Living with a person who’s never happy with anything you do – that’s how people with the eating disorder have described the demands of the bulimia nervosa “voice” in their head.
Ellen Jennings, communications officer with support charity Bodywhys, says it is an apt description.
“Those with bulimia speak of this separate voice in their mind,” she says, “not a hallucination, but rather an internal critic that is very harsh and unkind. Part of recovery is moving towards the more rational side of the person’s mind and trying to quieten that eating disorder voice.”
As well as the person recognising the eating disorder as a separate voice, it can also be helpful to families of the affected person to speak to the eating disorder rather than to the person themselves when trying to help the person recover.
“They could say things like, ‘I can see that the eating disorder voice is really loud in your mind right now’, and direct their frustration towards the eating disorder rather than to the person themselves. This creates a distance between the person and the eating disorder voice that is taking a hold of their thinking and behaviours.”
There are no figures for how many people in Ireland suffer from bulimia nervosa. That’s because of the stigma around it. About 21% of calls to Bodywhys come from those with the illness. ?Anorexia accounts for 71% of the calls with binge eating-related calls (overeating but no purging) now standing at 14%.
“Breaking down stigma around eating disorders is important,” Ellen says. “Men, in particular, are slow to come forward because, historically, eating disorders are seen as a female illness and we know that’s not the case. In the past the ratio was one man to 10 women but now one in four men has an eating disorder.”
Who is at risk?
But what makes people prone to developing bulimia nervosa?
“There is no one cause,” Ellen says, “but the risk factors for it come from both internal factors and the world around us. It’s like a knot of different factors come together to create the environment that can support the eating disorder.”
Internal factors
External factors:
Secrecy because of stigma
Episodes of binge eating involve over eating, eating rapidly even when not physically hungry, and eating until the person feels uncomfortably full.
“A sense of shame and disgust can come along with that,” she says, “and the person with bulimia will then use compensatory behaviour like vomiting or over-exercising or a combination of these in order to prevent any change in weight. As with all eating disorders, there is a focus on body image … Families or friends may not notice if a person has bulimia because the bingeing and purging happens in secret.”
Social media impact
Social media has a part to play in the increase in eating disorders like bulimia, she believes.
“Images on social media can affect how a person feels about themselves and they can make comparisons with what they see online even though what they are seeing online may not be realistic.”
On the positive side, in recovery, social media can be a space where someone can find a sense of community and share their recovery journey and find support as well, she adds.
“There are two sides to it but learning to handle social media properly is important. As we navigate that world, we should be aware of how we feel after interacting with certain content and try to follow content that is supportive of recovery.”
Trigger for getting help
Often, the person with bulimia or any other eating disorder may not recognise what’s happening because the eating disorder is “working” for them.
“It’s a coping mechanism where they feel a sense of control or comfort. They don’t feel that it is negatively impacting on them until it reaches a point where it no longer becomes a choice for them. Instead, as the eating disorder takes control of the person, they have to engage in the behaviours that the eating disorder is pushing them to engage in. There is a compulsion about it.”
Early intervention is really important, though, before the disordered thinking and behaviour becomes entrenched.
“That’s because the longer the eating disorder goes on, the more rules and rituals develop around eating and exercise.”
Help available
Bodywhys has an excellent website and a number of support services available for those with eating disorders and their families.
“You don’t need a diagnosis to avail of our services,” Ellen says. “We have our helpline and our email support and we run an online PiLar programme for partners, families and friends about eating disorders and how they affect somebody.”
Communication styles and techniques are taught to encourage conversation in the household.
“Learning about what you’re dealing with and how it can affect a person is important because oftentimes focusing on the behaviours can be counter-productive because really the feelings underneath are what’s impacting the cycle.”
While Bodywhys does not provide counselling for those with eating disorders, they do offer a listening ear and education and signpost the person to getting help.
“The important first step is acknowledging what’s happening. The next step would be a visit to your GP, who can then refer you on to a multidisciplinary team. With an eating disorder it is important that the different elements of it are addressed so the person would see a dietitian, a psychotherapist and the GP would look after the person’s physical health.
“The referral could be to public child or adult mental health services (CAMHS or AMHS) [your GP will contact community mental health services] or to a private hospital, as an outpatient or inpatient, depending on the situation.”
Aspects of recovery
What will a dietician do?
They will look at the way you think around food and help you regulate your eating patterns because when someone is not eating regularly it can leave them more vulnerable to the urge to binge.
Psychotherapy
There are different types of therapy that people can opt for, like CBT and family therapy, but no one size fits all and it might take a couple of tries with different therapists to find the person that you connect with.
How long does recovery take?
This differs from person to person and there is no one definition of recovery, Bodywhys says.
“Our ethos is that people can and do recover from eating disorders and we will often hear that as time goes on that eating disorder voice becomes quieter for the person. It can still be there in the background but the person has developed other ways of coping and doesn’t rely on the eating disorder to feel okay.”
Key message
It’s hard for someone on the outside to understand the eating disorder, but it’s also important to remember that the person with it finds it difficult to understand too.
“It’s not a choice,” Ellen states. “They are not choosing to engage in these behaviours. The eating disorder voice has that compulsion to it.”
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