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Are Eating Disorders Really Increasing in Middle Age?

» Mental Health Library » Disorders & Conditions » Binge Eating Disorder » Featured Article

By Gwen Gruber, LCSW

Gwen Gruber, LCSWWe live in a time where there is a tremendous obsession among many people to be thin.

The aim of this article is to elaborate upon various aspects of this obsession, especially relating to my experience as a therapist.

Carolyn Costin, MFT who is a well known author and practitioner poignantly illustrates in her book The Eating Disorder Source Book (2007) that eating disorders can strike at almost any age. Costin talks about how mothers used to call for treatment for their daughters; now she gets calls from daughters seeking treatment for their mothers. She talks about how Eating Disorders in midlife are becoming a growing area of concern. According to Costin, in the last few years cases of woman over 30 seeking treatment for an eating disorder has increased "400 percent." In my opinion an increase of "400 percent" is remarkable.

However, I see many women who have great concerns about their eating patterns and ability to lose or maintain their weight. I am not so eager to classify these women as having eating disorders. I see one of the issues leading up to this phenomenon as many women having a real difficulty maintaining weight. I witness women who have grappled the majority of their lives with weight issues that are intricately wrapped up with their self-esteem and self-worth.

Similarly, I have seen some women who are anorexic or bulimic. However, further exploration into their histories reveal that these disorders have a history most often leading back to late childhood and adolescence. I have observed that when someone has utilized deprivation, purging, binging, and/or a combination-- it is usually something which is established much earlier on. Many times, people are able to go into long periods of remission and recovery from previous traumas that have led them to self-destructive eating patterns. However, in some situations when presented with crisis and trauma, many people clinically regress back to earlier times. One example of this would be a woman who for many years is in remission from an eating disorder but in her mid 30's ends up in an intensely intimate and demanding relationship. Another example or common reason for relapse is a sudden divorce at middle age leading one back to self-destructive eating patterns. Fortunately, many women who have been hyper-vigilant about maintaining healthy eating patterns for years will seek help when they realize that they are losing control over their eating. Control is a significant for people when it comes to food. Actually, the impact that over-eating or under-eating has upon our bodies is one of the few things we can have direct control over and is significantly observable.

Eating is one of the easiest, self-soothing devices to acquire. Food is always in abundance in many cultures.

In the late 1980's I treated a middle aged man who had a binge eating disorder. He came from a family that was quite dysfunctional. His mother was either emotionally unavailable or overly solicitous. He never knew what to expect and was constantly walking on eggshells. However, for him food was always available and predictable. Beginning as a child he would become almost oblivious and tune out everything out in his binges. So food became his way of self-soothing from early childhood into middle age. Food was used as a substitute for emotional expression and as a means of avoiding forming appropriate attachments to healthy woman, as well people in general.

By the age of 47 he finally decided to explore his patterns of binge eating and how it impacted upon him. Although food was used as a mechanism to sooth and escape it left him in dreadful states of shame and self-loathing. He realized that he was very lonely and unhappy as he would frequently isolate himself and binge on high sugar and carbohydrate foods.

In addition to therapy, he went to Overeaters Anonymous as he believed food was his drug of choice, so to speak. One thing I poignantly recall him saying was that being addicted to food was a hard addiction to break because unlike alcohol or other substances food was not something you could become "abstinent" from.

So much emphasis has been placed on eating issues striking in adolescence. Of course they do! For instance many people do not realize that a person who is bulimic, unlike someone who suffers from anorexia, may actually be an average weight or even overweight. We can clearly see if someone is anorexic or obese. But there are signs we may see only upon close examination, like loss of enamel on teeth, or scars on the fingers from continuous purging. There are severe medical implications that one may suffer from. For instance, a woman who may have suffered from bulimia or anorexia could actually have bone loss. I have heard from a client in her 30's who was bulimic/ anorexic for a period of a year and a half  as an adolescent  who ended up with bone loss as evidenced by a bone density test.

