First published in The Telegraph, 2nd September 2013
A few days ago it was widely reported that new research on a simulated “out of body experience” could be useful in the treatment of anorexia
, because sufferers so often experience a disconnection between what they see and the actual shape of their bodies. My first thought was that it all sounded a bit science fiction, but I soon started to wonder why the article only mentioned anorexia, when bulimia sufferers are similarly beset with frightening body dysmorphia (an anxiety disorder which causes people to spend a lot of time worrying about their physical appearance). To me, this seems illustrative of a wider problem of silence and ignorance when it comes to the discussion of bulimia.
It is extremely difficult to find reliable figures on the number of people who have an eating disorder in this country, simply because data is collected only at the most serious end of the spectrum, when patients are so unwell that they require a hospital bed. Millions more cases go undiagnosed and there is no information regarding those who are currently waiting for treatment.
However, the charity B-eat suggests that 1.6 million people in the UK currently suffer from an eating disorder, and that 40 per cent of these are bulimic. This makes bulimia four times as common as anorexia and the remaining percentage includes those with EDNOS (Eating Disorder Not Otherwise Specified) which covers patients who exhibit mixed symptoms of anorexia and bulimia. Why then, are we not talking more about bulimia?
The first reason is that we like to have tangible, physical evidence of an illness before we take it seriously, which is why unhelpful attitudes still exist around mental health issues including depression. Anorexia manifests itself in evident weight-loss while bulimia sufferers can often be at a normal weight. The idea that if you’re not unhealthily thin, you can’t possibly have an eating disorder is hopelessly outdated but still widespread.
Kate, a 22 year-old make-up artist, describes her bulimia as something that the people around her found it “easy to close the door on and pretend wasn’t happening” because the physical symptoms were not always immediate. However, the damage that bulimia does is very real and side effects include anaemia, swollen cheeks, depression, dizziness, fatigue, dry skin, abrasions on knuckles, tearing of the oesophagus, blood in vomit, ulcers, low blood pressure, irregular heartbeat and electrolyte imbalance.
There is a greater stigma undeservedly attached to bulimia due to its characterisation by a cycle of bingeing and purging. Purging does not only refer to vomiting to compensate for a binge but includes the abuse of laxatives, compulsive exercising and fasting. I spent seven years struggling with an eating disorder and was diagnosed with EDNOS (Eating Disorder Not Otherwise Specified) because while at low weight that was part of the ‘anorexic range’, I would make myself sick after eating.
The anorexic part of my illness was treated by some friends as praiseworthy and I was repeatedly given positive reinforcement in the form of comments like “oh wow you’re so skinny” and “you’re so lucky, you can wear anything you want”. However, when the impulse to eat (and then binge) became too strong and bulimic behaviours began to surface, the negative and unkind responses were overwhelming. What I was doing was ‘disgusting’ and ‘wasteful’ and ‘selfish’. The iron-willed control and denial of anorexia was fine, but bulimia was seen as dirty and shameful, to be hidden at all costs.There is an obvious discrepancy between the number of people needing treatment and the services available, and appointments with specialist clinics can regularly take more than six months to materialize. GPs often do not have the specialist knowledge required to be helpful to those with eating disorders and during my undergraduate year at university I was told by a GP that all I really needed to do was “eat more baked potatoes”.
Kate is similarly candid and disappointed about her experience of healthcare professionals not taking the illness seriously. She says: “I was diagnosed with bi polar, when really if they had taken the time to discuss the bulimia with me they would have found that it was the cause, not a symptom of my mental health issues.”
The sense of shame felt by bulimics often prevents them from seeking treatment and this is completely unacceptable. Eating disorders have the highest mortality rate of any mental illness and misconceptions, social stigma and genuine lack of coordination on the part of health services must be recognised and challenged. When it comes to bulimia, we need to start talking because it is through honest discussion that social understanding and more meaningful support from family and friends is generated.