Breaking free from bulimia Part One

Breaking free from bulimia is difficult and can take a long time, so I thought I'd share a few ideas that have helped me. They may not help everyone because everyone's different, but if you suffer from bulimia, search for your own tools to escape this disease.

Avoiding binges

Stopping binging is really the key factor in recovery, because this prevents the guilt and dangerous purging methods. Binging can be caused either by emotional factors or by physical ones. The physical causes are much easier to deal with than the emotional ones.

The human body has had billions of years of evolution go into its creation and in most of that time, food was short so we have evolved instincts for avoiding starvation. Your body doesn't want you to die. So, when you restrict too much or exercise far more than your consumption, these starvation instincts kick in. You start craving sugary and fatty foods. This is a natural response that almost everyone has (the ones that don't are probably diagnosed anorexics). When you deprive your body of food, you will feel an overwhelming need to eat. Your body has evolved in times of little food so that when you see an availabilty, you will stuff your face because your instincts don't know when you'll have another opportunity.

This is a perfectly natural response that can be avoided. Never let your body get so hungry that a binge is instinctive. Eat regular meals and light snacks between them. I always have a supply of carrot sticks and dried fruit so that I can have something to eat if I get peckish and never get starving hungry so that I end up eating half the contents of a vending machine in one go.

Another method of avoiding binges is to remove the opportunity. Don't keep binge foods around. If you don't have any in the house, this puts an obstacle between you and the binge and can make it easier to resist.

Whenever I went to the supermarket, the temptation was there to fill up my basket with all the fatty sugary junk I used to binge on. So I never went to the shop on my own. Persuade a friend to go with you. If they know about your eating disorder, explain that it's to make sure you don't end up buying binge foods. If they don't know, then presumably you don't want them to know so it will be easier for you to resist buying all the things you know you shouldn't. Another possibility is ordering food online. I get most of my weekly shopping delivered by Tesco. It's much easier to resist a picture on a screen than a packet of biscuits within easy reach.

Someone on a forum mentioned a time locked safe. She puts biscuits and things like that into a safe that she can only get into once a day. When it opens, she can take out a couple of items, but for the rest of the day she doesn't have the ability to get in so she can't end up binging on whatever's stored in there.

Find whatever method is right for you, but make it hard to binge. If the nearest shop to you doesn't accept cards, make sure you never carry cash around. That way, you'll have to go further to buy supplies.

If you do feel the need to binge, go somewhere that doesn't give you the ability. Go into a cafe and order something small. You will be able to eat and get rid of any physical hunger, but you won't be able to binge.

Just keep putting hurdles between you and the binges and eventually you'll be able to resist them. Find whatever method works best for you.

Try and avoid triggers. What makes you want to binge? Are there certain places or types of events that make you feel the need to binge?

For me, loud parties with lots of people getting drunk always make me feel out of place, awkward and antisocial. I get miserable and feel like a freak for not enjoying myself. Then I go and eat. I've learned to politely turn down invitations to these events. It means I feel antisocial when I reject the offer, but I don't have a miserable evening that makes me go to the nearest late night shop or vending machine and stuff my face.

If there is any event that almost always makes you binge, don't go.

If you struggle to resist temptation when there's a large availability of food, don't go to places that offer a free buffet or eat anywhere that sells all you can eat.

Triggers are different for different people. Try and work out if there are factors that link your binges and then try and work out ways to avoid those factors in future.

That's not enough to be free. You will still struggle and binge and hate yourself for it, but if you can reduce the number of binges, you'll reduce the self-loathing and that will reduce the desire to binge again. There will still be the emotional factors affecting your desire to binge. It may be that the best way to deal with those is to talk to friends or see a therapist. Because the contributing issues are a varied as the sufferers of this disorder, I can't give a list of ways to make them go away. You'll have to deal with those yourself or get professional help.

What I'm offering is just a couple of tools. You'll have to built your own toolkit that helps you fight back against this disease.

Recovery

Another blog I read posted a list of what recovery looks like. I thought I would try the same with my own experiences.

Recovery is...

• Walking into the supermarket and coming out again with only the things that were on my shopping list.
  
• Not instantly thinking of an excuse to leave when a friend mentions ordering take-away.
  
• Eating a slice of birthday cake and feeling good that it's my birthday not horrible about the amount of fat and sugar.
  
• Going out for a meal with my boyfriend and focussing more on him than working out the calorie count of my dinner.
  
