Living with bulimia

When reading the classic definitions of bulimia, I marvel at the lack of insight of those who write them. They always follow the same pattern.
Bulimia, according to definition, is an eating disorder characterized by eating an excessive amount of food within a short time, followed by vomiting.
This definition on its own gives the reader no idea about the full scope of being a bulimic. It sounds absurd. Why would one eat so much food that you feel sick? Why would one then go and waste that food literally down the drain? And why make yourself sick on purpose??
Why? There is no logic. There is no because. The answers are as far for a bulimic as they are for anyone else. It is a behavior developed over a period of time, that has mutated into an illogical obsession.
Let us look at the stages, and some possible reasons of development of bulimia.

The most immediate question that pops into mind when we learn someone's bulimic is "why"?
Most people struggling with bulimia don't realize why they do it - that is because the root cause may be so far removed they don't remember it. You don't just become bulimic overnight. Usually there is a longer process leading up to the binging / purging behaviors.
You might get teased at school, for a variety of reasons. You may get teased for being fat, even if you're actually not overweight at all, just because kids are mean. You may get teased for a reason unrelated to weight at all. There may be problems at home; verbal, emotional abuse, culturally tolerated belittling of children, etc.
I talk about children, because most often that's where the root of the eating problem starts, but it does not demonstrate itself until later, in some cases it will take years to develop into a full-blown bulimic. This can occur whether the original issues persist, new ones arise, or even if they had all long been eliminated.
There may be triggers that remain, for example if you were teased at school for being short, and you have grown up to be a beautiful young woman, and still, whenever someone so much as alludes to your height, you begin to binge. You may not even be aware of the connection yourself, and wonder why you do it. But no matter what the initial reason might have been, the problem is there, and it remains to be dealt with.
Below we will discuss the stages of development, as well as what one might do to help.

The progress of bulimia can be fast and violent or slow and gradual. Here are the usual stages of development:

1. The beginning - food as a friend.

One day, food becomes more than just food. You were feeling down, had a snack, and realized it made you feel good. It almost felt like a gentle caress. Food provides the comfort you lack and need. So you call upon it when next you need a friend, or a companion in a lonely moment. It's better than a friend, because a person may not understand - perhaps you feel like no one would understand what you're going through. And food feels so good, the ice cream melts in your mouth, the chocolate's sweetness elates you; the savory chips add spice to your day.

2. Binging - the loss of control.

Having discovered a new friend and comfort in food, one might tend to overindulge. When you feel sad, misunderstood, mistreated, you return to food. But now, why not follow one chocolate bar with another? Or you may enjoy two sandwiches instead of one, and then retreat to eat a bag of chips, and why not have a little something sweet to complete the feat? The problem is, that you don't ever manage to get completely satisfied. One snack is not enough anymore, so in your desperate hope for some relief, you keep eating all within reach. And you still don't feel better. So you take one more. And another....
At this point you begin to use your new friend - food - for distraction from your daily toil, and even from yourself. Eating becomes the only thing to do when you don't know what to do. Eating becomes an escape - so you think. If you fill yourself with food, you won't leave room for your problems. Your stomachache diverts your mind from other pain; the numbness imposed by mindless overeating takes care of having to deal with any kind of emotions, because feeling anything at that moment - except for fullness or intestinal cramps - is impossible. Your bodily needs banish any mental concern. And you can't help it now. Once you start eating, it's like your body's on autopilot, and even if your brain tells it to stop, it will not, until it's on the brim of bursting.

3. Purging - a relief.

How long can one subsist on such excessive caloric intake without feeling their clothes tighten, their thighs and belly balloon up, their breath get heavy and seeing their image in the mirror expand? It may be just a pound or two, it may be a dozen - but when you become alarmed by what you see and feel, you want to seize control. You may go on an unsuccessful diet, severely restricting your intake, only to break down at night, emptying the fridge and the pantry, for good measure.
Boy, you feel disgusted by yourself now. You try for weeks on end. You may be successful in your diet, but gain the quickly lost weight back because the binge is stronger than you. You pray and plead with yourself, you promise you'll do anything if you can just stop eating, but you don't know how. After all, it seems as though your best friend, the one that made you feel so good at first, has turned against you, and is now laughing in your face. One day, you feel so sick you cannot take it anymore. You go to the bathroom and there, a solution presents itself so clearly - there is a means of control, after all!
When you have overindulged, just rid yourself of the last meal, and it will be great. No weight gain, no guilt, and still the ability to enjoy a feast of those yummy treats! You feel disgusted, but you also feel relieved. Mostly relieved. You didn't have to consult anyone, and you found a way to control your problem. If you eat a little snack, you begin to feel guilty, but then - why not go all the way? After all, there is a redemption.
And all the while, the world around you, reality, the people who care, become pushed more and more into obscurity. You don't want to deal with anything immediate. You will face your friends, your work, your responsibilities - later.

