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The “Double Life” of Bulimia Nervosa: Patients’ Perspectives

My psychiatrist once compared my life to Dexter. He said I was living a double life. It was the summer before my final year in undergrad and I was working in a neuroscience lab. Yet things were so bad that at one point I was very close to quitting and doing Day Program treatment. (I didn’t, and things ended up getting better, thankfully.)

This post is going to be more personal than most. One, I can relate well to the topic. Two, I feel that I can give voice to it under my real name. (As opposed to just discuss it abstractly, or anonymously. There’s nothing wrong with being anonymous, but I feel that, for many reasons I am in a position where I don’t feel I have to be anonymous any more.)

I think this is important because there are a lot of myths that surround eating disorders and those who suffer from them, and I want to do my part in crushing those myths. Moreover, while restrictive anorexia nervosa is often, at least partly, associated with positive traits like self-control, bulimia nervosa (rather, bingeing and purging more broadly) is never associated with anything positive. Not eating is one thing, but eating and throwing up is quite another. It is dirty. Wasteful. 

Bulimia comes with  huge stigma. This stigma is a huge barrier to treatment. Hepworth and Paxton (2007) found that “fear of stigma is the main barrier for help-seeking individuals  with bulimia nervosa” (emphasis mine).

Bingeing and purging is shameful, but it is also invisible: most bulimia nervosa patients are at a normal weight. It is easier to hide than anorexia, too. (Eating and purging is often easier than not eating and making excuses for it.)

There’s also this idea that you can just stop. Hey, just eat and don’t throw up. Aren’t you smarter than that? Why can’t you do something more productive with your time. Stop being so selfish and wasting money, you arrogant girl. The world is not perfect, get over it. 

There is so much stigma that in one of the studies I’ll talk about, for more than half of the participants, the study was the first time they disclosed to anyone that they had bulimia. They struggled with bulimia from 1 to 9 years (average 4). Imagine, nine years in secrecy.

Remember, too, that “bulimia occurs in all age groups, ethnic backgrounds, and social classes” (Broussard, 2005).

What I am about to write, I’m not writing to brag. It is to illustrate that there were many times I was both very functional and very sick. What I am about to write, I’m writing because I want to help end the myths that those who binge and purge are lazy, obsessed with being thin, stupid, greedy, self-centered, or arrogant. I’m writing because although someone once told me I didn’t look like someone who would have an eating disorder, I did.

(Side-note, purging often refers to vomiting as well as any other methods commonly used to compensate for bingeing, such as exercise, laxatives, diuretics, and fasting. In talking about myself, when I say “purging” I mean “vomiting.”)

I started purging at the very end of my first year in undergrad. It was at its worst in the summer before my final year and during the middle of my final year. But, I managed to finish my degree in Neuroscience with a high GPA. In that final year, I was the Review Board Manager at my University’s undergraduate journal in life science, and a News & Features Editor at JYI. That year I also applied to graduate schools in the US. I got into five schools, including two Ivy League Neuroscience PhD programs. (And then decided I didn’t want a PhD and I didn’t want to be in a long-distance relationship.)

I’ll be defending my Masters in the next 2-3 months and NSERC (Natural Sciences and Engineering Research Council, a major funding body, probably most similar to the National Science Foundation in the US) decided I was in the top 24 Masters level applicants across all fields in 2012. (I’m not, I guarantee you, but I’ll accept their scholarship.) And guess what, I was bingeing and purging a lot during the start of grad school.

If people did think something was wrong, few probably suspected how bad it was. I doubt anyone actually thought I spent most of the night bingeing and purging, and then went to the lab in the morning and did experiments all day. Few probably suspected that I purged between experiments in undergrad.

I wasn’t lazy, stupid, greedy, self-centred, or arrogant. And no one is just because they are struggling with an eating disorder. No one.

I was just sick. I didn’t know how to eat normally. I didn’t know how to eat without eating a lot. I didn’t know how to stop bingeing and purging without severely restricting. Purging was extremely calming. I liked it. A lot. It wasn’t something I could just stop by myself.

I was science student by day, bulimic, well, the rest of the time.

My experiences though, they are just an anecdote  So, what I want to do is share two good papers exploring the experiences and perspectives of bulimia nervosa patients. Prior to these papers though, there was a study by Orbanic (2001) that described the experiences of six women living with bulimia.

Five themes surfaced:

  1. A LIVING HELL: Thoughts were overwhelming about when, what, and how much they were going to eat and how they would avoid being caught. They were emotionally and physically exhausted.
  2. THE PERPETUAL CYCLE: Bingeing and purging became “habitual, automatic, self-perpetuating.”
  3. THE RIGHT TO EXIST: Felt justified to exist only if they were thin, need for approval and self-criticism were powerful drivers of the pursuit of thinness.
  4. FOOD AS ANAESTHETIC: Bingeing and purging was a way to “detach from feelings and emotions”
  5. LIVING A FAÇADE: A lot of time and thought went into how to maintain the façade of normalcy. 

