Article Contributed By: The Castlewood Staff
The support of a spouse is one of the most valuable resources an individual with bulimia can have available to them. If you have never struggled with an eating disorder, it can – at times – be confusing and frustrating to understand.
When someone we love is sick, we want to know why and what we can do to help them, but with an eating disorder, there is no single cause or cure. There are, however, ways to help your partner, and strengthen your relationship, by coming to terms with the condition. As a spouse, educating yourself about the facts is an important first step in understanding and caring for someone struggling with bulimia.
Knowing the Cycles and Symptoms of Bulimia
An eating disorder is an illness that causes serious disturbances to every day diet, characterized by extreme emotions, attitudes and behaviors relating to weight and food issues. Bulimia nervosa is a serious and potentially life-threatening eating disorder with recurrent episodes of binge eating followed by compensating behaviors such as self-induced vomiting.
These cycles can do significant damage to the digestive system, and purging behaviors will lead to electrolyte and chemical imbalances, which can seriously affect the heart and other major organ functions. As further detailed in this article:
Contributed Article by Courtney Kent, BA, Outreach Director, New Dawn, Marybeth Weinstock, PhD, Therapist, New Dawn, & Victoria Green, MFT, Clinical Director, New Dawn
If someone in your family is struggling with bulimia, chances are, they are very skilled at hiding it. As with other eating disorders like anorexia and binge eating disorder, those dealing with bulimia typically do so in secret. When confronted with life-stressors or tension developed from restricting food intake, those suffering from bulimia comfort their emotions through a process known as “binge and purge.” In this cycle, a person takes in large quantities of food (1,000-5,000 calories) in a short time period. If the person is on a diet, when the “forbidden” food is consumed, people with bulimia engage in compulsive behaviors like consuming much more in order to dull the unwanted feelings. Now full beyond comfort or satisfaction, fear of weight gain sets in. Purging is a technique that allows people to quickly rid the body of unwanted calories through the use of self-induced vomiting, laxative and diuretic abuse, and excessive exercise. These various ways of purging create a cycle that causes the person struggling with bulimia to feel yet more shame and lack of personal control(2). Strict dieting is then enforced until the next cycle begins. Typical feelings experienced in every binging and purging cycle are feelings of fear, shame, and guilt. It is no surprise that this ritual is performed in private often late at night while family members sleep or during times of the day when no one is home. Be aware of disappearances after meals, even if they are not to a bathroom. Your loved one may have another special place they go to in order to hide their secrets.
There are many misconceptions about eating disorders that allow the disease to flourish in plain sight. “She doesn’t look too skinny.” Or “he says he hasn’t eaten all day, of course he’s hungry!” There is no size requirement in the diagnosis of bulimia. A person struggling with anorexia who also exhibits bulimic behaviors may be on the noticeably thinner side, but many struggling with bulimia look average build or are slightly overweight. Purging does not prevent weight gain. Vomiting after a meal, at best, can rid the body of only 50% of the calories eaten(3). Other forms of purging are even less effective. It is also fairly common to restrict food intake throughout the day in order to binge later. People struggling with bulimia may purposely restrict their food intake, so that it is more socially acceptable to binge in public. The health consequences may not be visible from the outside except to the trained eye. While someone coping with bulimia may not look like they are starving to death on the outside, the tell-tale signs are discoloration of teeth, red blood-shot eyes, puffy cheeks and neck calluses on knuckles from induced vomiting, and weight fluctuation(3). Irregular heartbeat, kidney failure, and a ruptured esophagus can be complicating factors that lead to early death.
Maybe you are getting that feeling in the pit of your stomach and you know something is peculiar about your loved one’s behavior, but you do not know how to bring it up, and instead hope that it will disappear on its own. It won’t. Eating disorders will only get worse if left untreated. Eating disorders come from a place in our minds where we are struggling to cope with self-esteem, life changes, and body image(1). The “control,” a person with bulimia feels while managing their food and bodies is hard to give up. Your compassion, understanding, and willingness to talk with your loved one about getting professional help are key to their recovery(2). While they may feel defensive and unwilling to give up their way of coping with their world at first, knowing that you care enough to have that hard conversation can be the difference in achieving recovery from an eating disorder(1).
