Feminism | Posted by Rose M on 10/18/2010

Anorexia and Bulimia In Our Culture: Unspoken Questions

in the world of eating disorders...which type is worse?

in the world of eating disorders...which type is worse?

There isn’t exactly a “name” for this topic so, here, i’ll try to spell it out for you. It’s a topic that affects me personally and deeply, but also something that is very rarely talked about in the eating disorder community (both on blogs & in treatment or with mental health professionals, and even with friends). Is Anorexia Nervosa a more serious, deadly, scary, real, or traumatic illness than Bulimia Nervosa or ED-NOS?

I’d be interested in what people’s gut-reactions are to this question.

I don’t mean the well-formulated answers that people think of, I mean the feeling that comes, the spark of thought that enters the brain or heart when this question is posed. (or when it is presented to your face- is there an image that comes to mind when this question is asked?)

I honestly am afraid of asking this question. I’m afraid of starting this conversation. Its one that I’ve never seen or heard out in the open, and I think it’s time that it’s brought to the table.

I, personally, as someone who has always had a “primary diagnosis” of bulimia, have always felt as though i need to “justify” to people that it is an actual illness, with physical consequences and harsh emotional ramifications, like anorexia, despite the fact that it often does not leave it’s sufferers looking deathly ill.
My first-ever example of this was the very day that my mother confronted me about my “vomiting” when she said:

“Well, I’m just glad you’re not anorexic, I mean, those girls are really crazy.”

At the time, I had wanted to jump out of my skin when I heard this and scream at her and lecture her on all the awful things running through my head, and how much I was tormented by this disease every day and every second, and could she please (f!#@ing) realize that this was serious, but of course I shushed myself and threw up to “swallow” my need to speak up.

I understand completely that part of this whole “complex” I have about bulimia not being considered as “serious” as anorexia has to do with my own eating disordered-mindset, and how I personally always feared that I was “not sick enough” as many sufferers do. I would really like to emphasize however, that this dilemma, I think, reaches beyond that personal “fear” and, I think, is actually a really serious problem that still exists (albeit ‘underground’) in the eating disorder “sphere”.

I honestly am astounded and appalled at the number of top New York City- area Eating disorder ‘specialists’ (usually with big titles & rather fat pay-checks to show for it) who have, in one way or another, implied to me (or to other patients or professionals) that weight & how someone looks and whether or not they have lost their menses is the most important factor in determining how “ill” someone really is. There was a psychiatrist at the first treatment center I was at who was almost notorious for telling bulimics that they didn’t really have a problem, that being bulimic was just what someone did if they “couldn’t be anorexic”. (This is a man who did his residency at Stanford University Hospital under world-renowned eating disorder researchers).

I’d like to look at the researchers, and ask why there is always much, much more research done on Anorexia than Bulimia? Why when I type either one in on PubMed do I get over 22,000 results for anorexia and a less than 7,000 results for bulimia?
Why, when I visit a website that advocates for Maudsley (or Family-based treatment) is there a video on the front page about how to treat Anorexia whereas I have to search for information about treating Bulimia? I say this not to be a nit-picky complainer, but because these subtleties are important. This is how we are taught, in school, to read between the lines and to pick up on the editors’ (or writers’ or poets’ or artists’) message, to understand what is really being fed to us and to be conscious, educated consumers of information.

Why do I always find more blogs that are written by women/men recovering from Anorexia (or some {often restricting} form of ED-NOS) than Bulimia?

Is it shame?

Is it more shameful to say “I was bulimic” than to say “I was anorexic” ? Do you want my honest answer?

Honestly, I think it IS slightly more shameful.
I hate saying that i was bulimic.
It seems like it’s the difference between saying: Hello, yes, I used to stick my fingers down my throat all the time and I wasn’t even skinny! or Yes, I starved myself, and my sick body looked similar to that of one of the highly paid fashion models who represent a sick & twisted beauty standard that is idealized in a very confused culture.

What would you rather say?

I’d like to clarify a few things, so that I am not hated by all the wonderful people who decided to read this blog.

I am not trying to say that being bulimic is harder than being anorexic, or anything RIDICULOUS like that. I am talking about the way in which culture (and yes, even our insulated culture in the eating disorder world- meaning those who are even EDUCATED & EXPERIENCED in the eating disorder field) tends to still idolize, or idealize, or freak out about Anorexia more often and more strongly than it does Bulimia. This is separate from a persons personal experience of either illness, and is about how they are talked about & treated.

Also, that being said, many (and I mean MANY) of my best friends (from treatment) suffered from Anorexia. I relate to and respect them, their struggles and their strengths, and talk to them about everything & anything under the sun and I love them to pieces. Many of the ED related blogs that I read are written by people who are recovering/recovered from Anorexia. This opinion that I am sharing has nothing (and i mean NOTHING) to do with how I relate to other ED sufferers in the world, it is simply a cultural nuance that disturbs and perplexes me.