I can definitely relate to all of those, perhaps with the exception of number three. Number one, and especially number two, four, and five very accurately describe my experiences with bulimia. Spot on. 

Orbanic also found “that bulimic women often experience a sense of “satisfaction,” “completion,” and “calm” following vomiting.”

I’m so glad to see this written. There is a common assumption that bulimia nervosa patients like bingeing but feel guilty for the food and vomit. The assumption is that they don’t like vomiting, it is just to get rid of the gluttonous binge. For me, while that was true sometimes, I actually began to like vomiting and often binged to vomit precisely because it left me feeling incredibly calm and tranquil. There were times purging was something I felt compelled to do in order to actually fall asleep. I wanted to go to bed, but, I felt I had to binge and purge, otherwise, I wouldn’t fall asleep. I would be too anxious. 

Brenda Broussard, in her 2005 paper, and Gunn Pettersen and colleagues in their 2008 paper found very similar results to Orbanic. Instead of writing too much, I thought I’d make figures illustrating the main findings of the two qualitative papers (click on image to enlarge).

Broussard (2005):

Broussard - 2005 - Figure 1

SUMMARY OF IMPORTANT FINDINGS

Broussard (2005): 

  • Many thought their behaviours were “normal” or weren’t a big deal, but that they were afraid others would think otherwise.
  • Participant thought they were often perceived as being “gross,” “disgusting,” “sick,” “repulsive” or that there was something mentally “wrong” with them.
  • After vomiting, “rather than guilt, [many] actually felt “relief” or “good.” (This is similar to Orbanic’s findings.)
  • The participants faced a huge internal struggle, and attempts to rationalize the irrational but overwhelming desire to binge and purge.

Pettersen et al. (2008) found different, but similar, subthemes (note the differences between the participants):

Petterson - 2008 - Figure 1

SUMMARY OF IMPORTANT FINDINGS

Pettersen et al. (2008):

  • Thought often seen as being “manipulative” patients are often just trying to preserve their dignity and concealing their bingeing and purging is a way to accomplish this.
  • Participants hid their behaviour for fear of shame, stigma, and negative sanctions
  • Individuals who were less ashamed of bingeing and purging, and did not put as much daily effort into hiding it “may be judged as better off” (because mentally it is less exhausting).

Severity of bulimia is then not only related to psychiatric status, frequency of symptoms, or objective somatic conditions. Severity is equally a question about emotional fragmentation between shame and dignity, as well as whether the distance between the overt and the covert hampers daily life functioning.

What do these findings mean for therapy and treatment?

Pettersen writes that time should be spent both on reducing symptom frequency *and* reducing the same that it is associated with bulimia, as well as addressing the costs of the “double life.” 

Broussard (a nurse) recommends studies that “involve bulimic women in a discussion about treatment strategies.” She suggests further studies should address “How can health care providers effectively address the issue of eating disorders with clients?” and “What do bulimic women think would be most helpful?”

Wouldn’t it be great if all therapists and treatment teams asked you how you feel you can be helped (particularly if you are an adult, perhaps in your mid-20′s, and have a lot of other things going on in your life, like school and work)? I can’t wait for that day.

I’m sure a lot of readers who have struggled with bingeing and purging can relate to some of themes discussed in these papers. Feel free to share your experiences, and perhaps how treatment helped or hindered recovery. (As always, you can do so completely anonymously.)

Orbanic S (2001). Understanding bulimia. Signs, symptoms and the human experience. The American journal of nursing, 101 (3) PMID: 11279994
Broussard, B. (2005). Women’s experiences of bulimia nervosa Journal of Advanced Nursing, 49 (1), 43-50 DOI: 10.1111/j.1365-2648.2004.03262.x

Pettersen, G., Rosenvinge, J., & Ytterhus, B. (2008). The “Double Life” of Bulimia: Patients’ Experiences in Daily Life Interactions Eating Disorders, 16 (3), 204-211 DOI: 10.1080/10640260802016696

Written by Tetyana

Tetyana is the creator and manager of the SEDs blog. She has an MSc in Neuroscience from the University of Toronto. Tetyana is passionate about science communication and knowledge translation. To get in touch, use the ‘Contact’ form on the website.

Discussion

35 Responses to “The “Double Life” of Bulimia Nervosa: Patients’ Perspectives”

  1. Wow , you described me basically. It’s scarry, really.

    Posted by fernanda | December 24, 2012, 4:45 PM
  2. Thank you, thank you a million times thank you

    Posted by Fiona | December 25, 2012, 10:39 AM
    • Thank *YOU* Fiona for your kind words!

      Posted by Tetyana | December 25, 2012, 5:39 PM
      • All of this, and all the comments – I relate to. And obviously you have hit a nerve with many.

