'You’re just too old for this': What it's like to have an eating disorder later in life

Source: Insight

When most of us think of eating disorders, we picture a young person, but older people also struggle with them. People who’ve suffered eating disorders, and experts, tell Insight of the difficulties in finding the right help.

When Laura Fahey, 46, was in hospital for an eating disorder, she felt incredibly alone.

“You get girls talking about which school they go to…most of them live at home with their parents and some of them are at uni and might have flatmates,” she said.

“It’s just such a different time of their life, that to be there as an adult with a mortgage and two children is just really quite disturbing.”

In 2017, Laura was an in-patient at a Sydney private clinic, being treated for anorexia nervosa, which she developed in her early forties. In the lead up to her diagnosis, she was under tremendous pressure following the birth of her second child. As well as dealing with workplace stress, she was trying to manage the cost of childcare while working part-time. This resulted in her developing postnatal depression.

“The anorexia just sort of snuck in there. It was very much influenced by my mood because my mood was so low,” Laura told Insight.

Laura flew from Melbourne to Sydney for in-patient care, while her family stayed in Melbourne. Having previously lived in Sydney, she was more familiar with the treatment there, but that meant leaving behind her eight-month-old baby.

“I felt enormous guilt that I was not at home with my children. I kept thinking that I shouldn’t have been there, I was old enough to know better,” she said.

“It sounds ridiculous because it’s a mental illness but I was thinking, ‘you’re just too old for this.’”

...I never would have pictured myself in this position [20 years ago].

Laura suffered from bulimia in her early 20s, which was brought on by the stress of transitioning from school to university. She believed, based on information she was receiving, that it was something she would simply grow out of.

Even during her recent hospital stay in Sydney, Laura remembers similar conversations amongst younger patients.

“Things like, ‘God, I would never let myself be that old and still have an eating disorder,’ which some of them said outright and other times it was implied,” she said.

“That is how I would have thought at the time. I never would have pictured myself in this position [20 years ago].”

Dr Ranjani Utpala, Clinical Psychologist and Director of the Butterfly Foundation, said over one million Australians are estimated to be living with an eating disorder, but less than a quarter of those receive treatment or support. The Butterfly Foundation is Australia’s only national charity supporting people affected by eating disorders and negative body image.

While more awareness is being built, Dr Utpala said eating disorders amongst adults are often misdiagnosed or completely missed by health professionals because they don’t associate the disorders with an older cohort.

Data from The Butterfly Foundation shows that the peak period for the onset of eating disorders is between the ages of 12 and 25, and that girls and women experience body dissatisfaction more frequently than boys and men. However, research from the foundation also shows that eating disorders can affect anyone of any gender, from any age group, across all cultural and socio-economic backgrounds.

Research from the National Eating Disorders Collaboration (NEDC) shows that eating disorders can be caused by a range of biological, psychological, environmental and social factors, which may be associated with life changes and transitions. Some of these transitions include adolescence, pregnancy, postpartum and menopause. They also include periods of trauma, stress, grief and loss.

I thought, ‘I’m a 30 something year old male, how does this work?’

When Kelly Griffin, 44, was facing difficulties in his marriage, he started spending more time at the gym. Although being part of the gym community served as a distraction from the stressors of life, it also made him more conscious of his physical appearance.

“It made me forget about the challenges that I was having and just made me feel good, physically and mentally. It spiralled from there,” he told Insight.

At 36, Kelly was diagnosed with late onset anorexia nervosa, his first experience of an eating disorder. Even though Kelly knew he had an unhealthy relationship with food, he didn’t realise he had an eating disorder.

“I thought, ‘I’m a 30 something year old male, how does this work?’”

“…Even my daughter was like, ‘but you’re not a 15-year-old girl, Dad,’” he said.

At the time of his diagnosis, Kelly’s two daughters were aged 14 and seven. He said he struggled to reconcile his role as a father with his experience of having an eating disorder.

“The biggest thing that was playing on my mind was, ‘do not do this to your teenage daughter. What example are you setting right now,’” Kelly said.

Dr Utpala believes there is a lack of education and funding to effectively treat eating disorders and there are very few mental health professionals who understand eating disorders.

“Anecdotally, we hear from GPs - once they’ve done the screening, they don’t necessarily know the best pathways to access care,” she told Insight.

“Even if we do know who are the eating disorder professionals, the challenge is that the waiting lists are long….if people have got to wait three months, the nature of the illness is that you can deteriorate quite rapidly within those three months,” Dr Utpala said.

old person on bench
Conclusive evidence suggests eating disorders are also prevalent in those over 70. Malnutrition is thought to be a common cause of the disorder.

Right now, there is no official data to identify the number of Australians over the age of 30 who are living with an eating disorder.

A demographic that is particularly under-researched is the elderly, despite conclusive evidence that suggests eating disorders are also prevalent in those over 70. Warren Ward, Associate Professor of Psychiatry at the University of Queensland, believes that the most common cause of eating disorders is malnutrition, which is very common in the elderly.

“A lot of people think anorexia causes weight loss, but actually weight loss causes anorexia. It’s the other way round,” Associate Professor Ward said.

He explained that when the brain is starved and is not getting adequate nutrition, it causes a syndrome called starvation syndrome. This causes changes in the brain which can lead to an eating disorder.

Amongst the elderly, causes of malnutrition may include functional issues such as the inability to go to the shops to get food, but also things like difficulty chewing or loss of appetite. Associate Professor Ward, who is also the director of the Queensland Eating Disorder Service (QuEDS) at the Royal Brisbane and Women’s Hospital, said depression, anxiety and loneliness can also lead to poor diet.

Dr Utpala stressed that full recovery is possible at any age, but both she and Associate Professor Ward agree the key lies in research and spreading awareness. There is a dearth of research in relation to the older age group as confirmed by InsideOut, the leading national institute dedicated to the research of eating disorders.

As well as research, improving access to care is crucial to timely prevention and intervention. Dr Utpala said there are fewer than 40 publicly funded inpatient beds in eating disorder-specific units across the country, most of which are concentrated in Queensland, NSW and Victoria.

She acknowledged that the “supply just does not meet the demand,” while also emphasising the need for more community and residential care programs to supplement hospital resources.

“Even if we had lots of hospital beds, what happens is that our consumers go into very intensive and supportive environments, but then they come home there's very little follow up,” Dr Utpala said.

Australians being treated for an eating disorder are entitled to 40 Medicare sessions, which include both mental health care and dietetics. However, accessing low-cost or no-gap treatment is a challenge.

“That’s one of the things that people certainly struggle with, cost is a barrier for many people in accessing treatment, because oftentimes the dosage of treatment needs to be almost weekly,” Dr Utpala said.

Kelly was 40 when he started on the road to recovery. He is now working in the advocacy space to eradicate stigma around this illness.

Laura said that even though she is weight-restored, she has not yet recovered.

“My brain is not restored, my body image is particularly bad at the moment. Life stressors don’t go away, so it’s not like you can take a break and focus on getting better like you might in your teens,” she said.

A report published by NEDC found that older people with persistent eating disorder symptoms require a different approach and a different environment to engage with treatment. Laura believes how we look at the disease must change.

“It does affect people other than rich, white teenagers and people don’t seem to understand that.”

Readers seeking information and support about eating disorders can contact the Butterfly Foundation national helpline on: 1800 334 673. Readers seeking crisis support can contact Lifeline on: 13 11 13

Source Insight

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