In my late 20s, I started recovering from bulimia. Having surreptitiously battled the eating disorder for more than a decade, stepping out of secrecy was an important milestone in my life. In the six years since then, I’ve spoken candidly about my experience of food-related mental illness to shine a light on the harsh complexity of bulimia. It can be difficult to have such vulnerable conversations, but most days, I draw courage from knowing how important it is to talk honestly about mental health and disordered eating.
The hardest part of sharing my story has been the jarring realization that bulimia remains wreathed in stigma. There’s a lot left to investigate about the condition, even when it comes to why people develop bulimia in the first place. But due to the general lack of public discussion about bulimia, assumptions and stereotypes abound, sometimes creating a barrier to treatment and recovery.
Bulimia thrives on silence and isolation. Helping people to realize that it’s a serious, nuanced illness—and that there can be a path to recovery—is incredibly important to me. Combating prevalent misconceptions and chipping away at stigma are large parts of that. So, here are the points I wish everyone understood about bulimia and those who struggle with it.
1. Not everyone with bulimia makes themselves vomit.
Contrary to popular opinion, bulimia and vomiting aren’t inextricably linked, the National Eating Disorders Association (NEDA) explains, but this myth is so deeply ingrained that it can make it harder for people to realize when they or their loved ones need help.
In reality, bulimia (technically known as bulimia nervosa) is characterized by recurrent episodes of binge-eating followed by trying to compensate in some way, like through purging (vomiting), fasting, using laxatives or enemas, or engaging in overly intense exercise.
These tactics were all part of how I tried to “undo the damage” of overeating, but I especially want more people to understand how compulsive exercise can play into bulimia. Since exercise is often seen as purely healthy, many people don’t realize that working out too often and too intensely can be an emotionally and physically harrowing feature of disordered eating.
When purging became too unbearable and failed to offer the “relief” I was scrambling for in guilt-laden moments after a binge, I subjected myself to punishing exercise regimens. As a result, I regularly suffered from joint and muscle pain and recurring injuries. When I wasn’t thinking about food, I was trying to calculate how much exercise I thought might burn away the calories I’d consumed. It still never felt like I was doing enough.
2. Bulimia doesn’t just affect young girls.
Historically, eating disorders like bulimia have often been viewed as only touching a specific demographic: young women (especially white ones who can afford treatment). As such, my troubled relationship with food stirred up tremendous shame as I approached my late 20s. Taunted by the perception of bulimia as a younger person’s ailment, I often told myself that well-adjusted grown-ups didn’t have those sorts of problems. That couldn’t be further from the truth.
Having grown up in England, I’m particularly interested in understanding this issue where I’m from. In a 2017 BMC Medicine study, researchers interviewed 5,658 middle-aged women in the U.K. to estimate the prevalence of disordered eating. Just over 15 percent of participants had experienced an eating disorder at some point in their lives, and nearly 4 percent had dealt with one in the past year. By comparison, in a 2012 International Journal of Eating Disorders study on 1,849 U.S. women over 50, around 13 percent of respondents reported having at least one disordered eating symptom. Both pieces of research were conducted differently and have their limitations, like the fact that neither studied a nationally representative group (which might be part of the reason why the numbers are so different between the U.K. and the U.S.). Still, it’s clear that these types of disordered eating behaviors can emerge or persist at any age.
Another huge issue with this myth is that it ignores men and anyone else who isn’t a girl or woman. The number of men with bulimia varies based on the source, but NEDA estimates that, in general, around 0.1 percent of young men in the U.S., U.K., and Europe meet bulimia’s diagnostic criteria at any point in time, compared with 1 percent of young women. The true number could be higher; some men may not seek treatment due to shame, denial, or not realizing they have a problem because eating disorders seem like something only girls and women deal with.
Ultimately, the point is that eating disorders don’t discriminate. “Bulimia nervosa is a psychiatric illness seen in individuals of all ages, genders, ethnicities, sexual orientations, body weights, and socioeconomic groups,” Rene D. Zweig, Ph.D., an eating disorders specialist and director of Union Square Cognitive Therapy, tells SELF.
