Eating Disorders As a Midlife Crisis

More older women struggling with anorexia, bulimia

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HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

SUNDAY, Aug. 31, 2003 (HealthDayNews) -- 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. 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," says Patricia Saunders, a psychologist with Graham Windham Services to Families and Children in New York City who specializes in older women with eating disorders.

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.

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's attracting a substantial number of older women. It involves calculating every calorie that's 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. And they can go to some very unhealthy extremes in using exercise to control their weight," says reproductive psychiatrist Dr. Shari Lusskin, an associate professor at New York University School of Medicine.

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 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 divorce and the departure of grown children. 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," 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."

Sometimes, undiagnosed depression is to blame, 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 can't 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," Saunders says.

Today, by comparison, the message women get from fashion magazines, movies, TV and sometimes even from their own doctors is that "size two is the ideal and the thinner you are, the more desirable you will be," she says.

"It's doing a number on women's heads," Saunders says.

Indeed, a recent study by professor 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.

More information

To learn more about eating disorders, visit the National Eating Disorders Association. Or you can check with The National Institutes of Health.

SOURCES: Patricia Saunders, Ph.D., Graham Windham Services to Families and Children, New York City; Shari Lusskin, M.D., reproductive psychiatrist, New York University Medical Center, New York City

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