You're Not Gross If You Have Bulimia
By: Lindsay Hodgson, MSN
When you’re struggling with the eating disorder bulimia nervosa, it can feel really unsettling. You may feel “gross,” “disgusting,” and ashamed that your disordered eating behaviors are showing up in your life. Or you may feel all of those feelings, but not know if you have bulimia, making you confused and uncertain if you are “sick enough” to get eating disorder therapy.
No matter where you are in this moment, your struggle with your relationship with food and your body is valid. Something that isn’t often addressed with bulimia is the shame that people feel in their disordered eating. Well, that needs to change! Here we dive into what bulimia is and isn’t, why shame and stigma are involved, and what you can do to reduce shame as you pursue therapy for bulimia.
What is Bulimia Nervosa?
Bulimia (also known as bulimia nervosa) is an eating disorder known for a combination of bingeing and purging behaviors. All eating disorders diagnoses are based on certain criteria per the Diagnostic Statistical Manual (DSM) which is a fancy name for a book that outlines different diagnoses in the mental health field. An official bulimia diagnosis is made with the following DSM criteria:
Ongoing binge eating episodes, where the binge means
Eating within a particular time window “an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances”
The person feels a lack of control or feels they cannot stop eating during that time
Ongoing inappropriate compensatory behaviors (also known as purging) in an attempt to prevent weight gain. Often people associate bulimia with self-induced vomiting as the form of purging. While this is a common presentation, purging can show up in several ways:
Excessive amounts of exercise
Fasting
Diuretics
Laxatives
Supplements
Bingeing and purging both occur approximately once a week for three months
The behaviors are driven by body size and weight concerns
The DSM’s criteria for bulimia are helpful to form a diagnosis, and therefore they can be a good thing for insurance and other logistics purposes when someone seeks care. It also can be incredibly validating to receive a diagnosis after years of suffering or thinking that things “weren’t that bad.” So while it’s important to have an agreed upon standard for a bulimia diagnosis and can be so helpful for many, the criteria can also be problematic. This is because it can exclude people who exhibit some but not all of the signs of bulimia. In reality, there are many people who fall in this camp where they purge but do so less frequently or it has been occurring for a shorter duration than what would count as a formal diagnosis.
Let’s be clear. Any purging is disordered. Bulimia symptoms are just as valid as a bulimia diagnosis! You don't need a diagnosis to qualify for support. Further, nutrition therapy for bulimia looks essentially the same regardless of whether it’s the diagnosed eating disorder or symptoms that closely resemble a formal diagnosis.
Why Is There So Much Stigma and Shame With Bulimia Nervosa?
The experience of having bulimia, whether you have a diagnosis or not, is often distressing and filled with shame. If you are feeling this way, know that you are not to blame. Unfortunately, there are likely valid reasons you are feeling shame that are rooted in societal stigma, so let’s talk about why you might be feeling this way:
Eating disorders in general are still highly stigmatized in our culture because of stigma associated with mental illness and mental health. Stigma about eating disorders in general often prevent people from seeking treatment, or contribute to starting treatment later than they should based on their suffering.
Bulimia often doesn’t match stereotypes of what an eating disorder “looks like.”
One of the most common eating disorder myths is that a person struggling with an eating disorder or disordered eating has a small body size, and perhaps has lost a significant amount of weight. This myth doesn’t even hold true in all eating disorders, even in the case of restrictive eating disorders like anorexia. Eating disorders exist in all sizes of bodies, and sometimes people who deeply struggle in their relationship to food experience no weight changes. And, this can be especially true with bulimia.
Bulimia may be seen as less “glamorous.”
It may involve bodily fluids related to digestion, which you or others may consider “icky.” Similarly, you may find yourself relying on consistent access to a bathroom if you have the urge to purge or have a bowel movement after a meal. It can feel embarrassing to struggle with the aftermath of digestion regardless of how the bulimia behaviors are showing up. This is partly why those with bulimia go to great measures to hide purging behaviors.
