Anorexia in older women

The aging of anorexia:
Middle-aged women -- and older -- fight the devastating disease

By Lorna Collier
Published Oct. 24, 1999 (Chicago Tribune, Health & Family section)

When she was 35, Gwen wanted what many women want: to lose 10, maybe 20 pounds.

Not that the Chicago homemaker and community activist was fat. But she'd had five kids in 15 years, leaving her with about 155 pounds on her 5-foot-9-inch frame. Though her husband never complained, she felt flabby and unattractive.

Gwen started by cutting out fats and junk food and exercising regularly. During the following year, she began taking off the pounds, and the experience -- the control over her body, the compliments she received -- thrilled her.

Then her dieting and exercise began to escalate. She stopped eating almost entirely, weighed herself repeatedly each day, exercised compulsively and eventually dropped to a skeletal 100 pounds.

Gwen had developed anorexia nervosa.

"I could not believe this was happening," says Gwen, who asked that her real name not be used. Now 46, she was hospitalized eight times for the disorder before she recovered. "I argued with my therapist. I said, `This happens to young girls, to college-age girls. It does not happen to grown women in their 30s with five children who have a life.' "

But, in fact, anorexia and other eating disorders among older women -- in their 30s, 40s, 50s and beyond -- are not uncommon and, according to some experts, are increasing.

"There is a misconception that this is primarily or exclusively an adolescent or college women's issue," says Claire Mysko, administrative director of the American Anorexia/Bulimia Association in New York City. But, Mysko says, "we are definitely seeing older women -- more and more so."

No statistics exist to show how many women 30 and over have eating disorders. At the Center for the Study of Anorexia and Bulimia in New York City, about a quarter of the patients are over 30, while the majority of the people in support groups run by the National Association of Anorexia Nervosa & Associated Disorders in Highland Park are 30 or older.

About 8 million Americans suffer from eating disorders, with about 86 percent first seeing symptoms by age 20. The condition is often chronic; patients who don't recover and who don't die from their illness continue to experience symptoms into their middle years and even into retirement age.

"Anorexia nervosa in the elderly is just becoming recognized," says Dr. Stanley Coren, a psychiatrist at the University of British Columbia who has studied anorexia deaths in nursing homes. "I believe that with the increasing age of the population, we will be seeing more cases of older anorexia sufferers."

Older women with eating disorders fit into three categories: those who have struggled with the disorder since their teens; those who had an early occurrence, but recovered and remained symptom-free until later years; and those whose symptoms first cropped up well past their teen years. Experts also say older women are more likely to be bulimic -- to binge and purge, either through vomiting or through the use of laxatives -- than they are to be anorexic.

Gwen had suffered from anorexia for a year when she was 15, but had not had significant symptoms after that until she fell ill at 35.

Shelley Sokol, on the other hand, is a 42-year-old suburban Chicago woman who has been battling anorexia since she was 17.

Her 25-year bout with the illness has left her with osteoporosis so severe that she has shrunk in height from 5 feet 6 1/2 inches to 5 feet 4 inches. She has broken a hip, been hospitalized three times, seen her weight drop as low as 66 pounds, and now suffers from liver problems, swollen ankles, dizziness, fatigue and depression. Married for 18 years, she has never been able to have children. Last year, she had to leave her job as a buyer for a manufacturing firm because of her disability.

"Now there's so much help out there (for girls with anorexia)," says Sokol, who believes if she had received better treatment as a teen that she would not still be caught in anorexia's grip today.

Dr. Anne Becker, director of research at Harvard Medical School's Eating Disorders Center, says older patients who have been struggling with the disorder for a long time can be very difficult to help.

"Many of these women have had symptoms for a number of years that have gone unaddressed," Becker says. "It can be very hard to break the cycle once it's been an old friend for 5 or 10 or more years."

Kathy Jones, a schoolteacher in Pennsylvania, had a different experience: She had never had any symptoms of anorexia until she was 35 and trying to deal with the break-up of a relationship. Jones, now 43, says she was so grief-stricken over her lost love that she decided to kill herself by starvation.

However, three months later, the decision to die had faded, while the desire to lose weight had become all-consuming.

"Dying was on the back burner," Jones says. "Once you start losing weight, it was like a runner's high, like this real challenge. `Can I lose 5 pounds in the next two days?' I would weigh myself constantly to make that goal. If I couldn't take control of my life in this relationship, then by God I was going to take control of my body."

Jones, who has been hospitalized four times, now weighs about 90 pounds, up from a low of 75, but much less than the 125 she weighed before her illness began. She still finds it impossible to eat much more than vegetable broth, pretzels and sugar-free Popsicles.

"I don't know why I'm anorexic. I really don't," she says. "Yes, depression caused it, but I don't know why I can't get over it."

Doctors don't know why either.

"One of the big gaps in our treatment of anorexia is that there are almost no treatment studies to tell us what to do with older patients," says Dr. Daniel Le Grange, assistant professor of clinical psychiatry at the University of Chicago and director of the university's eating disorders program.

Bates, Sokol and Jones say they have been frustrated during their treatment by what they perceive as a lack of support for mature patients.

"While in-patient, I was always the oldest one on the floor," Bates says. "In group therapy, I was often in groups with young women who were the ages of my students. I never have felt really comfortable sharing my problems with girls so much younger than me."

Gwen had a similar experience while hospitalized.

