At any age, the physical repercussions of an eating disorder are myriad, but the risks are even greater for older women. “The body is generally more vulnerable,” says Elizabeth Midlarsky, Ph.D., professor of clinical psychology at Columbia University Teachers College. “Organ systems have weakened or become diseased.”
“At a time in a woman’s life when she should already be concerned about her bones and heart, an eating disorder adds an extraordinarily excessive strain,” adds Pearson. “It’s one thing for a 20-year-old to be straining her heart like that, but to be 55 with a potential family history of cardiac issues is that much worse.”
Diane paints a vivid picture of just how devastating the medical complications can be.
After eight years of purging, Diane has suffered from gastric reflux and bleeding, osteopenia, esophageal ulcers and severe anemia. Once, her esophagus closed up because of muscle contractions (dysregulated by the purging) and doctors had to insert what Diane calls “a balloon thing” so that she could swallow food. She has found herself in the ER repeatedly for episodes of dehydration and fainting, and once broke her tailbone when she passed out in the garage. “Medically, it has really hindered me,” she says. On most days, she suffers intense fatigue and finds that she “can’t do a normal day’s worth of work without having to take a nap or lay down.”
The risks only worsen with age, when malnutrition can cause confusion about the real root of medical problems.
Midlarsky works with eating disordered patients over 65 (the oldest is in her 90s), and she finds that cause is often blurred with effect. “They can seem depressed or demented from not eating,” she says. “I say, get her fed and then let’s talk. Nutrition and hydration can have a lot to do with health problems in later life.”
The social consequences can be even harder to manage.
Out on disability since 2006, Diane deeply misses the hospital where she worked for 23 years and the co-workers who felt like family to her. “We basically grew up together,” she says. “We graduated, started jobs, got married, had kids, all in the same time frame. I cried a lot about that.”
Her family life has changed as well. She and her husband had a once-vibrant social life but now rarely leave the house, and family gatherings like Thanksgiving, or even a simple dinner out, can cause enormous stress. “I know my daughter is very angry,” she says.
When asked if Diane’s behavior could increase her daughter’s risk of an eating disorder, Lynn Grefe, CEO of the National Eating Disorders Association (NEDA) asserts that such beliefs are misguided. “Moms don’t cause eating disorders in their daughters,” she says. “The traits may be passed down, but if a mom has an eating disorder, that doesn’t mean her daughter will have one.”
Still, Pearson does say it’s a risk factor. “Whenever a mother is embedded in her own eating issues, it’s hard for a daughter to develop healthy body image in that context.” The best action a mom can take is to watch her daughter for signs of an eating disorder and catch it early.
For older women, the road to recovery is paved with obstacles.
Grefe says that, in her experience, older women tend to be more secretive about the disease. “They think it’s a young women’s disease, so they’re embarrassed,” she says. That can keep them from admitting the problem. “We work very hard to say there’s no embarrassment,” she adds. “These are illnesses. It’s nobody’s fault.”
Unfortunately, the general public rarely reinforces that view. “People with eating disorders get a lot of anger directed their way,” says Pearson. “Older women especially can draw contempt from people who say, ‘Aren’t you old enough to know better?’”
In fact, Diane has heard those words before. When she checked into her first treatment center, her fellow patients were half her age. “I remember one of the parents saying to me, ‘Aren’t you a little old to be going through this?’ I just felt really embarrassed, like I should have my stuff together by now.”
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