Lifetime Eating Disorders
Implications
I have addressed recovery efforts for adults in a couple of posts to date:
Eating Disorders: Age 50 and Beyond
In fact, the vast majority of the posts on this site are for adults of all ages, as children and teens are the focus of treatment everywhere else. Focusing on the young is understandable as remission rates are strongest when someone who has developed an eating disorder learns to extinguish the neural pathways of food avoidance early.
However, this leaves the much larger community of adults not terribly well-served for getting to remission from an eating disorder.
I’ve been asked to specifically provide more information for those who are 50-60+. As I’ve covered off in the two previous pieces referenced above, for those with long standing eating disorders and late-life onset eating disorders, the living system is generally functional but brittle. While this is true for anyone who has an active eating disorder, the more that the system has had to cannibalize its own ability to function (which is what happens when it’s not getting the energy it requires), the more likely there may be crises throughout the recovery effort.
I have many, many articles on this site where I warn against the aggressive management of biomarkers as it can lead to overcorrections that cause further crises. For those actively pursuing recovery at 50+, it’s a good idea to have your healthcare provider monitor biomarkers, but always make sure to ask whether it’s possible to wait a bit before intervening. Recall in my Beige Food series the medical system is designed to limit liability and it will always err on the side of intervention as a way to limit its exposure to the risk of being sued by a patient or their family. However, by asking the question of your healthcare provider as to what the immediate risks for you might be if you waited another few months to retest, this will usually give you information to make a decision that doesn’t lead to overdiagnoses and overly aggressive treatment.
While it seems logical to go slowly and incrementally in recovery for someone older, it will largely fail to extinguish the avoidance of food. They would remain trapped with an active eating disorder continuing to steal their health and life. A medical provider would prefer you not shock your brittle physical system, and a psychologist familiar with eating disorders being akin to phobias, would prefer you not keep reinforcing food avoidance as your dominant behaviour. It’s a dilemma. A recovery effort at any age requires the effort to extinguish the misidentification of food as a threat.
You Cannot Be Scared Straight
There’s more than enough data quoted on this site on the life-limiting and disabling implications of living with an active eating disorder. Yet reading and absorbing all that information will not push someone to pursue recovery. The “switch” to recover actually gets flicked when someone dealing with an eating disorder feels the personal costs of remaining stuck in an eating disorder far outweigh the risks of the unknown in a recovery effort.
Trying to scare people straight is somewhat similar to asking people abused by their partners “Why don’t you just leave him?” (let’s be real, it’s most commonly a “him”). It’s the wrong question and simply adds to feelings of powerlessness and shame. An active eating disorder in one’s life is as if one were living with an abusive partner. The right question is “What can be done to make the thought of leaving become a real and actionable option?”
I knew someone with severe alcohol dependence who drank green tea when she was not drinking alcohol because she had read that the phytochemicals in green tea would protect her liver. I have also seen countless individuals with enduring eating disorders create similar kinds of dissonance-filled backstops when the actual need to eat is too daunting.
It’s easy on the outside to belittle these backstops as just reinforcing the avoidance and swimming in the thick goo of cognitive dissonance. Factually, it does reinforce the avoidant behaviours, making the eventual effort to extinguish them more of an ordeal. However, it is also fair to say that many of these backstops will actually buy time as well.
If you are backstopping your restriction with supplements and prescriptions (making sure to give your healthcare provider oversight on what you are taking and why), then it is kicking things down the road a bit but it is never reversing the ongoing damage and pile-up of problems from the underlying and untreated cause: restriction of energy intake relative to the energy needs of the body.
Part Two arrives February 20.
