Eating Disorders Resources and Support

Chronic Eating Disorders in Midlife

The development of anorexia, bulimia, or a related disorder in midlife is relatively rare, although it is becoming more common. Usually, an individual develops an eating disorder during adolescence and it continues in some form into adulthood. This might be because the illness went undiagnosed, the person was unable to find or stay in treatment, or the disorder appeared to be fully resolved early on, but resurfaced sometime later. This article addresses chronic eating disorders in midlife and how to approach them.

Resolving the Eating Disorder at Different Stages Eating disorders can be complicated and challenging to treat no matter when they begin. Generally, the longer someone has the illness the more difficult it is to change or resolve. An eating disorder that has been a part of someone’s life for 10, 15, or 20 years is different than one that has existed for a few months. Over time, the person with a chronic eating disorder feels she has fewer and fewer other options to cope with emotions and other facets of daily life. She also becomes less connected to other people as a consequence of the illness establishing itself as her strongest, if not, primary, relationship.

Often, a recent disorder will not have become as embedded in someone’s life, and in such cases a goal of treatment may be to entirely eliminate the problem. With a chronic condition, a more reasonable objective may be to develop additional coping strategies and ways the person can have a gratifying life, despite the presence, to some degree, of the illness.

Seeking Recovery After 30 Years A 43-year-old woman came to see me a few years ago. She had anorexia and bulimia for about 30 years and had been in a variety of treatment settings over the past decades. She was frustrated by her seeming “inability to recover,” and demoralized that every time she made progress in terms of food, weight, or being more involved in her life, she significantly relapsed, with enough weight loss to leave her medically unstable. She was sure she wanted to recover, but every time she relapsed she felt more like a failure.

Over the first few months in therapy we explored her idea of recovery—what about it appealed to her and what about it frightened her. She realized that after living with the eating disorder for so long she couldn’t imagine life without it. She began to understand the dynamics of her relapses: Each time she made a change in her eating or gained weight (for example, letting herself eat a new, previously “bad” or “unsafe” food), or when she participated more in truly living, she felt it meant she was moving toward totally losing the disorder, which terrified her, precipitating a relapse.

Since the approaches she had so far employed to work on her disorder had turned out to be largely counterproductive, we tried something else. We began to conceptualize a life where she could “keep” the disorder, as opposed to continually (and futilely) attempting to get rid of it. She was amazed at the idea that she might not have to “kill it off” and that she could stop expending so much energy in the service of an end result that she, in truth, felt was neither possible nor in her best interest. Giving herself this permission allowed her to explore other options, such as “How to begin to have more of a life I want, even though I might always have some part of this disorder.” It also freed her from her belief that she was “bad” and a failure since she hadn’t been able to fully recover after so many years of trying.

Managing the Symptoms In shorter-term eating disorders, the focus may be “How to fully resolve the disorder so the person can resume life,” the conceptualization being more akin to an acute medical condition. For example, imagine a course of action one might take in the case of a severe and suddenly occurring bacterial infection. All available resources would be devoted immediately and intensely toward eradicating the disease and returning the individual to health, ideally with little or no remaining effects from the infection.

In a chronic eating disorder, we’d do better to primarily work within the framework of “How can I live the best life possible?” as opposed to “How can I get rid of the eating disorder forever?” The difference in viewpoint can be illustrated by an approach likely taken with a chronic, as opposed to an acute, medical condition. One might hope for major gains in resolving the disorder, but the focus would more realistically be on managing the symptoms and additionally doing whatever one could do to assist the individual in having the fullest, most gratifying life possible. While this approach is not recommended for most cases, in chronic disorders it can be helpful.

No Relapses in Two Years The aim of acknowledging and accepting differences in treating and overcoming a chronic disorder is not to be pessimistic, but to be realistic, and in fact, as a result, hopeful. Working on one’s relationship the disorder is always a worthy endeavor. Remaining cognizant of the length of time the illness has been a part of someone’s life and consequently the nature of her relationship with the disorder, affords a structure within which to focus the therapeutic work.

The woman who came to see me a few years ago continues to work on her relationship with her eating disorder. The difference now is that she feels empowered and excited by what lies ahead, not ineffective and immobilized in her life. As a by-product, she has suffered no relapses in the past two years. Ironically, it has been “giving up the idea of recovering fully” that has allowed her to truly progress in recovery.

Johanna Marie McShane, PhD, has a private practice in Lafayette, CA. She is co-author of Because I Feel Fat. The second edition will be published by Gürze Books in early 2008.

Reprinted From: Eating Disorders Today

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Brothers and Sisters: How They Can Help You Recover By Walter Vandereycken, MD, PhD, and Ellie Van Vreckem, MA

They may be irritating and impossible at times, but your brothers and sisters may actually help speed your recovery from an eating disorder.

Over the many years that we have worked with families of anorexia nervosa and bulimia nervosa patients, we have learned how helpful brothers and sisters can be and the importance of their relationships with the patient and parents. Whenever possible, we try to involve siblings in therapy, regardless of their age or the fact that they are no longer living at home. All of the siblings are invited to participate, even those who other family members say are “certainly not coming” or “not important.” Most brothers and sisters react enthusiastically when asked to participate.

“Younger siblings may feel unfairly excluded if not informed about, or involved in, treatment; and not telling younger children might give the impression that they are part of the problem.” —Bulimia: A Guide for Family & Friends by Sherman & Thompson

Why should brothers and sisters be included in treatment? Siblings help clarify family interactions. First, siblings can help therapists understand and clarify past and present family interactions. They often have surprising and refreshing ideas about how the family functions. In this way, they can act as “consultants” to therapists, especially when issues between family members remain unresolved.

