HUIXIAN

If you or a loved one has an eating disorder, this severe preoccupation with weight can result in extreme disturbances in eating-related behavior. Eating disorders include anorexia nervosa, bulimia nervosa and binge-eating disorder.

Anorexia nervosa leads to self-starvation — a refusal to eat enough to maintain sufficient nutrition to support life. Bulimia nervosa involves repeated episodes of overeating, followed by inappropriate ways of trying to rid the body of the food before weight gain occurs. Binge-eating disorder involves repeated episodes of uncontrolled eating to the point of being uncomfortably overfull.

Donald McAlpine, M.D., a psychiatrist and the director of the eating disorders services at Mayo Clinic, Rochester, Minn., treats people with eating disorders. Here he discusses how midlife eating disorders affect older women.

Most people think of eating disorders as mainly affecting girls and young women. Can older women have these disorders, too?

It's true that eating disorders usually affect younger women, peaking in the late teens or early 20s. It's less common, but these disorders can begin later in life, affecting women in their 30s, 40s and beyond. Although some women first develop the problem later in life, others experience a recurrence or struggle with the problem in silence for years.

If you have an eating disorder as a young woman, is it likely to recur in middle age?

Most women who receive appropriate treatment improve to the point that they no longer meet the criteria for an eating disorder. However, many women will continue to have some degree of residual signs or symptoms — such as bingeing and vomiting or renewed efforts to restrict eating with significant weight loss — which may flare under stress.

Are the characteristics of eating disorders different in older women?

Some differences do exist. Young women with bulimia nervosa are motivated by excessive concern with weight, shape and body image. Older women may binge and purge to cope with unpleasant mood stages.

Denial, so common in younger women with anorexia nervosa, seems to be less common in older women. Denial is replaced by thoughts such as, "You've got to help me with this, it's ruining my life." Older women, worn down by years of symptoms, may be more motivated to seek help. Motivation for change often leads to a more successful outcome in treating the illness.

At the same time, response to treatment appears to be better when the condition is treated earlier in life. Early on, bingeing, vomiting and restricting food are usually driven by concerns about weight and body image. Later in life, other factors may sustain this behavior, such as seeking a way to ease tension, anger or anxiety.

Years of daily symptoms can become deeply engrained. Women who have had symptoms for years may ironically find it difficult to live without this identity or coping style, as uncomfortable as it may be. A sense of pessimism because of past treatment failures also affects many older women.

How does the treatment for eating disorders of older women differ from that of younger women?

It's common for older women to tell me that when they were younger — and still in denial about their illness — they bluffed their way through treatment. They would return to symptoms as soon as they were done with treatment. Now older and wiser, these women respond better to treatment because they no longer have that youthful sense of immortality and are more aware of the consequences of their disease, such as osteoporosis. For these reasons, they're more motivated.

We still have a long way to go, but treatment programs have progressed substantially in the last two decades. Cognitive behavior therapy for eating disorders — focusing on self-monitoring, homework assignments and goal setting — was in its infancy in the early 1980s. Women treated for eating disorders in midlife may find that the treatment they underwent 20 years ago offers much greater benefit to them now. And since their initial treatment, new medications have been approved for eating disorders.

Women discouraged by unsuccessful treatment when they were younger should seek help again. Much more is now known about eating disorders and their treatment.

How likely is it that if a mother has an eating disorder, her daughter will also? What can the mother do about this?

Parents' attitudes about food and their values about what constitutes a healthy weight definitely have an impact on children. It's not uncommon for mothers with eating disorders to seek help because they don't want to pass on their unhealthy attitudes about eating to their children.

As a parent, be on the lookout for warning signs of eating disorders in your children — such as weight loss, excessive exercise, skipping meals and being extremely fussy about food. With bulimia nervosa, you might see a lot of food disappear, frequent trips to the bathroom and evidence of laxative use. Watch for extreme concern about shape, weight and body image.