“My daughter said I have an eating disorder and need to see someone,” Allison said to me at our first session.
It’s an understatement to say Allison was incredibly thin. Looking at her, her skin ashen, her eyes with a frozen-like wince, I could tell she was suffering. Her daughter may have sent her to me, but she knew something was wrong.
Denying Anorexia at an Older Age
It’s all too common for someone suffering from an eating disorder to want to hide, shrink and deny the truth to health care professionals: they are embattled in a life-and-death situation with food.
And, tragically, I find this denial becomes more pronounced with age.
In other words, the older one gets, the harder it is to admit to themselves and to those around them that they have disordered eating.
“I should be a role model,” Allison told me, as she diverted eye contact and admitted to restricting her food. I hear similar comments from most patients over 60 suffering from eating disorders: I’m too old to have an eating disorder. This is a problem for young women, not someone my age.
But anorexia is not age discriminate. If it goes untreated, it can lead to death. And with older people, the danger soars. Our bodies are less resilient as we age, so the mortality rate is even higher in people over 60.
At the time I saw Allison, she was using a cane because she was too weak from malnutrition to walk unaided. She was in trouble.
Anorexia Is About Loss, Not Food
On the surface, anorexia looks like it’s about food. People with anorexia talk about food, think about food, and even spend hours preparing foods they don’t eat.
I need to be thin. My belly has fat. My thighs are touching. I need to lose weight. These words gush out of women with anorexia — women who have become so thin they’re at risk of dying. However, underneath the emaciated body is someone who feels helpless and out of control. People with anorexia are silently screaming: Help me. I feel no control over my life. And the only thing I feel I can control, is what I eat. Or don’t eat. I can starve myself, sometimes literally to death.
Anorexia can happen at any time in our lives, though it’s more common during life transitions (e.g., from girl to young woman). That’s because life transitions can be stressful or scary, and call attention to the harsh reality of life: We don’t have control over much that happens to us.
For younger women, it often has to do with changes in their bodies. However, for women middle-aged and beyond, the life event that most often triggers anorexia nervosa is loss.
In my first session with Allison, I learned that she was 66 years old, divorced and had recently lost both of her breasts to cancer. As we discussed her history, it became profoundly evident: loss was the trigger. Loss is an inevitable part of life, and as we age, losses become more frequent.
Loss of loved ones is often the trigger for anorexia in people over 60, but it can also be other losses: empty nest, retirement, loss of possibilities, loss of strength and energy. In Allison’s case, it was loss of part of her body and her former self.
Allison, thankfully, admitted that she was restricting her food. I was able to get her to voice her helplessness (although this took months). “My breasts are gone. I don’t feel like myself. I feel like they were…taken,” she cried one session.
She had become preoccupied with getting her stomach to be flat. This was where she tried to regain control: If I eat very little my stomach will be flat and somehow I will feel a sense of control over my life again.
Treating Anorexia in Older Women
Once I was able to get Allison talking about her helplessness she slowly started to eat. Her psychotherapy was combined with a group for women with eating disorders, a nutritionist and bi-monthly doctor’s visits.
Sassy and otherwise healthy, she slowly began to see that her life had changed, but was not over. She had many choices and opportunities. She actually began volunteering at a hospital, speaking with patients newly diagnosed with breast cancer.
Again, it’s not about food or being thin; it’s about deep feelings of helplessness and loss of control over one’s life. Trying to get someone to eat won’t help. If you or anyone you know has an eating disorder, please seek professional help.
People do recover, and there is hope, but professional assistance is required.
Editor’s Note: Allison’s name was changed to preserve her anonymity.
