Eating disorders are challenging and confusing for many people! This is especially true if they are not experiencing it firsthand. As a psychologist who specializes in the treatment of bulimia nervosa, I have seen dozens of clients in my office in Torrance and heard from many of them that they were able to keep their bulimia a secret from their partners for decades. Many times, the partner only realized the problem when the disordered eating had become so acute a trip to the hospital was necessary to treat medical complications or when my patients revealed the secret on their own. Secrecy is a central part of eating disorders, and it is often associated with the shame my clients often feel about their disordered eating behaviors.

Many people mistakenly assume that their partner’s bulimia is a phase that will pass. In all my years of clinical practice with eating disorders, I have never heard of anyone who qualified for a diagnosis of bulimia nervosa and recovered without professional support or treatment. What I have seen is that, depending on internal and/or environmental stressors, symptoms of an eating disorder might wane and wax; however, without treatment it can become a chronic condition with little prognosis for treatment. As a partner, you can play a powerful role in supporting your partner’s navigation through recovery from this deadly disorder.

The steps below will help you to address these issues with the sensitivity required and without jeopardizing your relationship with your partner.

Become Familiar with the Signs and Symptoms of Bulimia

Bulimia nervosa is a disorder that usually begins in the late teenage years or in young adulthood. Most people are symptomatic for several years before they seek treatment. Individuals who struggle with bulimia nervosa often consume large amounts of food, followed by purging, using self-induced vomiting, misuse of laxatives, over-the-counter diet pills, diuretics, enemas, or other means.

Many people engage in binge and purge behaviors when they are alone. They might not engage in these behaviors while they are eating in public or with family and friends; however, on several occasions “I have heard my clients tell me that they leave the table at once after eating to purge, as a way to manage their overwhelming emotions.”

Because binging and purging compromise the health of the body, sometimes you can see physical signs of an eating disorder. Here are a few of them:

• Swollen cheeks
• Tooth decay
• Calluses on the back of the hand
• Red dots on the face
• Mouth ulcers
• Abdominal bloating
• Edema
• Cardiac arrhythmia

Research Various Treatment Options

 If, after going through the first step, you are still suspicious that your loved one is struggling with bulimia, the next step would be to identify resources within your community. Depending on the acuity of your loved one’s symptoms, she or he might require residential, partial hospitalization, intensive outpatient, or outpatient treatment. The good news is that unless your loved one is medically unstable, they can start with outpatient care, and they will only be referred to a higher level of care as necessary per their therapist’s recommendation.

The treatment of eating disorders often uses a multidisciplinary approach, a team effort between a psychologist, a psychiatrist, and a registered dietician. Since the psychologist or therapist is often the “captain of the team” and coordinates care with the rest, the most important step is to find a therapist who specializes in eating disorders. Because many therapists only have generalist training, it is essential to find one who has had specific training and is knowledgeable about working with this population.

Talking to Your Loved One about Their Bulimia

Discussing something that they feel ashamed about with your partner is one of the most challenging but loving act you can do for them. You will not be able to support them unless you communicate with them that you are aware of their struggles and you want to help them.

When people are under pressure and feel uncomfortable about an upcoming discussion, they often feel a sense of urgency to bring it up as soon as possible. However, for your message to be heard, it is important that you set aside a time and place to talk to your partner about it and be intentional how you discuss it. Make sure the conversation is not before or after a meal, because these times are particularly challenging for individuals who are struggling with eating disorders.

Be specific about the problematic behaviors and symptoms that you have witnessed and express concern for your partner’s health based on that behavior. General statements are easy to dismiss, but if you highlight a specific behavioral pattern that you have witnessed for a while it will be more challenging to dispute it.

In addition to highlighting their behavior, it is essential to express openness and compassion toward their experience, even if it means letting them deny having an eating disorder. Ask them how they can make sense of the behaviors you have seen and how you can support them if this is something they are interested in addressing. Due to nature of bulimia, many people are in denial about the acuity of their condition; however, they might be more receptive if they hear from someone else how it is impacting their life.

If you sense that they are even slightly open to entertaining the idea of treatment, you can provide them the names of psychologists or agencies that you have found who are in your area. Furthermore, if they express interest in treatment you can offer to make the first call with them or accompany them to the first appointment.

Do not be disappointed if they minimize or deny their eating disorder. It is common to take individuals who are struggling with bulimia not to seek treatment immediately. I often get phone calls from a new client four or five months after their loved one has contacted me for a consultation. Recovery from an eating disorder is a process, and change happens when people are ready to make the change themselves. Even if they do not follow up your recommendations, because you have shown concern and support, they will know that you will be there for them when they are ready.