From about 1998 through 2005, I was bulimic. Today, I'd like to address how I stopped making myself throw up.
My road to recovery was long, and I made some good decisions, but a lot of bad ones, as you'll see in the story below. I don't suggest my path for everyone, as it wasn't always healthy. But I do want to share my story to perhaps reduce shame for people suffering from bulimia, and to close with what I think are some good tips for recovery.
Caution: this post may be triggering, as it includes mentions of foods and purging methods. If this is going to upset you, I do not suggest you continue reading.
Ipecac: a terrible love story
As previously mentioned, I suffered from bulimia for several years. Frequently, I would self-induce vomiting after eating large amounts of food during a frenzied, short period of time. During particularly bad spells it happened several times a week; during better times, a month could go by when I didn't binge and purge.
The first time I made myself throw up was after an eating binge where I couldn't stop eating leftover Halloween candy. I did it "manually"--by sticking my finger down my throat until I felt the little hanging bit in the back of my throat, my gag reflex activated, and I heaved out some of the candy. It sucked: it hurt, I had to keep on doing it, and I really didn't bring up anything of substance.
I probably never would have made myself vomit again had I not discovered ipecac. It happened in an unassuming way, not long after the Halloween candy incident: I was in a drug store with a friend, who was buying something unrelated, and I said "what's this?" regarding the syrup, which I had happened to notice because of its funny name. She said "that's what they give to babies to make them throw up if they eat something poisonous". Bingo. I went back the same day and bought the entire supply--about 8 bottles of the stuff.
I didn't use ipecac right away. For a while, just knowing that it was there made me feel better, helped stave off eating binges.
But then, on a not-much-of-anything type of day, I had the most epic of eating binges, which I don't believe I ever topped. It had started fairly innocently--I was waiting in the car, for my mom to drive me to work, and she was taking forever to come out. I noticed a package of pop-tarts in the console, and I inhaled them. I had already eaten breakfast; I felt badly about this. I resigned myself to not eating lunch to make up for this transgression.
But the binge continued. We had recently started selling gourmet food and fruit baskets at the flower shop where I worked, and throughout the morning, I found myself nibbling on the rich goodies, including buttery pretzel nuggets, package after package of shortbread cookies, nuts of all sorts, mixed and candied and salted.
Throughout the day, the binge continued, and included every "trigger" food you can think of: pizza, pasta, fried chicken, chips, ice cream, cake, shakes. More pop-tarts. I continued to eat in secret, but also ate a "normal" dinner with my family. Then continued my bingeing, under the guise of "going for a walk" which actually included picking up a ton of binge food at the grocery store and then walking while I ate it all.
By the evening, I was so full that I felt like a pinprick would make me ooze open. But more than feeling "fat", I felt awful. I felt like an engorged tick. I wanted to vomit just to feel relief.
The moment had come: ipecac would save me from this awful feeling. I unscrewed the lid from the ipecac and removed the tamper-proof foil lid. Ipecac comes in small bottles, maybe the size of a little rewetting solution container for contacts. I was greeted by an awful cloying medicinal scent that made my stomach turn. Cartoon character style, I pinched my nose, threw my head back, and chugged the whole thing, fighting the urge to gag all the while. The taste was even worse than the scent, and it made me shudder in disgust. Later in college, when I tasted Jagermeister for the first time, it tasted sort of like ipecac to me.
What happens when you take ipecac
Initially, you feel nauseous--like, you thought you were nauseous before you took it, but that was nothing compared to the wave that hits you afterward.
Ipecac doesn’t work right away, though. It takes 20 to 30 minutes, which allows you to segue into a sort of bored-nauseous phase. You drink water. You walk in circles. You say “come on come on come on”, waiting it to take effect.
Next, the shakes. You start to feel shaky and your mouth fills with saliva. Here it comes, you think. But no. Your body keeps you in a holding pattern for a good ten minutes in this phase, alternately feeling cold shaky and hot shaky, and your mouth beginning to drip saliva.
Impatiently, you might try to hasten the process by making yourself dizzy. My method included walking in circles while bobbing my head, looking like some deranged interpretive dancer. The vomit dance.
