National Eating Disorders Association

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Wthomps429
Dealing with chronic Bulimia in Fiance

I've been with my fiancé for 5 years now, engaged for less than a year. She told me about her eating disorder very early and said she has had it since her late teens and has dealt with it off and on ever since. It primarily takes the form of Bulimia with an obsession toward exercise as a coping mechanism. There are food triggers that she avoids, but generally tries not to restrict in any way. She has also been taking an antidepressant since she was about 18 and is 46 years old now. I don't believe that does her any good at this point, but she's addicted to it now.

Early when we were dating, she said she pretty much had it under control (occasional purging), but due to changes in her job and lifestyle (kid demands), she can't exercise as much as she used to and it struggling with weight gain. As a result, she's now purging more frequently and has sort of accepted this as part of her situation. To make matters worse, her 12 year old daughter, who lives with us half time, has now has developed her own eating disorder and is purging occasionally and restricting. She knows that her mom struggled with an ED in the past (she learned this in counseling but didn't know it at onset. She blames onset on a class in school where they taught them about BMI and restricting calories so as not to become obese), but doesn't know she still is and it actively purging. We have her daughter in therapy at an ED clinic, but it's still a constant problem.

All that said, I guess I'm just looking for perspective as to what to expect and options for her. Ironically, her sister is a psychiatrist specializing in eating disorders and they are close, but I know they rarely talk about my fiancé's issues. I ask her if she's discussed her ED with her sister and if her sister knows how often she's purging, but she just gives me a vague response of "yeah, I think she knows", which I don't believe. Her and I had an agreement early on that she needs to be completely open and honest with me about her ED for us to work, and she has been for the most part, but I have to ask her very directly and sometimes repeatedly to get the full truth. I'm concerned that she'll eventually start being much more secretive, as she's recently said when I've asked her about purging that she doesn't know what good it does to tell me about it. It has certainly created a lot of anxiety with her and tension between us at times. She also feels like a hypocrite being so strict with her daughter about her ED when she can't control hers. I've asked her if she thinks therapy would help her, but she just says she's tried all of that in the past.

Is there hope that she'll ever be able to stop this cycle?
Are there people who just "settle in" to a life where purging is the norm?
Are there treatment options for someone who's been dealing with this nearly her whole life?
If she isn't allowed to restrict her diet in any way (as she's told me) and she can't possibly exercise her way out of this, then how can she ever achieve a comfortable (for her) body as she ages?
Is it helpful or encouraged that she should continue being open with me about what's going on? I would think keeping this her secret would be destructive and support the ED.

I want to help her, but feel like there's nothing I can say or do to make any of this better. Any help or perspective you could give would be very much appreciated.

Thanks in advance for any responses.

BobJ48
Difficulties with persistent EDs

Thomps,

No kidding, EDs can be complex matters alright, as well as being quite tenacious. The fact that your SO started down this path at 18, and is still in it's grasp at 46 is certainly a thing that can happen to some people.

And all of the things which spring up to confront the person : Her sister apparently knowing, and the difficulties with her daughter as well…. I think most people in the general public really don't realize just how complex and tangled matters like this can become.

My assumption is that you have the "control" thing figured out by now ? In the beginning EDs often represent control to the sufferer : Life may present many problems, but at least there is one area where the person can exert some real control - eating and exercise and other ways of keeping the body from betraying a person through going weight. The self-discipline that's involved - most normal people simply aren't able to exert that level of control over things. In the midst of what may seem like chaotic life situations, there's always that one thing that they're in control of.

Of course after a while it becomes more and more obvious who's in control : The person or their eating disorder. But by then the association has become totally etched into the person's brain, and it can seem like there is not much they can do about it. Now, when things begin feeling uncertain or out of control, their brains go right to the weight-control thing pretty much as a matter of instinct. And to heck with how much they would like it to stop.

So yes, it's a tough deal alright, and it's a tough deal for your fiancé as well I suspect. Once that sort of brain-wiring gets laid down, it really can be hard to escape it, no matter how much the person might wish that they could.

Still, simply giving up on the idea is no good either, because how are they supposed to feel about a situation like that ? Here's this thing that was supposed to be about control, but now it's the thing that's controlling them instead. They can try and put that part out of their minds, and just proceed along blindly, but I think that this core paradox still exists, down under all of the purging and over-exercise.

" I've asked her if she thinks therapy would help her, but she just says she's tried all of that in the past."

Umm yes : There's the weak spot in all this. She's allowed herself to believe there's no hope. Which to be fair is understandable, given what must have indeed been a number of treatment failures in the past.

