Anorexia and Bulimia
This leaflet has been designed to make you think twice about how you view people
who suffer from anorexia and bulimia.
The campaign to increase the understanding of mental health problems and reduce
their [stigma] and discrimination.

Related links: Our main leaflet about eating disorders, Other resources
They say size isn't important. But when does a girl become a woman? Is it when she is
seventeen? Or when she has her first kiss? No, it is when she no longer looks like a girl. But
that isn't all of it.
A woman is woman-sized. She is also mature, responsible, motherly, caring, supportive,
submissive, strong, reliable, successful, sensual, compassionate, kind, sensible and … that
is a bit much when you are forty let alone fourteen. No wonder it takes time to grow into and
come to terms with the shape that nature has given you
It can be a problem discovering what sort of woman-sized woman to be. It is not just about
being fat or thin. It is about being gay or straight, or a mother or a daughter, working, playing,
anything that makes life what it is. It is about control of your impulses and destiny.
Sometimes it seems impossible to control all this. Or if you do everything might go wrong.
You might not fit anymore and everything will fall apart.
One way of coping is to develop an eating disorder. The girl who starves herself to a low
weight shows desperate determination. She knows exactly what she needs to be. Childsized. But she can’t be eleven forever. Her body is growing. The world is moving on and
expecting her to come with it. It becomes irresistible. Maybe she will eat, but she will vomit
until she is happy to be woman-sized.
1. Anorexia and bulimia
This girl thinks Marilyn Monroe is great. She hates Kate Moss. She thinks Kate Moss is
thinner than she is.
The girl with anorexia is convinced that she is fat even though she is not. She is so fixed in
this belief that it seems like she is being stubborn, or stupid. In fact she has her back to the
wall.
She has to be the thinnest person in the world. It’s the only way she can survive. She’s on a
knife edge. Too fat and she has to face the world. Too thin and she dies. Being in the world
is so awful she would rather die.
2. Anorexia and bulimia
This girl would rather die than eat a cheese sandwich. It’s not that she isn’t hungry. She is
starving. It’s that if she eats she will put on weight. If she puts on weight she will go totally
out of control. She will grow and grow and grow. And everything that she is terrified of will
happen.
The girl with anorexia nervosa doesn’t have a problem with being fat. She has a problem
with being woman-sized. Becoming a woman means growing up, leaving home, trying to
have relationships but not rupturing family links. This is frightening for everyone. For her it is
petrifying. Starving makes time stand still.
3. Anorexia and bulimia
If this girl thought she was going to put on weight she would throw up.
She wants to be thin. She wants to eat.
Women with bulimia binge and may then vomit. They feel they cannot control life. They are
taken over by the urge to eat. They cannot stop themselves. So they make themselves sick.
If they didn’t, they’d get fat and they couldn’t bear that.
The girl with bulimia is in a no-win situation. She has two intense and conflicting desires.
Vomiting is the only way she can either protect her low weight, if she has anorexia nervosa,
or avoid becoming really fat if she has bulimia nervosa.
4. Anorexia and bulimia
If you are what you eat then this girl is nothing. She used to eat a bowl of cereal a day. Now
she can manage half a carrot. When she starves herself she is somebody.
Her behaviour fills those around her with fear and frustration. They cannot understand why
she won’t eat. They say, ‘It’s easy, all you have to do is pick up a knife and fork’.
She can’t get them to understand. It is hard to explain the fear she has. How can she tell
them she would rather die than be a normal adult weight and shape?
5. Anorexia and bulimia
When she looks in the mirror this girl sees a fatty. She is blind to the hip bones and the ribs.
She sees the slightly swollen belly. The bud of a breast. The curve of a thigh.
And they disgust her. As she disgusts herself when she eats a cream cake. As they make
her want to be sick. Or hide. Under huge jumpers, massive coats. Invisible and shrinking
under layers of cloth.
As she jogs on the spot she mutters her mantra: 'when I don't eat I am in control', 'when I
am thin I am safe'.
FACTS ABOUT ANOREXIA AND BULIMIA
What are anorexia and bulimia?
