Stigma: Anorexia Vs Bulimia and Binge Eating Disorder

Every mental health problem has a troubling mist of stigma surrounding it, but recently I have noticed that not all stigmas are created equally, and often the level of judgement varies depending on what condition that judgment is focused on. 

It isn’t even as simple to organise as “personality disorders get this level of stigma and mood disorders get this level”, because the amount of stigma can vary even between conditions of the same category, especially, I have noticed, when it comes to eating disorders, more specifically, anorexia, bulimia and binge eating disorders. 

I am sure there are exceptions out there but as a broad overall in my experience, I have found that the stigma surrounding bulimia and binge eating disorder (henceforth referenced by its acronym BED), is a lot worse than that existing around anorexia, and considering they are both so similar in being considered under the umbrella category of eating disorders, it makes me wonder why that is. 

I hate to say it but the level of judgement isn’t even exclusive to people who don’t know anything about mental health, and I have found it is incredibly prominent in the world of eating disorder sufferers themselves. 

For example, over the years in various groups and hospitals, I’ve met a lot of people with anorexia and I have found that many of those people actually had the fear of becoming bulimic or having BED as one of their reasons to fear recovery from their anorexia. I even remember one particular incident in treatment where a new patient asked another patient if their eating disorder was bulimia and the insinuation that that could be the case was taken as extremely offensive. Obviously it isn’t exactly polite to go wandering around introducing yourself by asking people intrusive questions about their mental health, but that wasn’t the part of the question that was taken as offensive, it was the bulimia part, and I know for a fact that had the question been “do you have anorexia?” the reaction would have been more “yes I do but blimey that is a bit outright as a question, we haven’t even had a cup of tea together yet” rather than “how very dare you accuse me of such a thing”.

I suppose in life it is common to fear the unknown, so it is more likely you will fear something that you haven’t experienced as opposed to something you live with everyday. 

For example I used to be terrified of blood tests but now I have them every few weeks and am not scared of them at all. Indeed I am quite the professional and can now have blood taken whilst remaining perfectly relaxed and without so much as a shudder (as long as that blood is being taken by a professional using one of those syringe things…I don’t mean I am cool with having people stop me in the street and attack me with a chainsaw…I imagine that would result in quite a lot of shuddering so please do not do that to test my statement because I will certainly shudder and you will certainly get arrested).  

Still, as much as that would make sense for people who don’t already have eating disorders, it seems a bit odd for someone who is familiar with the life of living with an eating disorder that is trying to kill you, being so scared of basically an eating disorder trying to kill you with a different name. It’s a bit like the experience of having a tabby cat, living with a tabby cat, yet still fearing ginger cats when really it is the exact same thing only with a slightly more tangerine-esque glow. 

I actually don’t think the fear of the unknown is really a part of the increased stigma around bulimia or BED versus anorexia at all though, rather I think it has to do with the fact that so many traits and behaviours that are associated with anorexia are praised in society.

Despite the fact that not all people with anorexia are underweight and, contrary to popular belief, people with anorexia DO eat, as a general consensus, people associate being anorexic with losing weight, being thin and never letting a morsel pass your lips, three things that are seen as good by most people. 

Think about it, when it comes to all of those diet clubs out there like Slimming World and Weight Watchers, you get things like certificates and “I lost half a stone” keyring prizes for losing weight and I am pretty sure they only hand out certificates in life for things that you are supposed to be proud of. When I was learning to swim as a child at least, they certainly didn’t hand out prizes for the person who was drowning in the bottom of the pool (which is understandable as that is not exactly the aim of a swimming lesson but still a bit sad as it is the person who was drowning at the bottom of the pool who could use a bit of cheering up with a certificate, as opposed to the person who managed to swim a perfect ten lengths of front crawl…what do they need cheering up for? Isn’t it enough not to have water up your nose? Kids today are so ungrateful!). 

