Q. I'm a woman in my 50s. Ever since my divorce last year, I've developed an unhealthy pattern of eating and purging. A friend suggested I might have an eating disorder. Could she be right?
A. I understand why you ask the question, as most people think of eating disorders as a teenager's disease. But eating disorders also affect middle-aged and older women, and even some men.
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Experts disagree about what causes eating disorders. There probably is no single, simple answer. Genes seem to play a role. Identical twins are more likely to have eating disorders than non-identical twins, for example.
Eating disorders appear to be more common in people who have dieted frequently in the past, and in people who needed to be lean at one point in their lives -- because they were competing in certain sports, for example, or dancing.
People with eating disorders appear to be more likely to have psychiatric disorders, particularly obsessive-compulsive disorder, anxiety disorder and substance abuse. I'm not a psychiatrist, but I've always been struck by the parallels between obsessive-compulsive disorder and eating disorders. Both involve irrational behaviors that people cannot control. Eating disorders may be a way of responding to stressful events in life.
There are many reasons why eating disorders may develop or reappear during middle age. With age, for example, you are increasingly likely to lose people you care about. Restricting food or purging can be a way to deal with distressing feelings. Divorce is another common reason. In addition to grief and loss, the breakup of a marriage can spur a person to view their body unfavorably.
The type of disordered eating you've described sounds like bulimia nervosa. People with bulimia go through cycles of binge eating followed by purging. While on a binge, a person with bulimia may eat an entire cake rather than one or two slices, or a gallon of ice cream rather than a bowl. This is followed by a purge: making oneself vomit or using laxatives or diuretics.
Talk to your doctor about your eating patterns. If you do have bulimia, treatment can help you achieve a healthy weight and eating pattern, eliminate binge eating and purging, and address any stressful issues in your life:
• Psychotherapy is the cornerstone of treatment for eating disorders. Cognitive behavioral therapy (CBT) challenges unrealistic thoughts about food and appearance. It can help you develop more productive thought patterns. Interpersonal and psychodynamic therapy can help you gain insight into issues that may underlie your disordered eating.
• Through nutritional rehabilitation, a dietitian or nutritional counselor can help you learn (or relearn) the components of a healthy diet. He or she can help motivate you to make the needed changes.
• Fluoxetine (Prozac) is the only medication approved to treat an eating disorder. At high doses, it reduces binge eating and vomiting, particularly in combination with psychotherapy. Other antidepressants and the seizure medication topiramate (Topamax) may also be prescribed for bulimia.
With the help of these treatments, you can overcome your eating disorder.
• Dr. Komaroff is a physician and professor at Harvard Medical School. Send questions to AskDoctorK.com.