Help me help my bulimic friend

September 4, 2009 8:34 AM

Were you ever bulimic? Can you pin down a key thought or statement which helped you?

This weekend I have the opportunity to spend some time with a friend who I know is suffering badly with Bulimia at the moment.

I am going to try and talk to her about it, if she is open to it.

I don't want to give her any rehearsed schpiel, but can you give me any one question or sentence or idea which helped you, which i can bear in mind?

Thanks mefites.

posted by greenish to health & fitness (10 comments total)

This may sound like a little, ridiculous thing but it's really bad for your teeth; the acid corrodes them. Somehow the recognition of that makes the idea seem super gross to me.

That having been said, I would advise thinking very carefully about how/if you speak with her. Clearly this is a very serious issue and it's something that needs to be handled carefully, but if she feels like she's being attacked it could make it harder for you to speak with her about it and make her defensive about attempts to talk to her about this issue in the future, be them from you or from other people. I'm not saying definitely don't have this conversation, I'm saying that I would research this very carefully and make sure that anything you say is said in a calm, reasonable way that makes it clear that you care for her (which does not mean that you should calmly tell her how wrong she is; no one likes receiving a lecture). DO NOT get hysterical or blame her. DO NOT let her feel attacked. DO let her know that you are her friend who cares about her and that you are open to helping her however you can.

There's also the fact that you know she is suffering from bulimia; does she know that you know? Have you heard this from a friend? Believing that her friends gossip about her eating disorder is not going to help. If you heard this through a mutual friend, make sure that a) your information is accurate and b) that it is clear that this discussion arose because people who care about her are worried, not because people enjoy talking about her behind her back. Best of luck to both of you!
posted by Mrs. Pterodactyl at 8:57 AM on September 4 [1 favorite has favorites]

I'm afraid I have neither a key thought or statement to contribute...nor do I think you can expect her to be open to any discussion of her compulsion. In fact, I would prepare myself for her denial.

Ironically, considering Mrs. Pterodactyl's wise comments, I do vaguely recall reaching the conclusion that I could address my body's shape (and the image I held of my body) with a great many healthier methods, but if I completely destroyed my esophagus and teeth the ensuing cost and pain and illness would make me much more miserable than my reflection in a mirror.

In other words, after far too many years, logic finally kicked in.
I truly hope it does for your friend.
posted by squasha at 9:09 AM on September 4

Do not say anything about her body like, "Oh you look fine; you don't need to do this," or, "This is making you look really unhealthy." It is so, so, so not about looks. Do not say, "It's digusting," or "Don't you hate throwing up?" It is not because she thinks throwing up is fun or glamorous. Your friend is really suffering and the best (possibly only) thing you can do to help her is encourage her to seek professional help. Tell her you're concerned about her mental and physical health and offer to help her locate counseling or maybe some kind of support group. If she rebuffs you let her know that your offer will still stand and you will continue to check in and see if she's changed her mind. Tread lightly - this is a disease of shame and self-hatred and it's easy to trigger both by saying the wrong thing.

That said, the book Intuitive Eating really helped me in my recovery, but three years of therapy had made me ready to hear the message.
posted by JennyK at 9:35 AM on September 4

The problem with bulimia is that--unlike the drastic weight loss that comes with anorexia--the body stays around the same weight, generally, because the intake of calories from binge eating does actually contribute some weight to the body, even though it gets thrown up (calories in carbohydrates start being broken down and consumed by the body as they're being chewed, for instance). You might tell her something like, "Maybe no one might ever notice that this is going on and try to help you with it, but I notice and want to help."

I'm assuming she's not getting any kind of treatment for this? Help her find some, with a hospital/inpatient program or at least with a therapist who works with eating disorders.
posted by so_gracefully at 9:53 AM on September 4

This is a weird thing - but a lot of recovery, for me, was realizing just how tired I was of it - tired of the physical act, tired of the pretty serious logistical contortions required to interact with people normally and also be throwing up three (or four, or seven) times a day. And I got really tired of being paranoid about people suspecting, tired of putting friends and family in weird positions.

I don't know if that will help her, or if trying to talk to her is even a good idea, but that was the mental "oh!" that got me working on fixing myself - getting sick of being sick.
posted by peachfuzz at 10:17 AM on September 4

This may sound like a little, ridiculous thing but it's really bad for your teeth; the acid corrodes them. Somehow the recognition of that makes the idea seem super gross to me.

FWIW, in several books I've read about Princess Diana, it was a comment like this from her close friend that ultimately prompted her to seek help for her bulimia. Diana's friend Carolyn Bartholomew was so concerned about Diana's bulimia that she had threatened to go to the press and reveal Diana's secret, but according to interviews after the fact it was actually another off-hand comment that worried the Princess even more. Carolyn mentioned that she'd read that excessive vomiting was very bad for the teeth, which is a serious concern when you're one of the most photographed women in the world.

