A Mother's Tale of Her Daughter's Bulimia Recovery

This week I had the honor of talking with author, public speaker, and bulimia awareness advocate Selina Elison. In her soon-to-be-released memoir Bulimia-Understanding the Voice Inside My Daughter’s Head, she reveals a tale of undying love and compassion for her daughter and she provides practical recovery support strategies for other families. The book provides valuable insights for carers and healthcare providers alike. Selina is a certified trauma-informed Life Coach and Mindfulness Teacher who brings kindness and calm to the storms of eating disorder recovery.

Could you please tell me a little bit about how your daughter's bulimia started?

She was a ballet dancer. As a ballet dancer, you're in front of mirrors almost every day. And with the onset of puberty, my daughter did not like what she saw in the mirror, the changes that were happening to her body. She wasn't going to a ballet studio where there was fat shaming or anything like that, it was a very healthy environment, but I think we all feel a little bit uncomfortable in our bodies during puberty--it's a very vulnerable time. At that point, my daughter didn't go on a diet yet. But of course, she would think things like, "Shall I have this ice cream or not," and deprive herself of certain treats, so some of these thoughts about wanting to have a smaller body were there.

Then when she turned fifteen, her favorite uncle all of a sudden died. We had discussions about grief and I asked her to go to the counselor, but she didn't like to talk about emotions. She went to the counselor once, and then she came back saying, "It's not for me. I don't like her. And I'm fine." I have a son with a disability, and I think she got it into her head from the time when she was a little girl, ‘I don't want to ever be a problem for mom.’ Even though I have a very good relationship with her, I think that's why she maybe didn't approach me while she was upset about the loss and said, "Mom, can we talk?"

We had moved towns about a year prior to the passing away of my brother, and in the new school she had her first boyfriend. This boyfriend also became her best friend. So she didn't have very close girlfriends. She spent every day with the boy, and then all of a sudden this boy finishes with her, about a month or so after she had lost her uncle. So, suddenly, there was another loss there. Life was spiralling out of control for her. And, the boyfriend didn't give her a reason why he broke up.

There were other boys in her year group that told her she had fat legs. She had the legs of an athlete, her legs were not fat. We all know that the teasing often has nothing to do with reality. It was just boys being very stupid. And then with social media, she started comparing herself. And the boys made comments about ideal waist size, and saying things like, "Why are you eating your lunch, you with your fat legs. You shouldn't be eating. Why are you eating again?” She started to hate her legs, and then she decided to do something about this. And the idea that she could change her legs grew in her head. If nothing else, she could control the size of her legs. I think this is how it started.

She began restricting her foods, throwing her lunches away, and exercising more than usual. It went on for ten months, unnoticed by me because she had always been into exercise. She loved exercising. So if she'd go on an additional run, I didn’t think much of it. It never occurred to me that she would do it to lose weight. We are not a dieting household. I have never been on a diet in my entire life, and I didn’t think she wanted to lose weight. And, the thing about throwing her lunches away--I'm not in school. I didn't see it. Sometimes she'd come home and eat very little dinner. Whenever I noticed it, I would say, "You're growing. You should be eating a little more. What's up?" And then she would come up with excuses like, "Oh, after school, I went to McDonald's with my friends, and I've already eaten, and I'm not quite as hungry," and so forth. And then, when she binged in the evening, in secret because she had starved herself all day, it was on cereal, mainly. I think parents need to be aware that binges are subjective, and they are not necessarily what we read about. They aren't necessarily massive amounts of food that make you think, ‘Oh my god, my pantry is empty, all our food has disappeared overnight, what's happening?’ With binges, it's not so much about the quantity of food. It's more about eating the forbidden foods that you don't allow yourself, and it’s uncontrolled eating, rather than a massive amount that you might notice as a parent.

Do you believe that any one particular outside factor was a strong contributor to her illness?

Yes. I think it was the combination of what she saw on social media and the bullying in school, definitely.

While I was writing my memoir, I traveled and I met quite a few people who approached me, opened up, and said, “I, too, suffered from bulimia when I was younger.” When I asked how it started for them, all of them mentioned social media as a contributing factor. They all said the same. I think social media is so dangerous, especially for people, like my daughter, who are perfectionists. It feeds into that, doesn't it? It gives you this illusion that with anything, not just with weight, not just with looks, even in terms of careers, or what you own: That there is such thing as a perfect life. That you can be perfect if you just try. But beauty is in imperfection, really.