I see many people who suffer from what I refer to is the "yo-yo diet syndrome." I know of one woman who began dieting as early as age 11, and who went through the gamut of every diet there was since the 1960's to the late 2000's. Her problem was that she was never able to maintain the weight she lost. At one point her closet contained clothing from sizes "one to size 16."

Many of the reasons leading to her extreme weight gains were a result of emotional issues in her life such as the death of a parent and a death of a significant other. By age 60 the weight fluctuations were at there highest and she began having health problems as a result. She made a decision at the age of 70 that she was going to lose at least 50 pounds and this time she was determined to maintain it. One different strategy she had this time was to donate her "fat clothes." This seemed to be indicative of a new pattern and a sense of hope and commitment on her part.

This woman was successful in losing at least 50 pounds. However, she was haunted by the fact that all previous attempts at weight losses ended in tremendous weight gains. One of the main issues that frequently came into effect was the "all or nothing approach," to eating. I have witnessed this common phenomenon where a person becomes so fearful of gaining weight that food becomes the enemy, so to speak.

In utilizing the "all or nothing" approach to eating, we see many more woman and some men who are prisoners to their food.  But do not  be fooled there are men that also struggle with binge eating  but they do not ordinarily  take it as personally as woman do. For instance, some woman base their self-esteem on their weight. It creates a dreadful cycle which frequently causes them severe emotional pain.

 There are many women like the one I described who is brilliant and very successful in her business and in her social life. However, food has become a major preoccupation for her. If she has to go to a buffet or office party, she will at times prior to the event obsess about what she will eat and how she will prepare for it. However, once she is actually at the event and allows herself to have one starchy food or a piece of dessert, she ends up eating in excess.

One of the primary contributing factors I have witnessed has to do with the whole concept of "dieting as a way of life." The woman who is now in her early 70's, has achieved her goal of a significant continued weight loss for a year and a half. However, when she looked in the mirror she was not happy with what she saw, and what's worse, she lived in fear of the ghost of her "fat self." It is only two years since she made the commitment to lose weight that she is finally happy with the fact that she has somehow learned how to maintain her weight. This took both exercise and the idea that she would not deprive herself but at the same point not be excessive. She is finally able to celebrate a new outlook on life that is no longer controlled by the "all or nothing approach." This was achieved through extensive cognitive behavioral therapy and learning how to be mindful when eating. When I last saw her she was so glad that she finally learned to maintain her weight and she accepted herself with a sense of joy and relief.

In another instance, I know of a very striking and attractive woman in her early 50's whom others see as long and lanky. She went through a very lonely and painful marriage; a marriage that was maintained for the sake of her three young children. In the evenings, she would frequently seek comfort in a pint of ice cream. This type of binging was only a temporary fix to the misery that she was feeling. In time, she was able to gain the confidence needed to get herself out of her marriage. At that point, her children were all in their 20's. She was determined to lose weight. However, she was not looking for a diet that was going to be the end all of her problem.

Instead, she chose to remove ice cream from her life and began a consistent exercise program. It was exercise based on her own terms. She did not want a personal training or what she considered "invasive intervention from the gym." She began working out at a rate that was comfortable for her and she gradually and incrementally increased her exercise to where it was comfortable but not excessive.

Within a period of a year, she was able to lose and maintain the loss of over 35 pounds. Unlike the other woman, this woman did not forbid herself from foods that could be considered fattening. She did allow herself to indulge occasionally in a moderate manner. However, even though she looked "very thin" to many people she knew, she still believed that she was "not thin enough." She also chose to dress in a way that never really revealed what she looked like. She looked very thin in her face and the other parts of her body that were exposed. However, she tended to dress in a fashionable way but somehow she seemed to be hiding behind her clothes.

