Bulimia (boo-LEE-me-uh) nervosa, commonly called bulimia, is a serious eating disorder that is characterized by two things – a) binge eating and, b) purging out what you have eaten. Remember, Princess Diana and her battle with this disease? It’s documented in the Netflix series ‘The Crown’. But, despite the awareness about this disease in the western countries, it continues to not be taken seriously in India. More often than not, people suffering are either ignored or else the condition is misdiagnosed as something else.
How do I know this?
I know this because my Bulimia was misdiagnosed for the longest time.
Bulimia is a condition that mostly plagues people who suffer from low self worth. But, what leads to this sense of low self worth? In order for a person to develop bulimia there have to be some mitigating factors, no? I learned the hard way what those factors could be. Believe it or not but in my case the bulimia was brought on by post partum depression. In a span of two years I delivered both my daughters. The elders in the family told me – ‘In a way it’s good. You can raise them together and they will grow up faster and in each others’ company. That way you do not have to take too long a sabbatical from work’. I agreed with them. Little did I know the price that I would pay for my decision to have back-to-back deliveries.
Although, I was happy to be a mother, I did not realize the amount of pressure it put on me to raise two toddlers with little support. I developed post partum depression after my second delivery. For the first few months I did not understand what was wrong with me. I had never been depressed in my life before that. I have always been a person with a jolly outlook to life. And, I had thoroughly enjoyed my first pregnancy and had loved every moment of being a first time mother. What was wrong this time? Why did I feel like I was not cut out for this job? Why did I feel so bogged down all the time? I felt as if no one understood me.
As more time elapsed, apart from depression I started to experience bouts of irritability. I would break down into tears for no apparent reason at all. I felt overwhelmed and there were days when it took a mammoth effort to stir out of bed. I knew that I needed help. The person that I had turned into was someone that I did not recognize in the mirror. I had dark circles under my eyes and most days my face would puff up due to lack of sleep. The weight that I had gained during the second pregnancy was taking longer to shed than the first time around and that led me to hate my body. I constantly found fault with it not realizing that all my issues stemmed from my post partum depression. It was during this period of time when I suffered from low self esteem that I developed bulimia. Feeling bad about my body made me develop anxiety and I started throwing up my food because I believed that eating would lead to more weight gain.
Initially, I did not understand the reasons behind my behavioural change. I am a consummate foodie. I love sampling new cuisine just as much as I love cooking and baking, In fact, the kitchen is my happy place. So, when I kept throwing up my food, I knew that I needed help. But, when I sought help, I was diagnosed with a host of other things brought on by the pressures of motherhood – depression, irritable bowel syndrome, hyper-acidity and even indigestion at times. Not a single doctor tried to understand the cause and believe me I saw a host of specialists. The result was that all through the turbulent period of close to three years when I suffered, my body received a battering that was only symptomatically treated. The root cause for the battering was not diagnosed and thus went untreated. Within a year of developing bulimia it became a routine for me to stick a finger down my throat and vomit up my food after a good meal. The guilt of having consumed calories or of having enjoyed a good meal would niggle at me till I would feel the food rise up in my throat. That would prod me to purge what I had eaten. It was a vicious circle of eating and vomiting out what I had eaten. And, it led to a host of other problems like a weak digestive tract and the erosion of the enamel in my teeth due to the constant vomiting.
During my deliveries I may have bled from my uterus but now I was bleeding from my soul. Who could I turn to? Who would understand?
After the first year, my bulimia got so bad that I started hiding the bouts of throwing up from my family. Just as junkies hide the consumption of drugs, I felt addicted to vomiting and hid my visits to the washroom. My family did not understand the change in my behaviour. They scolded me at times and tried to reason with me at others. They offered me the line of symptomatic treatment that the doctors had suggested. I consumed gallons of antacids but they did little to alleviate my condition. How could they when the cause was bulimia and not acidity.
Why is it that I did what I did?
People who are bulimic secretly binge eat calorie rich food. They are emotional eaters. I was one too. However, overeating lead me to further feel miserable about my body and weight and that in turn led me to induce vomit to purge out what I had consumed so that I did not gain weight.
What can people with bulimia expect?
If you have bulimia, you’re probably preoccupied with your weight and body shape or are suffering from some form of low self worth. You possibly judge yourself severely and harshly for your self-perceived flaws (and believe me that when it comes to this condition, your mid is your worst enemy). Because it’s related to self-image, bulimia can be hard to diagnose and overcome. But effective treatment can help you feel better about yourself. It can help you raise your self-worth, adopt a healthier eating pattern and reverse serious complications. I know this for a fact because I recovered. It took me three years but gradually with the help of family members and also with the understanding that I was not alone in this; I took back the control on my life. And, I have not relapsed in the past decade and a half. And believe me when I say that this recovery is crucial to both mental and physical well-being.
Let’s understand what bulimia does to your body?
Bulimia is a serious condition. It can permanently damage your stomach and intestines, causing other problems like constipation, dehydration, mineral imbalance in the body, diarrhoea, and irritable bowel syndrome. It can erode the enamel of your teeth and can lead to a host of hormonal imbalances. In severe cases it can also lead to reproductive issues, including irregular periods, missed periods, and fertility problems.
