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In the United States alone, approximately 30 million people suffer from an eating disorder at some point in their lives, with bulimia nervosa being one of the most common." Bulimia is a complex eating disorder characterized by a cycle of binge eating followed by compensatory behaviors, such as self-induced vomiting, excessive exercise, or misuse of laxatives. But, this disorder is not merely about food or weight, but rather, it is a reflection of deeper psychological issues and societal pressures.
My story
Back in 1998, the high school version of me was obsessed with maintaining a low-calorie intake. Though I was well-liked, three-sport athlete and a perfect GPA, I wanted to look like the girls in magazines. I would only eat 900 calories a day unless I ran for an hour, then I would allow myself 1500. I was often so hungry that I would eat my snacks early and skip lunch, spending my time playing piano instead. I constantly counted my calories, even during class, worried I might have forgotten to count something. I was often irritable, especially towards my family. One day, I broke my own rules and had some cake at my sister's graduation party. It was good! So good. I became obsessed and ate a lot. An absolute no-no. I didn't even know how many calories there were! How many grams of fat?! Easily over my 10 per day maximum. I was in uncharted territory and gripped by a wave of anxiety, fear, and self-loathing, anticipating feelings of unworthiness, shame, embarrassment, and unattractiveness. In a desperate attempt to regain control, I fled to a secluded wilderness area, induced vomiting, and purged myself of the offending calories. It felt like the only option. The relief was immediate, a return to a state of equilibrium. My secret was safe; no one had seen, no one knew. I was just a closet screw-up. Plus, now I had discovered a loophole. If I ever broke my own rules, or needed to bend them for social occasions, I could simply purge. It was a disturbingly efficient solution, requiring far less time than hours of running. And thus was born a very destructive coping mechanism, that became a habit, and then an addiction. I was bulimic for 5 years. I went through it from start to finish alone. I finally kicked the habit using an approach that in hindsight aligns well with new science on how to get through addiction.
Because I didn’t seek support, I made the mistake of assuming the issue was specific to food and body image. Spoiler alert: its not. Other addictions -like alcohol would pop up later in life - only to get through each one using the same approach. To my great surprise, in marriage counseling, my bulimic history became relevant. I was identified as having cPTSD. While I knew I was far from the perfect wife and mother and professional I aspired to be, I had never even heard of cPTSD, or the idea that unconscious drivers from experiences my nervous system found to be traumatic may underly many of my struggles, even the bulimia. Hmm-what a closet screw up I indeed was.
That was until I learned that a virtual bulimia pandemic -a social contagion of bulimia occurred during the 1980-90s, one that has only accelerated until today. So, it wasn't just me, my genetics, my parents, it was a whole hell of a lot of us throughout the entire world that were raised using a diverse set of "best parenting practices" in different cultural settings. What gives? Are we all stressed out? do we all have cPTSD? Is throwing up our lunch somehow solving problems we all share? The thesis of this blog is yes. On all counts.
Main Points:
Main point 1: YES, we are all STRESSED: Stressors: Adolescence (think body changes, adolescent brain changes, developing executive function, individuation stress, biological sex drive stress). And adolescence is ripe with stress. Uncertainty over career path. Uncertainty about leaving home. Uncertainty about creating and maintaining friends. Uncertainty about the new world of dating. Uncertainty is perceived by human brains as a danger. it will always, definitely trigger a stress response. Many women are facing uncertainty and pressure to be 2 conflicting feminine roles. The stress of achieving the impossible. Optional unconscious Stressors that need to be re-programmed: perfectionism – creates ongoing story of inadequacy; Negative affect : low confidence: brain that predicts relational conflict due to parenting and a dire need for connection.
Main point 2: Yes- we all may have cPTSD. This is a widespread thing. not even recognized in the DSM- because if it were recognized, more support would need to be given in early childhood. people with cPTSD were typically not taught how to tolerate high levels of distress, and instead we developed ad hoc coping strategies based on our socialization. A lot of females land on two primary strategies: fawn and flight. So, when we are all faced with the new privilege/challenge of attempting to do the ambitious career track and plan for motherhood, we think it is in our best interest to do all this in heels, with a painted smile, and without support. We are the perfectionists. We are praise junkies- people pleasers. the busy-body high performers. Which sounds great, until you learn that Psychology considers these traits part of a maladaptive stress response. Until finally freeze takes hold or every now and then a fight.
Main point 3: Yes, throwing up our lunch helps. Why? dopamine. ....sugar...is a relief! A means to sooth. an abundantly available, socially acceptable way to sooth. except that we can't gain weight. so, yes bulimia is solving for a widespread problem. The problem of trying to be a perfect woman. this response doesn’t work when two pathways to acceptance are in conflict. Depriving energy needs and not being hangry. Eating only healthy foods, but eating socially acceptable food habits. Just has you toggling between the two. Until an addiction takes hold. Sugar for dopamine. But what separates the adolescence that develop bulimia from those that don't? perhaps sugar is the only substance you have access to. Thinness for dopamine.
Proof
In the late 1990s, anthropologist Anne Becker conducted a study on the impact of Western television on the body image and eating habits of adolescents in Fiji, a South Pacific island nation. Before the mid-90s, television was virtually non-existent in Fiji. The island's culture traditionally valued robust bodies, considering them a sign of good health and social standing. However, in 1995, American television was introduced to the island, bringing with it popular shows like "Beverly Hills 90210" and "Melrose Place." Becker's study, conducted three years after the introduction of television, revealed a significant shift in the body image and eating habits of Fijian adolescents. She found that 74% of the girls surveyed reported feeling "too big or fat" at least sometimes. The study also found a significant increase in self-reported dieting among the girls and a rise in purging behaviors to control weight. Becker concluded that the introduction of American television, with its portrayal of thinness as desirable, had a direct impact on the increase of bulimia and other eating disorders among Fijian adolescents. This study highlighted the powerful influence of media on body image and the potential for it to contribute to the development of eating disorders.
Next steps:
- Realize you aren’t alone. You are part of a very, very broad phenomenon. You can come out of the closet-we all can. Instead, let’s book an auditorium, start convening, and figure out how to move past this and prevent future generations from going through this. It's a pandemic that's been largely overlooked due to the stigma and misunderstanding surrounding it.
- Critically evaluate the idea of this perfect women. this aspirational figure that we all know exists, but we just can't seem to figure out how to get there. We look at where this ideal comes from, and evaluate whether we want to continue to internalize this ideal.
- Re-program ourselves to unload the optional stressors. The other stressors will remain. But this is not trivial. The deep work. Establish emotional regulation/resilience skills which are not taught in schools. Essential just like finance which is also not taught. The work that will allow you to heal not just from bulimia, but other addictions, and step into your true authentic self so that you can show up in the world with a sense of purpose.
- Apply this new sense of purpose to a new goal. A worthy, challenging, almost impossible goal that commands your attention.
Now that we have set the stage, let's begin to delve deeper into the ongoing bulimia pandemic, its causes, effects, and the urgent need for a comprehensive understanding and solution.