Then, the gagging. First, it’s a fake out: dry gagging, no vomit. Usually, it’s right when you walk away from the toilet that it comes for real, the vomit hot in your mouth and spewing, projectile-style, ideally into tub, sink, or shower, but sometimes you miss.
Vomiting with ipecac is no delicate spitting up. It’s violent and evil, like a machine is making you regurgitate. The first heave is powerful. You feel everything coming back up, and for me, it came with an awful gratification at having it out. The second heave is even more powerful. You thought you'd brought up everything, but after the second heave, you really know you did.
But then, it doesn’t end. You have maybe 15 or 20 more heaves, until you’re spitting up saliva and greenish brown bile-goo. You’re beyond empty. Yet somehow, amazingly, you feel like you have to go to the bathroom--like, number two, urgently. You hope you don't start vomiting again while you're using the toilet, but it's possible.
Ipecac is awful stuff.
Ipecac is truly terrible stuff. It causes a myriad of health risks, including cardiac arrest, which is an alarmingly common cause of death in the eating disordered set.
For me, the moment when I took ipecac for the first time was the moment when I progressed from dipping my toe in the bulimic world to full-blown disorder. Suddenly, vomiting was no longer "not an option". Yeah, it totally sucked to make it happen, but it was better than getting fat from all those binges, right?
Even while I continued to use ipecac more and more frequently, I tried to resist it. I knew I had a problem, I knew I needed help. I saw a therapist. I heard all of the facts and figures: that when you throw up you don't lose even half of the calories.
But somehow, I couldn't fight the urge to make myself vomit. It's like at certain moments a light switch was flicked inside of me, and vomiting was the only thing I could do to make myself feel better. I would do crazy things in the name of my disease when it was time to vomit. I once left a group dinner, saying that I was going to the bathroom, and just never went back, instead going to the nearest drug store to buy ipecac and walk the streets until I felt the urge to vomit. Another time, I told my boyfriend--who had come to the city where I lived to visit me--that I needed a little quiet time, and what I did with this "quiet time" was steal away with a bottle of ipecac and a bag of takeout chinese food.
The end of the affair
During "good times" I could go for a month or even more without throwing up. But during bad phases--when my boyfriend had broken up with me, when I felt lonely, when I was between jobs--I was throwing up daily.
I bought so much ipecac I alternated where I bought it. I knew all of the pharmacies that were open 24 hours in New York, and then Seattle, when I moved. I always tried to have extra bottles on hand. Once, a clerk looked at my purchase, which was 5 bottles of ipecac, and said "what's this for, honey?". I mumbled something about babysitting, finished my purchase and never went back to that pharmacy.
More than once, and I am not proud to say this, I went into the aisle, opened the bottle, downed it, and then bought something else. I wasn't motivated by a desire to shoplift, but more from a desire to not be judged when I brought the ipecac up to the counter.
And then, after several years, my affair with ipecac came to an end. I'd like to tell you I had an epiphany or that I really hit therapy hard, but those things would be lies.
The catalyst for my ceasing vomiting was this: ipecac was taken from the shelves and put behind the pharmacy counter.
My road to (sort of) recovery
Quite suddenly, the ipecac wasn't on the shelves where it used to be. It would usually be in one of two places: by the baby stuff or in the first aid aisle. I avoided those aisles when I wasn't buying ipecac because just the sight of the bottle made me gag.
One day, scouring the aisles for my drug of choice, I was coming up empty, and so I asked an employee if they had any. Because I was a babysitter.
She told me I had to ask at the pharmacy. Well, that was the last time I went to that pharmacy. Little by little, the other pharmacies in the area phased ipecac off of the shelves and behind the counter. It wasn't by prescription, but you had to ask for it at the pharmacy counter. It was that added step to get it I just couldn't take--there was too much shame, and I couldn't really ask for 8 bottles at a time without the pharmacist asking questions, now could I?
So, just like that, I stopped buying ipecac.
It wasn't particularly noble. I still wanted the ipecac, but the fear of judgment weighed heavily. Suddenly, it seemed, vomiting was less of an option.