Face swelling is one of the common effects of having bulimia and it’s the one thing that sufferers find most distressing. The swelling further makes people feel that they are fat or have gained weight and that in turn leads them to abuse their body by ridding it of the food that they may have consumed.
How can you know if you are bulimic?
The severity of the bulimia is determined by the number of times that you vomit. If you are bulimic, you probably do or feel one or more of the following:
- You suffer from a sense of low self worth wherein you are not comfortable about the external/physical appearance of your body. You are too judgmental about your looks. You either avoid looking at yourself in full-length mirrors or else spend too long looking at yourself and consequently feeling miserable.
- You live in fear of gaining weight. This may lead you to secretly binge eat and consequently induce vomiting.
- You feel helpless or feel a lack of self control during binge eating episodes. You feel the need to fill the emotional void inside of you with food. But, after these bouts of binge eating you feel miserable and then try to compensate the calorie intake by inducing vomiting so that you do not gain weight.
- You try to shed weight by excessive exercising, fasting, abusing laxatives, and misusing diuretics or by inducing vomiting.
- You may be hiding your episodes of vomiting from the family.
- You may have puffiness on your face or a swelling in the feet, hands or face.
If you are experiencing any or all of the above symptoms (they could be brought on by depression – PPD or otherwise, an over critical attitude of family members/friends, anxiety or sorrow, etc) then seek help immediately. The first step is to speak to your general physician who in turn will refer you to a mental health specialist.
Now, I know that seeking help for mental health related issues is quite the taboo subject in India. But, hey, it’s your body, your health and your life on the line here. Are you really going to let society or people dictate what you should or should not do? Trust me when I say (and, I speak from firsthand experience) that the earlier you seek help the better. The sooner this menace is nipped in the bud, the greater is your chance for a full recovery.
How can you help a loved one with Bulimia?
If you think a loved one is exhibiting symptoms of bulimia, the first thing to do is to reach out to them with empathy and sensitivity. Bulimia sufferers often tend to put up an emotional wall around them. So, it’s important to understand what their mental state is and then approach them with love and compassion. Talk to them. Have an honest conversation with them about what they are feeling. They may not open up in the first conversation but keep at it. Engage with the person on multiple occasions till you break through their defenses. Have an open discussion about your concerns. Bring up the topic of professional care. Now, you can’t force someone to seek professional care, but you can certainly offer encouragement and support and also tell them that it’s okay to seek such help. It’s normal to feel what they are feeling. Another thing that you can do is to seek the advice of a medical professional on behalf of the bulimic. Reach out to the doctor and understand what the sufferer is going through and what would be the best manner to approach them and help them. Then, make an appointment for the patient and offer to go along (if they prefer it). The important thing to remember is to give this time and not be pushy.
Apart from this there is one more vital support function that you can do to make a sufferer feel better and slowly regain confidence in them – Don’t castigate a bulimic for what they are feeling. Never, ever be judgmental. Instead, try to work on ways to make them feel good about their body. Compliment them. Encourage them to eat balanced servings of food. Encourage them to eat small meals throughout the day.
Most people with bulimia are usually normal weight or slightly overweight and it may not be apparent to you that something is wrong. However there are certain red flags that you can look out for.
- Does the person have a history of depression or anxiety related issues?
- Does the person constantly worry or complain about being fat? Is their weight constantly fluctuating?
- Does the person have a distorted, excessively negative body image?
- Does the person’s appetite yo-yo between eating large amounts and then literally starving themselves or fasting/dieting excessively?
- Does the person avoid eating in public?
- Does the person make a bee line for the bathroom after eating?
- Is the person exercising excessively, perhaps several times a day?
- Is the person complaining of tooth sensitivity?
- Does the person have any swelling on their face, hands or feet?
Now, I know that the above is not an exhaustive list of things that can help you to flag a bulimic but, it is a list of some of the more common things that you can look out for. And, if you do flag someone as being bulimic, the important thing to do is to not keep quiet about it. Do something about the person’s condition to help them because they may neither understand their condition nor may know how to help themselves.
Bulimia is a curable condition. I know this because mine was cured. It took time. It took a lot of support from my immediate family. But, once I understood what was happening to me and why it was happening to me, for the sake of my children and my family; I decided to take back control of my life and my feelings. Gradually, bit by bit, one day at a time, I conditioned my mind to accept food as a means of sustenance and not as an emotional crutch. I shifted my dietary habits from calorie rich food to foods that were richer in fibre, vitamins and essential nutrients. I included a lot of liquids in my diet – buttermilk, juices, shakes, water, etc – to compensate for the loss of hydration due to vomiting. But, more importantly than all of this, I diverted my mind. I sought refuge in things that made me happy. I took a sabbatical from work to let my mind heal along with my body and used the time to pursue interests that I had previously had no time for. I reconnected with people. Slowly, I learned to accept that the downgraded image of my body that I felt was a result of my mental insecurities and anxiety. That negative image existed in my mind. Once I learned to accept my body and learned to love who I was; my issues melted away. I became more confident and with time the physical discomforts that bulimia brought on, faded away.
Today, I am still slightly overweight but, I love and accept who I am. I no longer feel any negative emotions when I think of my body. I have embraced the truth that – I am who I am. For me, that is enough.
Glossary and links
PPD & bulimia – https://pubmed.ncbi.nlm.nih.gov/16498586/
Image – Google free stock images