• Buying an item of food because I like the taste, even when it has five more calories than another option.
  
• Standing on the scales in the morning, seeing my reflection and feeling hideously fat, then going and eating a healthy breakfast.
  
• Having a bad day, eating a load of junk in one go, and then managing to eat more than a stick of celery the next day.
  
• Taking a biscuit when a friend offers me the packet and knowing I'll be able to stop after one or two.
  
• Going to the gym because I want to keep fit, rather than because I want to burn off a binge.
  
• Not having a load of wrappers hidden around my room because I'm scared people will spot them if I throw them in the bin.
  
• Eating a bar of chocolate, fretting about the calorie count and then managing to cook dinner.
  
• Going for a long walk and not having to worry that I'll faint on the way.
  
• Being scared that I'm fat and hideous, but not letting it stop me living my life.
  

One and Lonely

Another Superchick song.

I would like to point out for any Americans who are watching this that the "size 12" mentioned at one point is the British size 12. This is size 8-10 in US sizes.

Scales

I don't use BMI to judge my fitness. It's a terrible scale and I can't understand why it's so universally used. It doesn't take into account muscle mass or bone structure. I know that weight isn't the best judge of fat content. So why do I still weigh myself every day?

Why do I feel close to panic when I see that I've gained three pounds since yesterday?

To gain three pounds of fat, I would have had to have eaten more than 10000 calories more than my body expended. Even my biggest binges wouldn't have reached that total.

My boyfriend took me out for dinner last night. It was at a nice restaurant with excellent quality and I enjoyed it. I was able to focus not on the thoughts of, "Oh, god, how much fat is in this?" but on the fact I was sharing delicious food with someone I love. That alone is a sign of how far I've come over the past few years.

But I still stood on the scales this morning and all the old thoughts rushed back. I know logically that I can't have gained that much fat. I know that it's natural fluctuations, water content and the remains of the dinner still in my digestive systems. Yet it still felt like failure.

There were a lot of times during my eating disorder where it felt that my mind was split into two parts. I don't me an actual split personality disorder. I just mean that I felt there was the sensible part of my mind that could see what was happening and understand it. And then there was the rest of me. Every time I went to buy food for a binge, the sensible part of my brain would be saying, "Make yourself a sandwich if you're hungry. You don't want to do this." But the rest of me was still under the control of the disorder and wouldn't listen.

Over time, the two voices have shifted position. Now the sensible part is the louder voice and keeps me in control. That's the part of my brain that tells me it's alright to have a biscuit and that just because I ate a lot the day before it doesn't mean I shouldn't have dinner. But the little disordered voice is still there in the background, whispering that I'm fat and a failure and that an hour at the gym just isn't long enough.

I wish there was some way to make that little voice disappear. All I can do is try to ignore it and hope it fades further into the background.

But I will keep getting on the scales each morning. It means giving in to that little voice a bit each day, but it's better than the alternative. It's better than not knowing and having my imagination add pound upon pound to my weight.

What Disorders Look Like

I had a comment asking, not quite so politely, why I wasn't skinny if I'd had an eating disorder so long. Why is there an assumption that eating disorder sufferers must be thin? Many aren't.

In this post, I will describe the general trends in weight of sufferers of the four main eating disorders COE, binge-eating, bulimia and anorexia. I won't discuss EDNOS, since the sufferers can have a wide range of symptoms and fall just about anywhere on the spectrum.

I would like to emphasize that I'm generalising. With the number of eating disorder sufferers in the world, there are bound to be exceptions.

Compulsive Over-Eating Disorder

Trying to find a clear definition of this disorder, I've found a lot of sites trying to tell me that this is the same thing as binge-eating. It's not There are similarities and there are wide grey areas between the two where sufferers might be classified as one or the other, but they're not the same.

With COE, the sufferer has an addiction to food. They will use it as a means of coping with emotions. They will eat when they're not hungry, eat until they feel uncomfortably feel uncomfortably full and spend excessive amounts of time thinking about food. COE sufferers might binge, which is why this disorder is often confused with binge-eating disorder, but they also might graze. Grazing refers to constantly picking at food.

Almost all sufferers are overweight or obese. Some might exercise or try to graze only on healthy foods, so the affects might not always be obvious. Generally though, these people are consuming far more calories than is healthy and so will be overweight.

COE is possibly the most misunderstand disorders, because people assume sufferers are just greedy or lazy.