3. Bulimia isn’t really about vanity.
Some people mistakenly assume that bulimia develops out of vanity or wanting to emulate thin celebrities. This dangerous way of thinking implies that a person can choose to stop having an eating disorder if they just quit caring so much about how they looked.
Most mental health professionals and researchers now understand eating disorders to be a complex interplay between genetic, psychological, and environmental factors. Socio-cultural pressure to be thin can be a prominent contributor, but it’s by no means the only one.
“The idea that bulimia is a lifestyle choice based on vanity perpetuates stigma, shame, and a reluctance to seek help,” says Zweig. “While a core eating disorder symptom is an overemphasis on weight, shape, and thinness, many patients additionally describe their behaviors as efforts to control their anxiety, shame, mood, and impulsivity.”
When I was suffering from bulimia, weight and appearance weren’t my main concerns, especially at the height of my illness. Instead, dieting, bingeing, and purging felt like a coping mechanism at times—a balm for uncomfortable emotions. I grappled with a false sense of control and felt as though these actions would somehow bring order to the chaos of my life. Over time, my disordered thoughts and behaviors started to feel uncontrollable themselves, but my fear of being judged for having superficial motivations prevented me from seeking help.
“People might not know what is happening to them,” Catherine Stewart, Ph.D., DClinPsy, senior clinical psychologist at The Maudsley Centre for Child and Adolescent Eating Disorders, tells SELF. “They might not know where to go to get treatment or how to ask for help. A lot of people feel embarrassed or ashamed about the behaviors that bulimia is causing.”
4. Willpower isn’t enough to overcome bulimia.
I’ve often considered myself to be a person with formidable willpower, having endured challenging circumstances and sometimes pushed myself to extreme limits to achieve a goal. This is probably why, for some time, I harbored the illusion that I could overcome my disordered eating habits through sheer determination. Despite consistently proving that line of thinking wrong, this belief kept me stuck in a loop of disordered eating for years. Not only was willpower not enough for me to overcome bulimia, but trying to rely on it for that purpose also exacerbated my cycle of disappointment and self-blame.
“Bulimia is a complex … disorder that usually requires outside assistance to disrupt and change,” says Zweig. “It’s incorrect to assume that willpower alone is adequate to change it or any other mental health problem.”
Although the research on the neurological similarities between bulimia and addiction remains ambiguous, some studies indicate that certain eating behaviors can actually be extremely addictive. For me, binge-eating and purging did often feel akin to an addiction. The more I tried to stop, the more out of control I felt. Once I accepted that I couldn’t force myself to overcome this problem alone, I reached out for help. Only then was I able to start building a healthy and intuitive relationship with food.
5. People with bulimia aren’t always underweight.
One of the misconceptions I’m particularly keen to combat is the idea that everyone with bulimia (or any other eating disorder) is underweight. I never fit that stereotype—my weight constantly fluctuated but generally always bordered a “healthy” range, which made it harder to accept that I had an eating disorder.
We need to stop using people’s appearances as a barometer of the gravity of their illness. Even when bulimia is enveloping someone’s inner life, on the outside, they can seem to be functioning just fine. To this day, close friends and family are often shocked to learn about my past issues with food.
My earliest experience of telling someone about my bulimia was extremely invalidating because of this myth. I told my doctor I thought I might have an eating disorder, but after he weighed me, he reassured me that my BMI wasn’t far enough below that of a “healthy” person to warrant any major concern. At the time, I was severely restricting my calories and purging daily. Since I didn’t really understand what bulimia was, my doctor’s reaction reaffirmed the notion that I couldn’t truly be sick if I wasn’t withering away.
6. Bulimia can be harmful and even life-threatening.
There’s a common (and incorrect) notion that anorexia is the only serious eating disorder, says Zweig. In reality, bulimia can lead to a host of health issues, like dental erosion, a sore throat from purging, anemia, fainting, hormonal and menstrual irregularities that can cause fertility issues, and more.