Similarly, as I have mentioned before, in society we have this weird obsession with associating refusing a piece of cake at a birthday party as “being good”, while those of us with icing on our chins are doing something “naughty”, so the idea that anorexic people don’t eat unhealthy foods is similarly admired, rather than feared as a sign that someone is potentially starving themselves to death. 

Anorexia is often seen as a sign of strong self control, whereas bulimia and BED on the other hand is associated with things like a lack of control and even more infuriatingly, greed/gluttony. These two things are so opposite to being admired that they are two of the seven deadly sins for goodness sake, and it drives me up the wall, back down round Tottenham and up the wall all over again because neither bulimia nor BED are anything to do with greed or gluttony. I am seriously considering getting that as a bumper sticker so that at least whilst I am doing all this being driven mad I am educating people along the way, although I would really rather not drive at all because I do not have a license and petrol is incredibly expensive. 

If a person with bulimia or BED goes around a supermarket and buys a lot of unhealthy food to binge on or eats excessive amounts to the point that they are compelled to purge (or not), it is not out of personal want or greed, it is because they have an eating disorder in their head that drives and compels them to do so. It is not the person with the disorder in control thinking “ah this will be a lovely way to spend an evening, I thoroughly enjoy a few hours weeping into a toilet with a throat as raw as sandpaper”, it is the disorder that is at the steering wheel, and when people are attempting recovery it is more about learning to steal that control back from the disorder rather than trying to control their personal desires. 

Similarly, anorexia is nothing about self control and I would even argue shows an extreme lack of control. You can praise people for not dunking a hob nob in their morning cuppa all you like, but how in the hell is it a sign of good self control to be incapable of eating and starving yourself to death? Who would give a certificate out for that? (I realise this may sound hypocritical considering I was arguing that we should give prizes to people drowning in a swimming pool five minutes ago but let’s just set that example aside for the time being…). Much like the person with bulimia, when I struggle to eat I do not feel in control of the situation and I do not look forward to an evening crying over a bowl of cereal, excitedly clapping my hands at the prospect of a few hours staring at a Weetabix. 

Bulimia, BED and anorexia then are, despite the varying stigma, very much the same and very similar in that they are about wrestling with a deadly eating disorder. That’s it. It doesn’t matter that two of the disorders are known for expressing themselves via binging and possibly purging, whereas the other has its name up there as a sign of a lot of lettuce and weight loss. Aside from the treatment required, the expression of the disorder has nothing to do with it just as the colour of a ginger cat means nothing next to the tabby, THEY ARE BOTH JUST CATS AND BULIMIA/BED/ANOREXIA ARE ALL EATING DISORDERS. Both bulimia and BED are as much about greed as anorexia is about self control, aka they have nothing to do with it, and I really think we need to spread that message to stop the level of shame surrounding such disorders. 

Admitting you have an eating disorder is hard and embarrassing, but it is even harder and even more embarrassing when you have extra stigma piled on top just because of the name of your condition. If bulimia and BED are portrayed as about greed and shame, people are far less likely to admit to having a problem and seek help which is incredibly dangerous as both disorders are serious, they are deadly and can be fatal with complications caused by things like electrolyte imbalances, heart attacks and other consequences of recurrent purging, so seeking support for these conditions is as important as seeking help for any restrictive disorders. We need to stop the judgement and discrepancies between different names for eating disorders and need to see them back under the same deadly umbrella, they are ALL serious, ALL dangerous, and ALL are worthy of the help and support needed to get better. 

Take care everyone x 

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Eating Disorders And Gender Identity

As you can probably tell from reading my blog, I am pretty open about my mental health, and I suppose, by putting my life online, you could argue that I am pretty open and honest about most things I experience. Nevertheless, there is one aspect of my identity that I have kept secret for years, not just online but with friends, something which I have only spoken about to my mother and certain therapists. In the past few weeks I have been asking myself why this is, and the answer to that is fairly easy (far easier than answering the question what is 4504 divided by 789 at least…NO CALCULATORS PLEASE), that being that I fear judgment and still see this aspect of myself as somewhat taboo. 

