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FeedWhen Thin Isn't In
By Margie Farnsworth
While the stereotype is a high school or college girl, there are growing numbers of women in their 30s, 40s, 50s and even 60s who have serious eating disorders, says psychologist Dr. James Spira, clinical director of Casa Palmera, a residential recovery facility in Del Mar that specializes in the maladies. The number of men is increasing, too.
Cases hes recently treated include a 32-year-old woman who had taken 100 laxatives a day for three years (She permanently damaged her intestines, and her potassium levels were so low, her heart was about to shut down); a 63-year-old woman who developed anorexia after her last child left home; a former Marine, 52, who had been purging himself after every meal for 25 years; and a 42-year-old male anorexic.
Boys and men have always been susceptible to anorexia and bulimia, although the problem hasnt received as much attention as with females, says Spira, whos been treating males with eating disorders since 1985. Men, he adds, are less likely to seek professional help because they are reluctant to admit to whats perceived as a womens problem.
Hes not surprised eating disorders are becoming more prevalent in men, given societys obsession with youth and so-called perfect body images.
It used to be that the preferred image for a man was John Wayne-ish, big and husky, Spira says. Now its a slender type like Brad Pitt.
Men are getting more of the same mixed messages from society as women have been, says Dr. Divya Kakaiya, a psychologist who founded Healthy Within, a San Diego outpatient treatment program for eating disorders.
Theyre being told that to be attractive and acceptable, they have to have six-pack abs, lean bodies and be super-athletic.
Meanwhile, the average American womanat 5 foot 4 and 140 poundslooks to the fashion pages, where the average model is 5 foot 11 and weighs a whopping 117 pounds.
More than 10 million females and 1 million males have anorexia or bulimia, according to government heathservice agencies. Twice as many are said to be undiagnosed. What exactly causes the disorders isnt known, and current research is focusing on possible biochemical or biological conditions that might predispose a person to the problem. Kakaiya cites research that shows even more are at risk. For every 100 dieters, 15 to 20 percent will develop some degree of anorexia or bulimia, she says.
While both the anorexic and bulimic are obsessed with their body images and relentless in their pursuit of thinness, there are significant differences between the disorders.
Anorexics weigh less than 85 percent of whats considered a healthy body weight, and may consume as few as 200 calories a day because of an intense fear of becoming fat. For a woman, at least three consecutive menstrual cycles have been missed. Moreover, anorexics dont see themselves as drastically underweight.
Its one of the most remarkable delusions Ive seen, says Spira. You can put an anorexic, all skin and bones, in front of a mirror with a normal-size woman, and the anorexic will say how beautiful that woman is. But then shell look at herself and say, Im so fat. Fat, ugly and stupid are the main words they use over and over to describe themselves.
One of two different behavior patterns may be at work in the anorexic. People with the restricting type of the disorder keep their weight low by limiting their food and increasing activity, often becoming compulsive exercisers.
The binge/purge type limits food but will also go through periods of binge eating followed by purging employing self-induced vomiting, laxatives, diuretics or enemas. A third of anorexics subsequently develop bulimia.
Unlike anorexics, bulimics usually know they have an eating disorder and may be normal or above-normal in weight. In one type of the disorder, the bulimic will compulsively binge eatin secret, and often with food thats been hidden and immediately purge the food.
Some have been doing it so long that they dont even have to induce the vomiting, says Spira. They just open their mouths and throw up. The non-purging type compensates for the binge eating by excessive exercise or periods of fasting.
Untreated, anorexia and bulimia can both cause severe malnutrition, seriously damage body organs and lead to death. The disorders also exact a profound emotional toll.
A person in the active stage of an eating disorder will tell you that 90 to 95 percent of their thoughts are consumed by food, calories, dieting, Kakaiya says. The eating disorder takes over everything.
EATING DISORDERS ARE NOT about vanity or even about food. Experts say anorexia and bulimia are manifestations of deep
psychological problems, such as feelings of worthlessness and self-hate, that have been displaced onto food.While a young girl may believe she has to be thin to be loved, older women developing eating disorders often are in a state of major transition, says Spira.
Many in their 40s or 50s find themselves divorced, and their kids have left home. Theres lots of stress, and theyre seeking some control over their lives, he says.
One thing they can control is their body. Older women and men with eating disorders, adds Kakaiya, are often intelligent professionals in demanding jobs who are high achievers, perfectionists and people- pleasers. These are really intuitive people, she explains. They are conflict-avoidant, they dont like tension, and theyre often very passive.
As with younger folks, exercise addiction is not uncommon among people over 30 with eating disorders, says Kakaiya. They think, Because I exercise, I can eat anything I want, and then it turns into bulimia. . . . They think theyve found the perfect diet, but no matter how much weight they lose, it isnt enough.
Treatment for eating disorders can be successful, and usually involves group and individual therapy. Casa Palmera, the residential facility, offers a three-month program that focuses on cognitive behavior therapies, understanding the triggers that lead to eating disorders, improving self-esteem and learning new ways to selfcomfort, such as yoga or tai chi.
We help show that you cant control your partner, your parents or many life situations, but you can learn to control your health, and thats very empowering, Spira says.
The outpatient program at Healthy Within is a 712-hour-a-week, six-week program; like Casa Palmera, it uses a multidisciplinary treatment team. Its a very immediately and thought it was the greatest. I didnt think any harm could be done. It was like an alcoholic who takes the first drink.
Years later, the disease was taking a serious toll. It was difficult for me to work, Goode says. There was the stress of hiding [the binging and purging] all the time. I was jumping out of my skin.
At one point she wore only 95 pounds on her 5-foot-7 frame. Her gums had receded from the stomach acid of the purging, and her esophagus was damaged.
I'd go through periods where I would try to eat normally, but then something would set me off. Pizza is a big trigger for me. It was nothing for me to eat two large ones at a time.
Visits to counselors and a short stay at a treatment facility in Florida helped but didnt stop the bulimia, Goode says. She finally confided in a woman friend, also in her 40s.
She said lots of women are doing it, and she thought it was okay. I was shocked no end. I said, Get me out of here!
Its been several months since Goode left Casa Palmera, and she feels safer and more comfortable with things. The program, she says, taught her foremost to be honest with herself and to put structure into her life.
I can never be cocky about this and think that [the bulimia] will always be under control, Goode says. No one can ever be 100 percent sure.
For more information: Casa Palmera, 888-481-4481 and casapalmera.com; Healthy Within, 858-622-0221 and healthywithin.com. The National Eating Disorders Association operates a nationwide helpline for information and referrals: 800-931-2237 and nationaleatingdisorders.org.
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