What does someone with an eating disorder look like? Most people would picture a thin teenage girl. But anorexia nervosa isn’t the only eating disorder, and maturity is not an automatic cure.
Older women with an eating disorder face different kinds of challenges from those of their younger sisters. They may have families to worry about. Behaviours and beliefs can be more deeply entrenched. Shame and embarrassment can be intensified by the feeling that they’re old enough to know better. And, as available treatments are often tailored to younger people, they might feel they have nowhere to turn.
Yet light does exist in the seemingly interminable dark. “Older women need to know they’re not alone and that help is available,” says Natalie Wild, a counsellor who works with people recovering from eating disorders. “Whatever your age, an eating disorder is a treatable mental illness and not something to be ashamed of.”
A serious mental illness
Four eating disorders are recognised by the Diagnostic and Statistical Manual of Mental Disorders. Broadly, anorexia nervosa is an obsessive fear of gaining weight that can result in life-threatening weight loss. Bulimia nervosa and binge eating disorder both involve episodes of binge eating but, in bulimia, this is followed by purging through vomiting and/or using laxatives. Other specified feeding and eating disorders (OSFEDs) are not clearly defined but have characteristics of the first three.
According to the National Eating Disorders Collaboration, no single cause of eating disorders has been identified but contributing risk factors include:
- Genetic vulnerability: notably within biological systems related to food intake, appetite, metabolism, mood and reward-pleasure responses
- Psychological factors: personality traits such as perfectionism, obsessive-compulsiveness, neuroticism, low self-esteem
- Socio-cultural influences: these include unrealistic, airbrushed images equating Beauty with thinness in women and lean muscularity in men
These factors aren’t age-specific. “While young girls are still the majority, I’m seeing more women around the 40 mark with an eating disorder,” says Tammy Shemesh, who teaches yoga in eating disorder clinics in Sydney. “This has often been precipitated by some kind of crisis, or an issue that has been deeply suppressed.”
Young women tend to develop the illness in times of transition; in older women, it’s most commonly a response to loss and grief. The death of parents or a partner, chronic illness, disability or children moving away from Home could all act as triggers for women well into retirement who have a predisposition to an eating disorder.
Others, however, have lived with the illness for most of their lives and that presents its own set of challenges. “Women with anorexia in particular can feel defined by the disease and afraid of who they would be without it,” says Wild. “As they get older, they may worry that their obsessive behaviour will drive their partner away or that they might die and leave their children without a mother, but they’re often more interested in finding strategies for living with the problem than fixing it.”
Resistance to change is an aspect of the illness that can make long-standing eating disorders harder to treat. “I feel as though the thoughts in my head are me now, and they’re very loud,” says Melissa, who started to restrict her food intake at the age of seven. “I’ve been seeing a psychologist but I find it really hard to change because I’ve been like this for so long.”
It didn’t occur to Melissa that she had a mental illness until she had to be treated in hospital. “In some ways that was a relief,” she says. “Spending time with people who struggle in different ways drove it home that we don’t choose to have an eating disorder any more than we would choose to have cancer. I wish more people understood that an eating disorder isn’t about being vain or stubborn.”
A culture of control
In the tabloid press, there’s a very fine line between an “enviably slim” female celebrity and one who is “worryingly thin”. Even at the worrying end of the spectrum, there’s often a subtle undercurrent of admiration for someone with such obvious self-control. It’s rarely reported that, while women with binge-eating disorder may be overweight, they are also extremely disciplined.
According to Natalie Wild, this is part of the problem for binge eaters. “They often restrict their food severely during the day so, by the evening, they’re starving. Then, as soon as they start eating, they feel they’ve lost control and just keep going. It’s a kind of numbness; most don’t even taste the food they’re eating. And some binge eaters restrict so strictly that they don’t gain weight at all.”
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Since she was a child, Annie has swung between binging and keeping a dangerously tight rein on her eating. But she’s heard and read so often that overweight people are lazy with no self-control that she has internalised that judgement.
