They do it even in their 90s.
Adult women starve, binge, and purge. Eating disorders, once thought to be the province of misguided teens who twist the cultural thinness imperative into ravaged bodies, are now rampant in the aging, health-conscious, baby boomer population. And beyond.
That's the news, according to a recent Associated Press (AP) article. In fact, the situation has been brewing for some time and is only now gaining national attention. Women in their 40s and 50s are showing up for treatment in numbers triple and quadruple those of ten years ago. (The greatest surge has occurred in the last 5 years.) The influx is so great that some treatment centers are creating special programs for older patients. One step further, the Park Nicollet Health Services' Eating Disorders Institute near Minneapolis, MN, is building a new facility, set to open in 2009, that will offer a special treatment track for mature patients.
How old is "mature?"
How about 92? That was the age of the oldest woman in my book, Lying in Weight.. She was originally hospitalized for pneumonia and, as she recovered, ate prunes and walked laps around the hospital ward. She felt horrible about lying around and getting fat.
Other women I interviewed for Lying in Weight were also living proof that the old saw, "You can never be too old to be thin," holds true.
Take Nilda, who at 68 was diagnosed with anorexia for the first time.
"Why?" I asked her.
"Because I'm running out of time, and I need to get my affairs in order," she replied.
What she meant is that she was afraid to die and leave her children bereft. Ironically, she was killing herself, subsisting on black coffee and toast. But distorted thinking is a hallmark of anorexia; Nilda's fears about dying were so strong that they wouldn't allow her to eat, which can only hasten the inevitable.
Nilda's story further reinforces the idea that eating disorders are about issues happening to "mature" women, in addition to teens striving to look like skeletal fashion models. Eating disorders happen to individuals who have a certain temperament ("genetic predisposition") and use destructive food behaviors and/or overexercise to cope with major transitions that occur throughout the lifespan. Genes load the gun. Environment pulls the trigger.
Consider Janet, who was 56 when I interviewed her. She was caught in the midst of a perfect midlife storm: an empty nest, divorce, and menopause. And fears about "looking too old" as she went online trying to find a new partner. She turned to bulimia to cope.
Janet's "coping" routine illustrates the horrors of an eating disorder in an adult woman. At 5'7" and 95 pounds, Janet regularly diets, vomits, and purges through overexercise. She eats half a bagel for breakfast, a tiny salad for lunch, and strawberries or an artichoke, along with a bottle of wine, for dinner. The stomach acid churned up from routine vomiting eroded her teeth -- which have all been replaced. When she's not skimping on caloric intake through dieting and purging, she's using maniacal workouts to exorcise what few calories do get burned -- every day she follows up her minimum five-mile run with a spinning or aerobics class at her gym.
The circumstances behind Janet's tragic story are becoming all too common; according to my research, adults face
15 major transitions during their lifetime, each with the capability of triggering a new eating disorder or reviving an old one. The transitions, which range from marriage and divorce to retirement and late-life realities, don't necessarily cause the eating disorder. Rather, eating disorders result from a mix of genetics, cultural, and psychological factors, some of which start very early in life and seed a latent problem. And then, another stressor emerges, launching the eating disorder into full gear.
So which transitions are the most stressful and most likely to trigger a new or latent eating disorder? Answer: all of them. Here are just a few examples:
Marriage. Jo acquired anorexia for the first time after she married a minister, relocated to a new parish, and tried to be the "perfect wife". Partners add to the complexity because they bring their own attitudes and baggage to a relationship in which the eating disorder drives them apart as a couple.
Pregnancy. Tracy, with a history of bulimia, got excited when pregnant because morning sickness gave her an easy way to "not get too fat." Other women - if they can conceive-- actually cut back or stop the eating-disordered symptoms during pregnancy because they experience the time as permission to be fat and a chance to do for someone else, their growing fetus, what they cannot do for themselves: eat. Maternal instincts often trump psychopathology.
Parenting. Lauren relapsed into bulimia after the birth of her daughter. With a wave of her car keys, she would tell her husband that she was going out to the grocery store. There, she would buy a bag of junk food, eat it in her car and throw up behind a dumpster. Other mothers who are suffering with their own food issues experience conflict with a toddler at mealtimes, a school age child refusing food or vomiting after overeating, or an adolescent acquiring an eating disorder in a recreation of her mothers' nightmare.
No, this is not just teen stuff. And as baby boomers age and feel the cultural pressure to look younger (read "thinner") the transitions associated with eating disorders will only become all the more potent.
How do we curb the rising numbers of people in need of help? To be sure, opening more specialized treatment centers that target mature audiences is a good thing. But that's the back end of the equation; we also need to learn how to anticipate the triggers beforehand and set up support systems for women who are going under. We need to help people discover ways of coping other than through self-destructive and self-defeating measures. Physicians, therapists, counselors, and social workers need to tune their radar screens to eating disorders, especially those on the front lines such as gynecologist, fertility experts, and dentists (they're often the first to see the signs of bulimia -- eroded teeth, as in Janet's case).
This is a wake-up call for prevention. We need to deconstruct eating disorders in older women, before they become realities that affect whole families and create legacies passed down to children.
As a society, we need to make it possible for family and friends to be comfortable about discussing eating disorders. Healing might even involve marital counseling or family therapy in which the mother is the patient. Even though eating disorders are sometimes visible, as in cases of anorexia or binge eating disorder, they are usually closet issues. One woman I interviewed had bulimia for 35 years and her husband never knew. Ironically, he was a detective.
The stakes are high and growing. As medical science pushes the frontiers on longevity and people now fast to extend their lives, imagine the catastrophe, the costs to our health care system and to families who suffer loving their wives, mothers, and grandmothers, who do it when they're 100.