I’m not trying to blame anyone. I wanted to bring this up because it affects me personally, and I feel very strongly about it and have never really had a platform on which to speak about it. I want us to move forward in the ED world, and learn how to move past “undercurrent” issues like this, so that there are no latent stigmatizations or unspoken judgements that are not out in the open, so that EATING DISORDERS are the only battle that we have to fight.

Rose also writes for her own blog Girl Spins Madly On

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  • Sue @ at 11:10 am, October 18th, 2010

    I think it depends on the person hearing about it. It was hard for my family to see that I was anorexic, but my mom was really disturbed when she found out that I was later bulimic. I think there is something about vomiting/taking laxatives that really scares people or grosses them out. Of course, it is scary. I feel like people see anorexia as a simpler concept to understand–”it’s just not eating, right?” It can also be harder to tell if someone is bulimic because they often are not emaciated.

    They’re both rooted in many of the same fears, though. Our culture needs to realize that BOTH are dangerous and that survivors do not need to be ashamed of EDs, binge eating disorder included. It would have helped a lot if I had been able to talk to people more about bulimia/BED, but I was too scared because there IS an invisible shame.

    Thank you for this post. It creates awareness. You’re incredibly brave for writing about your life :)

  • Kat @ at 1:15 pm, October 18th, 2010

    I think the varying degrees of shame have to do with gender stereotypes. Women are often taught they have to deny themselves; it’s reinforced by tropes of the motherhood that suggest women “give everything up” for the wellbeing of their children (to the point of not being human anymore, but merely feeding tubes to further the humanity of their children.) The idealization of anorexia I think stems from this: people think, if not consciously, “hey, she did the self-denial thing, that’s a girl thing to do.” Whereas people think of bulimia as people who “want to have their cake and eat it too.” That doesn’t fit as well into the patriarchal notion of what women are supposed to do, it seems more like “cheating the system” (at least, to people who don’t know anything about eating disorders, who unfortunately make up the majority of the population.) I think that probably fits into the mistaken notion that bulimia isn’t as bad as anorexia–people a: don’t think of it as “acting out,” but rather as “compensation for over-eating,”–and since “overeating” is also looked down upon in a kyriarchal standpoint, compensating for it is almost seen as a good thing rather than a bad one.

    Thanks for starting this topic–the complacent silence of mass media on eating disorders is frustrating.

  • Lolita @ at 1:37 pm, October 18th, 2010

    Because anorexia is easier to ‘see’. It get’s media attention more often (models, magazines, tv, movies) and bulimia is a ‘hidden’ disease. It’s easier to spot someone who’s not eating than it is to spot someone who purges (be it laxatives, vomiting, excessive exercise, or fasting). It’s not just the ‘yuck’ factor. It seems less dramatic, therefore people care less. My mother (and friends) are the same way it ‘just is’ it’s not a problem. I’m on my own.

  • C @ at 1:40 pm, October 18th, 2010

    My gut feeling upon reading the question was that both are equually bad. I mean, both can be equally soul-destroying, equally unhealthy, why does one have to be defined as worse than the other?

    Thanks for writing about this, it’s not a question I had ever known was ‘out there’.

  • Jessica @ at 2:00 pm, October 18th, 2010

    I have never thought about that, that’s why I can see why it’s so important for people like you speak up. I can’t imagine how hard it must be, for you to have a serious problem that’s minimized by others as “not to worry about”, and being compared all the time to anorexia. You said about blogs and all, do you have a blog where you talk about bulimia? Maybe you could start a blog or a forum where you could relate to other people and call attention for your issues.

  • Jennie @ at 2:10 pm, October 18th, 2010

    I suffered from Bulimia and I remember someone saying the same thing to me, “at least you’re not anorexic”. Doesn’t change the fact that I still have awful side effects like rotten teeth and haemorroids from too many laxatives. But I suppose those side effects are so easily depicted in magazines and pictures of emaciated women alongside a ‘before’ picture are. Bulimia isn’t quite so visual and I think people do ‘respect’ an anorexic’s self-control rather than a bulimic’s perceived lack of it.

  • Alex Catgirl @ at 3:25 pm, October 18th, 2010

    I think you are getting too hung up on diagnoses and not the actual group of diseases collectively refereed to as eating disorders.

    scientists, which includes doctors, like to categorize things and then go on to use very stereotypical cases as the basis for their case studies.

    Unfortunately, real life is very messy. I started out with a primary diagnosis of Bulimia and it was changed to ED-NOS latter on as I exhibited symptoms associated with Anorexia, Orthorexia, and exercise addiction.