However, I have started to realise that by keeping this part of me on the “down low” because I feel embarrassed, is only perpetuating the idea that this “secret” is something I should be ashamed about, and that isn’t going to help anyone out there struggling with the same thing. What if there are people who are feeling as uncertain as I am about things but who are scared to speak out? What if they feel as alone as I do?

Ok, so it is probably time for me to stop beating around the bush and get on with the topic (the bush is fairly battered by now…there are so many leaves about I can barely see the keyboard…sorry bush, you didn’t do anything wrong…not that if you had done something wrong that would be an acceptable reason to beat you…I don’t condone violence of any kind…gosh I feel I might still be beating around the bush…SORRY AGAIN BUSH). 

The topic around which my “secret” revolves? Gender, though more specifically, my personal gender identity and how that affects my mental health and experience of anorexia. 

As you have probably all assumed, I was born and am biologically female, yet I do not see myself that way. In all honesty I feel quite ill when people refer to me as “a woman”, and every time a stranger refers to me as a “lady”, I feel physically sick. Saying this may make people think that therefore, inside, I see myself as male, but again this is not the case. With regards to my gender, I do not feel like a woman (just one of the many personal emotions Shania Twain and I disagree upon), nor do I feel like a man, in truth, I feel simultaneously like neither and both all at the same time. Thankfully more and more people are talking about gender these days what with the transgender FTM/MTF bathroom debates going on in the US, and there are even labels out there to describe people like me who do not see themselves as belonging in either of the binary box options presented on health forms. Names like agender/gender-non binary/genderqueer/gender neutral are now words many people, rather than just those whom they affect, are familiar with, and there are even more pronoun options and gender identities available in the “about me” section of your Facebook profile. Which of these “non binary terms” I best identify with I am still not sure as I find my gender identity rather confusing. 

The one thing I know for certain however, is that I am not female, and having a biologically female body has had a bigger impact on my anorexia than most people would understand. 

I have written before about how anorexia functions in my life, as a sense of achievement, sense of control, friend, identity and many other things that make it a lot more complicated than the common understanding of “people with anorexia just want to be thin”, but the other way in which anorexia functions for me is as a way of trying to minimise the “femaleness” I am uncomfortable about in my body. 

I see a lot of females on recovery websites listing perks of recovery to motivate themselves and others to keep fighting their demons, and more often than not one of the things on this list will be “recover to get your boobs back” (for when a person’s eating disorder leads to weight loss/becoming underweight, “boobs” are obviously a part of the body that will undergo some shrinkage.) Indeed I have known people whose cup size has fallen several letters of the alphabet due to their eating disorder (side note: who the hell coined the name “cup size” as a way to describe the space taken up by a boob? Why don’t we just say “boob size”? Who the hell is putting their boobs in cups? Don’t people realise those things are for drinking out of not measuring body parts? You don’t call your shoe size your “colander size” do you? No! So what is this…SOMEONE EXPLAIN). 

This loss of BOOB SIZE is often met with discomfort and people saying things like “I don’t feel female anymore” as if that is a bad thing, when for me, that is part of the point. For this reason, people trying to motivate me to recover by saying things like “recover for boobs” or “recover for curves” is more like a threat of “if you gain weight you are going to have to wear massive bras and stop running for the bus incase you knock yourself out with a rogue breast”, so I often find that I cannot relate to people with eating disorders despite sharing a diagnosis. 

In a way the idea of my chest increasing in size shouldn’t scare me as much as it does, as, in terms of revealing another aspect of myself that people are unaware of, I actually wear a binder rather than a bra. 