Moreover, she was able to accept her occasional overeating, since she knew she would easily be able to compensate for her over-eating by eating less the next day and working out. She knew that she had ultimate control of what she did. She could clearly recall what it was like allowing food to be her main source of comfort for years. She was able to take more risks socially and at 52 went hiking for the first time in her life. She began to realize how she had previously allowed her fears and anxieties to control her. This time around she gradually and incrementally began taking risks and developed more satisfying life, relinquishing all her fears about food. She was able to heal and accept herself in a joyful and appreciative way.

In the last few decades, since the Serotonin Reuptake Inhibiters (SSRI), such as Prozac, Zoloft, Paxil, Lexapro, and Effexor, there seems to be a definite correlation between individuals gaining weight and taking these medications. Recently, attention and clinical research has been able to help us to understand the impact that food has on brain chemistry. I see people who have gained extensive weight while on anti-depressant drugs. Many feel that they are in a double bind situation as their depression has improved yet their weight gain has caused them anxiety and despair. There is  now emphasis on something called The Serotonin Power Diet.

I think that frequently diets intrinsically cause deprivation. Hence, deprivation leads to binging. This is what I refer to the "Yo Yo diet syndrome. In preparing this article I read many books on compulsive eating and eating disorders and was presented with many different approaches. I learned about many different perspectives. I believe that each book gave me some new knowledge or insight. However, no book gave me a solution or a single perspective that I would want to advocate. I believe that each person needs to understand why he/she eats the way they do and to examine if their self-destructive eating is a symptom of an emotional need that is not being met. I will provide the reader with a bibliography of suggested reading.

What I have presented were some drastic ways that woman can become enslaved by food to the point where it becomes a real determining factor of how they live. It is very common for people to resort to food as a sense of comfort and solace. Frequently, this pattern is established at a very early age. I strongly believe that people do have the capacity to change. I also believe that if a person is committed to change then they will. Achieving this commitment is the end result of successful therapy.

Bibliography / Suggested Reading

Costin Carolyn M.F.T. ( 2007) The Eating Disorder Source Book. New York: Mc Graw Hill Publishers

Carolyn Costin MFT providers the reader with the most Comprehensive book on the market on Eating Disorder. Ms Costin explores the psychological as well as the physical ramifications that one with an eating disorder can potentially confront.

Fairburn G Christopher Dr. (1995) Proven Effective in Clinical Research Overcoming Binge Eating. New York: the Guilford Press Publishers

Dr. Fairburn illustrates a wonderful book for the clinician and ordinary person who is interested in learning more about and how to stop Binge Eating

Roth Geneen (1982) Feeding The Hungry Heart. New York: Macmillan Publishers

Roth Geneen (1987) Breaking Free From Compulsive Eating. New York: Signet Publishers

Roth Geneen (1989) Why Weight? A Guide To Ending Compulsive Eating. New York: Plume Publishers

Roth Geneen (1991) When food Is Love. USA Plume Publishers

Roth Geneen (1998) When You Eat at the Refrigerator, Pull Up a Chair. New York: Hyperion Publishers

Geeneen Roth presents charming vignettes of women who have struggled through compulsive eating. In addition, she shares her own intimate struggle with overeating, I strongly recommend all of her books. Geneen Roth epitomizes a woman who has the strength to persevere in the face of adversity. She runs workshops in California

Wurtman J. Judith and Marquis Fruszajer Nina (2006) The Serotonin Power Diet. New York: Rodate Publishers

This book examines how the brains natural chemistry can help cut cravings, curb emotional overeating and help to lose weight. This book emphasizes the concept of how eating carbohydrates in moderation can help alter mood and enable one to lose weight. I found it to be informative. Some of my clients found it helpful especially while they were gaining weight from SSRI antidepressants

About the Author...

Gwen Gruber, LCSW is in private practice in Scottsdale and is now opening a new office in Central Phoenix. Gwen works with children, adolescents , adults couples and families. Some of her specialties are helping people with eating disorders, addictions as well as co-creating with her clients a way to achieve a healthy sense of self and well-being. She strongly believes: "Small changes can have enormous impacts."

Last Update: 10/11/2009

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