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4 Lessons from a Health Educator Who Lives With Bulimia

I have run booths about eating disorders, organized #MirrorlessMonday events and hosted body positivity yoga sessions. Nonetheless, today will have been two days since I last ate.

As fresh as the hypocrisy is, I have to remind myself: teaching about eating disorders and battling an eating disorder are two very different things. I have the education, and now I get the experience. Reading blogs, studying articles, even having a degree in psychology, all seem like futile attempts at understanding what I now get a front-row seat to. However, as futile as they may currently seem, I have to reluctantly admit that some of this education stuck. I swear by the counseling process, I know to take my medication every day and I did recognize the warning signs when my eating habits started hurting my day to day life. So, on that somewhat optimistic outlook, I will join in the “futile” efforts of blog writers everywhere to share what I learned from my eating disorder. These are the lessons I wish I had known about eating disorders when I was teaching about them, with the hope it may somehow help the next overzealous health educator.

My background is relevant to this blog façade of a personal journal. I hold a Bachelors of Science in psychology, have volunteered in health education for five years and coordinated a peer health education program. I was diagnosed with generalized anxiety disorder in 2014 that began to present itself as bulimia in 2020. I also have a dog. Each of these is equally important to who I am today — hopefully, I’ll get to choose what is important tomorrow.

1. Definitions don’t define everything

Yes, I am looking at past-me and my activity board that sorted symptoms into their corresponding diagnosis. Little cards with “binging-compensating behaviors” were sorted into the bulimia category, “long-lasting sadness” into depression, and so on. At the end of the day, diagnoses are important for communicating symptoms between health professionals (and perhaps your insurance company). They can help a client understand what they’re experiencing. They can create a community between people with similar experiences. But, diagnoses are not perfect. You may be struggling but not meet the exact criteria or severity for a diagnosis. Your specific health professional may decide on multiple or singular diagnoses depending on their training. You may, like me, debate your psychologist on length of whether your fasting qualifies you for “bulimia” as opposed to “binge eating disorder.” This particular argument ended with wise words of advice: “call it what you want, the symptoms don’t change.”

I’m not saying not to talk directly about anorexia, bulimia or binge eating disorder as official diagnoses (see the previously mentioned benefits of using official labels). Just don’t end the education with the symptom definitions. Talk about the experiences and what the struggle feels like, offering the diversity that these stories deserve. At the end of the day, call an eating disorder what you want, but it doesn’t change what it is: a mental illness that hurts you. It isn’t a rulebook to follow or a symptom threshold to be reached before you’re acknowledged. Don’t teach it like it is.

Health Education Tip #1:

Don’t rely solely on diagnostic criteria for teaching what an eating disorder is. Instead, emphasize stories of struggle and success. Remind your audience that any struggle is legitimate and valid and should be discussed.

2. Recovery is ongoing and dynamic

Before receiving my diagnosis of bulimia, I was triumphant in having “recovered” from generalized anxiety — apparently, I was wrong. I quickly made great strides in battling bulimia and drastically improved my eating habits…before ultimately and frustratingly falling backwards after a few months. What I once called “recovery” was a binary success or failure — this is not the case. I do not say this statement lightly, as I am still learning its true importance myself. Recovery is an ongoing battle that takes strength and resilience. It requires acknowledging setbacks without letting them overcome you, and periods of working to maintain wellness.

Even treatment can be a dynamic process. I have the privilege of not only having access to therapy, but finding the right fit in a therapist on my first try. I know others who have struggled with therapists or explored different types of therapy, from group to one-on-one or mindfulness to CBT. My therapy was once enough to hold my anxiety at bay; it stopped being successful a few years back, and I reluctantly went on antidepressants. While struggling with the ongoing battle of recovery, the dynamic nature of the very treatment tools you are using can be unexpected and exhausting. As health educators, we can prepare people for this reality with the knowledge of diverse tools and resources.

Health Education Tip #2:

Teach about the ongoing nature of recovery and that taking steps back is not failure. Promote diverse resources and tools so your audience is the best equipped they can be.

3. Shame is real

I binge eat. I cannot control it. I hate myself for it. I do not talk about it.

No matter how many campaigns I coordinate to fight stigma: I binge eat, I cannot control it, I hate myself for it, I do not talk about it.

This thought process seems immensely counter-intuitive. Somehow, I should connect the uncontrollable nature of my mental illness to self-compassion and forgiveness. (I don’t.) Somehow, I should connect my experience on stages behind microphones to allowing myself to openly talk about my experiences. (I don’t.) The incoherence of these arguments hurts the logical side of my brain. It is this duality that health educators must remind themselves of: a duality between emotion and logic. I refer openly to both my logical side (the health educator) and my emotional side (a sad blanket burrito of self-hate). Some days one side is louder than the other.

I did not realize the extent that shame can affect you until I tried to explain to friends and family my latest diagnosis. I used the term “eating disorder” instead of “bulimia” in the hopes we could leave the specifics out of the conversation. Me and my tray of mini-cupcakes would prefer to go unnoticed. It is this lesson that health educators must constantly remind themselves — shame is real, stigma is real and the battle must go on.

Health Education Tip #3:

Try to reduce stigma every chance that you can. No matter how many useful programs and resources you offer, stigma will stand in the way of someone asking for the help they need. Include reducing stigma as one of your communication goals in every campaign.

4. Love yourself again, and again and again

Not every lesson you teach as a health educator will stick. Not every post of “love yourself” on Instagram will change someone’s day. However, do not stop doing this. As a once idealistic health educator, I convinced myself that what I said would or would not have an impact. It’s far more complicated than that. Messages take time and repetition to have an impact. Your mind codes information each time it sees it. Seeing something multiple times and in different formats helps you learn and internalize the idea.

I struggle every day with thoughts of self-hate and body image issues. I repeat positive coping mechanisms and compassionate messages to myself. Many don’t stick, but some do. Just as I struggled one day, the same coping mechanism may work the next. I find these flip often throughout the recovery process, with the coping mechanism and compassionate thought sticking more and more each day.

Remind others to continue repeating these thoughts, to ride the waves of self-hate with just as relentless countering. One day you will listen, and you want to make sure that you are saying something productive when you do.

Health Education Tip #4:

Don’t just say it once. Repeat successful campaigns and address the same topic multiple ways with different campaigns. You never know which time may work.

Good health education works.

My last message to health educators is the importance of the work that I called futile at the beginning. I read the blogs, I studied the articles, I listened attentively to lectures about eating disorders. These did not stop me from getting an eating disorder, but they were never supposed to. My education was supposed to teach me to recognize the signs of mental illness, familiarize me with the resources to reach out to and remind me the importance of caring for one’s mind and body. I always thought my education was there to just help others — as much as I hope that it also helped someone else, I know that it helped me.

Good health education includes talking about the difficult topics, letting experience drive education, reducing the stigma surrounding them and repeating the message.

Keep teaching and keep learning.

Original image via contributor