At New Dawn Treatment Centers, we know that eating disorders affect the whole family. As a leader in eating disorder treatment, it is our mission to educate families and loved ones as to the signs and symptoms so that they may become part of the solution. We hope that you will take the step today to help a loved one towards a life without the shadow of an eating disorder.
(1)Brisman, Judith, Michele Siegel and Margot Weinshel. Surviving an Eating Disorder, Third Edition: Strategies for Family and Friends. Harper Perennial; 3 Rev Upd edition. 2009. Print.
(2) McShane, Johanna Marie and Tony Paulson. Why She Feels Fat: Understanding Your Loved One’s Eating Disorder and How You Can Help. Gurze Books; Revised edition, 2008. Print.
(3) Segal, Ph.D., Jeanne and Melinda Smith, M.A. “Bulimia Nervosa: Signs, Symptoms, Treatment, and Help.” Helpguide.org, 2012. Web. January 2012. http://www.helpguide.org/mental/bulimia_signs_symptoms_causes_treatment.htm
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Published Date: April 12, 2012
Last reviewed: By Jacquelyn Ekern, MS, LPC on 12 June, 2012
Bulimia is a complex, emotionally based psychological disorder, which can affect people of any ethnicity, gender or age as well as social or economic background. If you are a stranger to disordered eating, one of the first things to recognize is that this is not simply a matter of being insecure about looks.
You cannot force a bulimic to stop purging, and it isn’t a matter of exerting more control or willpower.
The Mental Causes of Bulimia
The underlying basis of disordered eating behavior relates to psychological conditions such as depression and emotional stress, which can be related to major life changes, social adjustment or the loss of a close friend or relative. Disordered eating, bingeing and purging are attempts to cope with emotional pain and stress. In addition to stressful events, family history may also be a cause.
Someone struggling with bulimia will commonly feel ashamed of their behavior, sometimes recognizing it to be unhealthy and unusual.
Don’t Take Their Actions Personally
It’s important to understand that although your partner may have been hiding their bulimia from you, it is not an indication that they love you less or that they do not trust the relationship. Find out that your loved one has been keeping their disease from you can be a challenge when you have been married for several years, and it’s normal to feel:
Remember, bulimia is defined by shame, guilt, hiding and secrecy. Try to separate the eating disorder from the person you know and love, and recognize that those with the disorder may seek to hide, minimize and/or lash out in frustration.
Eating Disorders Are Unhealthy Coping Mechanisms
Similarly to the way addiction operates, eating disorders are negative coping mechanisms that can begin to take control of an individual; it’s not uncommon for bulimia to be co-occurring with substance abuse issues. As explored in this article:
Article contributed by Jacquelyn Ekern, MS, LPC, President @ Eating Disorder Hope and Crystal Karges, MS, RDN, IBCLC, Special Projects Coordinator @ Eating Disorder Hope
The nature of addiction is complex and multifaceted, affecting an individual’s behavior and brain functions. Though addictions are typically relapsing and chronic, they are also treatable diseases that men and women can overcome with adequate care and intervention. Whether the addiction is to drugs, alcohol, or food, many commonalities link the nature of these vicious cycles. Understanding the root of an addiction is crucial to preventing the development of co-occurring disorders, or the combination of a mental disorder with an alcohol or drug use disorder.
Examples of co-occurring disorders include the combinations of alcoholism with a panic disorder, or a cocaine addiction with an eating disorder (such as Anorexia or Bulimia Nervosa). Though these disorders may interact differently among individuals, the mental health illness and alcohol/drug disorder can trigger or exacerbate the symptoms of one another. In addition to this, men or women struggling with co-occurring addictions will often experience more severe physical, emotional, and social problems. Individuals with an addiction to drugs/alcohol in addition to an eating disorder or a mental health disorder leads to increased vulnerability, largely because the worsening of one disease will impact the potential of relapse in the other.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated seven to ten million individuals in the United States have at least one mental disorder as well as an alcohol or drug use disorder . Research has also shown a high co-occurrence of eating disorders among women and men with substance abuse disorders, with women that have either a drug addiction or an eating disorder being more than four times as likely to develop the other disorder compared to women who had neither disorder . Other studies examining the relationship between substance abuse and eating disorders found that as eating disorders became more severe, the number of different substances used increased . The relationship established between substance abuse and eating disorders creates a vicious cycle where they feed on each other and increase their destructiveness.
