Elder Eating Disorders: Is Recovery Possible?
Panel Discussion with Clinicians from Mirasol Eating Disorder Recovery Centers
Much has been written about a spike in eating disorders among middle-aged and older women, but there's very little information on their prospects for recovery. A group of Mirasol clinicians got together to compare notes on their experiences with older clients. What prompts someone to finally seek treatment after decades of illness? Is it a reaction to other profound life changes, like children leaving home or the end of a marriage? Is it a gift to oneself in retirement? What are the special challenges for older women in eating disorder treatment? How do you feel about a 20-something telling you when to eat or go to bed? What are the odds of recovering from behaviors that have been part of your identity for 20, 30, 40 years or more? Can the older eating disorder client overcome the odds with superior motivation, resiliency and a stronger sense of self?
Diane Ryan, Executive Director
Maeve Shaughnessy, Clinical Director, Adult Program
Ann Twilley, MA, Trauma Therapist
Katie Klein, Primary Therapist
Jamelynn Evans, Primary Therapist
Kira Vredenburg, Primary Therapist
Mayra Villalobos, Neurofeedback Technician
Anne Ganje, Dietitian
Audrey Bailey, Aftercare Coordinator
Michelle Thomas, LPN
Rachel Nelson, Art Therapist
Kim Kellow, Spiritual Integration Practitioner
Download Audio: M4A
Diane Ryan: "There's a difference between people who have had their eating disorders for a long time and older clients with eating disorders. You could actually have a long-term eating disorder and be in your twenties. But there are qualitative differences between clients who have had their eating disorders for an extended period of time and those who have come into in more recently. We have seen an increase in the number of older clients, but most of them, on deeper reflection, seem to have had their eating disorder in some form or another for a much longer period of time."
Moderator: "Why do you think we're seeing more people who have had their eating disorders for a longer time?"
A lot of people have come to us from other treatment facilities where they have done more of the medical model of treatment, and they come to us because they're ready to try something different. The women who come to us in their 40s and 50s instead of their twenties seem to have a different level of commitment and motivation.
Katie Klein: "A lot of people have come to us from other treatment facilities where they have done more of the medical model of treatment, and they come to us because they're ready to try something different. The women who come to us in their 40s and 50s instead of their twenties seem to have a different level of commitment and motivation."
Michelle Thomas: "It's the realization that they've raised families, they've taken care of all these other people, and they finally have the realization that, 'wow, I better take care of myself.' At this point in their lives, either the kids have moved out, or relationships have changed with spouses, and now it's time to look inward."
Kim Kellow: "A 62-year-old woman called and said, 'I'm retired, and I'm done with this. I want the rest of my life to be free of an eating disorder.' We've had a number of calls like that, from people who are starting retirement, or thinking about retirement, and they're just done with the eating disorder."
Diane Ryan: "Having experienced the desire to not live the rest of their lives in the way they lived the beginning of it, do you think they tend to be successful?"
It's definitely harder for them because the behavior is so entrenched. With a young person, even if they've been doing it for 10 years, there's a sense that they can change some things because they have their whole lives in front of them
Ann Twilley: "What I witness, and it's very anecdotal, is that it's definitely harder for them because the behavior is so entrenched. It really is part of their identity, and to imagine life without it just seems crazy. How are they going to live their lives without this disorder and this coping skill? So I do think it's more challenging for them. With a young person, even if they've been doing it for 10 years, there's a sense that they can change some things because they have their whole lives in front of them."
Moderator: "So can you recover from an eating disorder if you've had it for 20, 30 or 40 years, and, if you can, what do you have to do differently?"
I think that people who show up here find that it's much more difficult than what they imagined, because they don't really know that they're signing up for changing everything.
Diane Ryan: "Everything. I think if you've had an eating disorder, your way of being in the world and your relationships have been colored by your identity as a person who copes with your life using eating disorder behavior, so in order to be able to shift that, you have to have great deal of open willingness. I think that people who show up here find that it's much more difficult than what they imagined, because they don't really know that they're signing up for changing everything. But that's kind of the keynote of recovery. You have to be willing to let all your old beliefs go, your behaviors, your way of being in the world. You have to make fundamental change in the way you relate to other people ..."
Moderator: "What can Mirasol do to support clients with long-term eating disorders in their recovery?"
Ann Twilley: "The most important piece is getting to the underlying issues. We've had a lot of clients — especially older clients — who do well in treatment because they're pretty compliant. But when they go home, even if they can hold off the eating disorder piece, they'll begin using other medicators. We have to get to the core issues as quickly as possible. If nothing else, at least start to identify what the core issues are. How many of them have come into treatment saying 'I really don't have trauma like other people have."
Moderator: "How often do you find that with these very long-term eating disorders there's some kind of buried trauma"?
Ann Twilley: "I don't know of a case where there isn't. But they may not identify it as such because some of the women in that age group look at it as if 'that's just life.' 'So what, I was abused, so were a lot of people.' Or, on the other end of the spectrum, we have people who are so dissociative that they have no conscious memory until you start taking away the medicators and then all this stuff starts popping up."
As a therapist, I have more hope for people who are older. The older people get, the more they have a sense of who they are without the eating disorder. They have the relationships, they have the family. When someone finally finds recovery at an older age, there's more hope that it's lasting.
Rachel Nelson: "For some reason, as a therapist, I have more hope for people who are older. I work with both teens and adults, and I see that the older people get, the more they have a sense of who they are without the eating disorder. They have the relationships, they have the family. But the younger generation has no clue. When someone finally finds recovery at an older age, there's more hope that it's lasting."
Michelle Thomas: "I think older people may actually have more resilience than younger people because they've grown up in a generation that had to struggle. So when they come in, they'll stick with it a bit longer, they'll try to persevere a bit harder because life hasn't been easy for them."
Katie Klein: "A lot of them have to finance this themselves. That takes a completely different level of motivation than the 20-year-old whose treatment is covered by her parents' insurance. We had a client recently who dipped into her retirement account, and said, 'I might as well spend this now, so I can have the rest of my life.'"
Women in their 40s [are] less willing to settle for the status quo, and the expectations of society. That wake-up call is pretty profound — it's pretty significant — and you don't want to look back. You throw everything out and are willing to start with something new.
Audrey Bailey: "I see this happening with women in their 40s. They're less willing to settle for the status quo, and the expectations of society. It's like 'Okay, what about me?' That mindset is 'give everything up for your family, your spouse, your children.' That wake-up call is pretty profound — it's pretty significant — and you don't want to look back. You throw everything out and are willing to start with something new."
Kira Vredenburg: "Something I've picked up on recently is that women coming into treatment are used to care-giving and not used to taking time for themselves, it's very difficult to for them to be here, where they don't have to take care of everyone else, and they can really devote that time to themselves and be taken care of. I see it as part of a control issue, having to give that up and be vulnerable."
With younger and older women together rather than splitting those generations up, you're going to get all kinds of dynamics and triggers 'at no extra charge' that really help to illuminate these issues.
Ann Twilley: "With younger and older women together rather than splitting those generations up, you're going to get all kinds of dynamics and triggers 'at no extra charge' that really help to illuminate these issues."
Michelle Thomas: "As an older person coming into a treatment facility, there's going to be someone there who may be your child's age directing you to eat something, or telling you what to do."
Jamelynn Evans: "What I have noticed with older clients is the motivation because they really do get to the point where they have to ask, 'Am I living? Is this living, if my entire day is wrapped up in the eating disorder?' As we get older we do start to see time a bit differently, so there's more desire for something different."
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