I told myself "this is it: the vomiting must stop." But it didn't--for close to a year, I still had an eating binge every 1-3 months, and berated myself for violating my self-imposed mandate.
I scoured the web for DIY vomit tricks. I tried drinking salt water. I tried drinking rubbing alcohol. I tried spinning around and around (really) to make myself dizzy. None of it was as effective as ipecac. Unsure that I was really "cleaning myself out", I began to be spooked off of binge eating.
Now that I didn't have ipecac, every time I had a binge, I had to deal with its reality, to literally "sit with" the food I had ingested.
This could have been a good thing, and maybe it would have, if I had had a good support system in place. But I didn't, and I channeled the energy I used to use on bingeing and purging on obsessing about every calorie. Because vomiting was no longer an option, I felt I had to be that much more careful about what I ate. I counted calories, and would never go beyond a certain number.
When I did have those increasingly less-frequent binges, I would tally up an estimate of how many calories I had eaten, and then treat it like a bank loan, deducting 200-300 calories a day from my daily eating until I had balanced out the amount of calories I'd binged. It made me feel even, it made me feel sane.
I didn't know how many calories I should be eating per day, so I settled on 1500, which felt like a good, round number. However, I rounded up everything I ate quite a bit, so I was probably eating more like 800 calories a day. I kept detailed lists. I always had the calculator function open on my computer.
The weight began to fall off. I got compliments. My clothing size dropped and dropped. When I got married, I wore a designer dress in size 0 at my wedding. It was loose.
At one point, I realized it had been six months since my last binge. Then, it was a year. I thought I was recovered.
I was obsessed with staying "recovered" and was convinced that it was because I was so careful about my food intake. My militance about calories only escalated. I would only eat certain foods at certain hours on certain plates with certain cutlery. I doused everything with hot sauce or salt so I could get the most flavor bang for my buck in every bite.
It took me a long time to realize that I hadn't recovered, that I had simply shifted eating disorders. Anorexia is for another day, though. Because in spite of the fact that I hadn't yet recovered, it was important that I had stopped vomiting.
While it wasn't the direct gateway to recovery, stopping vomiting was a huge milestone on my road toward it.
With the importance of the end of my self-induced vomiting in mind, I am going to spend a few minutes to talk about how to stop throwing up--do's and don'ts which are inspired by what I did right at the time, and what I wished I would have done differently given the progress in recovery I have made since then.
How to stop throwing up: dos and don'ts
I did some things right (like stopping vomiting) but probably more things wrong, because I ultimately ended up with another eating disorder. Here, I am going to detail what I consider hard-earned tips for recovery from self-induced vomiting.
DO NOT make ultimatums. "I'll never make myself throw up again." "This is the last time. This is the last time." How many times did I say things like this to myself? More than I can count. And then, each time, when I did it again, it felt even worse, because not only was I engaging in the behavior
DO decide that you don't want throw up. Even having said that you shouldn't make ultimatums, you should make an intention to not throw up. Make a conscious decision that you want to stop vomiting. It might not be immediate, but it could be your first step toward making it a reality. What would life be like if you didn't throw up?
DO NOT punish yourself if you do throw up or have a binge episode. It is highly likely that one or both will happen while you take steps toward recovery. While you don't want to resign yourself to it happening, you also can't kick yourself if it does happen.
DO NOT forbid any foods from your diet. This is a tricky one, because over time, I was able to identify that certain foods were triggers for me, and best avoided. But it was far healthier to make a conscious decision that I didn't care to have a certain food because it was a trigger rather than to simply say "you aren't allowed to eat this". It was also empowering. You can choose not to eat certain things rather than to make strict rules.
DO treat yourself. I made a pact a long time ago that one day a week, I would have cake for lunch. Usually it's Friday, but it might be another day if I feel I want/need it. I look forward to this day. I love choosing what cake I will eat and thinking about how good it will taste. I love that I have given myself permission to eat every bite if I want it. It's an indulgence, but one that I have permission for.
DO NOT keep trigger foods in the house. For a long time, I needed to have a completely empty refrigerator and shop on a daily basis for the household's daily needs. There was no bread in the house. Ever. In some ways this was a pain in the ass, but in many ways, it was necessary. I thought about it this way: if someone was in the early stages of fighting alcoholism, you wouldn't keep booze in the house. Why would you keep trigger foods around in the early stages of eating disorder recovery?
