Diana, Princess of Wales

In 1995, Princess Diana admitted during a BBC interview that she suffered from bulimia during her marriage to Prince Charles (BBC Interview, 1995). Although documented in Andrew Morton's biography (Morton, 1992), the public admission of Diana's condition shed light on bulimia as an eating disorder, and opened new avenues of education and research.

History

Princess Diana's struggle with bulimia began in 1981. Diana grew up in an atmosphere of privilege and wealth. At the age of 6, her two older sisters left for boarding school and her parents separated. Following their divorce, Diana and her siblings were remanded to her father's custody. Though she cared a great deal for her mother, her mother's absence often affected.

In 1980, she became engaged to His Royal Highness, Charles Prince of Wales and became an instant celebrity. Over the next 2 years, she would become one of the most photographed women in the world. Her marriage, aired internationally in more than 80 countries, would be just a prelude to the media attention she would receive throughout the rest of her life. In 1982, people lined the street for miles when she went into labor with her first son, Prince William.

Early Depression

In an interview the BBC in 1995, Diana described her experiences with depression after her son was born:

"Well, everybody was thrilled to bits. It had been quite a difficult pregnancy - I hadn't been very well throughout it - so by the time William arrived it was a great relief because it was all peaceful again, and I was well for a time.

Then I was unwell with post-natal depression, which no one ever discusses, post-natal depression, you have to read about it afterwards, and that in itself was a bit of a difficult time. You'd wake up in the morning feeling you didn't want to get out of bed, you felt misunderstood, and just very, very low in yourself (1995)."

It was also during this time that Diana began to injure herself. She described the injuries as a way to get attention, but also because she felt no one was listening to her. Her public appearance schedule meant she needed to maintain a pristine public appearance as Princess, wife and mother.

"Yes, I did. I had bulimia for a number of years. 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.

I t'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 (1995)."

Princess Diana purged regularly. The purges increased in frequency when she felt particularly pressured either by her public schedule or her private one.

Depends on the pressures going on. If I'd been on what I call an away day, or I'd been up part of the country all day, I'd come home feeling pretty empty, because my engagements at that time would be to do with people dying, people very sick, people's marriage problems, and I'd come home and it would be very difficult to know how to comfort myself having been comforting lots of other people, so it would be a regular pattern to jump into the fridge.

It was a symptom of what was going on in my marriage.

I was crying out for help, but giving the wrong signals, and people were using my bulimia as a coat on a hanger: they decided that was the problem - Diana was unstable (1995)."

Throughout the 1980s, Princess Diana struggled with her condition and the Royal family's disapproval. She struggled with her husband's relationship with another woman (Camilla Parker Bowles) and felt extremely isolated and alone. She would attempt suicide on more than one occasion and the Royal family covered up these incidences, although rumors began to circulate. Like other bulimics, Princess Diana was ashamed of her condition and sought to keep it hidden even as she cried out for help.Bulimia

Bulimia is one of three specific eating disorders listed in the DSM-IV (Hansell and Darmour, 2005). Bulimics share a similar anxiety about personal appearance. Adolescent females predominantly suffer from these eating disorders. Fear of gaining weight, imagined deficits in appearance as well as heightened stress may contribute to an individual's bulimia (Hunt, ET, al.,2008).

Bulimics self-induce vomiting, use laxatives or diuretics at least twice a week for three months. Bulimics may suffer from menstrual irregularities, anemia, dehydration and possible dental damage. Bulimics often binge eat and purge as a form of release for internal stress, poor self-worth and other feelings associated with depression (Hansell and Darmour, 2005). In Princess Diana's case, her self-worth was not entangled with her body image, but with her perceived image both public and private.

Diana wrestled with depression on and off throughout her marriage. She learned from a friend that depression may be exacerbated by mineral deprivation brought on by bulimia (Brytek-Matera, 2008). She began seeing a therapist on a weekly basis to get help with her bulimia and improve her eating habits (Meyer, 2005).

Public Image

Research on media images of thinness finds, for example, that Miss America contestants and Playboy centerfolds have become slimmer since 1950; this is said to have deleterious effects on audiences, in particular adolescent girls (Saukko, 2006). The press contributed to Princess Diana's stress because she was constantly under public scrutiny. At all times, she needed to maintain a picture perfect appearance.

When Princess Diana's bouts with bulimia became public knowledge, reported cases of bulimia skyrocketed. Some people speculated it was due to girls trying to emulate the Princess, whereas psychologists discovered that Princess Diana's admission empowered other women to come forward and admit their own eating disorder (Meyer, 2005).

The best treatment for bulimia is cognitive behavioral therapy (Hall et al,, 2008). For Princess Diana, this meant admitting her problem and engaging in self-help as well as therapeutic treatments with an eating disorder therapist. Over time, she also sought help from a hypnotherapist, an astrological counselor, a deep-tissue masseuse, an aroma therapist, an acupuncturist, a cranial masseuse, a practitioner of osteopathy, a clinician who gives regular colonic irrigations (a water treatment that cleanses the bowels), and a new-age therapist (similar to Primal Scream Therapy) who encouraged her to shout, scream, and hit a punching bag (Meyer, 2005).

In 1996, Princess Diana and Prince Charles officially divorced. Despite her disintegrating marriage, increased press attention and more pressure, she kept her bulimia under control.

Conclusion

Princess Diana's case demonstrates that fame and fortune do not buy happiness nor do they provide relief from lack of self-worth or self-esteem. Although Princess Diana lived her public life in a fish bowl, she learned to internalize her pain, confusion and depression from a very young age. This contributed to her eating disorder and cutting. Post-natal depression and later, her depression that was related to her bulimia continued this downward spiral.

Her admission of the eating disorder led to her seeking real help with real solutions. At the time of her death in 1997, Princess Diana seemed to have not only overcome her eating disorder, but achieved success in the life she was choosing for herself. Her public admission led to education on bulimia and to women around the world seeking help for their own condition.
References

BBC Interview with Princess Diana. (1995). "Transcription of BBC Interview with Princess Diana."

Retrieved from http://scoop.evansville.net/diana.html.

Brytek-Matera, Anna. Mood and emotional symptoms in eating disordered patients. Archives of

Psychiatry & Psychotherapy, Jun2008, Vol. 10 Issue 2, p65-71.

Hall, Mary N.; Friedman II, R. Joseph; Leach, Laura. Treatment of Bulimia Nervosa. American Family

Physician, 6/1/2008, Vol. 77 Issue 11.

Hansell, J., and Damour, L. (2005). Abnormal psychology. Hoboken, NJ: Wiley.

Hunt, Thomas J., Thienhaus, Ole and Ellwood, Amy. The Mirror Lies: Body Dysmorphic Disorder.

American Family Physician, 7/15/2008, Vol. 78 Issue 2, p217-224, 8p.

Meyer, R. (2006). Case studies in abnormal behavior. (7thed.). Upper Saddle River, NJ: Pearson.

Saukko, Paula. Rereading Media and Eating Disorders: Karen Carpenter, Princess Diana, and the Healthy

Female Self. Critical Studies in Media Communication, Jun2006, Vol. 23 Issue 2, p152-169, 18p.