For those of you who don’t know, a binder is basically a very tight vest like thing that “binds” your chest somehow (magic and wizardry I think), to give you the appearance of a flat chest, and it is often a thing warn by transgender men. Indeed it was from a trans man that I myself first heard of such a garment and immediately picked one up because I too hated my chest. What I couldn’t relate to with this trans man however, was the need for things like testosterone hormone injections and a desire for facial hair, and it is there that my confusion of “what the hell gender am I then” began. 

I have worn my binder for six years now at both healthy and underweight BMI’s, so I know that technically, no matter how far I am in terms of physical recovery, when I have to go out in public I do not need to worry about my chest. At either weight I know that my binder will give me the appearance of a flat chest, but I also know that I cannot wear my binder in places like the shower which is where the appearance of my chest really bothers me. 

I know that in the past when in the process of getting to a healthy weight, one of the main parts of my body I have feared gaining weight on is my chest, and my bare chest makes me so uncomfortable that I have often refused ECG tests in the past to check how my eating disorder is affecting my heart (these scans are apparently very clever but involve you having to be naked from the waist up…not that clever in my opinion then). 

It has caused such issues in hospital before that even nurses have been confused and contemplated forcing me to stop wearing a binder as they wonder if it could actually be an eating disorder driven choice to “make me look thinner”. People have also suggested that me wearing a binder could link to my desire to remain a child and not grow up into the scary world of adulthood, but as possible as that is, it doesn’t explain the other issues I have with regards to being called “lady”, “she” or even “daughter”. You might not have noticed but if you look through any of the posts I have written previously mentioning my mother, I always refer to myself as her “offspring” and never as “the D word”. Maybe you thought that was just because I wanted to sound fancy, but in actual fact all of those instances were me trying to write on my blog honestly whilst keeping a secret, which is sort of like trying to make a cup of tea without any tea leaves. 

Other things I have seen on websites to motivate females to recover is the idea of getting their menstrual cycle back/being able to bear children, yet again this possibility is something from which I want to run away in fear rather than welcome with joy. When I lost my menstrual cycle I was secretly thrilled and as terrible as this sounds the idea that eating might make my womb work properly was terrifying. I feel so guilty saying that, as I know there are so many women out there who can’t have children so I shouldn’t be wishing my fertility away in such a manner, but I can’t help it, I don’t want a womb and I do not want a monthly reminder that I am trapped in a female body with no escape. When I was told I had osteoporosis (caused by the lack of periods), I even refused to take oestrogen hormone replacements because the idea of getting my menstrual cycle back was more frightening than the idea of breaking my spine, and my google search history has more searches like “can you get a womb or breasts removed” than I care to count.

Unfortunately, I realise that yet again it is one of those “here is a mental illness problem people struggle with” without any conclusion or advice to support those out there struggling with the same thing, which sucks because I know how horrible and complicated this whole relationship between eating disorders and gender can be. That said, considering I don’t fully understand my gender identity in relation to anorexia myself, I would be hard pushed to say anything of any worth, yet still I wanted to write this post if only to get the topic out there and the conversation started. I haven’t come to a conclusion as to “what” I am and I haven’t given advice on how to manage an eating disorder when gender identity is one of the things causing problems with recovery, but I hope I have at least shown another aspect of how complex mental health problems like eating disorders can be, and done something to dispel the idea that they are simply a case of going on a diet that gets out of hand to look as thin as the people in the magazines. More importantly though, I hope that I have made anyone else who feels as confused and alone with this as I do, feel a little less weird, knowing that someone out there does understand, and that though they are also confused, at least you are confused together. Maybe the more people who talk about it the more research will be done and the more will be understood, so as anxious as I am about posting this, I am doing it anyway to add to the voices of those telling professionals that this is a problem only to receive responses like “I have never heard of this happening before”. As I always say, when it comes to mental health problems nobody is weird or a freak, and none of you are alone in any of your struggles.

