Anorexia Isn’t Always About Teenage Girls
Adult Onset Anorexia
Eating disorders such as anorexia and bulimia are conditions which instantly bring to mind the stereotype of a teenager, usually a girl, who is struggling with multiple issues. We all know that eating disorders, and especially anorexia, have the highest mortality rate of any mental illness, and there are an estimated 30 million people suffering from an eating disorder in the US alone. Treatment pathways for young people suffering from anorexia are already in place in most Western nations but what is less known is the growing problem of older adults suffering from anorexia.
Middle Aged Anorexics
In 2004, an Austrian hospital was the first to indicate a growing pattern for women in their 40s or 50s to present with symptoms of anorexia and this is backed by American figures indicating that 13% of women over the age of 50 have some type of disordered eating pattern. For many women in this age group their anorexia will have first surfaced in their teens or early 20s and without treatment, will have persisted into middle age. Other people develop anorexia for the first time at this stage of life and the Austrian researchers suggested various reasons and risk factors which might explain anorexia developing. One of the main factors is thought to be the natural ageing process and body dissatisfaction – as women reach their middle years, they feel themselves to be further from the ideal of young, slim and wrinkle-free. Other compounding factors may be loneliness caused by relationship breakdowns or children leaving home or the stress of caring for older children and elderly parents simultaneously.
Diagnosing Anorexia in Older Patients
The stereotype of anorexia being a disorder which affects teenage girls is one of the main factors which stop sufferers seeking medical help and which also stops friends and family identifying what is wrong. Adult sufferers might be embarrassed to have a “teenager’s problem”, and might be far less willing to seek any help than a younger patient, especially one who has a parent to advocate on their behalf. There may also be many other obstacles to treatment for patients, such as caring responsibilities or work. If anorexia is suspected, the patient is convinced to see their family doctor and the correct diagnosis is made, there are still other factors which might complicate treatment for an older patient. Older women whose fat stores have been severely depleted by anorexia may well find that symptoms of menopause are much more intense when compared to women with a healthy BMI. An older body may not be able to stand up to the ravages of a starvation diet, and figures show that mortality rates for women suffering from anorexia at an older age are just the same as for teenage patients.
Once diagnosed, the treatment of anorexia in older patients is broadly similar to that in younger sufferers. The main difference is that it can be harder to undo several decades of negative thinking about body image or fixed ideas about food and eating. Attitudes and thought processes are much more entrenched than in younger patients. Support for the adult anorexic from relatives can also be an issue; parents may be elderly, infirm or deceased and many women in this age group are living alone after a relationship breakdown. Most treatment programmes for anorexia combine a variety of psychological treatments such as CAT (cognitive analytical therapy), CBT (cognitive behavioural therapy), interpersonal therapy or family therapy. These “talking therapies” are combined with help to gain weight safely, working with a nutritionist and aiming for a target of 0.5kg a week. Anorexics may also be prescribed anti-depressant or anti-anxiety medication depending on what is thought to be the underlying factors leading to the anorexia.
Implications for Health Professionals
There’s a growing awareness of anorexia and other eating disorders as an issue affecting older women but the teenage stereotype persists. Health professionals, family members and social workers must be open to the possibility of eating disorders in older patients, as a prompt diagnosis maximises opportunities for successful treatment. Many experts believe that as the current generation of middle aged women move into the elderly age bracket, there could well be a gradual increase in eating disorders in this age group too.
Have you seen a change in how more mature women see themselves? Is there pressure on this age category to live up to unrealistic expectations?