Binge-Eating Disorder and Bulimia

I'm discussing these two together because I feel they fall at either end of a range. With both disorders, the sufferer will binge, where they eat vast quantities of food in a short period of time. With bulimia, the sufferer will try to compensate for their behaviour by various means such as induced vomiting, diet pills, exercise and fasting. With binge-eating disorder, there are no compensatory methods. I say they fall at either end of a range because it's hard to put discrete values on these compensatory methods. There is no clear line where binge-eating disorder becomes bulimia. A sufferer of BED might occasionally exercise or try diets, but not classify as bulimic. A bulimia sufferer might not use some of the more extreme methods and so be closer to being a BED sufferer than others. With these definitions, we are dividing a continuous scale into discrete sections.

Sufferers of binge-eating disorder will be overweight or obese. They will consume large quantities of food in their binges but there will be no purging activities to bring their weight down between binges or to prevent digestion of the food.

If someone displays the symptoms of binge-eating disorder but is not particularly overweight, it is more likely that they are bulimic, even if they don't induce vomiting after binges.

Bulimics can be overweight, or even obese. Bulimia often starts when a person tries to diet but ends up depriving their body of too much food and causing instinctive cravings for fat and sugar. A large number of bulimics will be a healthy weight or slightly overweight. Even with the purging form of bulimia (where the sufferer induces vomiting after a binge) it is impossible to empty the stomach completely and some of the food will be digested. Since the body is in "starvation mode" all the food will be stored as fat. Between binges, the metabolism will be slowed so fewer calories will be burned than for a normal person.

Some bulimics are underweight. This group will almost always perform extreme purging methods and many will have strong anorexic tendencies. Again, we get back to the problem of indistinct boundaries. Where do you draw the line between bulimia with anorexic behaviours and anorexia of the binge-purging type?

So, bulimics might be underweight, sometimes severely, or they might be a healthy weight, or they might be overweight, sometimes severely. That makes it rather difficult to tell if someone is a sufferer just by appearance, though there are more subtle signs.

Purging bulimics will usually have damaged teeth from the vomiting. This is very often not obvious, particularly if the sufferer is aware of the damage and tries not to open their mouth too wide.

Purging bulimics may also have cuts on the back of their hands. However, they could easily try using something other than a finger to induce vomiting if they wish to leave not visible marks.

A large number of bulimics suffer malnutrition or nutrient deficiency. This is because the foods used in binges are often high in fat and sugar. These junk foods are often lacking in nutrients so even if they don't purge, they won't gain any goodness from what they do eat. If the bulimia sufferer fasts or skips healthy meals, they will miss out on essential vitamins. The signs of nutrient deficiency are often invisible. A bulimic may be pale or tired-looking, but this is difficult to judge. If someone tans easily or has a naturally darker complexion, paleness will not be to any extent which makes it noticeable.

Another sign is brittle hair. Sometimes the hair will fall out. This is a symptom that the disorder has in common with anorexia, but because the bulimics get some food, this symptom usually sets in after the disorder has been present a lot longer than would be the case with anorexia.

A person can be bulimic for years before the signs ever become visible.

I think this is one of the major problems that needs to be overcome when a bulimia sufferer seeks help. Generally, they will not look ill. This can lead to people believing they are putting it on for attention or the sufferer being scared to ask for help because they fear that's how it will seem.

Anorexia

This is what people think of when they think of eating disorders: people so thin that their bones are poking through their skin. The physical signs of anorexia are much harder to hide than with bulimia, though sufferers will often try, wearing baggy clothes and severe make-up.

The obvious sign of anorexia is weight. To be classified as anorexic, a person has to be noticeably underweight.

There are other signs, but by the time these are visible, the weight will usually be enough of a giveaway. An anorexic will be pale, tired-looking and will have brittle hair, sometimes falling out in clumps.

There are plenty of other physical symptoms, such as bad teeth and lack of menstruation, but in terms of appearance, you won't need to see these to know that there's a problem.

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So there you have it. A person with an eating disorder may be any weight and the problem may be almost invisible if you don't know the precise signs to look for.

Never assume that a person doesn't have an eating disorder simply because they look a normal weight.

Weekly Update 18th May 2008

My weight's pretty much the same as it was this time last week. So, I've not lost any weight, but I've not gained any either.

I can't think of a single thing I've done this week that someone would class as bulimic behaviour (eating too much fudge doesn't count as a binge, since I made the box last three days).

Overall, I class this week as a minor win.