When Eating Disorders Strike in Midlife
By RANDI HUTTER EPSTEIN

Margie Hodgin, a nurse in Kernersville, N.C., had struggled to lose weight since she was a teenager. But it wasn’t until she turned 40 that she finally took off the extra pounds, and then some.

“It was a real sense of empowerment, that I can do this all on my own and no one is helping me, and I’m achieving what I want and fitting into my clothes better,” she said of her initial delight in shedding the excess weight.

But what started as discipline transformed into disorder. Ms. Hodgin would not eat more than 200 calories a meal, and if she did, she made herself vomit. She surfed pro-ANA, or pro-anorexia, Web sites for advice. She knew that what she was doing was wrong — more like adolescent, she said — but she figured she was only hurting herself.

Meanwhile, her chronic state of starvation was triggering wild mood swings. It was only after she and her husband had several therapy sessions that she came to realize that her eating disorder was wreaking havoc on him, as well as their three boys.

“At a certain point,” she said, “you cross that line and you can’t help what you are doing, and the eating disorder owns you. I lost my bearings on reality and maturity.”

No one has precise statistics on who is affected by eating disorders like anorexia nervosa and bulimia, often marked by severe weight loss, or binge eating, which can lead to obesity. But experts say that in the past 10 years they are treating an increasing number of women over 30 who are starving themselves, abusing laxatives, exercising to dangerous extremes and engaging in all of the self-destructive activities that had, for so long, been considered teenage behaviors.

The recent surge in older women at eating disorder clinics is not a reflection of failed treatment, experts say, but rather a signal that these disorders may crop up at any age. But while some diagnoses, like Ms. Hodgin’s, are not made until these women are in their 40s, they may have battled food issues for years.

The Renfrew Center, one of the largest eating disorder clinics, with centers throughout the United States, started a treatment track geared to the 30-and-older set in 2005. The Laureate Psychiatric Hospital in Tulsa, Okla., is about to start a program, too.

Cynthia M. Bulik, director of the Eating Disorders Program at the University of North Carolina at Chapel Hill, said her clinic used to have about one older patient at a time. Now, she said, about half the inpatients are midlife women. And the executive director of the Remuda Ranch Treatment Programs in Wickenburg, Ariz., Edward J. Cumella, said that clinic had had a 400 percent increase in admissions of patients 40 and older since the late 1990s.

“I think the degree of despair we are seeing among adult women about their bodies is unrivaled,” said Margo Maine, co-author of “The Body Myth: Adult Women and the Pressure to Be Perfect” (Wiley, 2005). “Eating disorders creep up during periods of developmental transitions, so the peak had been 13 to 15 and 17 to 19 — moving into adolescence and moving into college. Now, we are seeing them again during or after pregnancy and as women hit other life phases, such as empty nesting.”

No one knows what triggers eating disorders. Emerging studies point to altered brain signals, but it is tricky to decipher whether the defective biochemistry is a cause or a result of poor eating. The reigning theory is the same as it is for so many syndromes with no known cause: some people are born with genes that make them highly vulnerable to environmental stimuli. “Genetics loads the gun, and environment pulls the trigger,” is what the experts always say at the eating disorder conferences, said Caitlin Scafati, a recovered anorexic. And yet no one has identified the genes.

Gail Schoenbach, a 48-year-old mother of three from Warren, N.J., said she had been bulimic since she was 18 but did not get treatment until her 40s, when her friends alerted her husband and he started calling treatment centers. “I was very embarrassed and scared and humiliated and ashamed that I had lied about it,” she said.

Sharon Pikus, a 64-year-old grandmother from Manhasset, N.Y., had struggled since childhood with bulimia. But it wasn’t until her 40s, when her children were grown, that she finally got help. Of being bulimic, she said, “I just couldn’t be it anymore — I don’t know how else to put it.” She was better for a time, then had a setback 10 years later and was treated again. She considers herself recovered today, but says it is a constant battle.

Extreme dieting fads like weeklong fasts are supported by our thin-obsessed culture, said Lynn Grefe, the chief executive of the National Eating Disorders Association. She added that women who fall into the diet trap of overexercising and avoiding family meals are setting dangerous examples for their children.

“A problem is that friends, and even doctors, get used to seeing someone in their overly skinny state and may not recognize their habits and physique as dangerously unhealthy,” said Dr. David Herzog, the director of the Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital. He is also the endowed professor in the field of eating disorders at Harvard Medical School.

Unlike teenagers, who often must be coerced into treatment, many older women come on their own accord. One of the greatest motivators is having a teenage daughter, because many parents start to worry that their child may mimic their behavior, said Craig Johnson, director of the Eating Disorders Program at Laureate Psychiatric Hospital in Tulsa.

Another reason that older women may be more likely to enter treatment is that after years of anorexia or bulimia, they finally realize that their coping strategies backfired. What they thought would bring happiness never did.

Yet making that first difficult step to admit to the problem does not make recuperation easy. In fact, for some older patients, the path can be even more difficult than it is for teenagers. Therapy involves unraveling years of entrenched habits and jettisoning an eating-disorder identity that had been with them for decades. And the first step in getting better — healthy eating — often seems an insurmountable task to those who are terrified of food and gaining weight.

“This is asking these patients a great deal,” said G. Terence Wilson, professor of psychology at Rutgers University in New Jersey. “Being intelligent and successful doesn’t immunize against eating disorders.”

Ms. Hodgin, who is now 45, credits her recovery in part to a trial at the University of North Carolina, where researchers are studying whether family therapy works as well for adults as it does for teenagers with the disorder. Bringing her husband to therapy sessions, she said, “made me realize how much I was breaking him down, and the resentment I had of people trying to make me better.”

Every day remains a battle, Ms. Hodgin said, and she still feels strong urges to weigh less.

“But I’ve been able to see the damage I left in the wake of it, and I can’t bear to see what I’ve put my kids through,” she said. “You can’t have an eating disorder and think it doesn’t affect your family.”

Publish date: 7/13/2009