Eating disorders are well known among the general public, but they are often misunderstood; simplistic media portrayals and insensitive “purging” or “self-starving” jokes on late-night talk shows often see to that. Perhaps the most misunderstood of these eating disorders is bulimia nervosa. Most people are familiar with the characteristic symptomatic behavior of self-induced vomiting as a way of purging calories, but bulimia nervosa is much more than one symptom. It’s a complex intersection of a variety of symptoms and influencing factors.
Because it’s so complex, it’s easier for people who have no experience with the disorder to reduce it to a few simple symptoms and assume it affects only a select group. There are many myths about bulimia nervosa and eating disorders in general that persist – despite the recent increase in awareness about eating disorders due to the efforts of groups like NEDA and the rise in eating disorder awareness groups on social media in the past few years.
This article is here to help disprove some of the common misconceptions people have about bulimia nervosa. Beyond the need to set the record straight, dispelling these myths may aid in getting underserved populations the help they need for bulimia nervosa. Many of these myths revolve around what kinds of people can get the disorder, and that form of gatekeeping can cause people who need help to be overlooked. Similarly, clinical research and the contributions of specialized eating disorder treatment centers can prove these myths are not only incorrect but can be harmful. Here are some of the most misunderstood aspects of bulimia nervosa and what the truth really is:
MYTH: Bulimia Nervosa Is Something People Will Outgrow
This myth may be rooted in a misunderstanding of facts to a certain degree. The average age of onset for bulimia nervosa is 18 to 19 years old, and roughly 90 percent of cases are diagnosed before the age of twenty. There have been cases of bulimia nervosa reported as early as age 11. All these figures lead many people to believe that bulimia nervosa, and other eating disorders, are only a problem for children and adolescents, with some young adults also occasionally suffering from the disorder. This couldn’t be further from the truth.
The first part of offsetting this myth is that mental health disorders, including eating disorders, are rarely “cured” in the sense that a disease like the flu is cured. Left untreated, they may never go away, but even with one or more stints in eating disorder treatment, eating disorders always carry the risk of relapse, i.e. the return to disordered eating behaviors. What this adds up to is that many people who first presented disordered eating behaviors in their teenage years receive treatment and then years later relapse and begin to binge and purge again. Often, disordered eating behaviors are caused by stress. While adolescents certainly have stressors, adulthood brings additional challenges and setbacks that can trigger a need for coping mechanisms. Difficulties like losing a job, going through a bad breakup or divorce, or losing a child can all be triggers for eating disorders and are more likely to happen in adulthood.
Secondly, it’s important to remember that while the majority of cases are first observed in adolescence, a minority of a large number is still a large number. Hundreds of thousands of cases of bulimia nervosa are first noticed in the individual’s adulthood. The individuals have often been able to hide their symptoms for a long time (people with eating disorders often feel shame about their disordered behavior and attempt to mask them from their loved ones). In these cases, bulimia nervosa treatment may become complicated because the disorder has become entrenched. Adults with eating disorders have long been an underserved population in terms of diagnosis and treatment; it’s time to change that perception.
MYTH: Bulimia Nervosa Only Affects White People
Bulimia nervosa doesn’t discriminate. However, there is a misconception that still persists that eating disorders are a “rich white person’s” disorder. While the majority of cases of bulimia are observed among white women in the United States, keep in mind that white people are the largest demographic in the United States. A large minority of hundreds of millions of people is still millions of people, however, and bulimia nervosa affects every race and ethnicity. This means millions of people of color are at risk to develop bulimia nervosa or another eating disorder.
In recent years, thankfully, this perception has been changing. Over the past decade, several demographic censuses of bulimia nervosa patients show that Latina and African-American women are as likely, if not more so than white women to develop bulimia nervosa. One reason the idea of bulimia nervosa as a “white” disorder persists is a self-perpetuation of this myth; people assume that BIPOC do not get it and then discount cases that don’t fit their preconceived notion.