When painful situations arise, food and drugs often become the means for managing stress, especially in the absence of positive coping skills. A person who is seeking recovery from an eating disorder, for example, might turn to drugs or alcohol to cope with the difficulties encountered in recovery. In the same way, an individual recovering from a drug or alcohol addiction might develop disordered eating habits to compensate for the lack of chemical reinforcement they once received.
The combination of a substance addiction and mental disorder can be lethal, prying an individual into an endless cycle of deadly consequences if left untreated. Because of the potentially dangerous ways these two disorders can interact, professional treatment that addresses both diseases is crucial for recovery. Finding an integrated program that supports medical stabilization, nutritional rehabilitation, pharmacoatherapy, and psychosocial treatments can most effectively support recovery from both a substance addiction and eating disorder.
For the health care provider who is treating drug/alcohol addictions, being aware of the potential connections between substance abuse and eating disorders may be helpful in early identification of co-occurring disorders. Properly screening and assessing a patient for co-occurring disorders can lead to more effective interventions and treatment. On the other hand, if you or a loved one has been suffering with a substance addiction and eating disorder, understanding the relationship between these two diseases can reinforce your need for professional help and treatment. You have likely experienced the burden of two powerful disorders that could lead to the demise of your well-being and life. However, being aware of the resources and help that are available to you can empower your victory over these diseases. Reaching out for help is not an easy task, but it just might be the most significant step towards saving your life.
: ‘Co-Occurring Disorders’ Substance Abuse and Mental Health Services Administration (SAMHSA) – http://www.dpt.samhsa.gov/comor/Co-occuring.aspx
: ‘Clients with Substance Use and Eating Disorders’ Substance Abuse and Mental Health Services Administration (SAMHSA) – http://store.samhsa.gov/shin/content/SMA10-4617/SMA10-4617.pdf
Your spouse may be struggling to maintain a facade of normalcy, while still hanging onto the disordered behavior out of familiarity.
The recovery process requires the individual to learn to evaluate the contributing factors and to develop positive and healthy coping skills to replace the old ones. Without treatment, therapy and a program of recovery, it will be difficult for someone with bulimia to simply stop.
Talking and Showing Support
If the subject of your partner’s eating disorder has already come up in the relationship, it may be a strained issue, but remember, more opportunities will present themselves for you to talk constructively and show support.
If you have yet to confront your spouse about your concerns, make sure you are aware of (and possibly list out for yourself) the signs and symptoms that are concerning you. Recovery is impossible in an atmosphere of denial, and talking about it in a loving manner can be an essential step in taking back control.
The Key Points of Supporting Your Loved One
When speaking with your spouse, there are a few key points to be aware of that will promote a constructive conversation. Remember, they’re likely to be ashamed and possibly afraid or threatened, so it’s important to maintain a non-judgmental and supportive attitude.
Use “I” sentences and facts when speaking: “I am worried about you because I’ve noticed you seem unhappy.” Trust and integrity will return when you are able to establish a dialogue with your partner, one in which they feel they are safe.
Finding help for yourself, either by talking with a supportive friend or a professional about your concerns can give you an objective perspective to organize your thoughts and feelings. Be prepared for your spouse to be uncomfortable or even angry.
Being Prepared for Their Reaction
Your attempts to help might be refused or met with denial. This is another reason to get help for yourself; your spouse isn’t the only one who will need support! ANAD and NEDA are excellent resources for family and loved ones looking for information and support groups.
Try to encourage your partner to seek the professional help that will allow them an opportunity to overcome their bulimia. You will want to have resources available and treatment options ready when he/she decides they are ready to get the help they need. While you can do the research, be supportive, listen and encourage your partner toward recovery, in the end, it is your spouse who needs to make the decision to pursue it.
If your spouse is experiencing any of the following signs, you may need to encourage them to seek medical treatment immediately:
- Blood in stool or vomit
- Chest pains
For many cases of bulimia, the course of treatment will usually begin with stabilizing the patient’s health, followed by a structured treatment program.
While bulimia is a complex and damaging disorder, it is possible to achieve recovery with the help of an experienced treatment center.
Source: When Your Spouse Has Bulimia