Not Just for Kids

By Melba Newsome

Psychiatrist Ann Kearney-Cooke has been treating eating disorders for 23 years. About 10 years ago, the therapist, who is based in Cincinnati, Ohio, began to notice a disturbing new trend: the average age of her patients kept getting older. "We traditionally think of anorexia and bulimia as affecting those of college or high school age, and that was the case 20 years ago," she says. "Now about half my patients are women in midlife."

She's not the only one seeing that trend. In Philadelphia the Renfrew Center Foundation, which specializes in treating eating disorders, reported a 25% jump in patients older than 35 over the past two years; today those women account for nearly a quarter of its patients. At the Remuda Ranch in Wickenburg, Ariz., the percentage of patients 40 or older has nearly quadrupled, from 3% in 1990 to more than 11% last year.

Like their teenage counterparts, victims of midlife eating disorders tend to suffer from low self-esteem and perfectionism, according to those who treat them. But the triggers for their problem have a distinctly midlife flavor--divorce, an empty nest or the death of a spouse, parent or child. About half those affected are women who struggled with food-related issues in their youth. "This generation of women was brought up to be superwomen, and whether it's the supermom or the woman with the incredible job, both are expected to be beautiful," says Kearney-Cooke, a co-author of Change Your Mind, Change Your Body: Feeling Good About Yourself After Age 40 (Atria Books; 268 pages). Societal pressure to remain thin well into one's 40s and 50s adds to the stress. "Thirty or 40 years ago, a woman who had a few children was expected to be 15 to 20 pounds heavier than she is now," observes Kearney-Cooke. "Many have difficulty dealing with issues related to aging, and there's a sense of 'I can't control my hormones, and I may have memory lapses, but if I don't eat and lose a pound, that's something I can control.'"

Donna Smith, 41, of Springfield, Pa., acknowledges that her eating disorder sprang from a need to rein in her sometimes out-of-control life. Smith, a bookkeeper and part-time yoga instructor, had struggled with bulimia as a teenager and resorted to it occasionally as an adult. But the disorder returned with a vengeance three years ago when her estranged father resurfaced after a 20-year absence, then died. Smith coped by resuming her old self-destructive ways. By the summer of 2003, she carried less than 100 lbs. on her 5-ft. 3-in. frame. Only after she was hospitalized for bulimia did she agree to enter Renfrew's eight-week outpatient treatment program.

Five years earlier, Smith might have been surrounded by girls half her age, but Renfrew had recently created a recovery program called Thirty-Something and Beyond. Clinical supervisor Holly Grishkat developed the program after the center was bombarded with calls from women who wanted help but did not want to be in a program filled with adolescents. "Older women are dealing with very different issues than the younger girls," says Grishkat.

That's certainly true of Karen, 47, a human-resources manager in Los Angeles who developed serious bulimia after her husband died in 1991. Karen, who prefers not to reveal her full name, admits she has never had a healthy relationship with food and that, as a new widow, she found herself going on binges that lasted days, followed by days and even weeks of fasting. It took her years to get help. She looked for a program in which others could identify with her issues of loss and aging. This summer she turned to San Diego's Puente de Vida, a private, six-bed facility that requires at minimum a 30-day stay, which costs $30,000. During her time there, Karen says, three of the six women were her age or older. "I didn't want to be with a lot of teeny-boppers who might look at me and think, 'What's that old lady doing here?'" she says.

While Karen didn't mind a mixed-age program, facilitators at Renfrew say older women can be less forthright in such groups and tend to mother the younger girls instead of focusing on their own needs. "Women with eating disorders are very good at taking care of everyone but themselves," says Grishkat.

They're also very good at hiding their problems. Despite the rising number of midlife women seeking help for eating disorders, some experts think that large numbers go undetected not only because patients are secretive but also because doctors are oblivious. "Some doctors have a stereotype of who develops an eating disorder," says Cindy Bulik, director of the eating-disorders program at the University of North Carolina at Chapel Hill. "I know patients whose doctors said, 'You can't have bulimia. That's a young white woman's disease.'" The tendency to overlook the disorder is exacerbated by the fact that many mature patients can't be neatly classified as anorexic or bulimic. Most older patients at Remuda Ranch are classified as EDNOS, eating disorders not otherwise specified, says Dr. Edward Camella, Remuda's director of research and education. Such patients often rely on idiosyncratic dieting and compulsive exercise to control their weight. "It used to be that they were terrified of fat grams, but now they're terrified of carbs," says Camella.

An eating disorder can wreak havoc on the body at any age, but at midlife the damage can be swift: stress fractures from prolonged exercise, early osteoporosis from poor nutrition and heart arrhythmia brought on by being too thin and exercising to exhaustion.

As with other addictions, the first step to recovery is acknowledging the problem. Smith remembers being "very resistant" when she arrived at Renfrew's residential center. "I sat around crying and thinking, 'I'm not like these other people,'" she recalls, "but they wouldn't release me without a game plan, so I said what they wanted to hear for the first few days. After a while, I realized how much I needed help." Even then she was skeptical that she could beat a problem that went back to her teen years. She attributes her progress to psychotherapy, an organized routine and the group environment. "Prior to this, I had never talked to anyone about my problem or been around other people with the same problem, so I always felt very alone and isolated."

Renfrew's treatment protocol for women 30 and older centers on therapy that deals with food-related issues and problems related to aging. Patients take part in art and movement therapy, attend classes in grocery shopping and develop a sustainable, healthy exercise routine. Renfrew offers outpatient and inpatient programs, most covered by insurance. After her treatment there, Smith continued with psychotherapy and uses her yoga practice to stay focused on a positive mind-body connection. She has maintained a healthy body weight of about 117 lbs. "I try to eat really well, plan for meals so I know what to expect," she says. "I don't want to say I'm recovered. I think I'll always be in the recovery pro-cess in one way or another."

Doctors say mature women tend to be more motivated to get well and have better outcomes than their younger counterparts. "Young girls are here because their parents made them come," says Camella. "About half of the older women come in because they realize they need help. The other half are here because their husband or kids are pushing them to come in for treatment. Once they realize they need to recover, if you give them a plan, they will work it."