Tell me about your daughter's road to recovery.

Here in New Zealand, we have a public health system that is free of charge, but you can also go private. After her diagnosis, my daughter was referred to the mental health nurses who were part of the public system. There was very little understanding about bulimia then. This is changing, thankfully. Anyway, we saw a psychiatrist, who immediately wanted to put her on an antidepressant, and then she started therapy, CBT-e, with health nurses who told her that she should get over her teenage issues. My daughter left the sessions crying. We wasted a lot of valuable time.

I, then decided I had enough. I searched for private help and I found an eating disorder specialist, but we were put on a waiting list. I was told, ‘We give priority to patients with anorexia.’ A comment like this gives patients that suffer from bulimia the idea that they are maybe not sick enough. It feeds into the competition with anorexia. My daughter told me that she would compete all the time. When you suffer from bulimia, you feel like you failed at being anorexic, and so it's something that really shouldn't be said. Finally, after four, almost five, months, we started with family-based therapy. We worked with a therapist who my daughter really liked and trusted, and that's really important--the relationship with the therapist or recovery coach is really important.

As a parent, it took me a while to understand what my role was, and what I really needed to do. At the beginning, you are given a lot of information, but because you're so full of fear and so overwhelmed by the whole situation, much of it goes over your head. And it can be embarrassing to ask for clarification because you already feel like you have failed your child. I know this is wrong and you shouldn't be thinking like this, but you feel like, ‘Oh my god, what did I do wrong? How did I contribute to this eating disorder?’ And now, on top of it, you don't want to appear as if you aren’t coping and ask questions about something that you’re sure the therapist has already explained once. So, I guess, I contributed also to that we wasted more time because I wasn't firm enough at home. The eating disorder was clearly taking advantage of me for a good two months into family-based therapy until I finally got my act together, had enough knowledge, calmed down, and was able to set firmer boundaries.

I believe it's crucial that you get your child out of the malnourished state as quickly as possible. It is crucial because the rewiring of the brain will only start once the brain is nourished. In my daughter’s case, the rewiring of the brain took quite a while, but that’s to be expected. So the whole process took three years. Later during the recovery process, you can sort of step back as a parent. There comes a point when you have to trust.

Besides family-based therapy, I think it was important that I saw it as my role to create certainty in her life. An eating disorder is an uncertain, long illness which causes recovery fatigue and doubt. I tried to create certainty by reassuring her that I believed full recovery is absolutely possible. And I trusted that every single day she was doing her best. When she went off to university I kept reminding her to prioritize recovery over everything. I encouraged her to keep going to her therapist. I told her I would continue to pay for therapy sessions until the eating disorder voice was out of her head. I told her, “Don’t stop. Don't go halfway. Don't stop the sessions thinking, ohh, I'm eighty percent there. No. Do it one hundred percent.”

What are some of the ways you recommend carers can support themselves while caring for their loved ones?

You need to build up emotional resilience for a job like this. I realized that when I was overwhelmed by emotional distress, I was not coping well and not benefitting her. But to be twenty-four-seven with somebody you love so much and all you see is the suffering in their face, it tears you apart! The problem is that under emotional distress, you don't take in information properly, and you have all these feelings of fear, anger, guilt, shame get in the way of your decisions. So I think self-compassion and self-care are very important! You need to schedule breaks, you need to find a person who you can trust, ideally, your partner, and take turns. I wasn't so lucky. My partner did not understand the illness properly. So I was doing most of it by myself, but that's not advisable. You need breaks, although you may say to yourself, "Oh, you know, my child is suffering so much. I can't go out and have a good time. I don't deserve this right now.” But that’s wrong, you shouldn’t think like this.

Another advice I can give is: Learn as much as you can about bulimia. Knowledge empowered me and took that uncertainty away from the situation. The more I learned and the more I read about bulimia, the more empowered I felt, and the more I felt, yes, I can do this. There is a way. These days there are a lot of resources out there. You can research eating disorder associations or organizations online. They all offer a wealth of webinars, tools, and resources, and through most of them you can talk to people with lived experience. And I think that's one of the reasons why I wrote my memoir. I want to connect with the reader through my story because it's a lonely journey. 

