Word Vomit
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Up until I read Perfect I had never heard of bulimia. But I had struggled with body image issues my whole life. Given my childhood full of anxiety and trauma, I had learned to turn to food to cope. My mother and other family members calling me fat and publicly humiliating me every time we went out to eat did not help. So while I did not share Isabel Lee's eating disorder at this time, I felt like I knew what she was going through. I too, had felt shame and embarrassment about the way I looked. I too, was going through family problems and felt major anxiety.
In the novel Isabel Lee's mother finds out about her bulimia and makes her go to therapy to get help. Once in therapy she realizes the most popular girl in school, Ashley, is there, and also has bulimia. They become friends and as the story goes on Ashley loves having someone she can binge and purge with, but Isabel soon realizes this is not the way to live, and she sees that Ashley is not as perfect as she thought she was. It is alluded to that Isabel has decided to start taking her recovery seriously. It was a nice note to end on, and at the time 13 year old me thought it was the right thing for Isabel. Unfortunately, not everyone gets that happy ending. In fact, 6.2 million people in the United States, both male and female, will suffer with bulimia in their lifetimes. And out of those people only 1 in 10 will receive treatment for their disorders. Bulimia is caused by a mixture of genetics, environmental factors, and temperamental tendencies. Many with bulimia have co-existing psychiatric conditions, most likely anxiety or depression. Bulimia is a compulsion and often affects those who cannot regulate their emotions well or those who have 'all or nothing' personalities. Bulimia is more prevalent in Latinos and African Americans. Of those that do receive treatment 30-50% will relapse. The most common cause of death associated with bulimia is suicide. The average age of onset is the late teens. I was 14.
When I went away to boarding school, I was finally alone. Yes, I lived in a house with 11 other girls, but I was alone in the sense that I was not around anyone that cared for me or looked after my well being. At 14 years old and 5 feet tall, I weighed 160 pounds. I was a fat kid. And I was tired of it. I was already stressed out about being in a new place on my own, and I was tired of hating the way I looked on top of that. I decided to do something about it, and began purging.
My bulimia was a bit different than the normal bingeing and purging. I did not binge, instead I ate what was given to us (we were only allowed to eat what they gave us at the time we were being fed) and purged whatever that was. I skipped breakfast and ate lunch at school and purged in the restroom. Every night after dinner, I would go to the restroom and purge. This started in September of that year. When I went home for Christmas break I weighed 124 pounds. I think normal, loving people would have been concerned for me. When I arrived home, my family was elated. Everyone from my mother, to my third cousin, spoke about how beautiful I looked, a lot of them actually came out and said things like, "Wow! You aren't fat anymore!" and hugged me like I had saved the world. It was such a strange experience. I went to the doctors that break as well, for a check up, and to my surprise I was congratulated by the doctor for having lost weight. Ironically, he said I was now a 'normal, healthy, teenager'. I was flabbergasted. On one hand, I was glad nobody was catching on to my secret because I was happy with the way I looked. On the other hand I was horrified at how everyone, even a medical professional, was congratulating me just because I looked a certain way, without even pausing to think about how I might have gotten there. But when everyone is dancing around you, you get the urge to dance too.