        I went from restrictive anorexia to a long struggle with binge/purging and the shame has been crippling. I’m completely honest with my treatment team, but still, I think they vastly underestimate what it’s like, I think they think I exaggerate. It’s hard to have a concept of the violence you can wreak to your own body when you haven’t lived it and when you can’t see it so much any more (since I gained and maintained more weight). I have felt so, so alone. The shame is just over powering and I’ve said that a few times but that’s because it’s that huge! My life IS a double life, and I’m constantly scared of people guessing my disgusting secret. I feel like a criminal. and I feel like a FRAUD, because I’m being treated for ‘anorexia’ and I’m eating more in a day sometimes than I used to eat in a year in restrictive days. I feel like a fraud in general life too, because people think ah, she can’t be all that worried about food and eating when in reality, man, it’s such a war.

        I totally agree about the meal support. The treatment available at the moment means you do have to drop out of life, the catch 22 being that the more you drop out of life, the harder it is to recover. You need to ADD things first. There’s no chance of finding healthier ways to cope with life when it’s been reduced to sitting around all day.

        Most treatment in Australia is geared to very sick patients who are treated automatically like criminals or at the very least, spoilt little brats who have to be disciplined. And it’s even more disempowering to actually ask for help and as a result have your life taken over and find yourself committed to a treatment you had no input into whatsoever. A lot needs to change.
        First things first – we are PEOPLE. And we are not STUPID. Listen and treat with respect.

        Thank you again, Tetyana.

        Posted by Anonymous | December 28, 2012, 7:13 AM
        • I love your comment! It is so true on so many levels, thank you for writing it!!

          Unfortunately, I don’t have any advice :( I know it is utter shit to be in these situations, feeling like you are not being taken seriously, or are exaggerating. Feeling like you are living a double life. The catch-22 situation. It is all crap.

          I agree, so much needs to change!

          Thank you for your comment!

          Tetyana

          Posted by Tetyana | December 29, 2012, 3:34 PM
        • Treatment centres in Australia, I’ve found, tends to follow the ‘naughty little children’ model of ED treatment. It’s been years since I’ve been in ED tx, but a friend of mine has recently worked on an ED program in Australia, and she said the model is still very much in use and was horrified at the attitudes of the staff (ED specialists, I might add) toward the patients.

          My experience was also that basically all the anorexic patients with whom I’ve been in treatment, other than me, were restrictive types (or at least, no one admitted to being otherwise), so I felt very alone and ashamed admitting to any binge/purge tendencies.

          Posted by ES | January 28, 2013, 9:37 PM
          • I so agree about the added stigma of being a binger/purger in hospital. Everyone seems to act and look as though they restrict only, and usually they do, here in Australia, the starvers make it into hospital far more than those with bingeing disorders do, because low weight is given priority no. 1 still. And if you are a purger in hospital you are made to feel like you are a cheat, and like you are sneaky and ‘bad’. I have lost count of the times I have actually been lectured beginning with “You naughty girl..” or “You *know* that was the wrong thing to do..” and admonished to “behave myself.” I’ve been told that I’m being locked up and restrained for “my own good” and that “my actions have gotten me here and I have nobody else but myself to blame”. I’ve been called “sly” and “sneaky” and have overheard nurses calling me “a problem patient”. Worst is that they assume that because I struggle with purging, or worse, bingeing and purging, I don’t want to get better. Oh I DO. Their actions and words feed my disorder, by making me feel awful about myself, hate myself, disgusting, and so ashamed of myself and that I need to hide what’s happening all the more. Aussie professionals and nurses have a lot to learn. Unfortunately the professionals in charge of the ED units are at the ‘top of the game’ in Australia, so it seems their ideas although antiquated are rarely challenged. That needs to change.

            Posted by Fiona | January 29, 2013, 8:58 AM
            • I completely relate to how the bingeing and purging seems to classify the sufferer as bad and that it’s a choice. I’m a 26 year old male, I first was restrictive anorexia then it flipped to bulimia. I get blamed and threatened all the time for bulimia, whereas when anoretic, my low weight would be the focus and I would get ‘you poor thing’. Eating disorders, I believe, have the same roots, the differences being in behaviour.

              Posted by Mark | January 29, 2013, 10:57 AM
  3. “Wouldn’t it be great if all therapists and treatment teams asked you how you feel you can be helped (particularly if you are an adult, perhaps in your mid-20′s, and have a lot of other things going on in your life, like school and work)?”

    I was asked a question similar to this by my last therapist, but really, as a person who is “sick”, how are you supposed to find the words/ideas to answer such a[n] (potentially) overwhelming question? Even as an “educated” person who “knows” about ED treatment, I found myself floundering…

    Great post, by the way.

    Posted by Jenny | December 27, 2012, 1:53 AM
    • Jenny, I definitely see what you mean.

      What I was thinking though, was something along the lines of for example, when I was sick, I didn’t want body image, yoga, art therapy, etc.. groups. I didn’t want family therapy, or some 12-step program. I wanted someone to help me eat normally and keep it down. Someone to be there with me during meals.

      I was just discussing this issue with my psychiatrist a few weeks ago. He was saying he had this idea that it would be great to open up a bunch of places in the city where people with eating disorders could go and have meals. I mean, the logistics would have to be figured out, of course and maybe there would be different kinds, but, it wasn’t a 24/7 kind of treatment that infantilized an adult.