    Why people tend to focus on Anorexia over the others is that it will eventually kill those who suffer from it. Bulimia may as well, but the chances are much lower.

  • Nano (Nyxie) @ at 8:29 pm, October 18th, 2010

    There is a reason that bulimia is though to be “more sane” – it’s a core human instinct to feed ourselves, and keep ourselves well-fed, an an instinct without which we probably would not have survived as a species. (The phrase “hunger makes the best sauce”? Hunger would prompted our ancestors to eat whatever it took for their survival, no matter how disgusting). It also goes to show just how deep social programming goes, for so many girls to be able to over come this instinct.

    While vomiting over and over again is painful and has some serious health issues of it’s own, it doesn’t inherently go against the human instinct – whereas starving yourself does. From the outside perspective, that might be why bulimia is though to be more “sane” or less severe than anorexia.

    I, personally, feel they are equally terrible problems, and that any girl who has even the hints of either problem should get help immediately. That’s my gut reaction.

  • A @ at 10:32 pm, October 18th, 2010

    I think that they are equally serious. Throwing up more than average can seriously damage your digestive system and many other body parts. Though I wasn’t a big fan of my strict, no nonsense biology teacher, I appreciated how, when we learned about vomiting, he took ten minutes to explain how damaging to ones body bulimia really is. I think that anorexia also gets more attention because, no matter how bad it is, many people sort of envy anorexics. Bulimics are often of normal weight, so they do not get that same “positive” attention.

  • Jake @ at 11:08 pm, October 18th, 2010

    inb4 Seth the internet tough guy takes out his failures with the opposite sex on random people.

  • Jennie @ at 5:10 am, October 19th, 2010

    Two articles from today’s Daily Mail:

    http://www.dailymail.co.uk/news/article-1321599/Bulimic-Rowena-France-hanged-2-year-battle-eating-disorder.html

    and

    http://www.dailymail.co.uk/femail/article-1321719/Mother-girl-diet-age-two.html

  • manu @ at 8:50 am, October 19th, 2010

    I’m with Kat that the gender stereotypes greatly affect public portrayals of eating disorders. I also think we can add the Puritanical vein in North American culture, which would see as more shameful the “self-indulgence” and “wastefulness” of bulimia compared to the “controlled” anorexia, and thus not take it as seriously because the implied understanding would be that someone struggling with bulimia chooses to do so.

  • breawha @ at 10:02 am, October 19th, 2010

    this entry is my head on paper.
    holy shiz, everything you said just resinated, i’ve felt it all before.

  • Emily S. @ at 10:44 pm, October 19th, 2010

    I think there are a few possibilities:

    -In bulimia, since the food is ingested and at least partially digested, more nutrients are absorbed, meaning that someone who is bulimic usually does not experience weight gain that is as rapid or extreme as anorexia, thus making anorexia the more “visible” of the two.

    -Anorexia is dieting taken to its extreme – if a woman goes on a diet, she’s praised for her self-control and commitment, and her peers say things like “Wow, I’d never be able to do things like that! So, if a woman is anorexic, she’s still displaying these traits of extreme self-discipline that are usually looked upon positively. On the other hand, bulimia involves binging and throwing up – and in America at least, those two things are associated with excess alcohol consumption, which carried with it all kinds of negative connotations just like the positive ones with dieting. While I don’t think people actually make this connection consciously, I wouldn’t be surprised if it was subconscious.

    As far as other eating disorders, I think the visibility problem is even more extreme, especially since the girl may not know she has an eating disorder, or isn’t trying to lose weight or anything. For example, when I was a teenager, I was moderately active one summer – I had a job that didn’t require a lot of energy, I walked everywhere but nowhere in my town was more than a couple hundred yards away. Then, I started playing sports, and the coach pushed me harder than any other coach had ever done before. I was fine, kept eating just like I was before, but then I started getting dizzy spells, so I visited my doctor. She explained that I probably had a form of eating disorder that female athletes could get, where I simply wasn’t getting enough calories from my diet. We looked at calories-per-hour charts for different activities, and what I ate, and we discovered that although I was eating something over 2000 calories a day, I needed nearly 3000. We looked at the amount of food I would have to eat to get all those calories, and it was almost more than I could physically stomach, so I actually had to start adding slim-fast shakes to my meals! But, it solved the problem.

    However, nobody would look at me and say “wow, she has an eating disorder!” Yes, I was very skinny, but I’d always been that way, I was energetic, my hair was healthy, I’d eat everything in sight, and I had a reputation for my sweet tooth.

    So both anorexia and bulimia would definitely be more extreme and life-threatening than my form of ED-NOS, probably because mine was “easy” to fix and the root cause was just lack of enough information for me to make healthy eating choices.

