David Baxter PhD
Late Founder
Aging and Anorexia: Silent Crisis of Eating Disorders in Older Women?
by Pamela Cytrynbaum, Psychology Today
March 6, 2012
Are older women silently starving themselves?
National Eating Disorders Awareness Week just ended and I think that should be the beginning of our conversation, not the end. There is a lot of helpful information available on how younger and younger kids are struggling with eating disorders, how 5-year-old girls are saying they are "fat" and how boys are now struggling in significant numbers with one of the deadliest mental illnesses there is.
What you probably have not read, seen or heard much about is the increase in eating disorders among older people, particularly women. There was so little information, in fact, that I checked in with the folks at Eating Recovery Center, where I have gotten a lot of expert advice on eating disorders. Turns out, they are seeing a real upswing in cases of older people struggling with eating disorders and thought it was a great topic to explore. It presents with similarities and differences than the disordered eating in younger women, but because older people are more vulnerable in many ways, an eating disorder in midlife and beyond can be even more dangerous.
Dr. Emmett Bishop, MD, FAED, CEDS, founding partner and medical director of adult services at Eating Recovery Center, was kind enough to take time to help educate me - and now you - on this silent but significant issue.
Q: What are the myths surrounding eating disorders in older people and what are the facts?
Dr. Bishop: "The biggest myth is that this group does not have eating disorders. Although this group has flown under the radar, we are seeing quite a few women in treatment in their 40s, 50s and 60s. We even recently treated an 80-year-old woman."
Dr. Bishop warns that one of the most damaging and dangerous aspects of eating disorders in the aging is that too often, family members will assume the weight loss is related to simply being old, or "that's just the way she is," rather than exploring if something is going on.
Q: Describe the signs/symptoms family members should look for, especially in their elderly relatives and friends.
Dr. Bishop: "The signs and symptoms of an eating disorder are very similar to what you would see in the younger group: weight loss, avoiding situations where food will be available, excessive exercise, obsessions with calories and weight, using the bathroom directly after a meal and becoming more secretive or withdrawn. The biggest problem I have seen with the older group is people "blowing off" symptoms because the individual displaying them has behaved that way for a long time. Oftentimes, friends and family will say "that's just they way she is" until they see their loved one begin to develop medical complications."
Q: If you suspect an older loved one has an eating disorder, what should you do?
Dr. Bishop: "We see a lot of middle-aged patients entering treatment on their own because they feel like they are bad role models for their teenaged daughters. Many elderly individuals will seek treatment once they have experienced a medical complication. The goal is to help them get treatment before medical issues happen.
If you are worried, try to find a neutral setting in which to speak with your loved one. Express your concerns using non-judgmental language. Point out behaviors that you have noticed but do your best not to blame or shame. Offer to help your loved one seek treatment from a qualified professional. If expressing your concerns does not work, try to get as many people as you can together, express your concerns for your loved one's health and try to get him or her into treatment."
Q: Can you make distinctions between two populations — midlifers with eating disorders and elderly with eating disorders?
Dr. Bishop: "Distinctions between the two groups really have not been studied. However, in my clinical experience, many of the eating disorders I have seen in older women – versus those in midlife – are atypical. In older women, I have seen more eating disorders develop not from dieting, but rather, from intense food phobias."
Q: Does the disease look or progress differently in the aging population? If so, how?
Dr. Bishop: "This needs to be studied more carefully. However, from my clinical impression, we see a lot of medical complications, such as kidney dysfunction, cardiac issues and other medical problems, in the elderly group that we do not see in the younger group."
Q: What are the differences between an adolescent with an eating disorder and an older person?
Dr. Bishop: "In my experience, adolescents tend to display more denial and have less self-awareness about their eating disorders. Adolescents do not have the motivation to get out of their eating disorder because they do not see a reason to. Whereas, older individuals generally are very aware of their eating disorders and they do not want to have the disease, but they do not see a way out."
Q: What triggers eating disorders among older women? Are the triggers different than younger people?
Dr. Bishop: "A great deal of older women were triggered by an activity such as dieting when they were younger and have been suffering with their eating disorders for years and years. However, it is not out of the realm of possibility to see an older woman develop an eating disorder for the first time at an older age. Generally, I see late onset eating disorders more related to a medical condition; for example, a physical illness that has induced weight loss. The common factor is weight loss, but what precipitated the weight loss is different."
Q: I would assume most elderly people with eating disorders had them when they were younger too. Is that a myth?
Dr. Bishop: "Late onset is probably very rare. The individuals we typically see are those who have had an eating disorder for a long time and have relapsed from prior treatment or are entering treatment for the first time."
Q: What are the additional health issues/risks in play for older people with eating disorders?
Dr. Bishop: "Older individuals have much less resilience when it comes to physical damage from eating disorders. A lot of things can go wrong with vital organs, bone density can be impacted, dental health can suffer, and as tissues become less elastic, I've seen people aspirate from purging. A whole host of medical issues can arise as people abuse their bodies over time. Eating disorders are the deadliest mental illnesses and premature death is very common."
Q: Are there books, articles, websites, resources you can recommend to our readers?
Dr. Bishop: "Related to middle aged and elderly individuals, there is not a lot of age-specific information out there. The National Eating Disorders Association offers a wealth of general information about eating disorders and access to resources on its website, Eating Recovery Center additionally offers a number of resources, as well as confidential online chat with our intake team at Eating Recovery Center."
by Pamela Cytrynbaum, Psychology Today
March 6, 2012
Are older women silently starving themselves?
