The Princess’ Secret Disease

“…And that’s like a secret disease. You inflict it upon yourself because your self-esteem is at a low ebb, and you don’t think you’re worthy or valuable. You fill your stomach up four or five times a day-some do it more- and it gives you a feeling of comfort. It’s like having a pair of arms around you, but it’s temporarily, temporary. Then you’re disgusted at the bloatedness of your stomach, and then you bring it all up again. And it’s a repetitive pattern, which is very destructive to yourself.” Thus declared Princess Diana, who struggled with an eating disorder and also admitted that she used to harm herself. She also added in a television interview that she intentionally cut her arms and legs and had thrown herself down a flight of stairs on more than one occasion. The Princess first revealed her own battle with bulimia in 1992, when it was described in Andrew Morton’s controversial book Diana: Her True Story. In later interviews she spoke of the “secret disease” that had preyed on her for many years.

Bulimia is a type of eating disorder in which people are preoccupied with their weight and shape, often judging themselves severely and harshly for perceived flaws. People with bulimia experience episodes of binging and purging. During these episodes, they typically eat a large amount of food in a short period of time and then try to rid themselves of the extra calories in inappropriate ways, such as self-induced vomiting or excessive exercise. In between these binge-purge episodes, people with bulimia actually eat very little or often skip meals altogether. A person with bulimia often feels a loss of control over their eating as well as guilt over their behavior. They are usually aware that their behavior is abnormal. Bulimia is currently very common in adolescent and young adult women. People with bulimia are often of normal or near-normal weight, which makes them different from people with anorexia, another eating disorder in which the person does not eat at all.

Probably the earliest and most obvious sign of bulimia is an over concern with weight and body shape. People suffering from bulimia will try to hide their binging and purging behavior from others. This secrecy often makes it difficult to identify the actual problem until a serious complication from the physical self-abuse occurs. People with bulimia may also complain of generalized weakness, fatigue, abdominal pain, and loss of menstrual cycles. Vomiting or diarrhea is also present on persons with bulimia without revealing that it is self-induced. People with bulimia often have constant stomach pain. In fact, bulimia can actually damage a person’s stomach and kidneys as a result of constant vomiting. Bulimia can also cause a person’s teeth to decay because of the acids that come up to the mouth while vomiting.

Studies have shown eating disorders occur more frequently in relatives of people with bulimia than in others. This frequency appears to be related to genetics, but family influences may also be important. Researchers have suggested that altered levels of the chemical serotonin in the brain play a role. Serotonin levels can be related to the development of clinical depression. Experts also agree that cultural factors are very important in the development of eating disorders. Television, ads and modern society’s emphasis on health, in particular thinness, can greatly influence those who seek the acceptance of others.

People with bulimia often need several types of treatment. If a bulimic person’s life is in immediate danger, they may need treatment in a hospital emergency department for such issues as dehydration, electrolyte imbalances or severe psychiatric problems. Treatment is generally done using a team approach that includes medical providers, mental health professionals and dietitians, all with experience in eating disorders. With proper treatment, most people with bulimia recover. For some, though, the condition becomes a lifelong battle. Periods of binging and purging may come and go through the years, depending on life circumstances.

Whatever the cause of an eating disorder, the effects can be damaging, if not downright devastating and life threatening, such as the case of Princess Diana. However, the good part of it is that the decision by the princess to publicize her harrowing battle with bulimia resulted in double the number of sufferers coming forward for treatment. A study by the Institute of Psychiatry in London shows that reported cases of the illness rose to 60,000 during the 1990s after the Princess’s revelation. Since she first spoke of it in 1994, the number has almost halved, a trend attributed by researchers to the “Diana Effect” that persuaded them to acknowledge and seek treatment for their condition.

Fortunately, people with eating disorders such as anorexia or bulimia, can get well and gradually learn to eat normally again. Because bulimia involve both the mind and body, medical doctors, mental health professionals, and dietitians will often be involved in a person’s treatment and recovery. Therapy or counseling is a critical part of treating eating disorders, in many cases, family therapy is one of the keys to eating healthy again, and let’s not keep that a secret.