From The Naperville Sun:
Turned inside out
Adult women often find eating disorders come back to taunt them
April 11, 2010
By SUSAN FRICK CARLMAN
Anna was 12 when it started.
She had never been a skinny child, and her mother reminded her of that regularly. Sweet, indulgent foods were forbidden, but comforting. They became her guilty pleasure. And when she forced herself to throw it all up, it remained her secret.
"I've been doing this for 30 years," said Anna, 42, who lives in St. Charles and asked that her real name not be published.
It's not that she has spent all that time with a daily habit of gorging on food and then forcing herself to regurgitate. She has worked with support groups off and on since college, learning how to manage the compulsive behaviors of bulimia. She has successfully controlled it for periods of time, once eating normally for nine straight years while having children and caring for them when they were small.
But it has always stalked her.
Anna swallowed a handful of antidepressants last December, desperate to break the cycle. She wound up in the inpatient program at Linden Oaks Hospital at Edward, which has a unit concentrated on eating disorders.
Now she's learning to cope while staying at Arabella House, the group home on a shady street near the Naperville hospital. Women -- most of them significantly younger than Anna -- go there to be in a supportive environment while they work to recover from anorexia, bulimia and other disorders defined by unhealthy behaviors involving food.
Anna is far from unique in her struggle. Professionals who specialize in eating disorders increasingly are seeing women in their 30s, 40s and beyond who are sharply restricting their food intake (anorexia) or binge-ing and purging (bulimia). Some are resuming potentially deadly habits they took on when they were younger, spurred by fresh anxieties tied to mid-life and the changes it brings. Others are exhibiting a new way of dealing with issues they have kept buried for decades.
New vantage point
Laura Muniz thought she had her eating disorder under control, but it has dogged her for a long while. The Aurora native started cutting back her food intake as a fifth-grader.
"I think it was just the expectations of the world around me, and my house ... there was always the perception that you had to look your best," said Muniz, 22.
Restricting made her feel she was doing that.
"Not only did it help me numb emotions, but it gave me results," she said. "As I look back, the attention was different, and greater. It seemed like the world would pay attention to me more."
Still, she knew it was harmful. She grappled with the disorder for six or seven years, during which she was in and out of Linden Oaks' inpatient program.
"With an eating disorder, it's so easy to fall back into it, because it's something you're comfortable with, in terms of your life. It's the only way I could have control," she said. "If I can focus 99.9 percent of my attention on my food, then I don't have to think about my anger, my sadness, my frustrations, my struggles."
But now, with a baby due this summer and hopes of earning a psychology degree at Aurora University, Muniz finds herself a grown-up fighting old demons. As part of her resolution to put those things behind her, she returned to Arabella House recently and spent six weeks working to make sure she's ready for the new role that is quickly approaching.
"I need to start working on my past, so that I can handle my adulthood in a healthy and productive way," she said.
Determined to make this treatment stint her last, she sees approaching parenthood as a gift -- and her way out of the brutal cycle of her eating disorder.
"Now I do have something to worry about, something precious to live for," she said.
Two-headed beast
Trish Jones-Bendel, director of specialty services at Linden Oaks, said therapists there are hearing from women describing both newly surfaced struggles and the return of menacing habits they thought they had shaken.
Middle age normally brings slight weight gain, and in some women a history of disordered eating can be resurrected by that unwelcome change.
"As they become empty-nesters and have some other changes, they sometimes will go back to some of those past behaviors," Jones-Bendel said. "It starts out as a diet, or it starts out at the gym, and they start to feel good. They'll hear compliments, and so they'll continue."
For Anna, the nine-year reprieve ended with the South Beach Diet and its gratifyingly quick results.
"It screwed me up," she said, relating how it reawakened the part of her that obsesses over staying petite. "It triggered me right back into the eating-disorder mind-set."
For some women, the villain is a childhood trauma that has gone unaddressed for decades.
"That happens, unfortunately, more than we might like," said Laura Discipio, executive director of the National Association for Anorexia Nervosa and Associated Disorders, which is based in Naperville.
The hidden angst, Discipio said, transcends socioeconomic factors and ethnicity.
"Many times when people are older and they have some other condition, somebody can be addicted to some kind of pain med," she said. "You take away the med, then the eating disorder can be seen, and you hadn't known it was there."
Sometimes anorexia or bulimia emerges as the coping response to pain they have managed to keep buried until now.
"Eating disorders can be layered with other things in their life," she said. "(It's) not just about your relationship with food. It's about your emotions, and how you deal with them."
Hidden skeletons
Dr. Maria Rago, clinical director of Linden Oaks' eating disorders program, said about half of those receiving treatment at the facility are in their mid-20s and older. She sees reason to believe many of them are coming forward for help fighting a longtime, secret enemy.
"A lot of times people feel like they can get this under control themselves, without treatment," she said. "It is pretty amazing that someone can have an eating disorder and no one around them knows.
"I think it's a relief to come forward, and it takes a lot of courage."
There is always a lot at stake when someone reveals their food struggles, but it's different in adulthood from adolescence.
"It starts out with a lot of fear: 'Oh my God, what's this going to do to me? How is it going to change my life?'" Rago said.
Anna had that fear, even when she was still finding excuses not to sit down and eat with her family. Her son not long ago told her it had been a year since she had dined with her husband and kids.
She kept up the vicious binge-purge cycle, even though she deeply feared being discovered. The overdose came when she had reached the end of her rope.
"I knew I'd gone past the point where I could hide my disease," she said.
She hopes others are beginning to realize that the condition can take a lifetime to bring truly under control.
"I think what happens is everybody thinks it just magically goes away, but it doesn't," Anna said. "People just don't talk about it."
Lighting the darkness
At Arabella House, the residents often have to address the effects of unintentional harm done when they were quite young. Low self-esteem is a common thread, developed when girls heard the same thing Anna did: that they are larger than they should be, and that makes them harder to love.
"There's a lot of messages given at home that are so destructive," clinical leader Bev Watson said.
Still, while most of the residents have experienced a trauma that contributed to their eating disorder, Watson said the smaller amount of time families are spending together is also a factor.
"We've gotten away from the family dinner, and family time is so important," she said.
Also hindering the effort to help women recover is the economic downturn. Because inpatient treatment doesn't usually involve a life-threatening condition, many families are deciding they can't justify the expense.
"We've had a lot of women come through this winter who've said, 'I'd love to come, but Dad lost his job or my husband's salary has been cut,'" Watson said. "It's not that there aren't people out there who want to come ... they just can't spend the money."
As with many ills, prevention is key, Anna said. She said when parents discover their daughters are inordinately focused on their food intake, they must seek help right away.
"If you've had this for 30 years, it's going to be a lot harder fight," she said.
Muniz finds the old foe hard to shake, too.
"It's really easy to fool yourself, once you learn how to do it," she said. "It's a cycle. It sucks you right back in."
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