4. Binging and purging - the vicious cycle.

It is at this point that a bulimic discovers the vicious cycle. The principle of the vicious cycle: A person will start every day by saying he will not overeat. Then, he may eat a little snack, and say to themselves everything is in vain, they have already slipped, so they might as well continue and eat all they want, the purge will take care of it. They will try again tomorrow. Gradually, the notion of what is "too much" becomes blurred. How much can you eat and still be safe? Everything is too much.

And finally,

5. The inferno.

Here, dear reader, we virtually enter hell. This is the stage when everything falls apart, as it struggles to hold together.
This is the point where a bulimic may start to purge everything. This is the climax of out of control obsession. The person has long stopped to be able to taste any food - anything they eat is almost immediately swallowed, there is no pleasure in eating anything anymore.
Any food that enters the person's stomach feels uncomfortable, and has to go out. A steak, a cinnamon bun, a green salad - the person purges after almost every meal, several times a day. For some people purging becomes easier over time, for some more difficult. The person may understand rationally what they are doing, and what not to do, but they are unable to control themselves.
When left home alone, irrational and desperate binges will fill their time. The person feels as though they were outside of their body, watching helplessly as they devour thousands of calories in one sitting, with absolutely no reason nor rhyme. Canned peas may follow a custard pie, accompanied by a stuffed chicken breast with a donut or two, a hamburger and ice cream bar, tortilla chips with whipped cream, a bag of skittles, yesterday's Caesar salad and a canned beef stew - you name it - our participant feels like a passive observer, even as they alternate this gluttonous rampage with intermittent bathroom runs - nothing stays down long enough to be digested.
Once such an episode is over, this person will feel nothing but wretched, disgusted, hopeless and fatigued. This is when the physical pain of the effects of purging will set in - they will become aware of their sore throat, bleeding fingers, the mess around them, their exhaustion and the despair over not being able to help what they just did.
The person will cry and hope the next day will be better. And they will desperately long for help.

It must be emphasized that the case of each individual will be specific.

A bulimic will not be able to objectively judge their body - their image will typically be warped and at all times seem somehow larger, uglier or stockier than others.

It must be noted that unlike with anorexia, the typical image of a bulimic is NOT skinny - it is often a person of average weight and build, or even overweight. The person will often look healthy too, and it can be a person of strong character and high social position as well, such as you would never suspect of struggling with an eating disorder.

A bulimic will typically eat normally, or even slightly less, when accompanied by others, so again, his or her preoccupation with food may not be evident.

The person may not even be aware that there are various body types, having always believed they are bigger than normal, and thus comparing themselves constantly to people of any body type - even those with much smaller frames than their own, whose weight and size is for him or her impossible, and undesireable to attain.

They will often seek time alone, in the evenings, on weekends, even after meals at work or school, to be able to indulge in binging, purging, or the combination of those self-destructive behaviours.

Especially in the last two stages, they will often go binge shopping - stocking up on food they mean to use for their vicious cycle binge and purge ritual. Often when grocery shopping, they will be out of control and impulse buying various snack items.

Here are some things you may look for when you suspect someone is struggling with bulimia:

1. Seclusion - choosing to eat alone. Isolation, seeking time alone, especially after eating.

2. Spending an excessive amount of time in the bathroom.

3. Cuts, bruises, lesions, scratch-marks on fingers, knuckles.

4. Enlarged lymph nodes, swollen cheeks.

5. Wrappers of candy, food, especially fast food and microwaveable food, cans, empty food containers - especially an unusual amount in the garbage; food (especially candy) wrappers hidden in their bedroom, or other places around the house.

6. Unexplained or fast depletion of food supplies in the house, or disappearance of large amounts of food from the fridge and pantry.

7. Restlessness, dissatisfaction without having a snack, various irrational cravings.

8. Unusual noises from the bathroom, their bedroom or outside the house (such as might be indicative of binging or purging).

9. Hoarding or collecting food to eat later.

There may be other signs, especially if you see a change in their emotions, or signs of distress. Stress often aggravates the condition, as well as activates triggers.
You may also look for ritualistic behaviours, such as disappearing at a given time and reappearing looking frazzled, fatigues, or possibly relieved.

