‘I have bulimia’- How one UEA student conquered her demons.

On Wednesday, I had my tenth treatment session. It was also my last, and coincidentally falls in Eating Disorder Awareness Week. Hello, my name is Sarah, and I have bulimia nervosa.

The NHS definition of Bulimia Nervosa

When I was twelve, I saw a documentary about eating disorders online. Like many people, the idea seemed entirely irrelevant to me; I didn’t understand how someone could permanently restrict their eating by choice, or how it was possible to have a fear of one of our basic needs. I liked food. I liked spaghetti, cheese, ice cream and cake – cake most of all. But I was also insecure. Like seventy percent of girls in my age group, my relationship with my body was my greatest source of anxiety. I thought my stomach looked bulbous, and I had already gone full days without eating because I thought that’s what normal people did to avoid the evening food baby.

The truth was that I had a healthy BMI, and my body was no better or worse than that of any of my classmates. Eating disorders are typically divided into two categories: anorexia nervosa and bulimia nervosa. There are actually many other types, and the categories often overlap and merge into one another. BED (Binge Eating Disorder) is one, as is EDNOS (Eating Disorder Not Otherwise Specified). Many anorexics purge to maintain a low weight, and many bulimics don’t vomit, but instead fast intermittently or use laxatives.

This lack of awareness commonly leads people to believe that they don’t have a serious problem, because their symptoms don’t fit within one particular category. But since eating disorders have the highest mortality rate of all mental disorders, I would personally advise such people to take the side of caution. I dieted throughout my teenage years, and I hated it. The harder I tried, the more I wanted what I was trying to refuse. I had read and seen programmes about bulimia nervosa – most people had. But where other people would see the teenager with their finger down their throat and say ‘I couldn’t do that’, to me the idea looked appealing. It was a way that I could lose weight, but still eat; the unpleasantness of throwing up was only a minor disadvantage, and one which I could ignore.

Sarah at the peak of her illness.

I started vomiting when I was seventeen. I didn’t throw up everything. I would restrict as much as I could, and if I binged (which I inevitably would, either objectively or subjectively), then I would bring it up again. To me, dieting was either eating nothing, or so little that I couldn’t feel full by the time I finished. The sensation of emptiness felt like success. It became my sole objective: everything else was irrelevant, including studies, friends, health and relationships. In 2008, Bewick et al carried out an internet-based survey of mental distress in students in four UK higher education institutions. Twenty-nine percent described clinical levels of psychological distress. In 8%, this was moderate to severe or severe. In fact, with adolescence being the peak age of onset, eating disorders are especially prevalent amongst students, and new undergraduates in particular.

I became severely depressed within two months of arriving at university, and my eating disorder became unmanageable. I was throwing up on a regular basis, and not only after binging, but often after eating anything at all. Most of my purges were induced by stress and self-hatred rather than having eaten beyond any specific amount. I had parts in several drama productions, and I would regularly skip rehearsals because the vomiting became uninduced and automatic, or because I felt too ashamed to be around people in my own skin. I wore baggy clothes, even in summer, and spent as little time socialising as possible. I assumed people didn’t like me because I was elusive, or because of my appearance. I stayed away from them as much as I could to avoid confronting their imagined disapproval. My weight fluctuated whilst remaining within a healthy BMI, and I grew impatient.

What many people don’t realise is that most bulimics don’t lose but maintain their weight, and you don’t have to be less than 110lbs to have a serious eating disorder. Amongst the others I knew with a similar condition, I can’t count the number of times somebody was told ‘You don’t have an eating disorder; you’re not thin’. EDs are often the byproduct of underlying psychological issues, and sometimes manifest as a physical SOS. To quote from an episode of HBO’s Girls, ‘I want to be so small people ask me if I’m sick’. I stopped vomiting in the summer, 2012. Nobody could ever say that I was not self-aware. I knew what my actions meant, though I assumed that to call myself bulimic was overly-dramatic. But purge-type bulimia wasn’t making me any thinner, nor any happier.

One of several types of Bulimia Nervosa

I tried what I thought of as a ‘spin off’ of my condition, better known as ‘chew and spit disorder’. The concept is mostly self-contained; I would chew something and enjoy the taste – something chewy that couldn’t melt – and then I would spit it out again. It was another way to enjoy food without the calories, and it became almost a hobby. As long as I wasn’t swallowing, I thought, I could eat as much as I wanted. My overdraft disappeared, and I was spending up to £30 a day on food which would end up in a Tesco bag in my bin.

As can be expected, I did not lose any weight during those few months. But I was going on holiday in September, and I needed to do something. By that time I was active on several different online communities including PrettyThin, where I met a girl, Anna*, who agreed to be my ‘coach’. The plan entailed alternating between complete fasting and a maximum intake of three hundred calories, as well as at least one thousand five hundred calories worth of exercise everyday. I wasn’t allowed to sit down, and she would talk to me until 4am about our plans for the next day. I had to take pictures of my stomach when I binged, and I would cry and she would tell me that if I didn’t then she would stop helping me and would hurt herself as punishment.

Sarah’s online ‘coach’ Anna- whom she has since blocked- quickly became controlling.

I realise in retrospect how naive I was with Anna, but I was desperate. I was losing weight, but it wasn’t sustainable. Of course I binged. Binges happen when our blood sugar levels dip or become inconsistent, and I was taking extreme measures. I would binge, and then I would exercise until it didn’t matter. I wouldn’t tell Anna; I was too humiliated. Eventually I had to block her and dissolve all contact because I didn’t know what else to do, and my body was devastated by its treatment.

Anna began to entice Sarah to spend an unhealthy amount of time exercising.

Throughout my second year I tried what I considered to be a makeshift recovery. I became a vegan as an excuse not to eat my ‘trigger foods’, but what I was eating was a healthier amount. My weight stabilized, and even dropped a little. But this was short-lived, and my depression returned. I wanted to disappear. When I did things which hurt people, I showed them how sorry I was through the degradation of my own body. I stopped eating for weeks at a time, and lost a lot of weight. I looked ill. That was what I wanted. But such extreme measures are never sustainable. The survival instinct is strong, and our bodies are capable of extreme determination.

The first objective binge that followed my starvation cost two weeks’ worth of my budget, and the packaging filled up the bin. I put all the weight back on and more, because that’s what happens when we fight against ourselves. My body wanted to survive despite myself.

Sarah (right) is now in recovery.

In October 2013 I got into a relationship with my best friend and housemate. Until then I had assumed that nobody would want me, or anybody who did wouldn’t be able to sustain seeing somebody who didn’t have the confidence even to see her own body naked. But he had known me through some of my worst moments, and he supported me and encouraged me to seek treatment. I was accepted by the Norfolk Eating Disorder Service soon after, and officially diagnosed as one of the 1.6 million people in the UK with an ED.

It has only been ten weeks since I started recovery. My weight has stabilised at a healthy BMI of 23, and I no longer obsess about food or plan meals while I’m already eating. I haven’t binged objectively since November. I’m slowly learning to trust people and enjoy socialising with my friends, and I can wear figure-hugging clothes without crossing my arms over my stomach and sucking in. I’m not thin. When I go on holiday this summer, I won’t be worrying that my thighs touch at the top, or that my ribs don’t show in a bikini. I am human, and this is what an average, healthy human body looks like. I am more than my weight: I am the person who can enjoy dates out with her boyfriend, go dancing with her friends and study hard for a good degree. Hello, my name is Sarah, and I am in recovery.