“No one has to say or do anything; you [judge yourself] for them,” she says. “And fear of humiliation tinges everything you do. You worry that a chair will break under you or that you won’t be able to fasten your seatbelt on a plane. Or that, when you go into a business meeting, no one will speak to you because, if you’re fat, how can you be smart? Why should they listen to you?”
A constant tug-of-war
An eating disorder is typically all-consuming. Jenny, who began purging with laxatives when she was in her early teens, is constantly haranguing herself. “Luckily, I have a job I can do on autopilot because feelings of being useless, helpless and a total failure are on my mind 100 per cent of the day,” she says. “I feel I’ve got a permanent tug-of-war going on in my head, pulling me one way and then the other.”
Melissa also describes her life as a constant tug-of-war. “The logical side of my brain says, ‘You’ve got to eat’, while the other, louder side is saying, ‘No, you’ve got to lose weight’,” she says.
Sufferers often feel socially isolated and lonely. Jenny declines invitations to parties because she’s afraid of being judged for her size. Melissa keeps people at arm’s length for fear they won’t understand her feelings or her behaviour. And, according to Annie, 90 per cent of her relationships with men have been very unhealthy because she has always been attracted to people who undermine her self-esteem. “I think you choose people who reinforce the messages you’re sending to yourself,” she says.
Relationships with children can also suffer, complicated by secrecy, guilt and anxiety. “When I relapsed I did everything I could to hide my illness from my daughter,” says Melissa. “I wore baggy clothes and found ways to continue my disordered eating behaviour without her noticing. She just assumed I was tired because I was working too hard until I had to tell her why I was going into hospital. She cried, and that was devastating, particularly as I then had to spend five weeks away from her.”
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Jenny also does her best to hide her illness from her children but worries constantly that they have been influenced by her eating habits. “At one stage my 15-year-old stopped eating breakfast and was throwing her lunch away at school,” she says. “She seems OK now, but that really scared me. I couldn’t bear the idea of her life being like mine.”
Melissa does her best not to think about the damage she might be doing to her body. “On one hand I don’t want to grow old, but on the other hand I want to be around as long as possible for my daughter,” she says. “I remind myself that I must eat for her sake, then feel overwhelmed by the responsibility of having to do everything for other people.”
Finding the right treatment
Help exists for people with disordered eating, but it isn’t always easy for older women to find effective treatment.
“When I reached 160 kilos I felt desperate and decided to have a gastric band fitted,” says Jenny. This, however, has failed to address the root causes of her illness. “People believe it’s a quick fix, but it’s not — after 10 years, I weigh 120 kilos. Weight drops off me when I use it properly, but I can still binge on things like ice cream and milkshakes and when something upsets me I can binge for a month and put on 10–15 kilos. I think I’d probably weigh a lot more if I didn’t have the band, but I’ve no idea whether it helped the eating disorder itself.”
Annie once sought help from a dietician who told her that even a small amount of food can constitute a binge. “She said it wasn’t about quantity, it’s about the reason you’re eating, and that frightened me so much didn’t go back,” she says. “For me, eating a relatively small amount would be very positive because I would be tempering the voice in my head that’s telling me not to stop.”
Melissa found that, even in hospital, treatment didn’t meet her needs. “They focused almost exclusively on putting on weight and treating the physical symptoms,” she says. “Of course, I know that’s important, but anorexia is about the underlying issues. Just gaining weight isn’t going to help with those.”
She also felt very conscious of her age. “It’s very, very hard to walk into a room where everyone else is at least 20 years younger than you. Having to eat made me cry and I found that incredibly embarrassing. And, in group therapy, there was no way I could open up in front of girls just a few years older than my daughter. It’s as if you’re their mother and should be taking care of them, not on the same level. I felt very ashamed and like a bad example because I should be fixed by now. It was the same when I went to outpatients, so I stopped going. I really wish they had special units for older women.”
It takes courage to seek treatment and, when it falls short, it can be easy to dismiss it as “not for me”. But, as Annie points out, there are thousands of different counsellors and other specialists out there. “If the first one isn’t right for you, keep looking till you find one who is,” she advises. “I saw a couple of people who were fixated on my past history when I wanted practical strategies. I’m glad I persevered until I found someone who understood.”