      My problem was that Day Program at the time, meant quitting my work (and I signed a contract), and work was the one thing that kept me from bingeing and purging constantly, and I generally enjoyed it, so it gave me satisfaction. And it meant I had to spend hours after meals doing various programs I had no interest in doing…. I really just wanted help to structure a meal, eat it, sit with it, and repeat. Something like that wasn’t offered to me.

      Does that make sense? It might not be appropriate for everyone and of course, yoga, art therapy, whatever, if it helps you, great. I don’t meant to speak lowly of those things except to say that I wish treatment teams/personnel listened more to individual patients as opposed to lumping them all into one group.

      Mind you, a lot of these problems come from money. So, I don’t blame the treatment places, per se, just commenting on where I’d love to see treatment go.

      I should add, that kind of flexibility in treatment shouldn’t be the de facto state for everyone, but, I do think there need to be more options for adults with eating disorders that aren’t just slight variations of the treatments offered for adolescents.

      Tetyana

      Posted by Tetyana | December 27, 2012, 3:00 PM
      • Oh, okay, I totally agree with what you’re saying – I just couldn’t surmise all that from the question you posed. Everyone’s recovery/treatment from an ED should definitely be personalized; what works for one individual doesn’t necessarily work for another, etc.

        Also: that kind of ED meal-eating establishment sounds really awesome.

        Posted by Jenny | December 27, 2012, 4:08 PM
      • Tetyana, that is the best idea! If only funding would support something like that… And I totally agree about withdrawing from life for treatment. My only option to get treatment right now would be to either quit my job, go on leave, or cut back hours. The problem? The only times I’m NOT using symptoms are when I’m working. It gives me a sense of purpose, keeps me busy, and I have to eat regular meals with my clients. Yes, it takes a lot of time, but I think it serves a great purpose for me right now, as I mainly struggle when I’m NOT there…

        Posted by jessica | December 28, 2012, 11:32 AM
        • It is a catch-22, right. And, then there’s the issue of all the negative aspects of treatment (competition, being around sick people, being treated like you are 12).

          Maybe I should pitch this idea to a place in Toronto that offers eating disorder support. Or pitch the pitch to my psychiatrist.

          Posted by Tetyana | December 29, 2012, 3:37 PM
  4. ..”Orbanic also found “that bulimic women often experience a sense of “satisfaction,” “completion,” and “calm” following vomiting.”

    “I’m so glad to see this written. There is a common assumption that bulimia nervosa patients like bingeing but feel guilty for the food and vomit. The assumption is that they don’t like vomiting, it is just to get rid of the gluttonous binge. For me, while that was true sometimes, I actually began to like vomiting and often binged to vomit precisely because it left me feeling incredibly calm and tranquil. There were times purging was something I felt compelled to do in order to actually fall asleep. I wanted to go to bed, but, I felt I had to binge and purge, otherwise, I wouldn’t fall asleep. I would be too anxious.”

    This experience of the binge and the purge are so familiar to me, and yet I too have never seen it written down in such a validating(?) way. It’s a relief.

    ” Not eating is one thing, but eating and throwing up is quite another. It is dirty. Wasteful.”

    Another major truism for me and one that is deeply entrenched after years of contact with services who just don’t seem to understand the basic differences between “restictive” anorexia and “b/p” anorexia. In my case I was a normal weight bulimic for nigh on 8 years, as my weight gradually dropped and dropped to a diagnostically anorexic level. And here I am, 20-odd years later stuck fast in anorexia (binge/purge SUB-type) I believe the presence of binge/purge behaviours should be differentiated from restrictive behaviours and cause as much (if not more) alarm and ACTION as trhe purely restrictive type. Eating disorders can be seen as being on a sort of continuum, whereby some patients present with some symptoms and others with different/similar symptoms. Uusally, I suspect, the symptoms presented are those which give the most relief to that particular patient. Anxiety is such a common pathology in all eating disorders and naturally, our instincts are to reduce anxiety at all costs in a bid to be able to “think” more clearly. Sadly the brain is compromised by malnutrition and without good, effective, evidence-based intervention (as far as is practicable/possible), many are left to tread water by themselves. So true of bulimia, where the key to the door to treatment is often weight loss. *Sigh*. I’ve walked that road and thus far found no respite.

    Posted by Rufty Roo | December 27, 2012, 8:52 PM
    • Rufty Roo: Eating disorders can be seen as being on a sort of continuum, whereby some patients present with some symptoms and others with different/similar symptoms. Uusally, I suspect, the symptoms presented are those which give the most relief to that particular patient. Anxiety is such a common pathology in all eating disorders and naturally, our instincts are to reduce anxiety at all costs in a bid to be able to “think” more clearly. Sadly the brain is compromised by malnutrition and without good, effective, evidence-based intervention (as far as is practicable/possible), many are left to tread water by themselves. So true of bulimia, where the key to the door to treatment is often weight loss. *Sigh*. I’ve walked that road and thus far found no respite.

