Angela Barnett and Hannah Tunnicliffe have suffered from bulimia. Photo / Alex Burton
New Zealand researchers are seeking more than 3500 volunteers for the world's largest eating disorders genetics investigation. Sharon Stephenson discovers triggers like menopause and perceived loss of status in a youth-driven world can trigger mid-life bulimia.
"Usually after a good puke, you feel better right away," says Esther Greenwood, the protagonist of Sylvia Plath's 1963 novel, The Bell Jar.
I was 17 when I first read Plath's classic, the sweet-spot in the Venn Diagram where teenage hormones and first love overlap. With the tortured Plath, I had found my perfect home.
Although Greenwood vomits due to food poisoning, her joy was also mine, because I'd recently discovered how to empty my stomach by sticking my fingers down my throat.
Bulimia, according to the popular girls at my Lower Hutt school, was the answer to my weight-loss prayers. Not having been blessed in the height department, every calorie that passed my lips made its presence felt on my hips.
I was pudgy and unhappy, the opposite of what I wanted to be for my first boyfriend. So I spent my days with my head down the toilet, ridding myself of evil calories. Eventually, it consumed my thoughts and snatched away my common sense: I woke up thinking about being fat, spent my days binging and purging and went to bed worrying about how much weight I'd put on that day.
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And so it went until sometime in my 30s, a dentist looked me in the eye and told me to stop, that my stomach acid was stripping my teeth of its enamel. I felt embarrassed, and then silly, about my vanity. Not long after, I stopped wringing out my stomach like a wet sponge.
I was reminded of those days recently when, in the toilets of a posh Wellington restaurant, a woman in the cubicle next to me started vomiting.
When she emerged, and stood next me at the basin, I asked Jane - not her real name - if she was okay. She arranged her face into one of helplessness, the kind of helplessness I remembered so well. A bottle of wine down, Jane's words flowed easily: she was 42, recently divorced, the children she'd so desperately wanted never having materialised. Her work as a tax lawyer was stressful, tedious and not what she wanted to do.
"Sometimes this is only control I have over my life," she said, her arm drifting towards the toilet.
"I've dipped in and out of bulimia since I was 17. When things are good, I don't need it but as soon as life gets hard, binging and vomiting is my go-to coping mechanism."
She isn't alone: if your image of a typical person with an eating disorder is a pimply teenager, you need to readjust that picture.
"Stereotypically, the world sees people with eating disorders as adolescent girls or young adults," says Dr Roger Mysliwiec, co-founder of the NZ Eating Disorders Clinic.
"Eating disorders tend to appear early in life and are more frequent in females than males. But it's estimated that globally, around 13 per cent of women over the age of 50 are living with symptoms of eating disorders."
While some women may have had eating disorders in their teens and have never fully recovered, others may have gone through decades of recovery, only to relapse when they're older, while a third group has been preoccupied with food and weight for a long time, but have never been fully symptomatic until now.
"Mid-life onset of eating disorders is less common than early-onset but it does happen," says Mysliwiec, his voice fading in and out of range as he drives from his Waitakere home to his clinic in Freemans Bay.
Concerns about body weight and shape usually play a role at the start of the disorder, leading to fasting/restricted eating which, conversely, increases the body's need for more calories.
"When you restrict calorie intake, your body may react by binge-type behaviour because it needs the energy," says Mysliwiec.
While menopause and perceived loss of status in a youth-driven world can trigger mid-life bulimia, emotional stress is another: "An inability to deal with uncomfortable feelings such as loneliness or anger, divorce or an empty nest can lead to behaviours such as binge eating which give momentary relief. This is often followed by self-induced vomiting and feelings of disgust, which again leads to restricted eating habits, starting the cycle again."
Ironically, over time such habit-forming behaviour means the reason bulimic may have started in the first place – to be slim – no longer matters.
"If the illness persists over a number of years, it becomes entirely habit driven so women might not even care that much about body image any more, they simply cannot stop binging and purging."