  • Hannah @ at 11:37 pm, October 19th, 2010

    I am studying to be a psychiatrist and on the tail end of my junior year to get my BS in Psychology and then head off to med school. By no means am I an expert, but I have taken SEVERAL courses in which Anorexia vs. Bulimia was discussed. As far as mortality rates? Anorexia is more fatal and causes more deaths per year. However, no one can put a quantitative measure of how painful having an eating disorder is. For bulimics your teeth begin to erode from the hydrochloric acid that is in your stomach, and this acid also eats away at the mucous in your esophagus which can lead to holes developing from the sheer quantity of acid that constantly is traveling up the esophagus so that an individual with bulimia can throw up.

    Physiologically both mental diseases take a huge toll on the individual who has them. But clearly the impacts it has on them mentally, emotionally, and personally just cannot be compared.

  • Roach @ at 2:25 am, October 23rd, 2010

    @Jake
    Idiot

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  • Quinc @ at 6:28 pm, October 25th, 2010

    I’ve always heard anorexia and bulimia mentioned together, often with over eating discussed also. But my only experience with it is various educational and prevention programs. I always thought of bulimia as less common, but worse than anorexia

  • lillabell @ at 4:01 pm, October 28th, 2010

    i personally feel that bulimia is a very serious condition my sister that was a year older than me had as weird as it is bulimia and then decided it wasn’t working so then became anorexic i knew about it the hole time and never told our parents i mean when you looked at my sister she was gorgeously skinny the perfect skinny(before she became anorexic or bulimic) and saw a fat body which is a sin and funny enough i was the chuddy one of the family i guesss well compared to my sister and cousins and parents and of corse i think alot of people have thoughts of being belimic or anorexic i have too but there are real thoughts and almost sort of wishes my sister got soo skinny that she weighed 73 pounds at the age of 15 and passed out and had to go to the E.R my parents got really upset with me when they found out i knew and know my sister is in a body self image rehad type place i feel like if i would have told some one she wouldnt have became so sick but she would never forgive me….. i guess it goes to show you that just beacuse a secret is very large doesnt mean its always right to keep it if it will end up heartin someone. in conclusion i have gone and seen everything that goes with bulimia and being anorexic and your very right bulimia is VERY very important to know about and just as serious

  • jillian @ at 9:04 pm, November 1st, 2010

    I absolutely feel I would be a lot more open with my ED struggles if my ED was anorexia. As a bulimic, I feel like a phony; a failed anorexic. Jut discovered your blog, love it! thank you

  • Erica @ at 8:01 am, November 2nd, 2010

    I find it most telling that compulsive overeating wasn’t even mentioned in this entry.
    I haven’t bothered telling anyone other than my therapist about my problem because that disorder is basically treated as “oh, you’re just a fatass.”

  • Hope @ at 10:07 pm, November 11th, 2010

    I’ve been suffering from Bulimia for over 17 years now. For almost 6 years, I starved myself, but I also had some episodes of binging once in a while, and of course, purging. Then slowly Bulimia took total control of my life. All my family knows about this so-called secret, but nobody talks about it. They all think I’m just nuts, and at least I don’t look unhealthy. Of course, they haven’t paid much attention to my teeth, my hair, my skin, my throat, etc.
    I’ve seen many therapists and they all agree my “problem” is not a disease, I just have to take a pill to lower my anxiety level. I’m determined to learn how to live with this… Thanks for your testimony, it’s good to know I am not alone!

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  • Sage @ at 11:48 pm, October 28th, 2011

    This is interesting – however, I do have to say that for me Bulimia is MUCH scarier than Anorexia. Having dabbled in eating disordered behaviors unfortunately, I never received a diagnosis, Anorexia was much easier to… contain. On days when I wasn’t eating, or drastically cutting calories, when my nails began to become blue, I almost wished for Bulimia. My anorexia (beginning stages of Anorexia? EDNOS?) went unnoticed by everyone around me, but I felt like maybe if I they heard me throw up they;d really know – she’s sick. I mean I was binging and then fasting (isn’t that inherently a form of Bulimia?) so I wasn’t losing weight and even when I tried to tell my friends about my habits in hope of support they dismissed it as a diet. I’ve also always felt that Bulimia can cause death more quickly than Anorexia and that scared me.

  • Talia @ at 8:24 pm, June 16th, 2014

    It’s true. I’m bulimic and I’ve heard several times, “At least you’re not anorexic!”
    I think it’s because anorexia is shocking and dramatic. You can see it instantly and it is completely glamorized. Bulimia is gross and you’re not even skinny, so it must not be serious, right? Even though the fatality rates are almost the same. Here’s a quote from Marya Hornbacher, who suffered from both disorders. “I mean, we all know the dangers of starving, but bulimia? That can’t be that bad. It’s only bad when you get really thin. Who worries about bulimics? They’re just gross.”

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