National Eating Disorders Awareness Week just ended and I think that should be the beginning of our conversation, not the end. There is a lot of helpful information available on how younger and younger kids are struggling with eating disorders, how 5-year-old girls are saying they are "fat" and how boys are now struggling in significant numbers with one of the deadliest mental illnesses there is.
What you probably have not read, seen or heard much about is the increase in eating disorders among older people, particularly women. There was so little information, in fact, that I checked in with the folks at Eating Recovery Center, where I have gotten a lot of expert advice on eating disorders. Turns out, they are seeing a real upswing in cases of older people struggling with eating disorders and thought it was a great topic to explore. It presents with similarities and differences than the disordered eating in younger women, but because older people are more vulnerable in many ways, an eating disorder in midlife and beyond can be even more dangerous.
Dr. Emmett Bishop, MD, FAED, CEDS, founding partner and medical director of adult services at Eating Recovery Center, was kind enough to take time to help educate me - and now you - on this silent but significant issue.
Q: What are the myths surrounding eating disorders in older people and what are the facts?
Dr. Bishop: "The biggest myth is that this group does not have eating disorders. Although this group has flown under the radar, we are seeing quite a few women in treatment in their 40s, 50s and 60s. We even recently treated an 80-year-old woman."
Dr. Bishop warns that one of the most damaging and dangerous aspects of eating disorders in the aging is that too often, family members will assume the weight loss is related to simply being old, or "that's just the way she is," rather than exploring if something is going on.
Q: Describe the signs/symptoms family members should look for, especially in their elderly relatives and friends.
Dr. Bishop: "The signs and symptoms of an eating disorder are very similar to what you would see in the younger group: weight loss, avoiding situations where food will be available, excessive exercise, obsessions with calories and weight, using the bathroom directly after a meal and becoming more secretive or withdrawn. The biggest problem I have seen with the older group is people "blowing off" symptoms because the individual displaying them has behaved that way for a long time. Oftentimes, friends and family will say "that's just they way she is" until they see their loved one begin to develop medical complications."
Q: If you suspect an older loved one has an eating disorder, what should you do?
Dr. Bishop: "We see a lot of middle-aged patients entering treatment on their own because they feel like they are bad role models for their teenaged daughters. Many elderly individuals will seek treatment once they have experienced a medical complication. The goal is to help them get treatment before medical issues happen.
If you are worried, try to find a neutral setting in which to speak with your loved one. Express your concerns using non-judgmental language. Point out behaviors that you have noticed but do your best not to blame or shame. Offer to help your loved one seek treatment from a qualified professional. If expressing your concerns does not work, try to get as many people as you can together, express your concerns for your loved one's health and try to get him or her into treatment."
Q: Can you make distinctions between two populations — midlifers with eating disorders and elderly with eating disorders?
Dr. Bishop: "Distinctions between the two groups really have not been studied. However, in my clinical experience, many of the eating disorders I have seen in older women – versus those in midlife – are atypical. In older women, I have seen more eating disorders develop not from dieting, but rather, from intense food phobias."
Q: Does the disease look or progress differently in the aging population? If so, how?
Dr. Bishop: "This needs to be studied more carefully. However, from my clinical impression, we see a lot of medical complications, such as kidney dysfunction, cardiac issues and other medical problems, in the elderly group that we do not see in the younger group."
Q: What are the differences between an adolescent with an eating disorder and an older person?
Dr. Bishop: "In my experience, adolescents tend to display more denial and have less self-awareness about their eating disorders. Adolescents do not have the motivation to get out of their eating disorder because they do not see a reason to. Whereas, older individuals generally are very aware of their eating disorders and they do not want to have the disease, but they do not see a way out."
Q: What triggers eating disorders among older women? Are the triggers different than younger people?
Dr. Bishop: "A great deal of older women were triggered by an activity such as dieting when they were younger and have been suffering with their eating disorders for years and years. However, it is not out of the realm of possibility to see an older woman develop an eating disorder for the first time at an older age. Generally, I see late onset eating disorders more related to a medical condition; for example, a physical illness that has induced weight loss. The common factor is weight loss, but what precipitated the weight loss is different."
Q: I would assume most elderly people with eating disorders had them when they were younger too. Is that a myth?
Dr. Bishop: "Late onset is probably very rare. The individuals we typically see are those who have had an eating disorder for a long time and have relapsed from prior treatment or are entering treatment for the first time."
Q: What are the additional health issues/risks in play for older people with eating disorders?
Dr. Bishop: "Older individuals have much less resilience when it comes to physical damage from eating disorders. A lot of things can go wrong with vital organs, bone density can be impacted, dental health can suffer, and as tissues become less elastic, I've seen people aspirate from purging. A whole host of medical issues can arise as people abuse their bodies over time. Eating disorders are the deadliest mental illnesses and premature death is very common."
Q: Are there books, articles, websites, resources you can recommend to our readers?
Dr. Bishop: "Related to middle aged and elderly individuals, there is not a lot of age-specific information out there. The National Eating Disorders Association offers a wealth of general information about eating disorders and access to resources on its website, Eating Recovery Center additionally offers a number of resources, as well as confidential online chat with our intake team at Eating Recovery Center."
