Where there's bulimia, isolation isn't far behind. A person's sociability really doesn't matter; the dynamics of bulimia practically force isolation to emerge. Bulimia brings many factors that erode relationships and leave a struggler alone with only the eating disorder as a companion.
Bulimia's Rituals Mandate Isolation
One study subjectively examined the lives of 13 women with active bulimia. concluding that all 13 experienced isolation. Another study suggested that its participants lived "double lives," bound in secrecy. What drives those with bulimia away from those who care for them -- or vice versa?
Most obviously, nobody relishes the idea of inviting a friend to come over and watch a binging and purging episode. The binging/purging process becomes intensely personal, steeped in powerful rituals. The rituals require that the person be alone, even if the whole process takes hours (going to the store to buy food, preparing it, eating, etc).
Bulimia's Choice: Be Isolated or Feel Panic
The eating disorder demands single-minded attention, so the plan becomes to avoid the complications other people create. Social interaction means a loss of control over the person's immediate environment, which can be frightening. Often, a simple dinner invitation creates a sense of panic that leads to a surge of anxious thoughts: "Is it a loud restaurant where no one could hear me purge? Can I get away from the table with no one suspecting? Is there any chance that I'll have to eat without purging? What if everyone else orders food that's hard to throw up, and I feel as though I have to order something similar? Won't I stand out too much if I don't?"
The list of potential problems is endless. Instead, many with bulimia will often say, "No thanks; I can't go to dinner tonight." The relief outweighs the lost social contact.
Bulimia Creates Isolation Through Self-Hatred
A person struggling with bulimia generally has a series of messages that go through his (or her) head (as did this eating disorder survivor) telling him that he has no value:
"Come on, who are you kidding? You can't be a friend to that person. I'm the only one who can stand you. Now find some cereal so we can start binging."
"If I could call you something more worthless than worthless, I would."
"It's not going to get better. You can't even get a job at a coffee stand. I'm all you've got."
The theme rages: The person "hears" that he is of no value to himself, let alone others. I believe that this reduces motivation for moving toward someone else in friendship, since the assumption is that a potential friend will discover the person's "badness" and reject him.
Depression in Bulimia Feeds Isolation
Depression and bulimia are common partners. When depression takes hold, it reinforces the sense of powerlessness and worthlessness that bulimia tends to cause. The person feels smaller and weaker, and thus less appealing. As the world seems to narrow, there seems to be less room for friends and family.
Returning to Health Requires Contact and Intimacy
It's reported that 6% of those with bulimia seek mental health care. Choosing to get help is a hard decision to make: Treatment means telling someone else what's going on and eliminating some of the isolation.
Antidepressants can provide a boost here by loosening the hold of the feelings of powerlessness and worthlessness. In some cases, bringing these under control makes intimacy less anxiety-filled and more inviting.
One further step is to become involved in a recovery group of some form -- whether a formal therapy group, a support group, or a 12-step group like Eating Disorders Anonymous. When a group has good ground rules (that is, rules that don't reinforce disordered eating behaviors), finding out that others have similar struggles can be a huge boost in recovery.
Sources:
Broussard BB. Women's experiences of bulimia nervosa. Journal of Advanced Nursing 49 (2005):43-50.
National Eating Disorders Association. "Statistics: Eating Disorders and their Precursors." At nationaleatingdisorders.org. Accessed 9 September 2008.
Pettersen G, Rosenvinge JH, Ytterhus B. The "double life" of bulimia: patients' experiences in daily life interactions. Eating Disorders 16 (2008): 204-211.
