It's National Eating Disorders Awareness Week, and this year's theme is "Everybody Knows Somebody." Increasingly, that "somebody" might be a woman in her 30s, 40s, 50s or beyond. Although eating disorders often appear in adolescence, or (as I wrote in my last blog post) even earlier, they are also becoming more prevalent among middle-aged and older women.
Emmett R. Bishop, MD, a founding partner and medical director of adult services at the Eating Recovery Center in Denver, told me about the noticeable rise in older women seeking treatment for eating disorders at his facility. Although hard data is hard to come by, Dr. Bishop, who has been treating eating disorders for 30 years now, says, "I've been around long enough to see the trend, and we're seeing considerably more" such older women. At the time of my recent conversation with Dr. Bishop, at least six of the 28 or so inpatients at the center were older women. Several were over 40, a couple patients were in their 60s and there was one 80-year-old patient. Dr. Bishop called this a patient demographic "that you would not have seen ten years ago."
Often, these patients have been in treatment before and are returning after a relapse. Usually there has been a triggering incident, which might be a stressful life event such as divorce or medical illness. Gastrointestinal illnesses that cause inadvertent weight loss can trigger a new onset of dieting, and "exacerbate a fight [the patient] is already fighting," explains Dr. Bishop.
In other cases, the eating disorder has been obvious to family members but ignored by all, until physical complications make it impossible to do so anymore. When they do start, the physical problems can be numerous. Years of under-eating leads to "deterioration of the body, which leads to everyone becoming alarmed," says Dr. Bishop. "It's a common theme in this group: body decline." Even so, Dr. Bishop notes that these patients are most often coerced by their families to come in for treatment, whether because of shame or entrenched denial, or both.
The pattern among patients in their 30s and 40s, however is different. Often worried about the effect of their eating disorder on their children, they are more motivated to seek treatment on their own. Dr. Bishop frequently hears the comment, "I'm concerned about what kind of example I am for my teen-aged daughter." In many cases, the daughter is also struggling with eating issues, he notes, but there are also the instances "where I've had daughters come in and react in opposition. For as many who identify with their mothers, there are those who react and want their mother to ‘get her act in order,' so to speak."
The physical symptoms that tend to affect the long-term eating disorder patient, says Dr. Bishop are gastrointestinal and bladder dysfunction. If a patient has purged for years, chronic esophageal problems demand treatment, while long-term food restriction can lead to constipation-related issues that are very difficult to treat. Dr. Bishop is puzzled as to why bladder problems are so prevalent among the long-term eating disorder patient, but says it's been an emerging issue, "even among patients in their forties."
Another condition Dr. Bishop says is prevalent among "the chronically semi-starved individuals," as he puts it, is poor cognition, noting, that besides lack of clear thinking, "it's hard for them to shift gears [mentally]." Even though insurers can be reluctant to cover nutritional rehabilitation for such patients, Dr. Bishop has seen dramatic improvements in cognition with nutrition counseling and weight restoration, and an increase in motivation to get better on the patient's part. His belief, one that clinicians often must do battle with insurers to uphold, is: "We should never give up on patients."