Eating Disorders Increasing Among Women 35 and Older by Gina Shaw The words ìanorexiaî and ìbulimiaî usually conjure up images of waiflike teenage girls or young college women binging on three pints of Ben & Jerryís before bolting to the bathroom to throw it all up. When you think of eating disorders, you probably think of someone who looks like Mary-Kate Olsen, not someone who looks like your mother. Think again. Although young women in their teens and early 20s still account for the majority of eating disorders, physicians are discovering that their older sisters, mothers, aunts and even grandmothers are increasingly having troubled relationships with food as well. The phenomenon of women older than 35 developing eating disorders has only recently been identified and is still not well understood, so figures are hard to come by. But one Cornell University study, published in the International Journal of Eating Disorders in 2001, found that admissions to the Cornell eating disorders program for people ages 40 to 49 doubled between 1988 and 1998. That jibes with the experience of Philadelphiaís Renfrew Center, an eating disorders program, which saw a sevenfold g rowth in the number of women 35 and older admitted to its intensive treatment program between 2001 and 2003. Overall in 2003, some 23 percent of Renfrewís entire population was made up of women over 35. Faced with this trend, Renfrew has recently developed a ìThirty-Something and Beyondî group aimed at providing counseling and support for women facing eating disorders at midlife. Whatís behind this apparent increase in late-onset (or late-continuing) eating disorders? Itís hard to be sure. Because the trend has only recently been spotted, psychiatrists and other specialists are still working to decipher the causesóbut there are some theories. For one, itís not as easy to ìgrow old naturallyî as it used to be. How many commercials have you seen lately urging you to ìfight the visible signs of aging?î ìI think that today, thereís more pressure for women later in life to maintain a ëyouthfulí appearance, which is often associated with slimness,î said Dr. Nicole Posner, a New York psychiatrist specializing in eating disorders who works with the Renfrew Center as well as in private practice. There are also a number of stress factors facing women at midlife today that may not have been such an issue for their mothers and grandmothers. ìTheyíre experiencing biological changes, which arenít as acceptable now as they used to be,î said Posner. ìWomen are having children and parenting later, and at the same time they can be dealing with aging parents and career and financial stress. This may be an attempt for some women to gain control back by controlling what they eat.î In some cases, these are ìrelapsesîówomen who battled anorexia or bulimia in their teen years and apparently overcame it, only to struggle with eating issues again later in life. In others, the eating disorders never were treated and have persisted for years. And for still other womenóabout a third of those admitted to Renfrew in 2003, for exampleóepisodes of self-starvation, binging and purging, or ìanorexerciseî (obsessive over-exercising) didnít begin until after age 30. Is it easier or harder to treat eating disorders in older women? That can depend, said Posner, on the patientís history. Many older women who have just recently developed eating issues are highly motivated to seek treatment and less in denial about their problems than adolescents and teens may be. On the other hand, when an eating disorder has persisted for many years, it can have deep and tangled roots that are hard to dig up. ìOver many years of symptoms, the eating disorder can become part of the personís identity and the primary way that the person deals with stress. Often this person has forgotten other ways of coping with negative emotions,î Posner explained. ìAlso, if the eating disorder has gone on for many years, it can take up so much of the personís time and energy that [they] may be very isolated and have lost many of their supportive relationships.î Women over 30 with eating disorders need treatment approaches that are aimed specifically at them, such as the new program at Renfrew. Although they may have the same symptoms as their 15-year-old or 21-year-old counterparts, their daily lives and the issues that have brought them to treatment are often very different. ìOlder women may benefit more from being in the same groups with other women their own age who can relate to them, and more programs are being developed tailored to their needs,î said Posner. Such programs can also include specific components such as education about the aging processóoffering a realistic picture of how the body changes at midlifeóas well as individual therapy, couples or family therapy if a partner is involved, and parenting programs that educate the patient on how her eating disorder may affect her children. Finding a treatment center, program or specialist that offers programs aimed at women over 30 can still be a challenge, as the field is definitely ìstill a work in progress,î Posner observed. However, women can call (800) RENFREW for referrals to eating disorders specialists across the country. Other sources of help and information include the National Eating Disorders Association (www.nationaleatingdisorders.org, (206) 382-3587), Something Fishy, a Web site on eating disorders (www.somethingfishy.org), and the Eating Disorder Referral and Information Center (www.edreferral.com). Gina Shaw is the medical writer for The Washington Diplomat.