Things which Clinical articles don’t say about Bulimia.

Things which Clinical articles don’t say about Bulimia.

Girl (10-12) holding head over toilet, side view

I’ve come to understand that Bulimia isn’t precisely what one may read or hear about through the media or generally on the internet, in documentaries and the like. What is said in these sources is not untrue, but there’s a lot more to bulimia than the central themes which they paint for one to know about. The central themes we’re informed of through these sources are body image and food irregularities; we’re given to understand that Bulimia is very much about the subject’s images of physical appearance, specifically that they feel that they are too fat or that they feel that they are ugly. I have come to understand that body image is only a small part of a much larger picture when it comes to Bulimia.

Having been able to get close to somebody who suffers from Bulimia I learned that the disorder is far more complex and is probably more about self image than body image.  Self image includes “Who am I” as well as “What do I look like”.  In effect I say self image here to mean sense of identity. We human beings are social animals, we require social interaction, and it’s more of a need than a desire. In line with this instinctive drive we understand that we must be liked in some shape or form in order to be able to get the social interaction we require. For this to take place consistently, we must know who we are, or at least have an established sense of identity.

For an individual who does not have a well established, or rather, constant identity to feel as though they are liked, loved, understood, accepted is a very difficult thing. Perhaps think in terms of somebody who does not have a constant identity will not be able to establish which identity is the one who is liked etc. A person who does not have a constant identity will attempt to be whatever they think the person whose attention they seek, wants for them to be. They will also have difficulty accepting that they are liked, understood, accepted because if one must be somebody else to be liked, then it follows that one is in reality not liked unless one is being somebody else.

In my experience with an individual who suffers from Bulimia, the struggle is not necessarily with Bulimia alone.

In her particular case she was unable to empathize, I don’t mean that she was unable to show empathy, she wasn’t able to empathize. She was unable to understand that another person may have emotions of their own. She suffered from lack of object constancy, she was unable to remember during interactions with people that they were people who care for her.  She believed, because of the actions of her mother in the parenting process, that emotions create reality, rather than the other way around. If she felt that somebody had done something, as an example, to disadvantage her, then that must have been what had taken place, rather than being able to accept that it was more likely that they had done the thing to advantage themselves. She had an unusually great need for validation of these emotions. She was unable to accept responsibility when things didn’t work as expected, but was eager to accept responsibility when they did, even when she had no hand in making them so.

The combination of the above set of parameters is very dangerous, since we are social creatures who need connectedness, the inability to empathize make this difficult and sometimes impossible.  Combine with this the belief that those feelings of loneliness, because they exist, must exist for a reason, and we’re into some very dangerous territory. It wasn’t for her, too far a reach to begin to believe that the reason she felt lonely was because she was not liked. And that the reason she was not liked was that she wasn’t good enough to be liked.  Surely some people must have shown her that they like her? Absolutely, they did, and they do, but without object constancy that feeling is fleeting, and she resets to her default which is “Nobody Likes me, I must not be good enough”.  If a person feels that they are not responsible when things don’t go well, and relationships do not go well, they are likely to feel persecuted.

I came to understand that the binge eating was, among other things but to a great degree, about feeling powerful. Felling like there was something she could do to control the situation, to control others, so that she would either be acceptable, or so that it would not be needed.

In those hours of binge eating she seemed to feel powerful and in control, it was not a problem to overindulge and be imperfect, because at the end of it she could just “press the undo button”.  To be near her at these times was not a pleasure, she would try to exert this power over others during these hours. She would become very critical of others; anybody who walked into the room seemed to be fair game, or she would make demands of people, bark orders or berate them for not having done something she had demanded or not having done it to her satisfaction. She would make a point of chewing loudly, and with her mouth open if somebody was in the room, I noticed a few times that when there was nobody in the kitchen with her she would not go to any particular effort to eat noisily.

She would binge for up to six hours a day, every day. She would be destructive during these hours also, breaking dishes, containers, appliances, not violently, but almost surreptitiously.  That said, she would not be destructive towards anything she had paid for, any towards those things somebody else had bought, it was this that made it seem the destructiveness was about power, rather than just clumsiness.

She had a careful and calculated routine for binging. She would pick up a book, light reading, usually romantic novels, and most specifically always the same ones which she would read again and again.  First she would eat watermelon, perhaps half a watermelon, then some more fruit, apples, pears and kiwis, but rarely citrus. This would be followed by something that had been cooked, perhaps lasagna, or cottage pie or a quiche, generally three or four standard servings of these. Then she would begin dessert, usually something store bought, a cheesecake or caramel dessert, peppermint crisp dessert or a chocolate mousse, also several servings. She would follow this with several bars of fudge, several full bars of chocolate, gum sweets and around half a bag of marshmallows. This she would do three times a day. Lady Diana, in an interview, once criticized the royal family because they felt that she was wasting food, and she had made it known during the interview that she felt that they were being cruel in saying so. When one understands just how much is consumed and then purged perhaps it’s easier to see both points of view. I certainly could, the expense was very great, and perhaps four times what it would cost to feed a family of four each month. I could also understand that what she needed was validation of her emotions, and that pointing out the cost may have made her feel like the cost was a primary concern instead of being primarily concerned for her well being.

The purging was done behind a locked door, and she would run water which would help to mask the sound, but never really mask the sound. She would run the shower and both taps, and the bathroom would become steamed up.  When she did this a mix of sweet and acrid smell would permeate the house. I expect that the ritual which was repeated during each binge session would help her to know when it was all out, when the watermelon came back she was finished. When she was finished, as though somebody had flicked a switch, she was more pleasant to be around again.  This process would take around fifteen minutes each time.  The effect seemed to wear off quickly, or rather it seemed that if something happened which upset her, a comment by e-mail from somebody at work, a comment from somebody in the house not necessarily intended to offend but taken that way, she would head back downstairs to the kitchen and start the ritual again.

Being unable to empathize, feeling judged, or criticized when nobody had done anything which would indicate as much, and having a very high need for validation was a catch twenty two situation. If one denied being judgmental she would accuse them of gas-lighting or lying, admitting to it would worse. She would almost always feel that her emotions were invalidated which, given her high need for validation would to her seem a deliberate affront.  This was difficult for us, but for her this must be near impossible. Every day is a roller coaster. We lived in fear that any day something would happen, her liver would fail, or her kidneys, and that would signal the end. She lives in fear of so many more things.

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