We often think of eating disorders as afflicting teens. How much of an issue is it with women in midlife or older?
It is an issue we are seeing more and more with women in midlife. For the sake of clarity, let me briefly define the three major eating disorders, because there have been some changes in the last revision of the DSM. Binge Eating Disorder describes eating much more than one would typically eat in a discreet period of time, and there is a feeling a lack of control around it. My clients describe it as a sort of fugue state—they are not really tasting the food. It’s more about relieving an uncomfortable emotional state.
Anorexia is about feeling fat, and restricting calories. It’s what we think of when we see extreme dieters. It’s the most difficult of the disorders to treat. Many times, the client has almost a delusional belief that they are overweight, and nothing can change that. Bulimia is when there is some sort of compensatory behavior after eating—usually vomiting, exercise, or even using laxatives. Bulimics can be average weight.
Sometimes the disorder has been dormant since adolescence and reemerges during this very tumultuous time, sometimes it develops in midlife. The Renfrew Center—the gold standard for treatment facilities—reported that in the past decade, there has been a 42% increase in the number of women over the age of 35 who sought treatment at their clinic. Eating disorders are partially about managing anxiety and often emerge during times of transition. So you can see why they would develop around midlife as well as adolescence.
Why is midlife a time when eating issues can linger, resurface, or even present themselves for the first time?
As you know, there’s a lot going on during midlife. There are often major transitions and losses. For example, mothers who have spent so much of their time and energy parenting are sending their kids off. Parents and friends may be ill and need caretaking. One’s identity is in so much flux.
Eating disorders are a great distraction from uncomfortable feelings. They let us put our lives in a safe container; instead of allowing ourselves to feel invisible, sad, or jealous, for example, we can focus in on carbs, points, calories, or pounds. It’s really not about the food. And if there has been trouble in the marriage, women might start dieting in attempt to be “healthy,” or even to compete with younger women. We see that what starts out as a diet becomes an obsession. To make matters worse, initially the woman may receive praise and compliments like, “You look great! How are you doing it?” That’s hard to resist for anyone. All eating disorders initially start out as a well-intentioned diet.
How do you approach treating disordered eating with older women?
I see it as a way to solve a problem. Unfortunately, it has dangerous consequences. I explore what is distressing in her life. I ask how the eating disorder is working for her. What would she miss without the eating disorder? How is it helping her cope? I take a non-judgmental approach. Nobody wakes up one day and decides to have an eating disorder. It’s a really awful way to live. It sucks all of the pleasure out of life.
I remember watching a Dr. Phil episode where he supposedly cured an anorexic patient by describing all of the physical harm she was doing to herself. In real life, there’s no sense trying to scare people out of these behaviors. You can talk about physical damage all day long. The psychological and physical power of an eating disorder can be intense. Women have to be sick of having an eating disorder in order to start recovery. Some are pushed into treatment by their loved ones; but if they are not ready, it can become a power struggle that I, as the treating therapist, can never win. It can be heartbreaking because I know they are suffering and doing extreme, sometimes irreversible, damage to their bodies. Recovery is not a straight line, either. Clients, as well as clinicians, have to be very patient and celebrate small successes.
What is your best advice to women who are struggling with food issues in midlife?
To be compassionate with themselves and ask what they really want. I would have them ask themselves what they think will change once they are a certain weight. Often there’s a fantasy that everything will be great, life will be perfect. Recovery is tough in a society that tells us thinner is happier and healthier. Turns out neither of those is true. It’s so interesting to see women post-bariatric surgery. They are surprised that life is still challenging and confusing, even if they are wearing a smaller size dress.
But that being said, eating disorders have the highest mortality rate of any psychological disorder. So it is important to intervene before the eating disorder really get its claws in. The longer it’s been active, typically the harder it is to recover.
Women might ask themselves how rigid their diet and exercise routine are—as a way to uncover how stuck they are in obsessional thinking about their bodies. I had a client who could only eat one type of yogurt because she thought it was “diet friendly.” It really became a problem when she traveled. The thought of not finding the exact brand really interfered with her ability to concentrate at work. That kind of rigidity is a red flag that you are no longer in control of your diet—the obsessional thinking is.
What resources do you recommend for these women?
I would highly recommend Intuitive Eating: A Revolutionary Program that Works by Evelyn Tribole. She’s a powerhouse nutritionist who is passionate about intuitive eating. Geneen Roth is excellent as well, and very relatable. Some clients were put off by the title of her book, Women Food and God: An Unexpected Path to Almost Everything but it’s not religious. She does a beautiful job describing what it is like to be in the throws of an eating disorder.
Additional recommended books, pictured above:
The Joy of Half a Cookie: Using Mindfulness to Lose Weight and End the Struggle with Food by Jean Kristeller
The Mindful Diet: How to Transform Your Relationship with Food for Lasting Weight Loss and Vibrant Health by Ruth Wolever and Beth Reardon
Nourishing Wisdom: A Mind-Body Approach to Nutrition and Well-Being by Marc David
50 More Ways to Soothe Yourself Without Food: Mindfulness Strategies to Cope with Stress and End Emotional Eating by Susan Albers (and her first book in the series: 50 Ways to Soothe Yourself Without Food)
Another great resource is NEDA, the National Association for Eating Disorders.
Nicole Christina, LCSW, is a published author and psychotherapist of 25 years. In addition to her private practice, she develops presentations on wellness topics, including living optimally after age 50. Her work is based on the 75-year-long Harvard Study of Adult Development, the longest and most rigorous of its kind, and her talks offer immediate and practical tools which enrich and prolong life beyond middle age. She has taught at OASIS, Syracuse University and has presented at the New York State Conference on Aging. She authors a monthly wellness newsletter, BreatheTasteSavor. Her online course is entitled Zestful Living: Simple Habits to Improve Health and Live Longer. Her podcast, Zestful Living, can be found on iTunes.