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Eating Disorders at Middle Age, Part 2
from Eating Disorders Review
Just as the adolescent or young adult with body image disturbances, the individual at middle age may be unhappy with her appearance. However, because time and money are more available to them, affluent individuals may seek out plastic surgery to obliterate the signs of aging. Individuals may struggle with a psychological concern that gets channeled into an eating disorder; that is, the eating disturbance becomes a focus so that the individual avoids facing conflicts, losses, normative life-transition concerns (such as children going to college or aging parents) and even one's mortality.
Middle age is the time of life when one begins to "take stock" and to shift the focus from one's own life to encouraging and helping shape the lives of the younger generation. Psychologist Eric Erickson described the core issue of middle life as generating vs. stagnating. Any emotional or physical problem can prevent an individual from taking his or her place in the cycle of the generations. Eating disorders at middle life have both emotional and physical components that derail adaptive choices at this point in the life cycle. A focus on spirituality may enable some individuals to place greater emphasis on fundamental values, and personal transcendence, rather than on appearance, as a symbol of what constitutes a life lived well.
The journey of psychological discovery into the very source of the eating disorder is usually the keystone of the treatment process. Grappling with unresolved adolescent or adult conflicts or trauma, and addressing maladaptive behaviors such as smoking, food restriction, or drug abuse, or mourning personal issues and/or idealized body image can be costly in terms of time and money but hold the most hope for improvement.
In order for our patients to gain a sense of mastery over their feelings about aging, we encourage them to focus on why "staying youthful" takes on inordinate importance to them and try to help them to understand that nothing can stop the body from slowing down. In essence, existential issues must be dealt with by gently but persistently confronting denial.
Teasing apart the potential developmental antecedents of the body image disturbance that have led to and nurtured the eating disorder into existence includes helping patients to better understand themselves and their lives and the struggles that have shaped them into who they are today. This is vital not only for discovering and understanding the life events that have shaped the patients' eating disorders, but also for fully recognizing and appreciating their own personal growth. Doing so will allow them to gain the pride and sense of internal beauty that comes from the realization that they have lived a worthwhile life. Finding meaning in one's personal history provides a unique pathway to understanding the illness and ways to begin accepting the changes that accompany aging. 5,6
Some patients ask for more specifics. We summarize these extant theories on aging and provide references for them to explore further. In particular, we direct them to the growing biographical and mental-awareness literature that describe positive modes for aging.