Is there such a thing as 'a little bit' bulimic?

October 24, 2006 7:06 PM

My partner recently confided that she occasionally 'purges' part of her meals. What, if anything, can I do?

I am aware that bulimia has a number of very serious health effects, including risks of esophageal cancer and heart attack. But my partner believes that this is a fairly common behavior among women, and I am laboring to be supportive but not enabling. She has apparently been doing this since adolescence, including many times in our eight year relationship without my knowledge. Recently, she has combined it with calorie counting and (what appears to be) a healthy obsession with exercise. Does she have an eating disorder? Does she need to seek therapy? Should I pressure her to seek help? She doesn't seem willing to take advice on this front, so strategies for changing her perspective would also be welcome. If you'd prefer not to share your experiences here, please send them to "anonymaskme" at google's mail service.

posted by anonymous to Human Relations (13 answers total)

She's got an eating disorder, she should speak to a therapist about it. I'm glad she was able to talk to you about it. Don't forget to mention to her the nasty effect stomach acid has on your teeth.
posted by onalark at 7:14 PM on October 24, 2006

You need to go to the therapist together. You don't cure addiction on your own. She will need your help. This is a group project.
posted by caddis at 7:17 PM on October 24, 2006

She's correct that it's common. However being common does not make it okay. She has an eating disorder. People with healthy eating habits do not eat and throw up, period.

Likewise, for people with eating disorders it can be tough to differentiate what is healthy exercise with what is just another way to attempt to negate the effects of calories. Bulimia has other effects that are possibly more concerning in the here and now like terrible tooth decay as well as all the other potential problems associated with malnutrition.
posted by jessamyn at 7:19 PM on October 24, 2006

By the way, it's probably not "parts" of meals, but rather whole meals. That is kind of like an alcoholic saying they only had two drinks out of that suspiciously empty looking bottle.
posted by caddis at 7:32 PM on October 24, 2006

To illustrate the tooth decay issue: one of my ex-roommates was caught as a bulimic by her dentist who called her into his office and said, "Well, you're either gargling with battery acid every morning, or you're bulimic. Which is it?"

She's got an eating disorder, and if she's anything like the people I know who also struggle with this, she's going to be dealing with this for a long time, perhaps the rest of her life. She may get the actions under control, but the thoughts will always be there in some form.
posted by heatherann at 7:42 PM on October 24, 2006

Yes, yes, maybe.

First, she trusts you enough to tell you. Good for you.

Second, at some level she knows this is a problem. You don't hide a behaviour for eight years and then confide, unless you believe that behaviour is shameful or wrong or whatever.

So you have some traction. Definitely your ultimate aim should be for her to seek and complete treatment and stop doing this. However, you have to use your own judgement on how best to persuade her. From the little you have written, it sounds as though she is reaching out, so I would be starting with the gentle encouragement before I laid down any ultimatums. She's been doing this since she was a teenager, so a little while longer to come to terms with the need to deal with the problem isn't unreasonable.
posted by i_am_joe's_spleen at 7:50 PM on October 24, 2006

Maybe ask her, for your peace of mind, to go to a therapist with you so that the therapist can talk to her and, you hope, convince you there isn't a problem.
posted by amtho at 8:16 PM on October 24, 2006

I'm going to take the unpopular opinion that there is such a thing as a little bit bulemic. I'm by no means saying that what she is doing is healthy, but there is a difference between an actual eating disorder and disordered eating, which "refers to troublesome eating behaviors, such as restrictive dieting, bingeing, or purging, which occur less frequently or are less severe than those required to meet the full criteria for the diagnosis of an eating disorder" (scroll down for disordered eating section). This lady who wants to sell a book to frightened parents claims that 40-50% of college-aged women are disordered eaters.

I'm not sure what her age and situation are, but if she's on a campus of any kind, their psychologists and nutritionists deal with these sort of "bulemia-lite" issues all the time. Regardless, a meeting with a nutritionist and psychologist isn't a bad idea, even if her behaviors are not a symptom of an actual psychiatric disorder, and just of poor body image/poor coping skills.
posted by twoporedomain at 8:29 PM on October 24, 2006

and, you hope, convince you there isn't a problem.

