Eating
Disorders At Midlife
More
Older Women Struggling With Anorexia, Bulimia
"You
can never be too rich or too thin."
It was a mantra
that defined more than a generation of adult women. But now, experts
say, some have taken the phrase to its literal extreme - at least the
"too thin" part.
The problem is eating disorders such as
anorexia or bulimia, which were once confined mostly to teenage girls
but now plague a growing number of women of the baby boom generation.
"Anorexia and bulimia are no longer disorders reserved
for young women," says Dr. Patricia Saunders, a psychologist specializing
in older women with eating disorders at the Graham Windham Services
to Families and Children in New York City.
"They are becoming increasingly prevalent in older
women, sometimes recurring after years of remission, and sometimes occurring
for the very first time after age 45," she says.
Because the trend is so new, experts say there are no
reliable studies to document how many older women are falling victim
to the problem.
"Anorexercise"
a New Factor
Anorexia is characterized
by dramatic weight loss due to excessive or compulsive dieting, often
coupled with self-induced vomiting and chronic use of laxatives. Bulimia
causes excessive binge eating, followed by purging or vomiting, and
frequently, the use of laxatives. Both can occur independently or simultaneously.
A relatively new expression of eating disorders is what
some experts are calling "anorexercise," and it is attracting
a substantial number of older women. It involves calculating every calorie
that is consumed, and then devising a workout designed to burn those
exact number of calories - and doing it within 12 hours or less after
eating.
"Some women will get up at 5 a.m. to run, just
to burn off what they ate the night before," says reproductive
psychiatrist Dr. Shari Lusskin, an associate professor at New York University
School of Medicine.
"And they can go to some very unhealthy extremes
in using exercise to control their weight," she says.
While no one is
certain what causes eating disorders, many believe hormones may play
a role, particularly since the number of women affected far outweighs
the number of men. According to the National Institutes of Mental
Health, some 7 million American girls and women battle eating
disorders every day, compared to 1 million boys and men.
And much like the hormone fluctuations that occur during
puberty - when young women are at risk for eating disorders - similar
changes take place during perimenopause, a time when older women appear
vulnerable as well.
"Hormonally speaking, perimenopause is puberty
in reverse," says Dr. Saunders. "But it's the fluctuations
and the changes, not necessarily the direction the hormones are going,
that might influence the brain chemistry involved in eating disorders."
In addition, middle age ushers in some life-altering
changes for many women, including the departure of grown children and
possibly divorce. Without that family support system, some women are
left feeling isolated and out of control of their daily lives - setting
the stage for eating disorders, experts say.
"They attempt to gain some control back by controlling
what they eat," Dr. Saunders says. "And given the right circumstances,
some women cross the line from dieting to an eating disorder before
they even realize what is happening."
Depression
May Contribute
Sometimes, undiagnosed
depression is to blame, Dr. Lusskin says.
"Because eating and depression can be so intimately
entwined, it's likely that at least some older women with an eating
disorder are really suffering from an undiagnosed depression, with a
basic thread of unhappiness that ran through their lives for a long
time and probably didn't come to the forefront until they hit middle
age," she says.
Some experts also say you cannot underestimate the changing
cultural influences of the past 30 years and the role they play in how
women think about their bodies today. A real culprit is the evolution
of a style culture that pushed "thinness" to an unrealistic
ideal.
"Yesterday's Hollywood idols - women like Marilyn
Monroe, Rita Hayworth, and Lana Turner - offered women a realistic image
of body shape and size. It may not have been easy, but it was attainable,"
Dr. Saunders says.
Today, by comparison, the message women get from fashion
magazines, movies, and TV is that "size two is the ideal and the
thinner you are, the more desirable you will be," she says.
Indeed, a recent study by professor Dr. Laurie Mintz
at the University of Missouri-Columbia found that women who viewed advertisements
featuring typically thin and beautiful women for just three minutes
came away with increased feelings of depression.
The good news is that older women generally respond
to treatment for eating disorders faster than younger women, and are
generally more motivated to seek the help they need.
Treatment for all age groups includes counseling, medication,
and, for older women, having a spouse involved in treatment.
Most important, say experts, is to join a support group.
Studies show that sharing your feelings with others facing a similar
problem plays a major role in helping women of all ages overcome eating
disorders.
Always consult your physician for a diagnosis.
Online
Resources
Centers
for Disease Control and Prevention (CDC)
HealthierUS.Gov
National
Eating Disorders Association
National
Institutes of Health (NIH)
National
Women's Health Information Center
Office
of Research on Women's Health |
October 2003
In
This Issue:
Eating
Disorders As a Midlife Crisis
"Anorexercise"
a New Factor
Depression
May Contribute
Causes
and Symptoms of Anorexia Nervosa
Online
Resources
Other
Resources:
Find
a St. John's Mercy Physician
Women's
Services at St. John's Mercy
Women's
Health Information
St.
John's Mercy Classes and Programs
Causes
and Symptoms of Anorexia Nervosa
The
cause of anorexia nervosa is not known. Anorexia usually begins as
innocent dieting behavior, but gradually progresses to extreme and
unhealthy weight loss.
Social
attitudes toward body appearance, family influences, genetics, and
neurochemical and developmental factors are considered possible contributors
to the cause of anorexia.
Persons
who develop anorexia are more likely to come from families with a
history of weight problems, physical illness, and other mental health
problems, such as depression or substance abuse.
Further,
often persons with the disorder come from families that are challenged
by appropriate problem solving, being too rigid, overly-critical,
intrusive, and overprotective.
Persons
with anorexia may also be dependent, immature in their emotional development,
and are likely to isolate themselves from others. Other mental health
problems such as anxiety disorders or affective disorders are commonly
found in persons with anorexia.
Symptoms
may include:
-
distorted view of one's body weight, size, or shape; sees self as
too fat, even when very underweight; expresses feeling fat, even
when very thin
The
following are the most common physical symptoms associated with anorexia:
- dry skin that
when pinched and released, stays pinched
- intolerance
to cold temperatures
- development
of lanugo (fine, downy body hair)
Persons
with anorexia may also be socially withdrawn, irritable, moody, and/or
depressed. The symptoms of anorexia nervosa may resemble other medical
problems or psychiatric conditions.
Always
consult your physician for more information.
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