Take care everyone x

Gender

A Message To All The People Out There Who Are “Pro-Ana”

Before I get on with the main bulk of this post I just want to preface it by clearly stating the fact that eating disorders are not a choice and are horrible illnesses that barge into and take people’s lives without those people having a chance to stop the aforementioned barging. However, as involuntary as eating disorders are, there are some people out there who for some reason see them as a glamorous and desirable life choice/thing to aspire to. It is to THESE people and not all involuntary sufferers out there, to whom I address this post. All clear? Cool, let’s get on with it…

In life, there are many types of people that I do not understand. For example, I do not understand people who eat a piece of Christmas cake and leave the icing/marzipan behind (THAT IS THE BEST PART WITHOUT THAT IT IS JUST RAISINS), neither do I understand the people planning to vote for Donald Trump in the upcoming election. Possibly the most confusing people to me however, are those who frequent “pro anorexia” websites online (yeah. That’s right. They confuse me even more than Donald Trump supporters. At least Donald Trump has floppy hair you can laugh at when he is spouting bile. Anorexia has no floppy hair and therefore no room for visual comedy). If you didn’t know already, pro-anorexia websites are basically as horrendously sick and disturbing as they sound. Having avoided them like the plague myself, I cannot provide an in depth image as to what they show, but from what I gather it is pretty much a lot of pictures of skeletal bodies that people stare at in order to inspire them to achieve the beauty of collarbones that make you look like you have swallowed a coat hanger. There also may be forums where people can discuss diet tips, encourage each other not to eat and who generally see anorexia as something that is desirable, that they want to have (hence the ‘pro’ in the name).

Now I am not one to tell people what to do. When I do not understand someone’s life choices I am not going to stand in their way and insist they change their deepest desires. Though I do not understand people who leave the icing and marzipan from the top of Christmas cakes (or indeed people who choose to eat Christmas cake when the other option is chocolate log…there is no decision there…obviously it is chocolate log every time), I have never spied an icing abandoner, approached them in outrage and chased them down the street waving the forgotten almond paste and fondant. This is because although I do not understand this behaviour, I trust that they have tried icing before and following the full experience and all the knowledge available, they know that cake without icing is really what they want.
When it comes to people who want eating disorders however, I simply cannot allow myself to sit back and let them make these life “choices”, as in my eyes the only person who would ever make such a decision as to get an eating disorder would be a poor uninformed soul who doesn’t really know what they are getting into. For this reason then, today I thought I would just write a little post to all those people who want eating disorders, in order for them to realise what life with an eating disorder really is like. Basically I am enlarging the font of the little set of “terms and conditions” that accompany the joy of being thin and not eating, so that people can be sure it is what they want. So to all people who want to have an eating disorder, that is cool, but before you go ahead and seek one out, here are a few things that I want you all to know:

1. Eating Disorders are not great for your physical health: Not eating is great and all but it is important to be aware that not eating is potentially fatal and is the reason that eating disorders are the number one killers in terms of mental health problems. Even if you don’t die they will definitely wreck your body, so before investing in an eating disorder you may want to say goodbye to your health first, as lord knows you wont be seeing it for a while. For one thing your hair is going to fall out in clumps, your skin is going to become dry and pale and you will probably have bags under your eyes so big that you can fit a week’s food shop in them (no more paying 5p for a carrier from Tesco for you! Bargain!). You are also going to be freezing cold all the time no matter what the weather, so in preparation you may want to purchase forty to fifty hot water bottles, blankets and thick thermal fleecy undergarments (sexy). This does have the benefit of making you a good pastry chef (as all bake off fans will know, cold hands are essential to a good apple pie), but on the down side you won’t be able to eat that pastry without agonising guilt afterwards… Also you may want to buy a wheel chair or walking stick as eating disorders love to screw with your bones (picture anorexia as a dog having a good old gnaw on your elbow until most of the bone has chipped away, leaving an osteoporosis filled powder). Oh yeah, and if you want kids anorexia will probably render you infertile too, but hey, who cares! You will save a tonne on child care and you get to be thin right? Wrong…