      This so so true. Thank you for writing it. It is so frustrating to see this, and to see how many patients who really want treatment and recovery can’t afford it, get get the right kind of treatment, or can’t seem to find a treatment team that listens to them! Incredibly upsetting.

      Posted by Tetyana | December 29, 2012, 3:53 PM
    • I can’t articulate how much I can relate to everything you have said. I have been stuck in a vicious cycle of bulimia for 4 and a half years now. Often I have dropped to an underweight BMI but mainly my weight has remained the same. I suppose the main reason I have not sought help is the shame. Not only from the reaction I would receive from my family and the like, but from the medical professionals who would see me. Currently, I am in my first year of university. Most of my binging is occurring at night, these binges are large and there are many. I’m currently at a complete loss. I have gained approximately xkg in 6 months and have never wanted recovery more in my life. Ever. However, I am reluctant to get help while I am at this weight. I’m stuck in this mindset where I feel I have to look at least slightly sick on the outside, although I am almost positive I suffer from arrhythmia and my teeth and gums are ruined beyond comprehension. I have told 3 people of my eating disorder, all of which were close friends. All of them were present through the different stages of my disorder- beginning with over exercise, then restriction and exercise, then purge anorexia with o. exercise. However, because I did not resemble the waif like skeleton’s which are represented in the media and such, I felt none of them really believed me or took me seriously. I believe this is what caused my bulimia to escalate out of control. I don’t think they believe there is anything wrong with me anymore as I am weight restored and I no longer bring it up with them. It’s been a very tough couple of months, and I’m trying to work toward losing the intense binge-purge cycle as it is becoming more of an issue than I could have even anticipated. The only way I view myself as a deserving candidate for recovery is if I lose weight and become underweight again, which is horrific really. It’s a constant morphing of disorder and behaviour. Bulimia is so misunderstood and as has been said, carries such a stigma with it. Hopefully I will break myself out of this in the next wee while and find the strength I need to in order to seek help. Whether this is losing weight or something else, I don’t know yet, but all I know is I am sick to death of this shit and I would not wish it on my worst enemy if I had one. Bless you all, I found this blog this morning after a binge (usually mine only commence in full force after dinner, off to a good start today), and just reading and researching does seem to help. I think it’s just the knowing that you are sane to an extent and other people are living this hell. Have a good day everyone and sorry if this was triggering to anyone.

      [Edited by Tetyana to remove #'s for potentially triggering content.]

      Posted by Charlotte | May 15, 2013, 7:31 PM
  5. “•Thought often seen as being “manipulative” patients are often just trying to preserve their dignity and concealing their bingeing and purging is a way to accomplish this.”
    Yes. yes YES! This is right on the button for me.
    It’s like there is this constant pressure inside of me to keep the sordid details to myself, so as not to upset or worry anyone. It’s not manipulative, it’s akin to saving loved ones from the full-on hardcore nature of the beast. And re. professionals and disclosure on that level, when you feel so disgusting and abnormal and downright fearful of being judged as such, well, it is damn near impossible to vocalise one’s difficulties.
    Thankyou so much for this article. Brilliant Tetyana. Utterly brilliant.
    Sometimes I wonder if bulimia/binge/purge is a more emotional and psychological disorder and anorexia more a biological/physiological illness. I muse over the possibility that I fell to anorexia because I was genetically predisposed to it and my “way in” was through anxiety depression and consequentually bulimia which caused me to lose weight in order to get to a seriously malnourished state..The complexities baffle me.
    Again, SO many thanks for raising the issue of binge/purge.

    Posted by Rufty Roo | December 27, 2012, 9:12 PM
    • Thank you for your comment Rufty, I appreciate it a lot. I can relate to it and I’m sure many other readers do, too.

      “Sometimes I wonder if bulimia/binge/purge is a more emotional and psychological disorder and anorexia more a biological/physiological illness. I muse over the possibility that I fell to anorexia because I was genetically predisposed to it and my “way in” was through anxiety depression and consequentually bulimia which caused me to lose weight in order to get to a seriously malnourished state..The complexities baffle me.”

      Yup, I know what you mean. I’m not sure. I also don’t know how to best differentiate between biology/physiology and emotions/psychology, as to me, they are all about neurophysiology at the end of the day. I think you mean one might be more genetic and the other more environmental? Definitely, could be. It is very complex, though.

      Thanks again for your nice comment :)

      Posted by Tetyana | December 29, 2012, 3:52 PM
  6. This is an amazing article, especially the recognition of the release and sense of calm after a binge. I’ve often thought it must be the equivalent of someone who cuts. It’s like an uncontrolable storm happens in the brain during a binge, but the utter release and calmness that descends after purging is like hitting a reset button. You feel normal again for a while. You feel clear and at peace. This is the area i’d most like to understand: how to control the ‘storm’ part so as not to have to go through the habitual, out of control motions of the binge/purge cycle. Thanks for a great article.

