Living with Bulimia asks us to rethink how we view eating disorders

Posted 07/10/2020

Living with Bulimia lifts the lid on the truth about eating disorders. Now we must reconsider the way we think about and treat them, writes mental health campaigner James Downs.

Living with any eating disorder is difficult, exhausting and painful. As someone who’s lived with anorexia and bulimia for over 16 years, I waited nervously for Freddie Flintoff’s BBC documentary, Living with Bulimia, worried that the story it might tell would be too close for comfort. It was a difficult watch, but perhaps it should have been. There’s no papering over it – living with bulimia is a distressing, unglamorous and sometimes traumatic experience. I was glad that the show didn’t dilute the reality of the behaviours involved in bulimia, or the emotional pain that so often drives eating disorders in general. Whilst I was sad to watch Freddie talk about his ongoing difficulties – and felt very aware of my own recovery and how difficult it still sometimes is – seeing bulimia portrayed so honestly by another man came with a massive sense of relief for me.

In all my years of living with eating disorders, I’ve barely met another male patient, even though we know that 25% of people experiencing eating disorders are male. I’ve never been treated by a male clinician, and have often sat in clinics being handed leaflets telling me my periods would stop and my ability to get pregnant be compromised. When I looked for other people like me as a confused and isolated teenager, I saw no other men who might have had similar experiences. I was left feeling alienated, pathologised, and that there must be something inherently wrong with me. Feeling so alone and not seeing myself reflected in the world around me made me feel like I must’ve been having a singularly unique experience. I was the only one, so I was especially mad, sad, or bad.

But that wasn’t ever the case. I just didn’t see anywhere that eating disorders could happen to boys or men like me too. Worse still, professionals struggled to recognise and respond to me as a male with an eating disorder. Psychiatrists often thought that there must be some other diagnosis that could explain why I was presenting with such a stereotypically female condition. As one GP told me, “Why would you want to look like that? Only girls want to be skinny.”

Freddie’s documentary highlights that only 40% of men experiencing eating problems come forward for help with their difficulties, and I can see why. But this has to change. Hopefully this documentary will go a long way towards making other men feel like their experiences of bulimia and other eating problems are valid and worthy of support. Having an eating disorder might be problematic, but the problem isn’t with you. As we see in Living with Bulimia, eating disorders are diverse, complex and can happen to anyone, irrespective of their gender, background or how successful they might appear.

For me, it’s not just been experiences of other males that have been hard to come by. It’s also been lonely living with bulimia when accounts of eating disorders seem to focus overwhelmingly on anorexia. In my work raising awareness of eating disorders, people are often so surprised to hear that around 8% of people with eating disorders experience anorexia. More than double (19%) live with bulimia, and even more with binge eating disorder (22%). (Statistics from Hay et al, 2015.) The vast minority of people with eating disorders are underweight. These facts shouldn't be surprising, just as it shouldn’t be “groundbreaking” to see a high-profile man being so vulnerable and open about their personal struggles in the media. But we are still surprised and shocked by these facts and by frank accounts like Freddie's. This shows exactly why they are so needed.

My experiences of both anorexia and bulimia have made me feel like there is a hierarchy in the world of eating disorders. This isn’t just in the ways in which they are perceived and understood – the hierarchical view which considers anorexia as a more serious condition than others is reinforced and maintained by the ways in which eating disorders are treated, too. For me, anorexia was deadly and closed down my life as well my body, but bulimia was no better. The costs of bulimia as a hugely expensive financial drain (something that is rarely talked about) aren’t comparable to the costs of anorexia as a complete drain of my energy and sense of self. Anorexia might have involved chronic numbness and cold, but bulimia involved dramatic emotional waves I was not equipped to deal with. Both made it difficult to survive, both were equally serious, and both were valid in their different ways.

But both were not treated in the same way. It has always been harder to get support for bulimia. It’s also always been more difficult to get people to understand that I’m struggling when on the surface I appear fine. This is basic discrimination in its most essential form – you must be as you appear to be. The continual denial of support to people on the basis of BMI reinforces that you must be less okay because you don’t look okay. Most eating disorders services I’ve encountered (especially inpatient) are in fact anorexia services. And psychological support for binge eating disorder – where is it?

No wonder people write off their own problems as unimportant and become engulfed in shame and private pain when systems tell them they’re not unwell enough to warrant support. People say eating disorders are competitive, but the really problematic competitiveness is the competition for access to help and support, when it’s so rationed that we have to decide on an arbitrary basis who the most severely unwell people are. My own experiences aren’t representative of everyone’s, but that’s the point – we all experience things differently, so ranking different eating disorders in terms of the proportion of cases or severity of illness is unhelpful and outdated.

People ask me, “How does Freddie’s story help you as a man with an eating disorder?” Well, it helps me to feel less alone. It helps people like me to reach out because we might not feel so ashamed or alienated when we realise this happens to other people too, even people we might admire. But what it doesn’t do is make sure that, when we do reach out, there is a guarantee that help and support will be there for us when we need it, in the ways we need it. Charities like Beat have been a lifeline for people in this situation, saving lives and providing hope for people waiting for care or unable to access specialist services through no fault of their own.

The stereotypical views of mental health as someone sitting in the corner clutching their head and eating disorders as a skinny white teenage girl agonising over a salad are entirely outdated and exclusively narrow. The media telling stories of people who don’t fit these moulds does a huge disservice to people who have felt left out for so long, including those who, like Freddie, may not have a neat recovery story to tell.

We can never judge someone on how they appear, and this is as true of eating disorders as anything else. So we have to listen receptively and keep making space for people to tell their stories in the first place. Vitally, we must ensure that we have support systems that can respond to people irrespective of their gender, background or eating disorder diagnosis. In Living with Bulimia, Freddie Flintoff demands that we reassess our views of eating disorders as a whole, and that must also include our responses to treating them.

Contributed by James Downs

James is a mental health campaigner and expert by experience in eating disorders. He holds various roles at the Royal College of Psychiatrists and NHS England aimed at improving support for those experiencing mental health problems and eating disorders, and for their carers. James also represents various UK mental health charities and is a yoga and barre teacher. He has written extensively about his own experiences with the hope that those who read his work find comfort, affirmation and hope. @jamesldowns (Instagram and Twitter)