What Are The Differences?

A young woman with anorexia nervosa is typically a perfectionist and a high achiever in school or in her career. At the same time, she suffers from low self-esteem, irrationally believing she is overweight regardless of how thin she becomes. Desperately needing a feeling of mastery over her life, the young woman with anorexia nervosa experiences a sense of control only when she says “no” to the normal food demands of her body. In a relentless pursuit to be thin, the young woman starves herself. This often reaches the point of serious damage to the body, and in a small number of cases may lead to death.

An elderly woman with anorexia nervosa, is not as common, however elderly women who have been diagnosed with eating disorders often have the same underlying emotional triggers that are linked to eating disorders in younger women. The difference lies in the specific nature of these triggers, such as divorce or serious health issues. Even “positive” life changing events such as retirement or becoming a new grandparent can be emotional triggers that can lead elderly women into self-doubt and low-self esteem using food as a way to take control of their emotions. The loss of a spouse can often trigger unusual eating patterns. Not only do naturally strong emotions during this time play a factor in decreased appetite, but also this individual was likely the person with whom the elderly patient prepared and ate meals. The loss of a spouse can increase anxiety around food and meal times, which has the potential to snowball into an eating disorder.

The loss of control

For the young and old alike, eating disorders are usually about control. Many individuals who develop eating disorders feel that they have limited or no control over their life and as a result use food and dieting as a way to control what they put in their body. By restricting food, purging or engaging in binging behaviors; it allows individuals to feel they have temporary control over some aspect of their life; regardless how young or old they are. Elderly individuals might have felt in control their entire lives (holding a steady job, raising a family, etc.) but have recently lost independence. This newfound dependence can include the inability to drive, being confined to a wheelchair, or moving into a nursing home. Those with eating disorders often feel that food is the only thing in their lives they have control over. Whether or not this is true, using disordered behaviors to self-soothe or gain a false sense of control can have devastating consequences.

Stigma in the elderly population

The stigma surrounding eating disorders can be even more prevalent in the elderly population. Men and women in their older years typically deny the presence of an eating disorder, believing it is a “teenager’s issue.” Clinicians treating an older individual who denies there is a problem but might be seeking help at the insistence of a loved one face the same issues that come with treating a teenager unwilling to accept that he or she has an eating disorder. Elderly clients, just like teenagers, are often in denial. It can be more difficult to diagnose eating disorders in the elderly population because some clients will also have cognitive impairments and dementia where they forget to eat while many have underlying undiagnosed medical conditions such as swallowing impairment and gastric and hormonal disorder than result in changes in appetite, making it difficult for them to eat. Differentiating between underlying cognitive impairments and undiagnosed medical conditions from an actual eating disorder can be very difficult to do for many health care providers.

Seeking help in the elderly population

Asides from a treatment team that consists of therapists and dietitians, elderly clients will most likely need to be assessed by a geriatric physician who can differentiate any underlying undiagnosed medical conditions or dementia. Physicians who specialize in geriatrics are also acutely aware of certain medications that should be avoided in the elderly population because of their side effect profile. Although eating disorders are the same, in theory, across all age groups; the elderly population is very vulnerable to complications and as a result, a different approach must be taken while consulting physicians who specialize in geriatrics.