A lot of people say bulimia is the easy way out, and from the outside looking in it does seem that way. You can eat whatever you want, and then throw it up after, essentially erasing the consequences of those calories. But let me tell you, it is not the easy way out. You are always and I mean every second of every day, starving. And it is not just your body that is starving physically, it is your mind. You are aware of your deprivation, All you can think about is food, whether someone is kissing you, whether your best friend is mad at you, or whether you are taking a test. You count the seconds, the minutes,the hours, until you can eat again. And when you finally eat again, that is when the anxiety comes creeping up. Anxiety about what you ate. Anxiety about how much you ate. Anxiety about when you can get rid of it, where can you get rid of it. Will someone see you going to the restroom? Will someone be in the restroom and hear you? Will the bell ring before the bile that signals your stomach has nothing left to give comes up your throat and into the toilet? Will you have time to wash the vomit smell out of your mouth? Will the soap be enough to get the vomit smell off your hands? Speaking of hands, will anyone notice those callouses forming? Will they notice the red spots in your eyes from the blood vessels that popped as you were purging? You continue long enough, you stop caring what you look like. As ironic as that sounds, eventually it is not the outside that matters, not completely. Eventually it is the compulsion that takes over, and nothing else matters. All I could think about was purging, when I was not thinking about food. Even when my nails became brittle, my hair started falling out, my hand was full of callouses, and my skin had a yellowish tint, I did not care. I was happy. I was thin. And I would have given up anything to stay that way.
The girls I lived with knew I was bulimic, and they did not give a rats ass. At the time I was happy about that, but looking back now I think that is really fucked up. When I transferred to another program and a different school it was even easier to keep my secret. Because I was the oldest girl in the house, I had seniority in terms of boarding. I had my own room and bathroom. I count myself lucky in that, although they never found out, I did have those girls that cared about me, and would have stopped me. But nobody found out and I was alone in my shame. Despite being beautiful, despite having the social life and romances I dreamed about as a fat girl, I was exhausted. The bulimia was taking a toll on my mental and physical health. But I kept on, afraid to lose all that the bulimia had given me, and I kept on right up until graduation.
When I came home for college, I had to stop. My grandmother heard me the first time I tried to purge and she did not like it. Despite her being one of the many family members that congratulated the new me so many years before that, she did not want the ugly reality in her face. So I stopped, for a while, but I soon figured out that my music and the shower drowned out the sound of my purging. I do not purge like I did before, but the urge is always there. Sometimes I give into the urge. It is usually when I feel too full, or I feel like I ate too much. I begin to feel sick and I do not feel better until I let it all out. Unlike before, I do want to stop eventually. I know if I do not it will kill me. A lot of bulimia sufferers die from cardiac arrest, and I was born with a heart problem. I have noticed the effects of this illness already. Most of the enamel on my teeth is gone, and my teeth are discolored slightly because of all the acid from purging. I have terrible gastrointestinal issues and cannot eat a lot of things without getting ill. Most frightening is the way the bulimia has impacted my brain function. My memory is shot, I cannot remember anything long term, or anything from the past without being reminded. I have a hard time concentrating and a hard time learning new things. I have difficulty thinking and making decisions. You can learn more about how bulimia impacts the brain here.
I do not know how this story ends, only time will tell. I do not know yet if I am an Ashley or an Isabel Lee. But I am thankful to have a way to expel these thoughts. This blog is as much about healing as it is about connecting with you. I hope that in sharing my story someone reading this will know they are not alone in their struggles. As always friends, thank you for reading.
“You think you're the only one? Everyone has scars. We just don't all wear them on the outside.”
― Natasha Friend
Research
Marques, L., Alegria, M., Becker, A. E., Chen, C., Fang, A., Chosak, A., & Diniz, J. B. (2011). Comparative Prevalence, Correlates of Impairment, and Service Utilization for Eating Disorders across U.S. Ethnic Groups: Implications for Reducing Ethnic Disparities in Health Care Access for Eating Disorders. The International Journal of Eating Disorders, 44(5), 412–420. doi:10.1002/eat.20787
Mortality and Eating Disorders | National Eating Disorders Association. (n.d.). Retrieved August 30, 2015.
Rushing, J. M., Jones, L. E., & Carney, C. P. (2003). Bulimia Nervosa: A Primary Care Review. Primary Care Companion to The Journal of Clinical Psychiatry, 5(5), 217–224.
Smink, F. R. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of Eating Disorders: Incidence, Prevalence and Mortality Rates. Current Psychiatry Reports, 14(4), 406–414. doi:10.1007/s11920-012-0282
