Understanding Adult Anorexia

Photo: © iStockphoto

Eating disorders aren't just a teen affliction. With more women being diagnosed with anorexia than ever before, health experts are quick to point out that this disorder doesn't practice age discrimination. We spoke to eating disorder experts, anorexia survivors and others affected by the condition to bring you the very latest on anorexia in women.

The Truth About Adult Anorexia

For the majority of her life, 44-year-old Angela Lackey, a writer from Midland, Michigan, says she rarely fussed about her weight or worried about eating. She had a normal body image and, at 125 pounds, was healthy and fit. But shortly after being diagnosed with a thyroid illness that contributed to a sudden weight loss, she says friends began to notice her thinning figure. "Many people had complimented me on how 'tiny' and 'good' I looked," she says. She didn't know it then, but those comments would fuel unhealthy eating behaviors that would lead to full-fledged anorexia in a downward spiral that nearly cost Lackey her life.

While anorexia can hit at all ages, most people assume that it's an adolescent disorder. "The most common cases of anorexia in women are among those who had some eating disorder symptoms when they were teens," says Sari Shepphird, PhD, a clinical psychologist and eating disorders specialist in Los Angeles and author of 100 Questions & Answers About Anorexia Nervosa. "But the most current scientific literature suggests a vulnerability to developing eating disorders throughout the lifespan. Recent studies, in fact, indicate that older patients are being seen in increasing numbers and eating disorders treatment centers have seen a significant increase in the number of patients over age 30." One prominent treatment center, the Renfrew Center (with 11 locations across the country), reported in 2005 that as many as 20 percent of their adult eating disorder patients said they were age 30 or older when they first encountered symptoms.

Why the upsurge in adult anorexia? It's simple, says Dr. Shepphird: an increasing and intense social pressure to be thin. "The pressure on adult women to equate thinness with attractiveness has increased in recent years, now resulting in 80 percent—four out of five—women reporting dissatisfaction with their appearance," she says. "More women today feel like they are not 'successful' as women unless they are thin, which leads to increased eating disordered behavior."

Looking back on the road that led Lackey to anorexia, she says she "developed a strong fear of gaining any of the weight back." And, in a vicious cycle, she began using food restriction as a way of controlling those fears and anxieties as well as job-related stress. By November 2007, she had her eating down to a shockingly strict regimen: a cup of yogurt for breakfast, two slices of deli turkey for lunch and one-third cup of rice for dinner.

In January 2008, Lackey dropped below 100 pounds. In the end, after a few frightening emergency room visits for heart problems, it was a photo taken by a friend that helped her see that she, indeed, had a problem. "There was a picture of me that showed me stripped to the bone—my arms, my skull, my neck—there was no body fat anywhere. I was shocked and asked my husband, "Is that what I look like?" For the first time, I felt frightened for my life and agreed to get help. In the end, it took several visits to treatment centers and meetings with eating disorder specialists before she began gaining weight again and beginning her recovery. "I am working on being comfortable with change, which feels threatening to a lot of people with anorexia and other eating disorders," says Lackey, who is now in recovery.

Stress and Dieting: Risk Factors for Adult Anorexia?

While societal pressures continue to be a factor contributing to eating disorders in women, Dr. Shepphird offers up another possible culprit: Stress. "We know that anorexia is also often precipitated by, or triggered by, an emotional life event or period of significant stress," she says. "Significant stress, when coupled with inadequate coping resources, can combine with other risk factors to increase a person's vulnerability to illness." Common stressful life events that are known to trigger anorexia, and other eating disorders in some women, include divorce, childbirth, widowhood and menopause. "Additionally, eating disorder experts believe that chronic dieting may pose a particular risk for anorexia and other eating disorders in women as they age," she adds.

Adult Anorexia's Secondary Victims: Families

Blake Hill, a resident of Marina del Ray, California, was 19 years old when his mother, then in her 40s, began struggling with severe anorexia. "My mom was a beautiful person inside and out," he says. But he watched as his 5'10" mom succumbed to anorexia. In the years that followed, she shrunk to a mere 71 pounds. The disease, he says, caused a lot of grief for his family and complicated his relationship with his mom.

"Anorexia nervosa is an illness that can devastate the whole family," says Dr. Shepphird. "The mood and personality changes that result from anorexia-related starvation can wreak havoc on close personal relationships and family ties." In May of last year, Hill's mother died of the disorder. "It's extremely sad that she had to find peace in death," he says. "She's missed seeing her grandchildren's lives—Noah is 8 and Lily is 5." While he's accepted his mom's death, and forgiven her for what she put him—and herself—through, he says his life has been changed, scarred even, by this disease. "I can spot an anorexic woman on the street today, and I usually offer up a silent prayer."

"Sadly, anorexia has been known to destroy the connectedness that was once shared in otherwise loving families," says Dr. Shepphird. "I often recommend that family members receive help and support as well."

Advice from Survivors: How to Beat Anorexia

Shannon Cutts, a recovering anorexic and advocate for eating disorders awareness who founded the eating disorders mentoring community MentorCONNECT and wrote Beating Ana: How to Outsmart Your Eating Disorder and Take Your Life Back, says the first step toward recovery for many women is what she calls finding a "key to life," or something worth living for. "Recovering from an eating disorder is not going to be easy, and you need an extremely motivational goal to reach for to keep you going when you feel like giving up," she says. "Examples could include wanting to have a child someday, wanting to be there for your children, wanting to help others who have eating disorders, wanting to be able to see the world and travel, wanting to get married or save the relationships that are important to you."

"Find a good eating disorder specialist," adds Lackey, "someone who understands anorexia and particularly those who develop it later in life. Many doctors will not see patients over the age of 30, and many still refuse to believe it can develop—with no previous history—in someone in their 30s or 40s or beyond." Finally, continues Cutts, "don't give up—ever. There is always something else you can do to save your own life."

How to Tell If You Need Help

In her book, 100 Questions & Answers About Anorexia Nervosa, Dr. Shepphird offers a list of key questions. "If you answer 'yes' to any of these questions, regardless of whether you fit the diagnostic criteria for an eating disorder, your attitudes and behaviors about food and weight may need to be addressed," she says.

Do You:

1.Constantly think about your food, weight or body image?

2. Have difficulty concentrating because of those thoughts?

3. Worry about what your last meal is doing to your body?

4. Experience guilt or shame about eating?

5. Find it difficult to eat in public?

6. Count calories whenever you eat or drink?

7. Still feel fat when others tell you that you are thin?

8. Obsess that your stomach, hips, thighs or buttocks are too big?

9. Weigh yourself several times daily?

10. Feel that the number on your scale determines your mood and outlook for the day?

11. Punish yourself with more exercise or restrictions if you don't like the number on the scale?

12. Exercise more than an hour every day to burn calories?

13. Exercise to lose weight, even if you are ill or injured?

14. Label foods as "good" and "bad"?

15. Vomit after eating?

16. Berate yourself if you eat a "forbidden" food and compensate by skipping your next meal?

17. Use laxatives or diuretics to keep your weight down?

18. Severely limit your food intake?

Sarah Jio is the health and fitness blogger for Glamour.com. Visit her blog, Vitamin G.