DO tell people that you are recovering from bulimia. I told a few people, and it was always awkward, because they cared but they didn't know what to do or how to react. If I knew what I know now, I would assure them that I didn't need them to react to it, but I just needed to not have this secret anymore. And I wanted to explain my behavior or why I felt like getting together over food wasn't going to work.
I found this quote in a fiction book; while it's not about eating disorders, it's appropriate:
"Secrets are sickness, and once we voice our worst fears, it diffuses the power, and the hold those secrets have on you." - Jane Green, Saving Grace
DO socialize...but know your limits. If you stop vomiting, you might feel like the only way it is possible to maintain "sobriety" is to stop attending social functions involving food entirely. Honestly, it is going to make you pretty lonely and isolated to do this and it will probably actually fuel the desire to binge.
For me, what worked was this. I did avoid sit-down dinners; it was just too much. But if it was a social event where there were nibbles or appetizers everywhere, I would eat something beforehand. Part of me felt like I missed out on the food, but I felt like this was the way I could stay sane, in control, and keep myself from overdoing it and vomiting.
DO NOT let yourself get too hungry. Eat regularly, and eat enough. Go to a nutritionist, if possible, to find out how much is enough, and what you should be eating. I wish I had done this, because all I did was assign what I thought was a good calorie count and didn't leave any leeway. I was often too hungry. And I know that for me, waiting too long to eat has always (still is) a trigger, and I don't trust my judgment when I am over-hungry.
DO NOT eat in secret. It is so tempting to only eat by yourself, in a controlled setting. I get this - I still do it sometimes, or have the desire to. But remove the furtive aspect. Respect yourself when you eat. Even if you're by yourself, present the food nicely. Don't sit at your laptop and eat.
For me, something that worked was trying to eat in public as much as possible--in a casual cafe, or on a park bench, etc. Not at sit-down restaurants, but places where I could be in the world while eating.
DO seek out a therapist. Find a therapist. Find a therapist. Find a therapist. If you don't like the first one, find another one. It's hard to do. It's hard to make that call. But it's worth it.
DO seek out a recovery group. A group is great in addition to, or if you only have limited funds, instead of a therapist. You'll be surrounded by people who really, truly get what you are going through. That is priceless. I was part of a recovery group in Philadelphia where it was just so heartening to hear people talking about their food fears or insecurities, and thinking "me too!".
DO the work required to get the most out of therapy. Don't roll your eyes when they ask you about your mother, giving a rote answer while your mind turns to freshly buttered bread. Talk it out. Go to the hard places. They might make you want to binge in the short term, but in the long term, you'll be able to let your issues go, or come to more peace with them.
DO tell the truth. Tell the truth to your therapist, and to your friends. And to yourself. Let them know about your struggle. Let it be funny when it's funny. Let it be sad when it's sad. Give yourself permission to feel these things.
DO say yes. Try to say yes to things that you would normally say no to before. Like trying a new activity, or going out with coworkers after work. Give yourself permission to enjoy life and feel joy. This might seem like a small thing, but change your viewpoint. Say yes to life. It's better than your eating disorder, and if you decide to live life, you'll be way more interesting than when you had an eating disorder, because you'll have a lot more interesting experiences and stories to share.
DO fill your time with meaningful activities. When I decided to take recovery seriously, I took up yoga. Sometimes I went to three classes a day. While some might say this was an exercise addiction, it really wasn't. Sometimes I didn't do all the poses. Just being in a room full of other people helped. I thought I was just filling the time I used to spend obsessing over food, but it turned out I was doing something meaningful.
DO engage with people. This was a tough one for me because deep down I consider myself a loner. I had to force myself to engage people in conversation. But after some practice, I got good at it by simply thinking "what about this person might be interesting?" and exploring it. Usually, I found that people actually are interesting. So I talk to the grocery store clerk. The yoga teacher. The person next to me in the post office line. Maybe people think I'm crazy, but it makes me feel more like I am a valuable part of the world.