Despite the critical voice in your head, you are not gross for struggling with bulimia. At the same time, you deserve better. You deserve to pursue nutrition therapy for bulimia to create a healthier relationship with food and begin to stop disordered behaviors that are consuming your precious time and energy.
How To Stop The Shame With Bulimia
Shame makes things worse. It makes you feel alone and uncertain if you are worthy of support. Shame and self-criticism are often intertwined, and can fuel the disordered voice and behaviors. On the flip side, self-compassion can be a very powerful tool through bulimia treatment, as well as healing your relationship with food in general. Self-compassion helps create a kinder inner voice to speak to your shame. Here are a few things to consider as you begin re-framing your thoughts and attitudes about the eating disorder bulimia:
Eating disorder behaviors have a function. You may be thinking, “how could that be possible? It’s a disordered behavior.” While you may be engaging in behaviors that are dysfunctional to your well-being, oftentimes there is a very valid underlying reason behind the behavior. Your purging may be a way of expressing emotions, surviving, or an attempt to get your needs met. It may be a way that you exert control, rebellion, punishment, numbing, experience a release and more. It may have also been a way before or now that feels like you can control your body shape and size.
When you start the path to recover from bulimia, the question of, “what are your disordered behaviors trying to communicate?” is an important one. With a registered dietitian nutritionist or licensed mental health counselor and throughout nutrition therapy for bulimia you will explore this question and peel back the layers of the disordered behaviors.
This takes a tremendous amount of bravery, but doing so is important in re-framing your shame. When you start healing work and begin to understand the function of your eating disorder, you can begin to understand that you haven’t been purging for no reason. You have been doing the best you can with the tools you have.
There is no eating disorder hierarchy. The idea that one eating disorder is “worse” than another also perpetuates shame. In receiving online nutrition therapy for bulimia, it is important to remember that your struggle is just as valid as someone else’s in eating disorder recovery even if it looks different. Anorexia is not the superior eating disorder. All eating disorders are destructive in their own ways, and all of those who find themselves in a disordered relationship with food deserve support for recovery.
The amount or frequency you’re purging doesn’t make you more or less worthy of support. You don’t need to meet the criteria for bulimia to earn the right to get support from nutrition and mental health professionals. As previously discussed, diagnoses leave people behind who would deeply benefit from eating disorder therapy. Human beings don’t fit nicely into categories, especially when you consider individual behaviors. While the frequency and severity of disordered behaviors should be taken seriously, your overall experience and how you feel is what matters most.
Secrecy perpetuates shame. The longer you keep the eating disorder to yourself and don’t get support, the worse things will get over time. Oftentimes we feel the most shame when we are alone with our thoughts, and there is nothing to counteract the critical voice inside your head. If you haven’t yet sought support, speaking to a trusted friend or family member may be a significant step in addressing some of the shame you feel. Further, as you are willing to be open about your challenges and pursue online nutrition therapy for bulimia, your conversations with your providers will help to reinforce a more compassionate mindset.
There is nothing wrong with you. Eating disorder stereotypes and misconceptions unfortunately fuel the shame people experience when it comes to their struggle with bulimia nervosa. We want that to change this because shame can deter people from healing from bulimia.
Everyone is worthy of support, no matter body size, diagnosis, and more. At Bravespace Nutrition, we believe that a desire to heal your relationship with food demonstrates profound strength. We recognize that each client’s struggle is unique, and yet we believe that full recovery from bulimia is possible. If you find yourself stuck and ready to get professional help, online nutrition therapy for bulimia may be an essential next step for you!
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Eating disorders have so much stigma around them, espeically bulimia nervosa. You may have been waiting to get help and support because you don’t think your ready, are sick enough and/or feel ashamed. If so, you’re not alone and we know this struggle very well at Bravespace Nutrition in Seattle WA. Our clinicians work virtually helping people who are struggling with food and body image. Learn more about Bravespace Nutrition, our philosophy, and the services we offer.