Anorexia nervosa and bulimia nervosa are the two main eating disorders. People with
anorexia have extreme weight loss as a result of very strict dieting. Some people may also
make themselves sick, abuse laxatives or do excessive exercise to try and lose weight. In
spite of this extreme weight loss, people with anorexia believe they are fat and are terrified of
becoming what is in fact a normal weight or shape. About four out of ten people with fully
established anorexia make a full recovery, and others improve. Only about three in ten
continue to have major long-term illness. Untreated, about 15 per cent of all sufferers will die
from the disorder within 20 years of its onset.
People with bulimia nervosa crave food and binge eat, though they are not emaciated.
Afterwards they make themselves sick or misuse laxatives to get the food out of their bodies.
Sufferers are very afraid of becoming fat.
Who has anorexia or bulimia?
Anorexia nervosa most commonly starts in the mid-teens. About one in a hundred 16 to 18
year olds has the illness. It is much more common in girls. Bulimia nervosa usually starts
when people are a little older, but is again more common in girls. Bulimia is more common
than anorexia, although people with anorexia in particular do not always ask for treatment.
Occasionally men develop eating disorders, but anorexia nervosa is rare. Male development
in puberty is very different from that of females. Related bodily concerns are different and
less often lead to the extremes of dieting which commonly precede anorexia nervosa.
What causes eating disorders?
Eating disorders may develop partly in response to difficult life experiences such as abuse or
social pressures arising in puberty and in growing up. They are also more common in
cultures where it is considered desirable to be slim. Genetic factors seem to be important,
especially in anorexia. Sometimes people with an eating disorder are depressed, and they
may have obsessions.
What treatments are available?
Mental health professionals need a variety of skills to treat people with eating disorders. A
doctor can help diagnose the illness and any associated physical problems resulting from it.
In both anorexia nervosa and bulimia, self-help strategies can be very helpful. If this
approach does not work, health professionals may suggest a course of psychotherapy. If
someone has lost a dangerous amount of weight, the first step will be to help the person start
to regain that weight in order to survive. Some people with anorexia may need to be admitted
to hospital and the nursing staff has an important role in supporting the patient in the early
stages of treatment. Psychological and psychotherapy skills are also necessary at this acute
stage, so that the mental health team can begin to understand why the illness developed and
how to help the person to overcome it.
In anorexia, this talking treatment will involve the individual with the illness and sometimes
other family members. The long-term aim will be to help that person change their attitude,
behaviour and ways of thinking, and enable them to cope with the strains of life without the
illness as a protection. Shorter-term expert talking treatments and also specific cognitive
behavioural treatments are often effective with bulimia nervosa.
What can society do?
We can strive better to understand the distress that underlies and drives these disorders. We
can provide access to such information and develop health promotion campaigns aimed at
teenagers and young people. Information on how to cope with feelings and fears about
growth or about being too fat is useful. We can offer more support in secondary schools and
user-friendly services for troubled teenagers.
Further reading
Bulimia Nervosa:
Overcoming Binge Eating (1995).
Christopher Fairburn. Guildford Press.
Bulimia Nervosa:
Getting Better Bit(e) by Bit(e) (1993).
Ulrich Schmidt and Janet Treasure.
Psychology Press.
The Essential Handbook of Eating Disorders
Self-help
beat (formerly the Eating Disorders Association,
EDA)
A national charity offering help and information
to people with anorexia and bulimia nervosa,
their families and friends.
 Adult Helpline (over 18 years of age):
08456 341414
help@b-eat.co.uk
 Youthline (up to and including 18 years
of age): 08456 347650. Text service:
(2005) Janet Treasure. John Wiley & Sons Ltd
When dieting becomes dangerous: a guide to
understansing and treating anorexia and
bulimia (2003) Arthur Crisp, Deborah M Michel
and Susan G Willard Yale University Press.
07786 20 18 20
fyp@b-eat.co.uk
Bodywhys - The Eating Disorders
Association of Ireland
Providing help and information to people
affected by eating disorders.
Helpline: 1890 200 444
info@bodywhys.ie
Last update: August 2006
Acknowledgements
We would like to thank Dr V Y Allison-Bolger and Dr R L Ramsay for their tremendous help in writing
these booklets and factsheets. Our thanks also go to the Campaign Management Committee and to
the members of the College Faculties and Sections who have generously given their advice and help.
Professor Arthur Crisp
Chairman,
Changing Minds Campaign Management Committee