Case Studies : Bulimia

BulimiaI have spent the last 14 years of my life being bulimic, what a waste. It started for me the same sad way that it does for many teenage girls, thinking my life would only be worth living if I were thin. I thought I had really found a fantastic alternative to dieting, where I could literally have my cake and eat it. At that stage I didn't know it by its correct name, bulimia.

Interested friends that know about my past ask me what it was like being bulimic. My first few attempts at it involved the customary fingers down the throat method; at that stage it was all I knew. However, within just a few weeks I discovered that digging my fingers into a place in my abdomen had a more dramatic effect, a side issue was that it also created permanent bruising.

I started reading everything I could find on bulimia, quickly becoming something of an expert. I read about the technique of using a 'marker' to enable me to accurately confirm just when I had reached the end of a purge. This simply involved eating an easily recognisable food item, 'a marker', at the beginning of the binge, such as a piece of red pepper, the idea was that when this exited my body it signified the end of a purge. After a while, I felt this was no longer accurate enough, so I started routinely flushing out my system with water after a binge, not being satisfied until I could see bile, and often blood.

I became obsessed with being a 'better bulimic'. When seeking shared accommodation, my choices became completely dominated by my bulimic behaviour. My selection criteria included flatmates being out of the house for long periods of time, and the location of the bathroom in relation to other people's bedrooms. It became an ongoing challenge to justify to my flat mates the abnormally frequent occupation of the bathroom with my 'hair washing' and 'beauty treatments'. Even then I would create a toilet paper veil over the toilet bowl, to muffle the sounds of the vomiting, and I always burnt scented candles to mask the smell.

During the time I suffered with bulimia, I went through phases of throwing away the entire contents of my fridge and food cupboards, only to retrieve it hours, or even days later. When I needed to binge, I needed food quickly, the quality was irrelevant, out of the bin, often out of date, stale, raw and even frozen food, the only criteria was that I could throw it up again.

I didn't care, after the binges I would sit and cry for hours in disbelief and disgust at the level I had allowed myself to sink to, swearing that this was the last time. At that time I thought no one suffered as badly as me with bulimia, however my own research has shown that my actions were relatively normal, rather than extreme.

Of course as the years passed I lost a lot more than just weight, I quickly lost most of my friends, I managed to single-handedly ruin my relationships, my health, education, career prospects and any self respect I once had. And at the darkest times, like so many others, I very nearly lost my will to live.

During that time I swung between periods of starvation and purging meals, to spending days alone eating my way through gigantic amounts of food, followed by the ritual of purging, often more than 15 times a day, this normally carried on until my money and energy had run out.

My periods stopped for years at a time, and I was often aware how frequently I was dangerously underweight. My throat often bled, my teeth deteriorated, even my hair stopped growing. I found myself feeling anxious and unsteady a lot of the time due to the potassium I was depleting through the purging.

I moved from city to city, and even different countries, looking for fresh starts, alienating family and friends as I went. Ironically, my original quest for perfection was creating the exact opposite, but it had gone past that. I was on a one-way path of self-destruction, but losing weight was all that mattered at that point. A boyfriend once told me he wished there was 'more of me to love' but I just wanted 'less of me to hate'.

Over the years I saw numerous counsellors and therapists, both on the NHS and as a private patient, continuing my often-sporadic attempts to cure myself. I studied a catalogue of self-help and textbooks about eating disorders and worked my way through several varieties of anti-depressants that had been prescribed by the many doctors I saw along the way. Even though most of the people I saw were sympathetic, I struggled to connect with them.

My life had resulted in a whirlwind of unrealistic targets and structures, failures and chaos. The professionals I saw bombarded me with eating plans, food diaries, weight tables and nutritional advice, like others suffering with an eating disorder I quickly became incredibly knowledgeable of the subject. I developed my own rules to cheat the system; I always had my own agenda.

My mum and dad pleaded with me for months to get help, and eventually, in 2007, they convinced me to fly over to a specialist treatment centre in South Africa. The centre promoted a 12-week residential program that would help me overcome my problem, at a cost of several thousand pounds. This coincided with my own realisation that I wasn't invincible. Both my physical and mental health was suffering, and I was approaching my 30th birthday.

When I flew from London I was both positive and committed; I arrived at the residential centre full of hope. Their approach was to reinforce the general thread of all my previous therapy, that I was an addict, a bulimic, and made that way. They instilled in me that food was my addiction, and I was destined to spend my life battling to control it. They even encouraged me to stand up and introduce myself as 'Rachel Bulimic' at all meetings and group sessions.

I felt truly trapped at the centre, the purging not only continued whilst I was there but also became out of control. After 6 weeks they discharged me.