Figures show eating disorders can kill more people than any other mental illness, with patients of all ages also suffering from impaired brain function, infertility, kidney failure, cardiac arrest and dental failure. Older women are thought to be particularly at risk for damage to the heart, brain and bones. "When you're younger, your body can withstand more," says Mysliwiec "But bulimic behaviours may have a greater effect when you're older and aren't able to bounce back as quickly."
Pinned to the wall of Hannah Tunnicliffe's North Shore pantry are two photos: one was taken on her 2008 wedding day, the other a few years ago when she was 30kg heavier.
"I'm smiling in both photos but I look at the second photo and think, I'm the heaviest I've ever been but also the happiest I've ever been," says the 40-year-old.
"It's taken me a long time to address my beliefs about thinness and fat-phobia, to have a normal relationship with food. Having those photos in the pantry reminds me that thinness doesn't automatically mean happiness, health or success. That those things are possible in any size body."
As anyone who's ever fallen under the tyranny of an eating disorder will tell you, it's easy to start but hellishly hard to quit. Tunnicliffe, an author and mother of three daughters aged 9, 7 and 3, was 17 when she first began having issues with food.
"It was the perfect storm – a sense of not being in control combined with social pressures to look a certain way. The message was, this is what success looks like, if you're hard working and determined enough you too can be beautiful."
Tunnicliffe started life as a skinny kid, but then puberty arrived, bringing with it breasts and extra kilos she was determined to get rid of.
"I was doing part-time waitressing at the time, so I'd tell my parents I'd eaten at work and my boss that I'd eaten at home. I got really sneaky about restricting my eating."
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Tunnicliffe chased a social sciences degree at Waikato University with two years in Melbourne and another two in London where she worked in HR.
It's where her eating disorder kicked into high gear. "I'd oscillate between binge eating, restricted eating and crazy amounts of exercise. I'm not sure when the bulimia started, but it's on the spectrum, so it was just another disorder eating behaviour I hadn't tried."
Tunnicliffe eventually dragged herself to her London GP who dismissed her for not vomiting enough.
"He basically said I was going to have to have to say I threw up more than I did if I wanted help. In other words, I was a shit bulimic who needed to step it up!"
Like many disordered eaters, Tunnicliffe is a high achiever, so when someone tells her she's failing, her overachievement gene goes into overdrive. "I got worse and worse."
In the end there was no great Road to Damascus moment; Tunnicliffe simply decided she was tired of urgent appointments with the toilet.
"Let's face it, making yourself throw up is gross and messy. I think it's probably more socially acceptable to have anorexic behaviours."
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And she was doing okay until, three years ago, Tunicllife realised that while her bulimic behaviours may have changed, her mindset had not.
''There was still the constant anxiety that if things went wrong, I could tip back into it. I would look at people who had normal relationships with food and think, will mine always been so screwed up? I also didn't want my daughters to have the same disordered relationship with food."
Tunnicliffe approached a couple of Auckland therapists but no one had the capacity to "take on someone like me who wasn't urgent".
She found an American therapist, Isobel Foxen Duke, whose Stop Fighting Food online programme caught her eye.
"It cost $2000 I couldn't really afford, but it was an investment in my mental health, so I signed up for her programme about intuitive eating and health at every size."
It was, admits Tunnicliffe, "like an explosion going off in my head". "It changed the way I thought about food, why diets don't work and that there's no good or bad food. It was like being freed from a cult."
Tunnicliffe turned to social media to share her thoughts on body positivity and health at any size, building a community of like-minded women keen to share their experiences of disordered eating and of being ashamed, secretive and worried they'll be judged for it.
"I'm being open and vulnerable online, so others can too. It's the only way to move forward."
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For Jane, it started with a litre of chocolate chip ice-cream, shovelled with great gasping spoonfuls into her mouth.
"I was 17 and had just got my licence, so I drove to the supermarket and bought ice-cream, sausage rolls, two family-sized pizzas and a loaf of white bread," recalls the Wellingtonian.
And then she locked the door to her bedroom and ate. And ate and ate.
"There was no joy to it, I barely resisted what I was eating or how it tasted. It was like being in a trance, on some crazy mission to eat as much as I could as quickly as possible."