2. Eating Disorders do not make you thin: This disclaimer is a tricky one but allow me to explain. Basically there seems to be this idea that when you have an eating disorder attacking your mind, this will be physically evident in a lot of weight loss. For one thing, not all eating disorders involve weight loss, and for another thing even if they do, you will not be able to appreciate it. Sure you will be able to get on the scales and see the numbers go down but when you look at the reflection in the mirror it is likely you will not see that weight loss at all. Interestingly, when you don’t eat enough and become underweight, self perception becomes more and more distorted, so you may even see yourself as having gained when really the opposite is true. Its just a fun little game eating disorders like to play (the jokers!), so if wanting an eating disorder to “look thin” then maybe look elsewhere in terms of life goals and ambitions as looking thin is not a package deal with an eating disorder. The physical complications mentioned above are a package deal no matter what though, so no worries there.

3. Eating Disorders do not make you happy: Much like the myth that eating disorders make you thin, there is the idea that they will make you happy (probably because there is the association that being thin makes you happy but the happiness idea remains nonetheless). Yeah, if you want an eating disorder because you think it will make you happier, once again I would advise you to reconsider, as being undernourished is actually a way to encourage our good friend depression to join the party rather than the desired eternal bliss. Often anxiety will pop round too, so again be aware that those two delights are part of the package deal. You will often note that in these pictures on ‘thinspiration’ websites there will often be “models” without a face (primarily the images show thigh gaps and rib cages), and the reason for this is because were consumers to see the full image, the whole thing wouldn’t look so appealing. After all it is a lot more difficult to sell the idea of how beautiful a hipbone is when the owner of said bone is crying and waiting for the pain inside to end.

4. Eating disorders will mess up your social life: Aside from the effects eating disorders will have on your body and mood, it is also important to note that they affect your social life, and by “affect” I mean utterly destroy it until you are left all alone. You can have the best friends in the world but ultimately with all the “catch ups over drinks” and “dinner reservations” you will constantly find yourself avoiding them as you cannot join in with any activity whatsoever. You may be thinking “Ok I will ruin pizza night but I can still go out to play mini golf with friends”. That is a really nice thought, yet alas this will get ruined as well. Even if an activity is not revolving around food, you will still not want to go either because you have exercises to do or because you are too miserable, anxious/hate yourself and are too self conscious to socialise.

5. Eating disorders will/are likely to cause some issues in the workplace: Much like socialising with friends, working or holding down a job will also become impossible with an eating disorder, even if your job is not food related. Again we have the classics of depression and anxiety making it hard to leave the house, as well as the required sick days for your battered physique (you may pick up virus’ and illnesses a lot easier than most people due to damaged immune system, so stock up on the cough syrup). Bigger than that however will be the issue of concentration. Yeah…with an eating disorder your ability to function mentally will spiral away faster than water down a plug hole (especially water down the plug hole in your bath remember as all your hair will have fallen out and blocked the pipes with soggy wodges of entangled strands). Ahh, nothing says “living the life” like a Saturday night spent in the house pulling hair bundles the size of kittens from your drain (top tip: if you put goggly eyes on those bundles they look even more like kittens. They are adorable. Great Christmas presents too and December is coming! Get malting!). With mental functioning at an all time low then, it is likely you will lose any job you do have and money problems will likely follow as well as our old pals who love to join money problems for a party, depression and anxiety!

So that is only five of the terms and conditions important to be aware of when wanting an eating disorder (there are millions, trust me), but I think that for now I have made my point/ helped potential eating disorder investors to be a little more aware of what they are desiring/encouraging when scrolling through those pro anorexia websites. Like I said, I am not one to tell anyone what to do so if these points don’t diminish the glamour of the thigh gap photos, then go ahead and have fun. I just want you to know what you are getting yourself into so you can make an informed decision. There are people out there who want eating disorders, but I doubt they would find the unwelcome surprises that come with them as appealing.

Take care everyone x

pro-anorexia