"Unfortunately, the fact remains that most of the people in eating- disorder programs are young kids, so you are going to be with young kids. It became hard for me to relate to them. I felt like they were my kids; I'm sure they looked at me like I was their mother and were wondering, `What are you doing here?' "

She would have liked to have met more women her age with her problem, so that she would not have felt so alone.

"For me, it was very shameful," Gwen says. "Here I was, a woman in her late 30s, and I had this horrible, horrible problem. People looked at you; you were treated terribly by other people. I was so ashamed that I had an illness that primarily strikes young girls. I still feel ashamed."

Mysko says she would not be surprised to see treatment programs developed soon that will focus strictly on the needs of older women, who often have children and jobs to contend with, and who may be struggling with midlife crises.

"For some women, the aging process is very traumatic," Mysko says. "They feel anxiety at getting older and don't feel they can accept themselves in our culture. We live in a culture that is very obsessed with weight, with a narrow ideal of beauty, which means being young and being thin."

Sharlene Hesse-Biber, a Boston College sociologist and author of "Am I Thin Enough Yet?"(Oxford University Press, $13.95), argues that eating disorders can in large part be blamed on our current weight- obsessed society, in which older women are expected as never before to achieve youthful figures -- to look as fabulous at 40 as Christie Brinkley, as fit at 50 as Cher.

"The pressure is to be a certain kind of body in this culture," she says. "The impact of being in the wrong kind of body is devastating, at any age. You are not absolved from the cult of thinness at menopause."

Many experts, however, don't think that eating disorders can be blamed entirely -- if at all -- on society's emphasis on thinness. Most say the disorder is extremely complex and is caused by multiple factors, from family stresses to biological predisposition to personality type. However, dieting can precipitate eating disorders in some people, says Dr. Regina Casper, a Stanford University psychiatrist and leading eating-disorders researcher.

Gwen has been recovered from her anorexia for the last four years. Her turning point came, she says, when she realized that she had to choose between living and dying. "I decided I wanted to live. I have a life, a marriage, five incredible kids."

She also believes she has forever freed herself from caring about having a perfect, model-thin body.

"So what if you're a 14 or a 16 or an 18? Big deal. What is really the crime in it? We're taught we have to look a certain way, but I don't care much any more. I really don't.

"I am at peace with myself."

SIDEBAR: THE IMPACT OF A PARENT'S ANOREXIA

Mothers with eating disorders often worry that they will somehow pass their illness on to their children.

"This is a very, very serious concern," says Claire Mysko, administrative director of the American Anorexia/Bulimia Association in New York. "We are finding that eating-disordered behavior and concerns about fat and weight are filtering into a younger and younger populace because we have mothers who are not OK."

A recent study published in the International Journal of Eating Disorders concluded that mothers with eating disorders interacted differently with their children when it came to feeding and weight concerns than did other mothers, suggesting that "the risk factors for later development of an eating disorder may begin very early in life."

However, other studies have shown more mixed results, and doctors still don't know enough about eating disorders to say what causes them in anybody, whether in the mother or her child.

"I don't think parents cause anorexia nervosa," says Dr. Daniel Le Grange, assistant professor of clinical psychiatry at the University of Chicago and director of the university's eating disorders program. "I always tell parents we have no evidence to suggest that, but we don't fully understand the heritability of eating disorders." Le Grange says current research into the possibility of an "anorexia gene" is still under way.

When Gwen, a Chicago homemaker who asked that her real name not be used, developed anorexia at age 35, she had five sons, ranging in age from 4 to 16. She didn't have problems feeding them, but they were nevertheless quite affected by her illness.

"It was very, very devastating for my kids," she says. "I was a real anchor for them; I was very close to them. They cried a lot when I went into the hospital."

Her sons never developed eating disorders themselves, but as a consequence of her illness, "they are not interested in real skinny girls and they don't like people who don't eat."

Dr. Susan P. Sherkow has been concerned enough about how eating disorders in mothers affect their children that, five years ago, she started the Eating Disorders Therapeutic Nursery in New York. Her program is aimed at helping eating-disordered mothers with small children, ages 5 and under.

Sherkow, an expert in infant development, began the center in 1995, after caring for a baby who was losing weight. She discovered the infant's mother couldn't feed the child properly because she was anorexic and the sight of solid food repulsed her.

Sherkow brings groups of such women and their young children together for therapy and for meals. She has treated one family for four years; the oldest child, now 7, has already shown signs of bulimia, which Sherkow says the child developed after observing the behavior in her mother.

Not all mothers with eating disorders find it difficult to feed their children, experts say. Many love to feed their families but will avoid eating any of the meals themselves.

John Mead, a psychologist who co-directs the Eating Disorders Unit at Rush Presbyterian St. Luke's Medical Center in Chicago, believes the best way to ensure a child does not develop an eating disorder is through the development of a strong, attached relationship.

"If the mother has had poor parenting herself and she's had trouble establishing a secure attachment with her offspring," he says, "then she's at risk for creating an eating disorder."

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For more information on anorexia and treatment options, contact the National Association of Anorexia Nervosa and Associated Disorders, P.O. Box 7, Highland Park, IL 60034 (847- 831-3438) or the American Anorexia/Bulimia Association (AABA), 293 Central Park West, Suite 1R, New York City, NY 10024 (212-501-8351).