You starve yourself, shedding pounds, and it feels too good to ever stop.
Or you eat lots - as much as you want, more than you want - and then sneak away from your loved ones to purge it all.
But you're not 16, not 19, not 21. You're in your 30s, 40s or 50s. And you can't stop.
Anorexia and bulimia used to be considered health problems that afflicted teenage girls. But doctors are finding that a growing number of older women are now being diagnosed with some sort of eating disorder.
It can happen to anyone
"It can happen to anybody at any stage of their life," said Dr Alexander Sackeyfio, a psychiatrist and eating-disorder specialist at the Beaumont Hospital in Royal Oak, Michigan. "I think we're becoming more aware of it and are better at diagnosing it."
People tend to make another mistake in their perception of eating disorders - they assume they are relatively benign psychological problems that are easily treated and without lasting physical effects, said Doug Bunnell, clinical director of the Renfrew Centre in Wilton, Connecticut.
"People are surprised when they learn these have the highest mortality rate of any psychiatric diagnosis, somewhere between 10 and 15 percent," said Bunnell, who's also a member of the US National Eating Disorders Association board of directors.
Anorexia produces dramatic weight loss caused by excessive or compulsive dieting. An estimated 0.5 percent to 3.7 percent of women suffer from anorexia nervosa at some point in their lifetime, according to the US National Institute of Mental Health.
An obsessive minefield
Anorexics see themselves as overweight even though they're dangerously thin. The process of eating becomes an obsessive minefield and unusual eating habits develop, such as picking out just a few foods and eating them in tiny, carefully measured quantities.
Bulimia is characterised by excessive binge eating followed by purging the food through vomiting, laxatives or over-exercising. An estimated 1.1 percent to 4.2 percent of American females will struggle with bulimia nervosa in their lifetime.
Because of the purging, people with bulimia usually weigh within the normal range for their age and height. But they still suffer the same fears about weight gain as anorexics. So, they often perform bulimic behaviours in secret, feeling disgusted and ashamed when they binge, yet relieved once they purge.
Bunnell said he's seeing more middle-age or even older women coming in for treatment of an eating disorder. But, he's not sure that all of these are new cases developing later in life.
"My experience is that virtually all the women we've seen with eating-disorder symptoms in their 30s or 40s had some prior activity in the more typical age range," Bunnell said. "It may not have been diagnosed, or just short of being serious, but there was a period when they were really struggling with it. We've not seen a lot of brand new, out-of-the-blue eating disorder cases in older women."
Hormones may be involved
Other doctors believe that hormonal fluctuations that occur near menopause could set off an eating disorder, as could mid-life changes like divorce or the departure of grown children. As the family changes, some women find themselves grasping for some semblance of control - one of the needs that an eating disorder can fulfil.
Complicating matters for the older patient is the fact that women coming in for treatment later in life may find it harder to get the help they need. For decades, the focus has been young women, and only recently has the therapeutic field begun to expand into treatment for older women - and men, Sackeyfio said.
"No one is catering to their needs," he said. "That's the same problem that gentlemen had for a while."
Bunnell said anorexics tend to be preoccupied with their body shape or weight, and often suffer from anxiety, perfectionism and obsessive-compulsive disorder. By contrast, bulimics tend to be depressed and impulsive, often struggling with substance-abuse issues.
"The anorexic style is more overly controlled, tense and rigid, while the bulimic style is less controlled, impulsive or disregulated," Bunnell said.
Team-based treatment preferred
Treatment for eating disorders has evolved as well, with doctors now emphasising a team-based approach, Sackeyfio said.
"Originally, what people would look at was that it is a psychological problem, but it quickly becomes a physical problem," he said. "You need somebody who's aware of those physical changes to work with you if you're a therapist."
Ideally, someone with an eating disorder should be working with a team that includes a psychiatrist, a nutritionist and a physician, Sackeyfio said.
Most important, the people surrounding someone with an eating disorder need to understand that the patient truly is out of control and needs help, Sackeyfio said.
"They aren't spoiled brats who are trying to make people's lives harder," he said. "They really have very little control over the physical changes that they cause in their own bodies." – (HealthDayNews)
Eating disorders Centre
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