    Posted by Anonymous | December 30, 2012, 8:38 PM
    • Hi,

      Thank you for your comment! I agree with you 100%! I think the analogy to self-injury is probably spot-on. (I’ve never self-injured, but it does seem like it is probably the same cycle of, as you said, “an uncontrollable storm” and “utter release and calmness” that happens after. I agree with you, though, for me, the only way to prevent bingeing/purging is to prevent or control the storm part from the early point, when I feel it coming. When it is there, or almost there, for me, personally, it is too late to do anything. I find for me it boils down to realizing when I am somewhat anxious for whatever reason. Exercise is one thing that helps me really manage that day-to-day low-level anxiety so it doesn’t grow to be too big. (Of course, that’s not possible if one has a problem with exercise, but, I don’t. I listen to my body, and I don’t push it.)

      Thanks again & Happy New Year!
      Tetyana
      Thanks for the comment!

      Posted by Tetyana | December 31, 2012, 10:14 AM
  7. Thank you for sharing such an insightful and well researched perspective on something that is so deeply personal to me. I am also currently in grad school with an eating disorder. I do okay (not tops, but fine) in grad school, but my eating disorder is pretty out of control and has been for awhile. Sad to say that i’ve learned to live with it like this. I’ve tried to get better and I never do so….? :/

    Posted by Thank you | December 31, 2012, 9:56 AM
    • It is a double-edged sword, I feel: learning to live with it. On the one hand, you are able to be productive and do things that will probably benefit you one you recover (as opposed to being sick and not moving ahead with schooling, for example, for many years) but on the other, learning to live with being sick means, well, you might stay sick.

      Please email me if there’s anything I can do? I’m not (and don’t want to be) a recovery guru or something like that, but maybe there’s a way I can help, even if a little bit?

      Posted by Tetyana | December 31, 2012, 11:05 AM
  8. Let me know if I can help as well- like tetyana I’m in research (i’m a post-doc) and the difficulties that accompany research certainly makes for one hell of a trigger! but humans (i.e., you, I and everyone else) are incredibly strong, you will find.

    Thank you:
    Thank you for sharing such an insightful and well researched perspective on something that is so deeply personal to me. I am also currently in grad school with an eating disorder. I do okay (not tops, but fine) in grad school, but my eating disorder is pretty out of control and has been for awhile. Sad to say that i’ve learned to live with it like this. I’ve tried to get better and I never do so….? :/

    Posted by l | January 10, 2013, 10:12 PM
  9. Hi Tetyana,

    First of all, I’m now obsessed with your site :)

    It’s wonderful, and so important and valuable, that you took this personal approach. That level of intimacy and disclosure is a small antidote to the secrecy and double life that these studies are looking at. Look at the comments you ignited.

    For me, when I first connected with the woman who is now my coach, it was an enormous relief just to have that one non-judgmental person who completely understood and could allow me to release my secrecy for just the 30 minutes a day when I’d email or talk with her. This is because she herself is a recovered bulimia sufferer and also a PhD-holding professor of sociology that has taught and researched at very prominent universities.

    She mentors a few other women with EDs and guess what? All of them have scarily impressive careers, public track records, these glittering ‘perfect’ lives. Just like you did, and just like I did. By day, or in public, I was someone that everyone wanted to be like… that random strangers on the internet actually put on a pedestal and came to for advice on confidence, career, and being a “super successful and super fit” young woman in a man’s world (internet startups). God what an exhausting performance that was!

    When I was in the lowest valleys of my bulimia, I’d assess my motivations for recovery. My most major motivation of recovery was that I was simply tired and sick to death of hiding myself and my reality behind the facade. Only I knew how tragic things really were.

    I had just come out of 5-year relationship (in a very bad way) right near the onset of my bulimia, and it was a life event that precipitated the disorder to lows that I can barely even think about today. But then, I started dating again, I wanted not to be single anymore and move on from the breakup. It took me months and months of enduring horrible, boring dates and limitless loneliness to face just how much my bulimia was blocking me from everything — every single thing — I truly wanted in life.

    In the end, the worst side-effect of bulimia was the isolation.

    I know this may not be the case for everyone — bulimia being such a block — and indeed, there were many times when I was outwardly ‘functional’ with it (though I’d probably have been more functional without it). I don’t hate the bulimia — it made me a much more self-aware person, and, perversely, a better person to be around. But it’s really been the recovery process that has been my teacher, rather than the ED itself, so that’s been an important realization too.

    Also, on your psychiatrist’s idea for the eating program… I actually dabbled with a few things like that, and yes I think it helps a lot. A couple things that ultimately helped me immensely in recovery were:

    (1) I did a vipassana meditation course (the free 10-day silent meditation course where you go to a center and all your meals are highly structured and simple — bp would have been possible but the environment is very NON-triggering).

    (2) meeting my current boyfriend, whom I live with, who does an athletic job and thus eats literally the same exact meals every single day of his life (and our life now), thus removing most of the chaos that was so triggering for me in the past.

    Anyway, something like that would be a fantastic program…

    Finally, thank you again for this awesome site! It’s a nice healthy focus for me during the various moments of recovery — the proactive, intellectual approach is very motivating!

    Posted by Susan | July 11, 2013, 5:11 PM
    • Thank you SO much for your comment Susan!