I returned to the UK and spent some time with my mum before returning to Spain, where I had been living with my boyfriend. I rapidly hit rock bottom, I felt like giving up. My mum and dad, like my partner, were supportive, but also very close to breaking point, I promised them I would not give up, that I would carry on seeking help.

Whilst surfing on the Internet I came across a British non-residential clinic in Spain that was using CBT, Cognitive Behaviour Therapy, to tackle bulimia. I sent them a few emails and eventually agreed to go along for an informal chat. When I arrived I was surprised to find it so un-clinical, there were no scales or weight charts, I felt completely relaxed by the informal feel of the place. I talked with them for over an hour about my past, my bulimia, and me, the CBT approach that they explained, was both refreshing and different.

After telling with my mum and dad about it they agreed to pay for me to have a few trial sessions. They also arranged to fly over to visit the clinic themselves; they were still 'reeling' from the cost and negative results achieved in SA.

After my first session, and I can honestly say for the first time in over fifteen years, I left the clinic that day with an overwhelming feeling of hope, I am not sure why but somehow I knew this was the one, the solution I had been searching for.

In the past my therapists had always told me that my future would involve a possibly life-long road of fighting bulimia, and that I should expect a constant battle. That was in stark contrast to what I was now being told, over a number of sessions, they told, and convinced me that I simply didn't have to be bulimic anymore: 'If you are finished with it now, let it go'. They went on to show me that I wasn't born a bulimic; I had simply learnt to be. During later sessions I was shown how I could live the life I deserved. They helped me to realise the massive significance of wants and needs and the difference between thoughts and facts.

I had succumbed to an illness that for years had defined who I was and how I behaved. My days had been peppered with needing to purge and needing to restrict my food, needing to binge and needing to live in a desperate and debilitating manner.

Their approach to the so-called rules and regulations and the successes and inevitable failures of eating plans, food diaries and the like, were for me completely liberating. I had been so accustomed to the textbook timetables that were so obviously not working for me. They quickly convinced me to stop looking at the clock that had often policed when I ate. All of a sudden I found myself eating when I was hungry, and when I wasn't, I didn't. I started listening to my body instead of fighting it.

One day the therapist at the clinic asked me what would happen if I stopped indulging in the behaviours linked to bulimia, the ones that I thought I needed. He asked me what would life be like tomorrow, how would I feel, what would I look like, what would my mum and dad think and feel. I thought about those questions a lot over the following couple of days, crying all the time. The questions of course made me think, see and imagine myself for the first time without the illness, I liked what I saw, I liked it a lot. I realise now just how clever and deep those questions were, for me they marked the start of a change, a permanent change in my life.

During future sessions we discussed all the positive things that I could have in my new life, the way I would feel, and the relationships I could mend, all by simply giving up the things I thought I had needed. When I first entered the clinic I arrived as Rachel the Bulimic, by the end of the first week I was leaving as Rachel, who has abnormal methods of dieting, and in time just as Rachel.

They never criticised me for wanting to look after my body, but helped me find exercise I enjoyed, and good food that I actually liked. A fundamental part of my therapy was that I was encouraged to ring them whenever I wanted. In fact part of our personal contract was to ring them if ever I felt the bingeing was about to take hold, which proved critical.

Between sessions I spoke with them every day on the phone, sometimes just for moral support. The therapy never stopped when I left the clinic, I never felt isolated.

My family, much to their relief and I suppose surprise, were included from the start, as was my partner, who was encouraged to take a session with me, which I know helped a great deal. They had always felt shut out in the past, adding to their helplessness. The whole CBT approach was completely results driven and person centred, and after each session I felt myself growing and becoming more and more positive. I no longer feel separated from the life and person I thought I wouldn't have and couldn't be.

With all the things that I have rediscovered about myself, the bulimia has paled into insignificance, I simply have no room or time for it anymore. In fact now it's just a word. In hindsight it was nothing more than a simple choice, and I made it. Now my weight is stable, my skin is clear and even my hair is growing. I am no longer breaking the hearts of the people I love. I thought for many years that I needed bulimia; I didn't.

What now? That's the really exciting part: since my success, the clinic has been receiving more and more calls from sufferers in the UK wishing to come over to Spain for a couple of weeks of treatment. They have offered me the chance to spend a day or two with each one, explaining my journey and how I became free.

So now I am on a mission, determined to help every other person suffering with bulimia to at least explore CBT. As a solution it is probably not a panacea, but it is real and it works; I, like many others, can vouch for that.

Rachel recorded a series of four interviews about her experiences with Leah Dunne on southern Spain's radio station, Onda Cero International, (OCI). Click on the links below to listen to them.