By Dr Kimberli McCallum, M.D.
Women and men in their 30s, 40s and 50s are now seeking treatment in increasing numbers, challenging beliefs that eating disorders occur mostly in adolescent girls. The prevalence of eating disorders in middle age is not known and older adults are not all alike in their presentation. To date, little is known about late onset of eating disorders in men; however, in our experience, older men are increasingly seeking treatment particularly for concerns about body fitness, struggling with binge eating and compulsive exercise. Additionally, some patients may present with new onset symptoms, re-emergence of symptoms, increased awareness and distress associated with persistent low grade symptoms or enduring and severe symptoms. Those with chronic or intermittent symptoms, never treated for an eating disorder, may finally seek care because they find themselves in a health crisis precipitated by many years of disordered eating behavior. Older patients may present with the whole gamut of symptoms including compulsive exercise, rigid eating, vomiting or laxative use, extreme body dissatisfaction, preoccupation with plastic surgery, restrictive eating, binge eating, low weight, obesity or extreme weight fluctuations. Co morbid psychiatric and medical conditions are common as they are in youth, particularly struggles with alcohol, anxiety and depression.
Late life can also pose its own developmental challenges, straining one’s capacity to adapt. Things like pregnancy, weight gain and body changes may intensify body image concerns can have a complicated effect on women who have struggled with eating and body dissatisfaction. Middle age is also a time when many are faced with aging and illness of their own parents. Shifting from adult child to caregiver for their own parents, unresolved hurts and frustrations can trigger old behaviors. In today’s economy, middle aged adults may face job loss or change, financial stress. These factors and more can overwhelm ones’ capacity to adapt leading to relapse, especially in patients with fragile coping styles and limited supports. Vulnerable individuals can become deskilled, reaching for old ways of regulating emotion.
It is important to remember that not all those seeking treatment later in life have struggled with severe or enduring symptoms throughout life. Many have been able to build careers, families and have had periods of relative wellness with partial or full remission of symptoms. If not entrenched in their symptoms or when the symptoms recur in the context of a role transition, emotional maturity and confidence associated with age and experience may facilitate psychotherapy and recovery. Growing awareness and acceptance of one’s own mortality may engender courage to face our fears.
Dr. McCallum is a board-certified psychiatrist in child, adolescent, and in adult psychiatry. She is a fellow of the American Psychiatric Association (FAPA) and a Certified Eating Disorders Specialist (CEDS) and remains an Associate Professor of Clinical Psychiatry at Washington University. She received her medical degree from Yale University, completed her adult training at UCLA Neuropsychiatric Institute, and her Child and Adolescent Psychiatry Fellowship at Washington University School of Medicine. Dr McCallum is a member of the Academy of Eating Disorders (AED) and serves on the board of directors of the National Eating Disorder Association (NEDA) and also the International Association of Eating Disorders Professionals (IAEDP). Dr. McCallum is the founder of the Dahlia Partnership, a non-profit organization for family support and advocacy and a NEDA affiliate in St Louis.
She has developed several eating disorder treatment programs, including inpatient, partial hospital and intensive outpatient programs. Dr. McCallum has lectured across the country on a variety of topics achieving national recognition for her skills and knowledge in treating eating disorders. She is the founder and director of McCallum Place, an eating disorder treatment center in St. Louis, and is Co-Founder of Cedar Springs, an eating disorder treatment center in Austin, Texas.
For more information please call 314-737-4070. www.mccallumplace.com.