Jenny also finds practical strategies helpful and is now focusing not on weight but on improving her health. “In the past I thought I couldn’t be healthy unless I was thin but I realise now that you can be overweight and fit,” she says. “This is helping me to feel better about myself.”
In her sessions at eating-disorder clinics, Tammy teaches a very gentle, sensation-focused form of yoga designed to support the healing process. “The problem with fast and strenuous forms of yoga is that they are often ambition-based and become part of the quest for a thinner body — just another form of exercise,” she says.
“My teaching invites students to become deeply intimate with what they can feel in their bodies, which is something people with eating disorders can really struggle with. I guide them towards trusting themselves and trusting their bodies. It’s not a cure for eating disorders, and it’s certainly not a quick fix, but this awareness can and does help to bring about change.”
Supportive friends & family
People who have no history of disordered eating find it difficult to comprehend their loved one’s tortured relationship with food and self. Annie hates the fact that the first question most people ask is, “What do you eat when you binge?” “Even my mum is guilty of that,” she says. “When you’re struggling with eating too much or, I’d imagine, too little, the last thing you want is to feel you’re being cross-examined about food.”
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Family and friends often feel bewildered and frustrated. “At first, I felt as if I were walking across a minefield, constantly worrying that I was going to do or say the wrong thing,” says Mary, whose 41-year-old daughter is recovering from anorexia nervosa. “Until my daughter became ill, I hadn’t given much thought to how often we make judgemental comments about other people’s appearance, and our own. I learned to stop doing that for my daughter’s sake and it has made me very conscious of how powerful apparently casual remarks can be.”
It’s also easy to focus too strongly on appearance as opposed to the internal experience. “At one stage, my daughter was so thin I honestly thought I was going to lose her, so when she started edging back towards a healthy weight I wanted to believe she was cured,” Mary continues. “Now I understand that recovery is a continuing journey. She needs as much support now as when she was obviously very unwell.”
Recovery from an eating disorder can indeed be a bumpy ride, cautions counsellor Natalie Wild, and it’s important not to become disheartened. “Women can be very hard on themselves when things get a bit rough, and their loved ones can feel desperately anxious and disappointed,” she says. “It’s only natural to want recovery to be ‘perfect’, but I believe that a ‘perfect’ recovery would mean missing out on many of the learning experiences that help build resilience over the long term. It’s important for everyone to focus on how far they’ve come rather than how far they have to go.”
Helpful tips from Natalie Wild
If you have an eating disorder
- Have realistic expectations. Recovery is about the journey, not the destination.
- Try to avoid comparing yourself with other people. We know we didn’t choose our height or hair colour, yet we have somehow tricked ourselves into believing we can choose our healthy weight and shape.
- Think about the impact your eating disorder is having on things that are important to you, such as your health, relationships and happiness.
- Remember that it’s normal to feel uneasy or have disordered thoughts, even when you look physically better, but that other people may not understand this.
- The right mental health support network is key to recovery. If one person isn’t helping, keep looking until you find someone who makes you feel comfortable and safe.
If you’re close to someone with an eating disorder
- Don’t be impatient. Recovery takes time and is bound to have its ups and downs.
- Avoid “diet talk”, making comments about appearance and comparing people’s weight. These are contradictory to your messages of support and they won’t go unnoticed.
- Take care of yourself. Eating disorders can become all-consuming for families and close friends, so it’s important that you make time for things you enjoy and find supportive people to talk to.
- Listen to advice but remember that it may not right for you and your particular situation. Think carefully before you act on it and don’t assume that you’re doing something wrong.
- Avoid guilt trips and focus on the positive. Comments like, “Look what you’re doing to your family”, or “When are you going to get over this?” aren’t helpful for someone with fragile self-esteem who could well be feeling guilty already. Instead, try to build on what has been achieved and strategies that have worked.
- Remember that visual appearance is not an accurate measure of mental health. Even when your loved one is looking well, asking questions like, “Where are your thoughts now?” or, “How are you feeling about …?” not only gives you a better insight, it reminds you both that recovery is a work in progress.