And then she vomited it up, having being sold bulimia by a girl at school who called it "easier than dieting or exercising".
"The sense of relief was immense. I don't think I've ever got such satisfaction from anything in my life as I do from emptying my stomach."
Jane has had a wobbly relationship with food since she was 12, when her mother called her fat.
"One school holiday I was trying my tiny mother's wedding dress on and it wouldn't do up. She was horrified, called me fat and said I was going on a diet immediately," says Jane, her face still burning at the memory.
That one conversation set the only child on the ferris wheel of disordered eating, a ride she's still on.
"I don't binge the huge quantities I used to but mainly throw up a normal sized meal or a snack. And I can go months without doing it. But then something crap will happen to me and I'm back in the loo."
Although Jane has tried therapy, nothing has ever stuck.
"My head tells me it's not normal or healthy but my heart won't let me stop."
It was 1981 and Angela Barnett was competing in the high jump at her Cambridge intermediate sports day.
Shortly after clearing the bar, her 11-year-old boyfriend split up with her, "He'd seen me do the jump and said I was too chubby," admits the now 49-year-old writer. "That's the moment I learned to equate skinny with love."
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It was a lesson that burrowed deep into Barnett's adolescent subconscious and set her on her disordered eating path.
"I was never a skinny kid but I lost weight by cycling to school, excessive dieting and doing things like 100 sit-ups before bed."
When Barnett moved to Wellington to do an arts and commerce degree, all night drinking and 2am pies piled on the weight. Her dislike of the extra kilos spilled over into bulimia.
"I called it my secret monster and it became the equivalent of a bottle of whiskey – what I'd reach for whenever something shit happened."
So proficient did Barnett get at emptying her stomach that at one flat the landlord had to replace the sewage pipes.
"Plumbers dug up the front garden to replace the clogged pipes. But I told the landlord it was my vegetarian flatmate's fault, blaming his lentil burgers!"
By then Barnett was working in advertising, almost drowning in an industry obsessed with perfection.
"I'd sit in meetings going through audition tapes with people saying, no, that one's too freckly or that one's thighs are too big, all the time trying to be cool and hiding my secret monster."
Barnett realised she had a problem when her boyfriend accused her of having an affair. "I was three hours late coming home because I'd been throwing up at work. And then I doused myself in perfume to cover the smell so he thought I was seeing someone."
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She eventually fessed up to her best friend who set up a meeting with a counsellor. Neither that nor the group sessions she attended at Wellington Hospital helped much.
"I hated being vulnerable so never went back. I also found it hard to admit that I had a disorder. I was from a good family and had been deputy head girl at college. People like me weren't supposed to have disorders."
But something had to give and three months out from her 30th birthday, Barnett vowed to stop smoking and stop throwing up.
"I had all these strategies, starting with only binging and vomiting on Mondays and then every second Monday and so on."
Breaking the habit was tough, and Barnett had to find other coping mechanisms. She eventually started a website, F****** Awesome Bulimics I Know, a portal for women to share their stories of what she calls a "stinky, shameful secret".
Logging time on a therapist's couch also helped her finally put the monster back in the cupboard.
Two years ago, the mother of a 12-year-old son and 10-year-old daughter started Pretty Smart, travelling around New Zealand to talk to teens about the often false and damaging images perpetrated by both traditional and social media, of the never-ending quest to fix the unfixable.
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"There's whole industries making money off our insecurities about our appearance, often using manipulated images that don't celebrate our differences. Pretty Smart is about feeling comfortable in your body and with what you see in the mirror – something I know a bit about."
• New Zealand researchers are seeking volunteers with first-hand experience of an eating disorder to enrol in the local arm of the world's largest ever genetic investigation into the complex, devastating illnesses.
Volunteers need to be over 16 years of age and have currently, or at any point in their lives experienced anorexia nervosa, bulimia nervosa or binge eating disorder. To learn more, or to register for the study: visit www.edgi.nz
If you, or a loved one is currently living with an eating disorder, contact Eating Disorders Association of NZ for support on 0800 2 EDANZ or info@ed.org.nz.
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