Trying to help and support a person with an eating disorder is one of the most trying tasks. It may be frustrating because of their denial, refusal to cooperate, societal pressures, and not lastly the fact that in the end it is the afflicted person themselves, who has to take the necessary steps to get help. But do not despair - the best thing you can do for your friend, child, parent, loved one struggling with bulimia is to be there for them; to offer support and your availability, with an open mind. It may not seem like enough, but in fact it is the best and most helpful thing you can do.

Why confronting a bulimic directly does not work.
The simple answer is, because they don't know why they do it. They are unable to answer "What's wrong?", "What's making you feel like you need to binge / purge?", "What is food a substitute for?", or "What's at the root of this; what is it that's really bothering you?"
Sometimes they may even feel completely fine - except that the binge / purge learned behaviour which they can't control. They are angry at themselves, and humiliated, because they think they should be able to control it, and to eliminate it.
And finally, they don't want to touch it, because if they do, then they will really have to deal with it, and they are very afraid to face the reality - as might an alcoholic, or a gambler.

Here are a few hints as to how best lend a hand to a person dealing with bulimia:

1. Apprach the issue carefully, and gradually

Do not confront the person directly about the eating issue at first. There is every likelihood that if you do, you will only meet with opposition, possibly making it very difficult to ever apprach the topic, as well as the person, again. If you are going to talk about their bulimia,
you must apprach it from a distance.
How to approach them? You can only do it if you genuinely care about the person, and make sure they know it. Perhaps you can start talking about a little issue, such as pressure at work, what's going on at school, try talking about a topic that interests them and where you may perhaps offer your advice.

2. De-personalize the issue.

You may want to start by discussing an issue that you are struggling with yourself, or a character from a book or movie's problem, and then gradually draw the conversationi to how eating is used today as a coping mechanism. Feel your way around. Do not push where you sense any kind of resistence. Again, you must make sure they know to trust you.

3. Make your availability, openness and readiness to support be known. Let them know you will not judge them - and do try hard not to. Offer an ear, and a shoulder. You don't have to come up with solutions.

4. Make them feel hopeful, optimistic. Let them know that it is possible to overcome this.

5. If possible, discuss the underlying issues, because it may just be that with the elimination of those, the food-related struggles may subside. If you are able to discuss and ease the other issues, it may be easier to approach and discuss the eating.

6. Be prepared that this may need a lot of time and patience.

7. Do your homework - research as much as you can about bulimia and eating disorders, and find out what kind of help (health services, mantal health and nutritionist) is available in your area, so that when the time is right, and if the person is ready, you may be able to direct them where to seek professional help. Once you've found them professional help, do not leave them on their own. Assure them you will stand beside them.

Once you have reached them and they are ready to cooperate, here are a few helpful tips:

1. Offer to make yourself a point of accountability!
You may ask them to report to you daily or weekly, whether they binged or purged that day or week. Their accountability is first and foremost to themselves, but they can use you to actually stick to the plan. If they feel they have someone to do it for, who would be disappointed if they failed, that will motivate them to keep focused.

2. Offer them to call you next time they feel like binging / purging. When they call, you may talk about anything, related or not to whatever's going on at the moment, about an issue that troubles them, about food, or just about the weather - the point is to provide a distraction. Often, when a bulimic feels like binging and/or purging, and they are able to hold it off for 10-15 minutes, they can overcome the urge completely.

3. When you talk to them, make it a point to tell them something that makes them feel good about themselves. As a morale boosting comment, that one sole thing may just keep them away from destructive behaviour. Don't forget to always assert your pride and belief in them! When you put your faith in them, it will be much harder for them to engage in behavior that might undermine it.

4. And finally a very important note! Helping a bulimic is a very exhausting task, and I want to emphasize to make sure that you take time to care for yourself as well. If you get run down by the negativity or anxiety you may encounter while dealing with your loved one's issues, you will not be able to take care of them as you promised. Do get some time out, and do not feel guilty for thinking about yourself too!

This lense has been written with the insight of personal experience. All that lies in here is to help better understand the complex issue of bulimia. Of course in all its complexity, this is but a peek into what all is hidden within.

Bulimia, like any other addiction, is something that stays with one for life - you must only avoid the destructive behaviour. Much love, support and compassion is needed to help one get better - but it is possible. Keep in mind that unlike those suffering from gambling, drug, or alcohol addictions, a bulimic is unable to put his or her "drug of choice" - food - aside, and never touch it again. It therefore takes an incredible amount of determination to be able to resist being daily subjected to temptation. Understanding this is a foundation of overcoming any eating disorder.