      There’s so much I agree with, I don’t even know where to start.

      Bulimia is very isolating and it is a double-edged sword. It makes me feel like I’m protected. In a glass shell of sorts. I think this was particularly prominent when I lurked/participated in communities that were mostly for bulimia nervosa sufferers. It feels like nothing can harm me because I have b/p-ing to fall back on. A nonsensical and illogical thought to anyone who has not experienced bulimia or treated it for many years, I bet.

      Structuring my eating was very important. At first, I ate at more-or-less the exact same time and integrated hot foods (which was always a problem for me) back into my diet. That said, I would not have been able to do that if I didn’t go on SSRIs to help me decrease my anxiety levels (grad school can make the least anxious person a mess, so it definitely made me anxious as hell). That was crucial for enabling me to even get to a point where I was calm enough to follow a plan.

      I think at some point, I certainly would’ve been more functional and successful if not for the eating disorder, but in many ways, the eating disorder helped me. The isolation and the focus on succeed in undergrad, well, my eating disorder helped. I know that once I’m happier, I’m less motivated by marks, less motivated by external validation (marks, haha), and so on. Less single-minded, in a way. That focus and drive fueled my eating disorder and my academic career, I feel. Now that I’m a million (pretty much) times happier, I’m, honestly, less driven. I can’t imagine spending 16hrs in a library for days on end because I wanted a high 90 in a third-year neuroanatomy course or a fourth-year course on ion channels.

      I’m really glad you are finding the blog useful! Please always feel free to let me know what you are interested in reading about (topics or even specific papers). Just leave a comment in the “Topic Suggestions” page or use the contact form to get in touch. I love getting feedback from readers :-)

      Cheers,
      Tetyana

      Posted by Tetyana | July 13, 2013, 12:56 AM
  10. Hi Tetyana,

    What a tough and on-point observation — I also got a ton more “done” when I was actively b/p, living for external praise and reward and vastly less happy and content than I am now. When my inner world is stable and peaceful, I feel less driven to strive in the “ladder-shaped” world of my industry, social group, etc.

    I think it’s related to another topic you’ve written about — the seratonin boost that bingeing, and even purging, can induce, and the feeling of almost-mania that it can bring on. I used to worry I’d never be able to “think straight” or solve tough intellectual problems without b/p.

    I used to literally *solve* these problems while I was in the midst of bingeing, standing alone in my kitchen eating nonstop (well, stopping to occasionally purge) while I worked on my web startup’s business problems at my laptop. In fact, I experienced some of my biggest ‘wins’ career-wise during this time.

    But obviously, the cost was enormous. The mania would always be followed by the lowest emptiness, and between demanding work hours, a very public “woman in charge who’s nonetheless feminine and unthreatening” role to play, and the isolation of bulimia, I felt like I had absolutely nothing, despite being this outward success.

    I’m not bitter or regretful of that time, but I’m very glad I’m done living that kind of life! And I’m sure you’re glad to be done with graduate school as well.

    It’s a version of that now-common story of people who are on all kinds of drugs, not to mention everyday stimulants, to get through college, grad school, demanding jobs…

    Without the bulimia (and I’ve taken a sabbatical from work as well), it’s not that I am lethargic or unmotivated, it’s more that I’m far less motivated by the same ‘carrots’ as before. Like many perfectionists, bulimia sufferers, and people who dislike themselves, I’m learning to be motivated from the inside… and this is hard. I think this requires a life adjustment period, all recovery changes aside.

    Anyway, thanks again… on to my next ScienceofEDs article (waiting for me in the next tab over ;)

    Posted by Susan | July 13, 2013, 7:30 PM
  11. you said, imagine 9 years of secrecy.

    I’ve been hospitalized twice for anorexia with a binge/purge subtype. Now I’m going on 11 years of an everyday, fuck every moment and sometimes in my dreams, active eating disorder. I’m pretty much bulimic now, and I honestly don’t know how to eat normally, or know how to deal with the feeling of fullness. I don’t easily digest food. I’m scared…very scared. I’ve made more then a few attempts to try healthy living…this time I think I stubborn enough to end my life with an eating disorder. tomorrow is my day one start-date. Thanks for sharing your story, it gives everyone hope that they too can be a better version of themselves, and be whole again–not split into two.

