When you hear the word bulimia, you probably have a picture in your head. And that picture can make it harder to recognize what's actually happening.
We tend to have this very specific idea of what bulimia looks like, who has it, what purging means, and how serious someone has to be before their struggle "counts." Which is a problem, because a lot of people with bulimia don't look anything like the picture we've been given.
In this episode, I'm getting into the parts of bulimia that are easier to miss. The purging behaviors that don't involve vomiting. The restriction that often gets overlooked. The shame that keeps people from telling the truth about what's happening. The dissociation that can happen during a binge. And the very real medical risks that can exist even when someone looks completely fine on the outside.
Quotes
"At a certain point it doesn't really matter what the name of the diagnosis is. If somebody is suffering from an eating disorder, whether it's called bulimia or other specified or whatever else they might be called still an eating disorder and still just serious enough to require treatment."
"We as a treatment team community need to know when to ask more questions, when to be soft, when to push a little harder, and when to make space to be able to talk about shame."
"Purging doesn't only mean self-induced vomiting."
"The body can be carrying real acute risk while looking completely fine on the outside. It's not that it doesn't exist; it's just that it's sort of invisible to the naked eye."
"There's this other less-paid-attention part of the issue, which is the restriction because the restriction is actually something that they like, so that's not really a problem."
"One of the biggest pieces of bulimia is shame, and when we feel ashamed, we're not talking about it. So if there is any environment ever that can be created for this person to be able to identify feelings of shame and talk a little bit more explicitly with detail and honesty about what they're struggling with, that in and of itself is the treatment."
"You don't have to check boxes in order to have suffering count as real."
Frequently Asked Questions
1. Can you have bulimia if you are not underweight?
Yes. People with bulimia can be in average-weight or higher-weight bodies. Body size alone cannot determine whether someone has bulimia.
2. What counts as purging in bulimia?
Purging can include self-induced vomiting, laxative misuse, diuretics, enemas, fasting, and compulsive or excessive exercise used to compensate for eating.
3. Can excessive exercise be a form of purging?
Yes. Exercise can function as a compensatory behavior when someone is using it to compensate for eating, such as feeling that they need to exercise because they ate a particular food or amount.
4. Is bulimia dangerous even if someone looks healthy?
Yes. Bulimia can involve serious medical complications, including electrolyte imbalances and heart complications. Someone can look physically fine while still experiencing significant medical risk.
5. Why do people with bulimia hide their symptoms?
Shame can make it extremely difficult to talk honestly about bingeing, purging, and other eating disorder behaviors. Some people may also minimize their symptoms because they don't believe their experience is serious enough to "count."
6. What is the relationship between restriction and bulimia?
Restriction can be an important part of the binge-purge cycle. Someone may have significant food rules, limit their intake, cut out foods or food groups, or simply not eat enough, which can contribute to bingeing and subsequent purging.
7. Can you have an eating disorder without meeting the criteria for bulimia?
Yes. The episode emphasizes that someone can have significant eating disorder behaviors and suffering without meeting every criterion for a specific diagnosis. The exact diagnosis does not determine whether someone's suffering is legitimate or whether they deserve treatment.
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