Bulimia (bulimia nervosa) is a serious eating disorder that may require extensive treatment and recovery time. Family and friends often find it very difficult to know how to support their loved one struggling with this disorder. Family members can be helpful. The best way to help sufferers of bulimia is by learning the symptoms, being familiar with stages of change, how these stages play into deciding when to seek treatment, and understanding what kind of support is helpful. This is Sarah’s story.
Sarah is a 35 year old real estate agent who has struggled with her weight for as long as she can remember. As a child, she remembers being slightly overweight and very shy. Sarah hates the sharp pain she feels when someone mentions her size, and she doesn’t deal with stress very well. She started following a very strict calorie count in order to control her weight, but before long, she would binge on sugary foods. Sarah feels so guilty about these binges that she throws up or uses laxatives to get rid of the food. This relieves the stress and helps her feel back in control for a while. Just when she thinks she’s in control of her eating, she binges again. Throwing up multiple times per day has a way of bringing back that out-of-control feeling around both her eating and her emotions. She’s at her breaking point.
Symptoms of Bulimia Nervosa
Let’s take a look at the diagnostic symptoms Sarah experiences:
- She frequently engages in binge eating. Binge eating is defined as:
- Discretely eating an amount of food that is larger than what the average person would eat at that time under the same circumstances
- Feeling a lack of control while eating
- She frequently engages in extreme behavior in order to prevent weight gain including using laxatives and self-induced vomiting.
- She binge eats and engages in the extreme behavior to prevent weight gain multiple times per week.
- She bases her self-worth on body shape and weight.
These symptoms are confusing and difficult to understand. And, they look different in each individual. For example, while Sarah uses self-induced vomiting (throwing up) to compensate for her binges, another girl with bulimia may refuse to leave her house due to feeling depressed because the bathroom scale reads that she gained a pound or two. She might compensate for these feelings by exercising for hours at a time to compensate for that pound or two, because she believes this will make her feel less depressed. These behaviors make those who experience them feel crazy and those who love them feel powerless to help.
Do you feel like you know someone suffering from bulimia? How can you help?
Understanding Stages of Change
Your loved one may realize that she has bulimia, but that does not necessarily mean she’s ready for professional help. Why? Girls with disordered eating often believe that having bulimia provides more benefits than not having bulimia. For many eating disorder sufferers, the disorder serves as a coping mechanism to deal with other stressful issues in their life. Therefore, they may or may not be ready to consciously let go of this coping mechanism. It’s helpful for family and friends to understand the five stages of change.
- Precontemplation: She does not see her eating disorder as a problem, and therefore, does not believe she needs to change.
- Contemplation: At this stage, she is weighing the pros and cons of her eating disorder.
- Preparation: Now she’s gathering resources for the change process. She is trying to prepare herself. It is important that she finds a change strategy that works for her.
- Action: Now she’s ready and is actually implementing strategies for change and actively resisting urges to binge and use inappropriate coping behaviors.
- Maintenance: At this point, she has returned to normal eating and is practicing coping strategies to cope with eating disorder symptoms.
It is important to identify which stage of change your loved one is currently in before trying to discuss the eating disorder. For example, discussing treatment options with someone in the precontemplation stage would not be beneficial. It would be most beneficial to voice personal concerns to the individual struggling with an eating disorder during the contemplation stage and to discuss treatment during the preparation stage.
In Sarah’s case, it sounds like she is moving from the precontemplation stage to the contemplation stage. Due to Sarah’s binge eating and throwing up multiple times per day, she is realizing that she does have a problem. Sarah will begin weighing the pros and cons of her eating disorder. A family member who is concerned about Sarah would find it beneficial to ask Sarah if they could discuss a few concerns the family member has about Sarah’s eating habits. If Sarah agrees, the family member would be most helpful in identifying a few specific behaviors that they are worried about (example: throwing up multiple times per day). The family member’s statement may sound something like: “Sarah I appreciate you letting me talk with you about a few concerns I have about your eating behaviors. I have noticed that after each meal you go to the bathroom for 10 minutes. I am concerned that you may be throwing up the food you ate. I am very worried about your well-being.” After making this statement, it is most helpful to let Sarah respond and listen carefully to her response. Next, the family member should summarize Sarah’s response. This will help Sarah feel heard and understood.