Siblings may act as “nurturers.” Brothers and sisters often lean upon each other for support, particularly in families that have poor parenting. One surprise is that real and genuine help is often provided by those siblings from whom one would expect the least help—for example, the “silent” sister who is having problems herself.

We try to understand each sibling’s position within the family and ask for everyone’s second opinions. If for some practical reason they can’t come to the treatment sessions in person, we interview them on the phone or ask them to write us a letter. We explain our treatment principles and goals in separate sessions. Usually siblings understand the significance of the eating disorder and its social effects very well. By understanding what is going on in treatment, siblings can also act as “co-therapists” at home, getting the family involved in discussions or more freely expressing their opinions about daily life.

Siblings can act as role models. Finally, siblings who have independent lives while keeping a positive contact with the parents can act as “models” to help patients make the often-difficult transition from child to independent adult.

Setting boundaries Siblings can be a tremendous force for good, but can also be part of the problem. For example, a sibling, usually an older brother or sister, can be over-involved or may try to act like a parent. Or there may be sibling rivalry or incest. Each of these problem areas is handled individually, with special sessions.

Although we have only touched on a few aspects of including siblings in treatment, our conclusion is clear: we can learn a lot from brothers and sisters. They help us deepen our understanding of eating disorders and enlarge the scope and potential of treatment.

The Authors Walter Vandereycken, MD, PhD, is Professor of Psychiatry at the Catholic University of Leuven, Belgium. Ellie Van Vreckem, MA, is Clinical Psychologist and Psychotherapist at the Eating Disorders Unit of the University Center St. Joseph in Kortenberg, Belgium.

Sisters with Anorexia Nervosa Question: Two of our three daughters have symptoms of anorexia nervosa. Is this common, and, if so, why don’t all sisters develop it?

Answer: The fact is, sisters of girls with anorexia nervosa (AN) do have an increased risk of developing this disorder because it does run in families. The good news is that only a few sisters of girls with AN also develop it. Eating disorders do appear to run in families, but we still don’t know why some sisters are affected while others are not. A recent study of 45 pairs of sisters gives us a few clues. In that study, those with AN differed from their healthy sisters in several ways. First, they were more perfectionistic and/or more likely to comply with their parents’ wishes. Next, they had feeding problems when they were infants. Daughters who developed AN also reported that their parents had higher expectations of them, and that they were highly competitive with their sisters. They thought their sister was their parents’ favorite and that she was more attractive than they were. The sisters with AN were also more likely to report sexual abuse. There were no marked genetic differences among the sisters (Psychological Medicine, volume 31, page 317, 2001).

Reprinted From: Eating Disorders Today

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Eating Disorders: Risk Varies By Age And Gender

Binge eating and purging can occur in boys and girls at a variety of ages, but the risk factors for these behaviors largely vary by age group and gender, according to an article released on June 02, 2008 in the Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.

Eating disorders, such as anorexia nervosa and bulimia nervosa, are syndromes that involve compulsive eating or compulsive undereating, and they generally are detrimental both mentally and physically for the sufferers. One habit common in these disorders is binge eating, when the patient eats uncontrollably for short bursts of time; another such habit is purging, in which the patient vomits or uses laxatives to limit the digestion of the food and thus control his/her weight. Body image and control issues have been attributed as causes for many documented cases of eating disorders but there has been very little research in teens who are not actively in treatment regarding the early development of these habits.

To help elucidate early causes of behaviors such as binge eating and purging, Alison E. Field, Sc.D., of the Children’s Hospital Boston and Harvard Medical School, Boston, and colleagues analyzed data from the ongoing Growing Up Today study taken between 1996 and 2003. In total 6,916 girls and 5,618 boys, aged 9 to 15 at the start of the study, were questioned regarding various habits and influences. The study examined various risk factors, including frequent dieting, attempts to mimic persons in the media, negative weight comments from fathers or from peers, and any maternal history of an eating disorder. It then correlated these risk factors to the development of frequent binge eating, purging, or both.

In the seven years of follow up, 10.3% of the girls and 3.0% of the boys began binge eating or purging at least once a week. For girls, purging was slightly more common, with 5.3% of the total population, while binge eating was less common with 4.3%. In males, the opposite was true, with 2.1% binge eating and 0.8% purging. A very small proportion of boys and girls engaged in both behaviors.

For girls under 14 years old, a mother with a history of an eating disorder was associated with a tripled risk to begin purging. However, this association was not true when patients were older. “Maternal history of an eating disorder was unrelated to risk of starting to binge eat or purge in older adolescent females,” the authors say. “Frequent dieting and trying to look like persons in the media were independent predictors of binge eating in females of all ages. In males, negative comments about weight by fathers was predictive of starting to binge at least weekly.”

The authors conclude that different risk factors are important for different groups of children. “Our results suggest that prevention of disordered eating and eating disorders may need to be age- and sex-specific. Efforts aimed at females should contain media literacy and other approaches to make young persons less susceptible to the media images they see,” the authors conclude. “In addition, programs for females should focus more on becoming more resilient to teasing from males, whereas programs for males should focus on approaches to becoming more resilient to negative comments about weight by fathers.”

Family, Peer, and Media Predictors of Becoming Eating Disordered Alison E. Field; Kristin M. Javaras; Parul Aneja; Nicole Kitos; Carlos A. Camargo Jr; C. Barr Taylor; Nan M. Laird Arch Pediatr Adolesc Med. 2008;162(6):574-579.

Written by Anna Sophia McKenney Copyright: Medical News Today

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