Bulimia can even be life-threatening. When talking about deadly eating disorders, again, people often focus on anorexia, noting that some numbers pinpoint it as the deadliest mental illness. But bulimia may be similarly lethal. NEDA cites a 2009 study in The American Journal of Psychiatry showing that, in a group of 1,885 people who were patients at the Outpatient Eating Disorders Clinic at the University of Minnesota between 1979 and 1997, the mortality rate for those with bulimia was 3.9 percent compared with a mortality rate of 4.0 percent in those with anorexia and 5.2 percent in those with eating disorder not otherwise specified. (Now known as other specified feeding or eating disorders, eating disorder not otherwise specified basically means disordered eating that doesn’t meet the criteria of other diagnoses.) It’s hard to know exactly how deadly these illnesses are because some death certificates used in various estimates may not cite an eating disorder as the cause when it really is, but the point is that they can clearly be fatal.
Sadly, there are multiple ways bulimia can kill, like by throwing a person’s electrolytes off-balance. Electrolytes are chemicals that help keep your heartbeat regular, among other important roles, so imbalanced electrolytes can cause life-threatening emergencies like cardiac arrest. Extreme bingeing can lead to stomach rupture; a strained esophagus from long-term purging can also rupture—both potentially deadly complications. People with eating disorders, including bulimia, are also at an increased risk of developing other mental health conditions like depression and attempting suicide.
Certain symptoms of bulimia can compound the risk of potentially lethal complications. For instance, Zweig says, people with bulimia who exercise excessively may be at higher risk of dangerous complications like electrolyte imbalance and dehydration (and resulting problems like cardiac arrest), along with a possible increased risk of suicide.
I experienced suicidal ideation at my lowest point with bulimia. The disease was like an insidious tornado slowly wreaking havoc on my life until I was no longer sure if I wanted to live. That forced me to finally accept that I had a problem and needed help, but you don’t need to hit rock bottom to start recovery. Getting help as early as possible can make it easier to change harmful patterns, says Stewart.
7. It’s possible to recover from bulimia.
When I first started recovering from bulimia, I abstained from potentially triggering foods I’d previously binged on. Wanting to protect myself from falling back into my old habits, I latched onto the belief that bulimia was a lifelong disease that lay dormant, always on the verge of being re-ignited. Eventually, though, I started consuming all foods in moderation again.
Recovery looks different for each person with an eating disorder, just as the illness can manifest in myriad ways. While there’s always potential for relapse in eating disorder recovery, it’s not inevitable for everyone.
“It is important for patients and their families to know that effective treatments do exist,” says Zweig. “All of these treatments require commitment and effort but can produce lasting change.” Reaching out for support is an integral part of this process. “Very few people recover from bulimia on their own,” says Zweig. “Given the severity of eating disorders and their many possible complications, [I advise seeking] out a qualified, evidence-based therapy to maximize the changes for complete and lasting recovery.”
Family-based therapy (FBT), often called the Maudsley Approach or Maudsley Method, is a popular treatment for adolescents with bulimia, NEDA explains. FBT is designed to help patients establish healthier eating habits with the support of those close to them. Although FBT is also sometimes recommended for adults, cognitive-behavioral therapy (CBT) is generally the first-line bulimia treatment for people past their teenage years. (CBT has been incredibly helpful for me.) The goal is to help patients adjust the beliefs, attitudes, and cognitive processes that maintain their disorder. “Dialectical behavior therapy (DBT) has also shown good results for the treatment of bulimia,” says Zweig. DBT is meant to teach people new skills (like mindfulness) to challenge disordered eating habits. (Sometimes this therapy happens in residential treatment for people whose eating disorders are severe enough to warrant that step.) Medications like anti-anxiety drugs and antidepressants can also be helpful for helping people to manage other mental health conditions that can be linked with eating disorders, the Mayo Clinic explains.
Although I’ve made monumental strides in recovering from bulimia, disordered thoughts occasionally slip through the cracks. My greatest hurdle in the long-term has been the disconnect between the disordered mental script I sometimes still adhere to and my commitment to recovery. I’ve continued using CBT to reframe and let go of the destructive beliefs that once kept my disorder pulsing, and I’m working toward body acceptance every day as part of my journey. Embracing the idea that full recovery is possible for me has been a vital step towards my moving past bulimia.