Like the others have said, however, tread lightly. This is akin to telling an alcoholic "You know, drinking too much could be bad for your liver." They are aware that they have a problem, but for the time being the pleasure they're getting from their habit outweighs the future possible risks; they're willing to buck those odds. Bulimics gorge for the same reason junkies shoot up or alcoholics race to the bottle - it's a security blanket. And the act of vomiting releases endorphins into the system which gives a very pleasant, momentary high, a feeling of peace.
posted by Oriole Adams at 11:19 AM on September 4

Eating disorders are tricky to confront because they have a tendency towards preserving themselves at whatever cost - the disorder wants to perpetuate itself and keep itself alive. Many people in the thick of eating disorders will respond to interventions/offers of help with further withdrawal, secrecy, flat-out denial, etc. It's not unlike trying to rescue a stray cat - it takes a lot of patience to get the cat to come out and trust you, but make a move to pick it up and it goes dashing back off into the shadows. Even if the person, your friend, genuinely wants the help, it's the nature of the disorder to resist. It's not uncommon for bulimics and anorexics to genuinely want to recover, but find that it's an uphill battle against the disorder. It's sort of like battling depression in that way; as desperately as you want to be better, it's a lot harder than deciding you won't purge or making up your mind to be happy.

So if you want to help her out of this, you will need to be very patient; it may take a lot longer than one weekend. You might not be able to bring up the subject of bulimia for a long time without her shutting down or being evasive. Rather, work on being someone that she can come to. If you can, continue to be available and supportive long after this weekend's visit.

One specific thing that has helped me is having people to talk to who don't make me feel crazy or wrong. I don't expect people to fully understand what I'm going through when I'm going through hard emotional times, but I'm much more hesitant to open up to someone who will react with alarm, judgment, incredulity, or an obvious "whoa, I don't get it" response. It hurts to confess that you tried to purge last night and be met with "Why would you do that?" or "But you were doing so well." It hurts enough to do it and to talk about it; if the response hurts too, it's easier to keep it inside. It's easy to feel isolated and different and crazy while in the midst of an eating disorder or depression, and it hurts to have a close friend imply "goodness, you really are nuts."

(Full disclosure: I am not bulimic, though I have a history of various eating/body image issues and I've attempted to purge - unsuccessfully - more times than I care to admit.)

Good luck and good on you for wanting to help.
posted by Metroid Baby at 11:43 AM on September 4

I'm currently in recovery for bulimia. There is no key thought that works for everyone; what works for me might mean nothing to her, even send her thoughts spiraling on a negative path. The "it damages your teeth thing" other posters mentioned doesn't help me at all; I just don't care, and if someone brings it up I get annoyed and defensive - I know, and I don't need the lecture, thanks.

I'm in recovery because I KNOW that a life with an eating disorder holds nothing of value. There is no possible way I can be happy and have an eating disorder. It took me a long time to learn that, but now I know it's true. I'm struggling a lot, partly because I don't have a lot of hope that I can get better - but getting better is the only option I have, because staying sick is not an acceptable option.

I think that talking to her about it could be really good - but I think the listening part is the important part. Try not to come in with too many ideas of what to say or how to help or opinions or answers. Bring it up, then just listen to what she has to say. Most people with eating disorders are very intellegent and insightful, and spend a lot of time - perhaps too much - thinking about the disorder. She would probably love to have a nonjudgmental, supportive ear.
posted by insectosaurus at 12:58 PM on September 4

I've suffered most of my life with eating disorders, bulimia for about 12 years. I'm pretty open about it now as I feel like I've successfully beaten it for the most part. She probably already knows all the risks of her disorder, so reminding her of these things in detail really isn't going to have much effect, at least it didn't for me. But what did always help me and make me try to get better was when people told me they cared about me and wanted to see me happy and healthy. No lectures, no morbid details, just genuine concern for my well-being. So, maybe say something along the lines of this: "I know I can't possibly understand what it's like for you to suffer bulimia, but I do know the risks associated with it. I care about you a lot and I don't want this to beat you. If you ever need to talk about it, I'm here for you and I won't judge you." From there you can assess whether or not she wants your help and you can go from there.
posted by MaryDellamorte at 2:48 PM on September 4 [1 favorite has favorites]

Just to clarify: absolutely *nothing* that anyone said to me made a difference. Every conclusion I reached was on my own. Nobody got close enough to discussing it, and I quickly sidestepped the relationships with people who expressed concern. Every change I made over the last 15 years, I made alone.

I think it's the nature of the beast...it's still something I work on alone, and I still need full control. Control over what I allow to remain in my body, control over my life. I just start the removal process before a binge begins, now. In my food selections, and my portion sizes. Does this mean I will always identify as bulimic? Possibly.

Maybe I would have been open to discussing the control issues, when I was actively purging, but avoided the conversation because I expected everyone to skip right over them to the physical aspects they found most disturbing. The only way I can see you being of help to your friend is if you focus on how she is feeling as opposed to what she is doing.
posted by squasha at 6:07 PM on September 4