How to Communicate and Provide Support
Finding out a loved one is struggling with an eating disorder is very troubling, and it can be difficult to know how to be supportive. Let’s discuss this issue by using three animals to help you visualize the best way to provide support to your loved one suffering with an eating disorder. In these examples you are the concerned person.
- Kangaroo Care: The concerned person wants to protect their loved one from the eating disorder just like a Kangaroo protects its young in its pouch. You try to keep the sufferer safe by treating them like a child and giving in to demands. This type of response is not helpful because the sufferer does not learn how to cope with eating disorder symptoms.
- Rhinoceros Response: The concerned person becomes stressed and exhausted with the eating disorder symptoms. The loved one feels that there is an easily solution that the sufferer is not trying. The problem with this type of response is there is too much control and direction. The sufferer may not feel that she can recover on her own.
- Dolphin: This is the recommended style of support for individuals suffering from an eating disorder.
- Be flexible with consistent encouragement
- Discuss why the sufferer wants to change and reasons why they may not want to change.
- Discuss steps that the sufferer feels they can take toward change, even little steps can be helpful.
- The focus should be on the anxieties of the sufferer about change than on the logical reasons to change.
- Most importantly, listen to her and reflect back on what she tells you. This helps her feel heard and understood.
As Sarah weighs the pros and cons of her eating disorder, she discovers that there are more harmful consequences to her disordered eating than benefits. For example, even though throwing up after binging makes her feel in control, Sarah knows that this response is harmful to her physically and only relieves anxiety for a short period of time. She appreciates the concern that her family member discussed with her. As a result of feeling heard by her family member, Sarah was able to discuss reasons she wants to change and fears about treatment. By gathering information about treatment options and facilities for bulimia, Sarah has the resources to start the change process. With the support of her family, Sarah called a counselor in order to be assessed for bulimia and start the therapy process.
If you have a loved one struggling with an eating disorder, the most helpful thing you can do is to be there to listen to her feelings and fears. Often those struggling with bulimia feel unloved, unwanted, and not good enough in some area of their lives. Being there to listen to your loved one share feelings and fears about her eating disorder and struggles communicates the love that you have for her. It is also helpful to reflect back to your loved one the things that she shares with you. This helps her know that you were listening and understood her feelings. In the example with Sarah, her family member shared concerns about the specific behaviors that caused worry. When talking with a loved one struggling with bulimia, it is important to share concerns about specific behaviors and be willing to thoroughly listen to her response to your concerns. In most cases, the only way to recover from an eating disorder is to seek professional help. If you are concerned that a loved one may have an eating disorder, research treatment options in your area and schedule an appointment to discuss symptoms and concerns.
Restoring our Bodies, Reclaiming our Lives: Guidance and Reflections on Recovery from Eating disorders edited by Aimee Liu
Skills Based Learning for Caring for a Loved One with an Eating Disorder by Janet Treasure, Grainne Smith, and Anna Crane
The Overcoming Bulimia Workbook. Your Comprehensive, Step-By-Step Guide to Recovery by Randi E. McCabe, Traci L. McFarlane, and Marion P. Olmsted
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th edition, text revision. Washington, DC: American Psychiatric Association.
McCabe, R., McFarlane, T., & Olmsted, M. (2003). The overcoming bulimia workbook: Your comprehensive, step-by-step guide to recovery. United States: New Harbinger Publications.
Treasure, J., & Macdonald, P. (2011). What to suggest and how to suggest it: Talking tips to parents with open communication. In Liu, A. (Ed.), Restoring our bodies, reclaiming our lives: Guidance and reflections on recovery from eating disorders (pp. 50-52). Boston: Trumpeter Books.
Treasure, J., Smith, G., & Crane, A. (2007). Skills-based learning for caring for a loved one with an eating disorder. New York: Routledge.
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