    Posted by Anonymous | August 23, 2013, 12:11 PM
  12. I’m fat and this week, out of nowhere, I began purging. Every day. I’m in my 30s and never had bulimia or anorexia. Every time I eat junk food, like ice cream, I purge. Afterwards, I feel so calm and fresh, innocent and renewed. I never expected these feelings or that I would start doing this every day. I never thought I would become bulimic. I know it’s bad for me but it’s like, every time I eat something that’s unhealthy, the temptation is so strong to just get rid of it, so I won’t have to absorb it into my body. It sounds weird but I feel like I’m sparing my body. I’ve done a lot of damage to it by the things I’ve eaten in the past and I want to stop. But those cravings just get the better of me, especially as I live a very stressful life in an abusive home situation that I am at present quite powerless to change. I feel I have no help from ANYWHERE, not even God. I feel like God has abandoned me to fight my battles on my own. Every day, there’s different demons to fight, and I have no help from anyone, only judgement and abuse. Food is my only friend. Without being able to eat my chocolate when I want, I feel like there’s no point to life; everything just goes grey and lifeless and depressing. Even though my brain KNOWS that’s not true, my heart just can’t seem to get it and be happy. But now, be honest with me please, if you bring up food and it doesn’t taste sour, if it still tastes the way it did going in, does that mean you still ruin your teeth? I hope I’m not being gross, but I really need to know. I’ve vomited before when ill and it burned badly. But purging straight after eating has not burned at all; in fact, the food tastes sweet. I don’t eat meat, only sugary things, does this make a difference? All I want is to kick-start my weight loss and maybe get over my obsession with junk food. I’m already starting to be seriously over it through this purging. I can’t enjoy it like I used to, especially after a purge. Anyway, thanks for telling the truth about bulimia. It’s not what people think it is. Famous people like Princess Diana have had it; it’s nothing to be ashamed of. If anyone should be ashamed, it’s the big businesses that try to get people hooked on the wrong foods, all to make a profit. We little people are only trying our best to get by in life, a life that’s increasingly harder every year.

    Posted by NeverThoughtItWouldBeMe | November 7, 2013, 2:36 AM
    • I’m so sorry that you are in such an awful situation. I relate. It does feel that way at the beginning for many. It feels good, like the solution to all your problems. Unfortunately later when you are far beyond the point of return and desperate to get out, that’s when you fully realise just how trapped you are. I hear you saying you just want to kick start your weight loss as if you believe you will stop then. Join the club, I’ll go out on a limb and bet there has never been a single person who didn’t think they too could stop when they had enough. I repeat – it is a trap. What you are doing feels good now but only will make everything a million times worse and could even kill you. 
      Re your teeth, my own vomit rarely ever was acidic either, I used to think that I wasn’t piling stomach acid and would avoid teeth problems. I’m now wearing dentures after a long run of incredibly painful and embarrassingly ugly tooth problems. Yes you are doing damage. To your esophagus and stomach too. And you will probably get chipmunk cheeks at some stage. 
      It doesn’t help the majority lose weight and many still gain – your body still holds on to quite a lot of what you have eaten. 
      I’m really sad you are going through what you are and I urge you to seek help. You shouldn’t be powerless to get out of your abusive situation. You need to tell people what is going on and ask for the help to leave. There are organizations and shelters and refuges out there to help you. Please reach out to someone. It takes a lot of courage but I hear it in your comment- courage in spades. You don’t deserve to live a nightmare of abuse you just don’t. It IS POSSIBLE to get free. I promise. Hang in there. Bulimia is NOT the answer.

      Posted by Fiona | November 10, 2013, 1:08 AM
  13. Hey allegedly smart girl, it’s “binging” without an “e.”

    Posted by Alex | May 8, 2014, 4:11 PM
  14. Wow, thank you for this post. So much of it rings true. The constant planning as to how to avoid being “caught.” In college, for the first few years, I didn’t really give a damn if anyone found out about my bulimia because I was way too depressed to spend all the energy it takes to cover it up. What I found is that that is the quickest way to get everyone to avoid you like the plague. No one in my building would even make eye contact with me in the hallway. I eventually was forced to leave the school and go to treatment, and when I came back, though I was still just as sick, I was a lot more secretive, which allowed me to be more “functional.” The whole time, I was maintaining a true double life, with perfect grades and internships and the whole nine yards while I was a horrific mess, and every once in a while I would fall apart and land in the psych hospital.

    Now I’m not as “sick” and depression-wise, I’m much better. I’ve moved back to my hometown, and I’m a nurse in a hospital and I still binge and purge at night and come to work in the morning ready to take care of people as if I had my life together. No one at work knows anything about it, and it makes me feel terribly isolated and sometimes like I’m only half there that there’s this whole chunk of my life I don’t talk about. However, after my experience in college with being a social outcast and being forced into treatment, I’m militant about keeping my bulimia secret. We sometimes get patients with all manner of psychiatric illness, and other nurses say things and I just stand there as if they were truly talking about “them” and not me and I hate myself for it.

    I feel that as a health professional, I ought to know better than to be bulimic, but knowing and doing are two totally different things, I find it really offensive when professionals say “you’re too smart for this” as if I were deciding to be bulimic the way I decided where to buy a car.

    But as far as purging, I sometimes don’t feel like it and will dread having to do it, but usually, I actually find it relaxing. Like taking the top off a soda can, and you get that pop of released pressure and you can just feel the tension melting out. I, too, often find that it’s the only way I can sleep. Additionally, I find that spending time “sitting with myself” is damn near impossible. I can’t read, I can’t watch TV, and I can’t sit around relaxing, so I binge and purge simply to pass time that I otherwise would just spend getting more and more anxious.

    Posted by Katie | June 16, 2014, 9:13 PM

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