Trust me, there's a problem. Bulimia is a serious addiction and like other addictions it is cloaked in secrecy. Her admission is most definitely a cry for help. Please take this seriously. Together you can beat this addiction. Good luck to you both.

One issue is that in addressing the addiction she will likely gain some weight. This is the hardest part. I think denial is the easiest path for most victims and you can aid that by keeping your mouth shut about the weight gain (which means no acknowledgement whatsoever). A conversation about how she "still looks great despite the extra 10 pounds" can throw her right back into the maelstrom. She looks great, yes, but avoid any comparison to the full on bulimic appearance.

One of the most important things you can do to help is to just be a rock of support. No matter what, you love her, you will always love her, you aren't going to change on this issue based on anything that comes out of her addressing this issue. Like any addict, bulimics will perform some awful behaviors. If you find out about some stuff that hurts you I suggest you let it slide as long as it is in the context of moving beyond the bad behavior.

Certainly, there are ranges of addiction. Some alcoholics down a fifth or more a day, but some much less. Ditto with bulimia. As suggested by twoporedomain this may be on the light side, but nevertheless, the issues remain very serious. Don't let a mild problem deter you from a vigorous solution and frankly be suspicious of a "mild" problem as with any addictive behavior the addict tends to try and minimize the extent of the problem. Any purging at all is serious. Make sure the two of you deal with it.
posted by caddis at 1:32 AM on October 25, 2006

"and, you hope, convince you there isn't a problem." "Trust me, there's a problem."

Caddis, I think amtho was suggesting that the OP use this as a technique to convince the partner to see a therapist. You know: "There's probably no problem, but I'd really like it if you saw a doctor so I could hear it from an expert." Not a bad suggestion, as it takes a bit of the sting out of being told you need professional help.
posted by robcorr at 1:38 AM on October 25, 2006

She's telling you because she doesn't want to be alone with it anymore. So please continue to be supportive for her. I don't think you need to do anything in particular, just being concerned helps (which you obviously are). Like any addiction, one has to want to stop, before it can be stopped. Telling somebody is a first step (a lot of people with eating disorders keep it a secret so that they can keep on doing it without interference). The fact that she told you means that she knows it is wrong, and something she doesn't want to do anymore. But please be prepared for the fact this will take time to beat. Ultimately, many people do view people with eating disorders as superficial/weak-minded, so you've already done a lot for her just by hearing her and witholding judgment.
posted by mjao at 6:01 AM on October 25, 2006

Sometimes I think an effective strategy with mild eating disorders is to play to the person's vanity. Although eating disorders can stem from prior traumatic situations, or a need to portray a "perfect" image, there is also clearly a link to vanity and the desire to be thin and attractive.

So, yes, mention the teeth thing, although she probably does already know about that.

And it might help to remind her that bulimia is not an effective weight loss strategy: Surprisingly, being underweight is not a characteristic sign of bulimia, even though people with bulimia are afraid of being too fat. Individuals with bulimia often are of normal weight or overweight because they eat a lot. (Hopefully she won't make the connection/find it worthwhile to opt for anorexia, which is at least effective in terms of weight loss.)

You could also try reminding her about Terri Schiavo, and how many people think that Terri Schiavo ended up in her situation because of a potassium imbalance caused by bulimia. Not hot.

Counseling is probably a good idea. I'm not sure if you know this, though, but people with eating disorders learn a lot from each other - so when someone in a group therapy session, for example, or in educational films, explains the horrors of his/her eating disorder, s/he teaches a whole new crowd of people what the best techniques are furthering their goals of weight loss. So that can be a concern.

How long has she been exercising? Maybe get her subscriptions to Fitness and especially Women's Health or Self or Shape - these magazines tend to emphasize the positives of strength and good health, not just a low weight. She might start getting excited about being healthy and strong and fit rather than just thin.
posted by Amizu at 7:22 AM on October 25, 2006

I don't like the ideas of trying to scare her straight, so to speak, with all these stories of rotting teeth, weight gain, Terry Schiavo, etc. She probably already knows these things, and it will just make her obsess even more over the problem, which, in addictions, tends to make the problem worse. She needs professional help and your love and support.
posted by notswedish at 8:32 PM on October 25, 2006