Growing up, Equip Peer Mentor Makailah Dowell remembers learning about the dangers of just one type of eating disorder. “I was taught anorexia is an awful and deadly disease,” she says. “It seemed that bulimia was less dangerous than anorexia, a myth that made it easier for me to let it into my life.”
Dowell says that because no one ever explained to her the dangers of bulimia, she wasn’t aware of the insidious aspects and potentially fatal consequences of the illness—and neither were her loved ones. “My grandmother thought it would be easy to tackle my bulimia and understand how to prevent and stop it,” she says. “But she didn't know my eating disorder could thrive in new ways. Like all eating disorders, bulimia is embedded in secrecy, and I got creative with my dishonesty.”
Given her personal experience, Dowell believes that one of the biggest myths about bulimia is that it’s easy to identify s. The truth is, bulimia is a complex disorder and can manifest in a myriad of different ways. While people of any size can suffer from any eating disorder, individuals with bulimia are even less likely to exhibit weight-related symptoms than individuals with anorexia, which can make the illness harder to identify. According to one study, about 65% of people with bulimia are considered “normal weight” and only 3.5 percent are “underweight.”
But that’s just one of the many myths that continues to keep bulimia a mystery to so many, and keeps so many struggling without treatment. Here, Dowell and two of Equip’s experts break down — and bust — the most common bulimia myths.
Myth #1: If someone has bulimia, they’re by definition thin
One of the most harmful and pervasive myths about bulimia is the belief that it only in affects one particular demographic, a myth that persists for a number of reasons including media representations and lack of research in diverse groups.
“There’s a myth that bulimia only affects young, white girls, yet actually it’s equally prevalent in all races and ethnicities, with a slight increase in prevalence in Black and Hispanic adolescents,” says Equip Senior Vice President of Clinical Programs, Cara Bohon. “And although the onset of bulimia peaks in late adolescence, it can occur throughout a person’s lifespan.” Bohon also points out that although the rate of bulimia is three times higher in females than males, “a substantial number of males do suffer, and likely a greater number of transgender or gender non-conforming individuals, as data suggest rates of eating disorders are five times higher in that population.”
Dowell says that when she was suffering with her disorder, few people would have suspected she had bulimia. “No one assumed that me, Makailah Dowell, who wears size large shirts and eats lunch at school everyday, would actually have an eating disorder,” she says. “No one would have assumed I was acting so intensely on my eating disorder behaviors that it hurt while also smiling everyday at school and eating normally in public. People tend to believe that you need to be relatively small to have bulimia.This was completely untrue for my story. Anyone can have this eating disorder.”
Myth #2: Bulimia isn’t as serious an illness as anorexia
“This myth is harmful because it creates a narrative that if someone is at least eating, then it's ‘not that bad,’” says Equip Director of Therapy, Reggie Ash. “This is false in so many ways. Someone diagnosed with bulimia has both physical and psychological concerns, both of which can lead to long-term health problems or even death—just the same as anorexia. To compare and say one is more severe than the other isn't true.”
Bohon says that because people with bulimia may not appear visibly ill, it can be difficult for others to understand the severity of their illness. “However, there are many health consequences and risk of death in bulimia,” she says. “Electrolyte imbalances caused by purging can lead to heart or organ failure and death. Dehydration, throat damage, stomach damage, and other serious health consequences occur. Additionally, suicide risk is higher in those with bulimia compared to the general population.”
Myth #3: Vomiting is the only form of purging in bulimia
When most people think of bulimia, they think of episodes of binge eating followed by self-induced vomiting to purge the food. And while bulimia is characterized by episodes of binge eating followed by purging, that purging may or may not take the form of vomiting. Other versions of purging include use of laxatives, enemas, or diuretics in an effort to eliminate food they’ve eaten from their bodies. In other cases, people may not “purge” in any of these ways, but rather fast for prolonged periods of time or engage in excessive exercise to “compensate” for their binges.
Ash says this misconception about bulimia can lead people to minimize the symptoms and severity of the disorder. “Someone may think everything is fine’ because the person isn't vomiting,” he says. “This thought then causes someone to overlook the overexercising someone may be doing, or their use of laxatives or diuretics.”
Myth #4: Bulimia is all about an inability to control overeating
While some people believe bulimia is rooted in the drive to overeat or the inability to stop eating when full, Bohon says there’s so much more to it than that—in fact, it often starts as the opposite. “One of the core symptoms of bulimia is an extreme valuation of shape or weight,” she says. “This results in food restriction or dieting as an initial behavior and precursor to the eating disorder. The drive to eat or loss of control around eating doesn’t indicate an overarching impulsivity problem, but instead is a natural response to insufficient nutrition.”
Ash also notes that bulimia—as well as anorexia and other eating disorders—may indicate the presence of other emotional or psychological issues. According to the National Eating Disorder Association, people with anorexia and bulimia “more often than not” have an anxiety disorder that began before the onset of their eating disorder. People with bulimia also have significantly higher rates of post traumatic stress disorder (PTSD) than individuals without an eating disorder.
How can you cut through the misconceptions and support those with bulimia?
Given the abundance of misinformation about bulimia, how can families stay attuned to the actual signs and symptoms of trouble? Admittedly, it can be difficult, given the shame and secrecy that often accompanies the disorder. “Just like with any eating disorder or mental health diagnosis, a lot of symptoms happen in secret, so it might not be clear what a red flag looks like” Ash says.
That said, the obvious signs of trouble are consistent with those of other eating disorders: significant mood shifts, feelings of inadequacy, body shame, increased anxiety and isolation, and more.
There are also a number of red flags associated with bulimia specifically. “I recommend families pay attention to the timing of bathroom breaks or trips to the gym—are they always after eating or after eating certain foods?—skipping breakfast, large amounts of food missing from the kitchen, and frequent weighing,” Bohon says.
If you’ve noticed some of these red flags and are concerned that someone you care about may be struggling, it’s important to broach the topic carefully. “Be sure to approach loved ones with compassion and curiosity rather than as an accusation or judgment about behaviors,” Bohon says. “The primary behaviors in bulimia of binge eating and compensatory behaviors are often shameful and secretive, so you may need to be more proactive in figuring out if someone is struggling and asking questions about how you can support them. This is not a ‘vanity issue’ to be ignored, or a phase that will pass. Treatment is available, and recovery is possible. But the first step to getting help is identifying the problem.”
- Hudson, James I et al. “The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.” Biological psychiatry vol. 61,3 (2007): 348-58. doi:10.1016/j.biopsych.2006.03.040
- Nagata, Jason M et al. “Emerging trends in eating disorders among sexual and gender minorities.” Current opinion in psychiatry vol. 33,6 (2020): 562-567. doi:10.1097/YCO.0000000000000645