There are people with lived experience that operate helplines. Talking with someone with a lived experience is sometimes better than talking to a friend because, in the end, well, I got tired of explaining the difference between anorexia and bulimia over and over again. They're well-meaning people my friends, but yet because they have their own lives with their own problems,  the complexities of eating disorders are not on their agenda. So, they said things like, "She looks fine now, doesn’t she? She hasn't lost any weight." And I found myself explaining again and again that she is suffering from bulimia and that weight loss or gain has nothing to do with how well she is doing. It's exhausting. So it's better to talk to somebody who actually knows.

Lastly, I would like to mention that practising mindfulness has helped me a lot. Getting rid of judgment. I think getting rid of judgment is a game-changer. Instead of judging yourself, your child, the recovery process, trust that your child every single day is doing the best they can, trust the recovery process and trust yourself. Don’t judge!

What kind of changes in bulimia recovery care would you like to implement?

More awareness amongst health professionals, definitely. Let me give you an example: During one of the visits to the GP, he asked ”How's the eating disorder going? Her BMI is fine. She must be doing great.” And I was sitting there thinking, ‘why doesn’t he ask about her menstruation? Why does he mention the BMI and give her the impression that she is not sick anymore?’ There was never a question about menstruation. So she hid from us that she hadn’t had her menstruation in months. The BMI-talk is not helpful. It feeds into the eating disorder. And then I had to deal with the situation at home, when she said to me, "See the doctor thinks I'm fine." So it's dangerous, really.

And I also think that health professionals who treat eating disorders shouldn't assume that you as a parent are coping. I was, for example, never asked if I could afford therapy, if I had to give up my job or not, if I was under financial strain. I know we as parents do whatever it takes. But we are only human. We need empathy and understanding. I sometimes wished I would have had a parent support coach, well, at least initially for just four or five sessions, who I could have texted in difficult situations. Especially at the beginning of the recovery journey, you need someone who takes the time to sit with you and explains what to expect during the recovery journey, explains family-based therapy without rushing, and listens to you, your concerns. You need emotional support, and open communication, which is my next point.

When your child turns eighteen, all of a sudden, because of confidentiality, you're cut off. And that gives the eating disorder voice a wonderful opportunity to make up lies again. Your child may lie to the therapist saying that there are doing so much better now, as it happened in my case. I was receiving emails from the therapist saying she's doing fine, and I was thinking, ‘this is not the picture that I see at home.’ There needs to be open communication between whoever is treating the patient and the parent, without breaching confidentiality, of course, but still asking questions like: What is the picture that you see at home? What do you see when you go out to eat in a restaurant?

Do you think that there is anything we as a society can do to prevent bulimia or other eating disorders?

I think awareness about the dangers of dieting is key. Our young people are very vulnerable to what they see on social media. I remember I had one conversation with my daughter that made me so sad, especially since I taught in schools for many years. I remember in the staff room we talked about racial discrimination and drugs. We never talked about dieting.

And so, I'm sitting with my daughter and she says to me, "Mom, you know what? We had so many assemblies in school. And we always talked about meth and the dangers of drugs and how everybody's dying from it. If I would have known dieting could give me an eating disorder, I would have never ever dieted."

It broke my heart to hear her say this. So I think schools can do a lot. As parents, we can do a lot by being mindful what we say around the dinner table. And, of course, as a society, we need to be more aware about eating disorders. There are still people who think eating disorders don't happen to good families. Or that there has to have happened sexual abuse in the family to have somebody struggling with an eating disorder. 

What would you like those struggling with bulimia and the parents who care for them know about reaching full recovery?

Full recovery is a possibility! Your child is sick enough to deserve treatment. No matter what the eating disorder voice tells your child. Get treatment as quickly as possible. And stick with it until your child is one hundred percent recovered. What I mean by that is that the eating disorder voice is not there anymore. And should it come back, and it might occasionally, it might even come back after two or three years, your child will know how to deal with it confidently.

What my daughter tells me is that she has learned from her therapist, that when the voice comes back, it's actually a warning sign for something else that's going on in life that needs sorting. And when it does come back, she can just sit there and calmly ask herself, ‘What is the evidence of this thought? Is there any evidence at all?’ And then she lets the thought go. She doesn’t act on it. She manages well like that. She looks at what's going on in her life right and asks herself, ‘Is there something that I need to do? Why did the voice even come back again?’ And then she makes the changes she needs to make and this prevents relapse.

Author: Merrit Elizabeth

Certified Eating Disorder Recovery Coach, CCIEDC 

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