Of course, these misconceptions cause the BIPOC population to be underserved regarding getting a correct diagnosis and subsequent eating disorder treatment when they suffer from bulimia nervosa. By understanding that bulimia nervosa can affect anyone, anywhere, and refusing to ignore its symptoms based on ethnicity or wealth, we can hope that moving to the future, proper treatment is available for all who need it.
MYTH: Bulimia Nervosa Only Affects Women
In a similar vein, the predominant perception is that men don’t get eating disorders. While it’s true that women display disordered eating behaviors at a much higher rate than men, there are still millions of men who struggle with their body image, eating patterns, and exercise compulsions. Studies performed over the past few decades have shown that while eating disorders affect women more than men, the number of men who suffer from bulimia nervosa is significant. It’s estimated that as many as 750,000 men will experience bulimia nervosa at some point in their lives, as compared to as many as 4 million women.
The number of men with eating disorders may also be much larger than what these studies reveal. In the United States, at least, there is a social stigma attached to the concept of men having an eating disorder or a distorted body image. All people with eating disorders feel a sense of shame at times concerning their eating behaviors; for men who want to be perceived as “macho” or tough, admitting these emotions and behaviors may be even more difficult than it is for women.
Eating disorders are also much more frequent in gay men and trans men than in the straight cisgender population. These groups are often doubly underserved when it comes to eating disorder treatment. They are facing the stigma that affects other men as well as the discrimination society still hands out against the LGBTQ population. That’s why gender-affirming care and LGBTQ-informed treatment are “musts” at any modern eating disorder treatment center.
MYTH: Bulimia Nervosa Is Only Dangerous If the Person Is Visibly Thin
People with bulimia nervosa often have a distorted body image that makes them think they are overweight or otherwise flawed; it’s not the only causative factor in bulimia nervosa, but the urge to remove calories and remain thin is an important one. The goal is to eliminate calories taken in during a binge eating episode and avoid gaining weight. In some extreme cases, this can lead to weight loss and becoming medically underweight, but this is the minority of cases.
Unlike anorexia nervosa, weight loss and inability to maintain a certain body weight are not diagnostic criteria. Many people who are in eating disorder treatment centers with bulimia are of average weight or even overweight. This may prevent some doctors from making a correct diagnosis if they are not properly informed about what bulimia nervosa “looks like.” At any weight, however, many negative health consequences can arise.
The repeated cycle of binging, purging and dieting puts great stress on the body and its systems. Dehydration from vomiting can cause electrolyte imbalances that cause fatigue, dizziness, and even strokes. Binge eating episodes often involve unhealthy junk foods which can contribute to high blood pressure, heart disease, and type 2 diabetes. There is also a risk of damage to the esophagus and teeth from frequent vomiting.
No matter the size or weight of a person with bulimia nervosa, the health risks are there. For this reason, the awareness that bulimia nervosa has no standard “look” is essential in getting the highest number of people help who need it.
MYTH: People With Bulimia Nervosa Always Purge by Vomiting
Self-induced vomiting is the most well-known form of purging related to bulimia nervosa. Most likely, if you ask a person who has no experience with the disorder, it’s the first thing they would mention. However, there are various forms of purging which might be used in addition to vomiting, or separately. A person with bulimia nervosa might never induce vomiting, or they may use another method when the sounds or odors would reveal their disordered eating behaviors. More discreet purging techniques allow these individuals to mask their disordered eating behaviors.
These methods include abusing several kinds of medicines. Laxatives and diuretics, which respectively increase defecation and urination in a person, are often abused by people with bulimia nervosa since they flush the gastrointestinal system. Also common is the practice of exercising to the point of excess. Exercise addiction or compulsive exercise is another form of purging that is easy to miss. In our society, exercise is usually looked at as a universally positive thing. However, people with eating disorders often exercise past the point of pain or injury. It can become a compulsion, causing the individual to miss social functions or important work dates. Mindful movement classes are usually part of a comprehensive bulimia nervosa treatment program for this reason.