When Diets Turn Deadly: Adult Eating Disorders
Women at Risk
Becky Marsella is far from alone. Though long thought of as an ailment that affects teenage girls, anorexia is now overtaking more and more women in midlife. So are other food-related disorders, including bulimia and compulsive overeating.
Although there are no hard statistics on the age distribution of the estimated 5 to 10 million female Americans who suffer from some form of eating disorder, experts attest to a startling rise among midlife women. "We've seen a fourfold increase in the percentage of our 40-and-over patient population since we opened in 1990, and a threefold increase in women over 50," says Edward Cumella, PhD, director of research at Remuda Ranch, a treatment facility in Wickenburg, Arizona. "The number of teens in treatment nationwide has grown much more slowly."
In a culture where plastic surgery has become a spectator sport and weight loss is a $50-billion-a-year business, the growing prevalence of eating disorders among midlife women perhaps isn't surprising. "Everywhere women turn, they see messages about being thin and being young," says Holly Grishkat, site director at the Renfrew Center, in Philadelphia, the nation's largest eating disorders treatment facility. Midlife women are particularly vulnerable to these siren songs because, like teens, they are undergoing a cascade of physical, emotional, and social changes as they move from one stage of life to the next. One survey also found that 57 percent of middle-aged women are dissatisfied with their bodies -- three points higher than the rate for teenage girls -- and that almost 40 percent say they would willingly give up three or even five years of their life to achieve their ideal size. As a result, Grishkat expects the number of older women seeking treatment for eating disorders to continue to rise.
That means the number of women who suffer eating disorders' worst effects also will increase: The disease kills more people than any other form of mental illness. Between 5 to 20 percent of anorexics will die of heart arrhythmias, brain damage, and other effects of long-term starvation. Bulimia and compulsive overeating -- disorders that are even more common among midlife women -- can also often have severe and even fatal health consequences, from permanent intestinal damage to sudden heart stoppages. Indeed, Terri Schiavo's cardiac arrest was reportedly the result of a potassium deficiency due to her bulimia, which in turn caused severe brain damage that resulted in her spending 15 years in a vegetative state.
How can behaviors that are both dangerous and exceptionally unpleasant -- starving, vomiting, exercising to the point of collapse, overdosing on laxatives -- become so difficult to control? Douglas Bunnell, president of the National Eating Disorders Association, describes the effects of bulimia as in some ways similar to a chemical addiction. "People say that afterward they feel grounded, calm, numb," Bunnell reports. "One woman told me she usually feels like an overactive pinball machine, and bingeing and purging is like a giant reset button."
For Debra G., a 47-year-old homemaker in Smithtown, New York, an obsession with food was a secret salve for childhood wounds. Her father would demand that she eat every morsel on her plate, sometimes forcing the food down her throat until she threw up. He also mentally, physically, and sexually abused her. Chubby when she left home as a teenager, she went on a starvation diet right before she got married, at age 24. Afterward she continued to cut back on eating and pushed herself to exercise. Her weight sank to 88 pounds.
Although anorexia often impairs fertility, Debra became pregnant. That shocked her out of her pathology. "The doctor told me I was going to lose my baby unless I got some nourishment," she says. "I did what he said and gained 50 pounds."
Her first child was born in 1985, her second in 1989, and motherhood seemed to banish her problems with food. Then seven years ago she began to have disturbing dreams about her childhood. Although her father was long dead and she no longer had any contact with her mother, the anger and pain she thought she'd set aside bubbled again to the surface. So did her anorexia.
"I didn't want anything to do with food," she says. When she did eat, she would sneak off to the bathroom to purge. "I felt too full, too overwhelmed. I'd vomit and feel as though all my troubles had gone away."
But the bad feelings always came back, compounded by shame. She cooked elaborate meals for her family but ate less and less herself. She began downing laxatives and obsessively weighing herself, sometimes getting up every hour at night to stand on the scale. Her thick blond hair began to fall out. She purged as often as eight times a day.
Debra later learned that her then-adolescent kids sometimes overheard her purging but, not knowing what to do, kept silent. Her husband, an electrician, had no idea what Debra was doing to herself. "She did a really good job of hiding it," Mike says ruefully. "I was always totally in love, and her size never mattered to me."
Even if Mike had noticed, or if her children had spoken up, it's far from certain that Debra would have listened. Insistent, sometimes ferocious denial is typical of this form of mental illness. "Their eating disorder is the only thing they have that gives them a sense of self-esteem," explains Dr. Cumella of Remuda Ranch. "They're terrified of not being thin, and those emotions blow away any logical thinking." Family members are often bullied into silence, forced to watch impotently while their loved ones self-destruct.