"If she isn't allowed to restrict her diet in any way (as she's told me) and she can't possibly exercise her way out of this, then how can she ever achieve a comfortable (for her) body as she ages? "

That's a core question I think. And one that will continue to be problematic as long as she continues to have all of these seemingly hard-wired associations between how she views her body and all of that other psychological stuff. Success, failure, the "Am I good enough? " thing. As long as the only thing that can ultimately answer those admittedly important questions for her is how she views the state of her body, then she's going to continue to have problems I think.

So…it would seem important for her to take up therapy again, is how I tend to see it. The whole thing about whether we are in control of our lives, or if we are a "good enough" person or not - These are reasonable things for anyone to be concerned with I think.

And as even she might admit, are not properly judged by adherence to rigid self-discipline, or by a set of numbers on a scale.

Bob J.

Wthomps429
Thank you so much for your

Thank you so much for your post. I will contact her sister and discuss the issue with her. It ebbs and flows. When she has time to exercise and low stress, she's fine, but as soon as the stress goes up and the schedule gets busy and interferes with her workouts, she resorts to purging as both a way of coping with weight gain and (I think) a way of sort of punishing herself for the lack of control. There's nothing I can do about that. In addition, I had gained some weight over the winter and made some changes to lose that this spring (diet adjustment and exercise) and this seems to have bothered her and she says it's a trigger for her. She'd be happier if I gained the weight back, which of course I won't do, as this is a healthier and happier weight for me.

Generally, we get along well and things are okay, but everything food related is complicated and it can be frustrating. I see her eating things that I know are contributing to her weight problems, but can't say anything and don't. If she could just make some adjustments, she'd be better off, but this insistence on no diet restrictions makes it hard to treat and seems to contribute to the problem. Regardless, I'll talk to her sister and see what she has to say. I suspect she has no idea my fiancé is having the problems she's having and maybe she can talk to her and get her some help. My hands are really tied on this.

Thanks again for your help!

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dropthemetaphor
re: Thank you so much for your

Hey wthomps429--my first piece of advice would be to refrain from judging your fiance's behaviors surrounding food and exercise. Eating disorders are complex mental illnesses, and those of us who suffer from them can't simply "cut out the snacking before bed" to solve all our problems. What may work or make sense for you doesn't necessarily translate to someone who has been struggling with eating disorders for nearly 30 years.

As someone who's been in full recovery from my ED for nearly four years, I can tell you that the "no diet restrictions" thing is a pretty huge piece of developing a healthy relationship with food after beating an ED. I don't mean to sound harsh, but nobody should be giving your fiance advice about her diet or exercise regime except a professional dietitian or nutritionist who knows about her ED history. You're absolutely right that most comments or suggestions involving diet, exercise and the like will be triggering for someone with an ED, so please avoid them and try to remember that your fiance did not choose this life.

You might consider informing yourself a bit on the topic of EDs so that you have a better grasp on what to say and what not to say as you try to support your fiance. Here are some links from the NEDA website that may be helpful:

General information about EDs (https://www.nationaleatingdisorders.org/learn/general-information): breaks it down by symptoms, consequences, the recovery process and more

Information about specific EDs (https://www.nationaleatingdisorders.org/learn/by-eating-disorder): definitely check out the bulimia section here but some others may be relevant as well, such as orthorexia

How to help (https://www.nationaleatingdisorders.org/learn/help): I'd focus on the "Family, Friends and Caregivers" section

Parent toolkit (https://www.nationaleatingdisorders.org/parent-toolkit): not just for parents! Super helpful resource on how to support a loved one who's suffering from an ED.

I hope this helps get you started. Please keep us posted on how your fiance is doing!

BobJ48
Psychological function of EDs.

Thomps,

Yes, it's not surprising that her symptoms rise and fall with her perceived stress levels. EDs can transform themselves into ingrained coping methods as time goes by. "Am I doing OK, or is life out of control ?" People with ED's often turn to their EDs, in order to answer these questions.

Which is not the best way to judge one's self of course, but when things become habits, it's pretty much the way that things go.

And as you said, as long as she insets that no one challenge her efforts in these areas, it's hard to know how things will ever change.

Again, she'll need to start seeing these matters as problems which need to be dealt with, if things are really going to change. If she continues to see the situation as hopeless, and something that will never be open to change, you may have to reconsider your relationship with her.

Which is a harsh thing to say, I know, but in my experience talking with other fellows who find themselves in the same situation, it's really is not something that you can be expected to ignore forever, no matter how much affection you have for her.

So yeah, unless you start seeing some willingness on her part to take up therapy and confront all of this, or her being willing to label it a problem that needs to be addressed, I doubt that you'll find yourself able to make any sort of permanent peace with it. Nor should she expect you to be able to, to be honest.

So it's a dilemma for sure, and a matter that she'll need to be the one to confront. Because as you said, most of it is indeed out of your hands. Which is simply not a comfortable position for any caring parter.

Bob J.