Can We Talk About Madison?- This Is Us, episode 12

A person struggling with bulimia nervosa is obsessed with their weight but their relationship with food is more heavily influenced by emotional triggers than a pure obsession to be thin.

Another episode with my favorite family. I thought we would get some big reveal with Kevin and Miguel talking, but I felt a little let down. Did you? I’m glad he and Rebecca are truly happy, even if it is a “quieter and older” happiness. I still think Kevin has some stuff to work through to really accept his stepfather, there’s an argument waiting to happen I think. Randall was on a wild goose chase until he ultimately decided he wanted to purchase an apartment complex to improve the lives of the tenants, much like his father William tried to do while he was alive. We also got a window into another side of Kate’s relationship with food – one where she starved herself until she got to a size 7 and realized it still didn’t make her happy. This struggle with food and her recent return to the Overeaters Anonymous group made it easier for Kate to spot what was going on with Madison. There is still so much to learn about Madison, but her possible bingeing and purging definitely made me think we should talk about a little bit about bulimia.

What Bulimia Is

People often talk about bulimia and know it as an eating disorder. It is actually called Bulimia Nervosa and focuses on repeated binge eating that is followed by behaviors that compensate for the binge eating. This is the key to Bulimia Nervosa – not just the binge eating, but what they do afterwards. Purging is a term used to explain what a person might do after binge eating. The most common example of purging would be to induce vomiting, which is what Kate knew Madison did during the wedding dress appointment. Someone struggling with Bulimia may also use laxatives, diuretics, enemas, or any other substance to help them “purge” the food they ate. What’s often surprising is that people with bulimia may also do excessive exercise and put strict controls on the food they eat. This can make others think they are anorexic, but people with bulimia are more likely to hide their bingeing and purging behaviors from others. Signs that may give away a struggle with bulimia may be frequent gaining or losing weight, damage from excessive vomiting – like damage to teeth or gums, gastrointestinal problems, or fainting. People with bulimia are at risk for ulcers, problems with their esophagus and heart failure.

Who Bulimia Can Touch

Anyone can suffer from bulimia and go undetected for long periods of time. Women are more often diagnosed, but men can suffer as well. People with bulimia can be underweight, normal weight or be slightly overweight as well, which some might find surprising. While anorexia may have a “look” (excessively thin), bulimia nervosa does not. A person struggling with bulimia nervosa is obsessed with their weight but their relationship with food is more heavily influenced by emotional triggers than a pure obsession to be thin.

What Bulimia Is About – a Loss of Control

While anorexia is about control, bulimia is about feeling out of control. People struggling with bulimia often feel unable to stop themselves from eating and this then creates a deep sense of guilt and shame after bingeing. The purging becomes a method of “damage control” from the bingeing that they could not control. Someone with bulimia may feel disgusted with their eating behaviors, and this can wreak havoc on their overall sense of self worth.

Many people with bulimia may have difficult relationships with their family and research shows a strong history of sexual or physical abuse. This means there are many emotional triggers to binge – family arguments, trauma triggers related to previous abuse, being alone, the grief of a breakup and any other pain we may experience. They may have trouble with impulse control in other areas of their life as well, so any other problems created by their lack of impulse control can lead to more bingeing and purging in secret. Those struggling with bulimia are often using the bingeing and the purging as an attempt to cope with more serious emotional experiences they do not want or know how to address.

What About Madison

Madison was upset that Kate confronted her about her problem and later acknowledged that she did not feel she could call her own family for help when she fainted at home. Madison does not need to be in an Overeaters Anonymous group, she is not “addicted” to food. She needs to find a therapist who specializes in eating disorders to help her understand her relationship with food and where to place her purging behaviors in this larger struggle she has with her body image. She has a distorted view of her body image and is displaying an erratic, out of control way of trying to manage the negative feelings this causes her. It remains to be seen if Kate will stick around as her new “best friend” while she tries to sift through these issues. My guess is that Kate may not jump into this role right away and this may cause another out of control response from Madison.

What did you think about Madison?

Will Kate jump into another caretaking role now that Kevin is trying to help himself?

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