it’s true that most people struggle with their bodies, it’s rarely, if ever, the sole reason. What do I hear more often? It’s about control or release or enacting a feeling of numbness.
It’s often about rebelling against the body or society — having one last vice or one tantalizing hurrah that still feels taboo. Self-esteem is typically at play, but self-esteem is so much more than skin-deep.
The bulimic ritual is as sacred as it is sick, as comforting as it is disturbing. Even though body image may play a pivotal role in the development of an eating disorder (going on a diet), most strugglers will candidly state: it’s not even about how my body looks anymore.
3. There’s Always Some Form of Restriction
I hear this one often when talking about bulimia recovery, and the intentions are good. However, we need to acknowledge that some people do consume square meals and snacks: and they still struggle with compulsive or binge eating.
Even if the person holds onto entrenched forbidden food rules or regulations, that doesn’t mean they are currently restricting or “depriving” themselves. It doesn’t mean that everyone struggling with bulimia restricts and then binges.
There is an in-between, and we must acknowledge that (or we’re presumptuous). With that said, it’s premature to simply assume that decoding bulimia recovery means decoding ulterior motives of restriction.
Yes, it’s true that many people who are struggling with bulimia attempt to control their food and then “lose control” with bingeing. But this is not always the case. Some people engage in “normal-eating,” followed with intense periods of compulsive or binge eating. Nobody should discount that.
4. Trauma Happened
Most mental health professionals want to search for the trauma underlying the eating disorder. The intention is typically sound. In fact, research shows high correlative rates between childhood trauma and eating disorders.
However, it’s certainly not always the case. When we assume trauma is part of the story, we invalidate those individuals who do not present with traumatic pasts. Inadvertently, we may even shame them: as if to say they needed to have trauma to warrant their disorder.
Although eating disorders may have the connotation of being an adolescent or young adult problem, the onset can happen at any age. There is no one consensus as to what defines the precipitating event. Yes, it may occur in childhood.
For others, it may result from unnerving societal pressure and getting carried away on a diet. For others, it may correspond to another mental illness, such as depression, anxiety or a substance use disorder.
Final Thoughts on Bulimia Recovery
Like with all mental illnesses, bulimia recovery is unique and individualized. The more we learn about eating disorders, the more critical it is for all of us to take a compassionate and non-judgmental stance.