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Friday, 8 April 2011

Denial in Bulimia Nervosa

It’s normal to want to be in control over our eating habits. It’s normal for some people to want to let go of that control some of the time like at Christmas time or when you are having a picnic with friends. It’s very normal for some people to eat a horribly bad diet full of junk food, because they like the taste. Perhaps they think that people who eat healthy food are boring? I often wonder if they are in denial about how dangerous their eating habits really are, when they tuck into their ready processed trans-fatty laden foods. But who am I to judge? If we all ate what is best for us, the economy would collapse. Who would be left to buy chocolate flavoured coco pops or one kilo chocolate bars?

On the other hand, since I have just written a blog about Orthorexia which invited some dissention, I wonder how many healthy eaters out there are in denial about the emotional issues that are behind their dietary rules. When it comes to food, we do the best we can with the resources we have at the time.

So, there is lots of denial around and so what, anyway. Experts say that where bulimia is concerned, denial isn’t really an issue because sufferers are already fully aware that their control over eating has been undermined. They know that they have a problem, and they know that normal people don’t do what they are doing -which is why they take such trouble to hide their rituals. I guess that last sentence doesn’t apply to Jockeys – where purging is normal, or models who teach each other all the tricks for staying thin so that they won’t be accused of looking fat.

People in the early stages of bulimia may be in denial about their behaviour. They don’t yet know it has a name. They almost certainly don’t know that what starts as a way of controlling weight gain quickly becomes an addiction. In the beginning, it is something they control and it ends up controlling them. They never know when they will think they have eaten one bite too many and will have to get rid of it as soon as they can. They certainly don’t know that what begins as a way of controlling food turns into a way of managing feelings. They are denial about their ability to stop.

They also deny to other people that they are doing anything unusual and go to a great deal of trouble to cover things up. Spraying perfume in the bathroom or playing the radio to mask the sounds of purging are common tactics. Pretending to your boss that you have a stomach upset is better than saying you have taken too many laxatives. This makes sense; few of us would want to admit to doing things that would cause us shame.

Denial has a lot of different meanings. People can think that what they are doing is okay because they lack the information which would help them to think differently. Many people who vomit or take laxatives think that this is a really good way to control their weight and they are therefore terrified to stop. Purging is a wonderful weight gain strategy in the long run and many bulimics gain a great deal of weight. This is because purging affects the appetite chemistry of the brain and purging interferes with the body’s ability to burn off calories.

The word “denial” implies, however, that even with the right information people say “this doesn’t apply to me” or “I don’t believe it” or “what I am doing now is better than any alternative that comes to mind” or “I don’t have a problem and can stop whenever I like”.

Perhaps the most interesting form of denial is to say “I know I have a problem but I am not sure I want to do something about it”. Therapists call this “ambivalence” and they are anxious to turn this into a real desire to change. We can understand ambivalence by turning our attention to the benefits of having an eating disorder. For one thing, purging allows us to have what we like without having to pay for it, to have our cake and eat it, so to speak. Taking laxatives helps get rid of everything that feels bad and dangerous and that mustn’t stay inside.

Bingeing and purging isn’t just a way of getting rid of food, it gets rid of feelings as well, and it helps us to get on with our day. I have often thought that purging is a kind of communication. It says what someone is unable to say, such as “I hurt, I am angry, I feel confused, I can’t cope with this, I hate you because you are more popular than me”.

And people can also be very ambivalent about change because they aren’t convinced that their problem is all that serious. One person put it like this:
“I found that - the part about me having a very serious eating disorder - hard to listen to ..because I physically look totally fine so I have been saying if it were that serious then I would surely look as if I have one when I don't and ….eating disorders are mental health conditions so if they are right and I do have a serious case of bulimia then I actually have a mental health condition and I feel really uncomfortable about that…”

So here we have two aspects of denial, one about whether the problem is serious enough and one about being willing to accept what the bulimia might mean about you.

Regarding seriousness, let’s make no mistake. Bulimia is not just about getting rid of food. Everything is affected, your brain, your fertility, the cells in the throat and mouth, the damage to the gut. Blood tests tell us very little about what is changing in our cells so it may be years before the damage shows up. It’s much the same as smoking. You can live a long life with bulimia – of course, but I doubt it will make you very happy. I don’t call to health risks to persuade people to change. On the other hand, bulimia makes you gain weight very easily and that does make people with bulimia very uneasy.

If you want to deny the seriousness of bulimia in case it means you have a mental health disorder, take heart that some bulimics DON'T have serious mental health problems. And some normal eaters DO have mental health problems so why bother to get into a strop about labels. I will have to another blog about that!

An eating disorder - whether you think it serious or not - is something that stops us from having to pay attention to what isn’t working underneath. It’s easier to think that you have an eating problem which isn’t really going to do you much harm, than it is to grapple with a problem that is really painful. Many bulimics have had a history of serious invalidations, unhappy childhoods, struggles coping with an alcoholic parent or abuse from other people which they were powerless to prevent.

For these reasons, I do not fight against denial nor do I assume that my enthusiasm for recovery will be taken up by my clients. Some people have been upset with me for so-called labelling people as bulimics, anorexics or orthorexics. At the end of the day it is about people, not about labels and it's about figuring out how to help someone to be happier. I know that purging, starving and binge eating helps someone feel safe but isn’t a recipe for a happy life; it is happiness and a meaningful life that is always in my focus.

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