Tuesday, September 22, 2009

When mum has an eating disorder

Typical brands of Potato Chips at a superstore.Image via Wikipedia

Older adults, too, suffer from anorexia and bulimia

Eveline Gan

Cecilia stopped eating and began losing excessive weight in her early 20s. Cecilia stopped eating and began losing excessive weight in her early 20s.

FIFTEEN minutes before this interview, Cecilia (not her real name) had been throwing up in the bathroom. The twice-daily purges, during which Cecilia would force herself to vomit what she has eaten, are an everyday affair.

While most people look forward to having a hearty meal, mealtimes are a torture for Cecilia, who weighs a mere 38kg.

"I love food, but I hate what it does to me," she said.

Although she likes savoury food such as potato chips, she tries to stick to a strict diet of two teaspoonfuls of muesli for breakfast, no lunch and a few raw vegetables for dinner. Sometimes, she goes on maniac food binges. Afterwards, she simply heads for the toilet to throw up.

Cecilia is among those who suffer from eating disorders anorexia and bulimia. In anorexia, patients typically starve themselves, while bulimic sufferers go on an eating binge and then purge themselves.

But unlike most cases, in which sufferers are in their teens and early adulthood, Cecilia is 43 and a mother of a four-year-old.

Not exclusive to the young

There are no local figures on the number of older adults suffering from eating disorders.

Singapore General Hospital (SGH), which runs an Eating Disorders Programme, saw about 120 cases last year. Most are teenagers and those in their 20s. About 10 per cent are above 30 years old, said Dr Lee Huei Yen, director of the SGH Eating Disorders Programme. The oldest patient Dr Lee has seen is in her 60s.

Private psychiatrist Dr Ken Ung, who specialises in treating eating disorders, estimated that up to 10 per cent of the patients he sees for eating disorders are in their 40s. Dr Ung is a senior consultant psychiatrist and psychotherapist at Adam Road Medical Centre.

While eating disorders among the middle-aged are "less common", they are not new, said Dr Adrian Wang, a consultant psychiatrist at Gleneagles Medical Centre. He sees a handful of cases each year.

And like younger patients, he added, older sufferers tend to display the same pattern of behaviour. "Stress and self-esteem are common themes. The victims tend to be extremely anxious perfectionists and they have a need to control things in their lives," said Dr Wang.

While the underlying issues may be similar, triggering factors in older and younger sufferers are very different, said Dr Lee.

For older female patients, the trigger could be marital problems, work stress or weight issues tied to pregnancy and ageing. In many instances, an eating disorder can wreck havoc on family relationships.

"It affects their ability to care for their kids and may even put a big strain on their marriages," said Dr Wang.

A constant battle

While eating disorders can crop up at any age, many of the diagnoses are what Dr Ung calls "chronic cases", like Cecilia, who has been battling food issues for years.

For Cecilia, her battle lasted two decades, even through her pregnancy. She stopped eating and began losing excessive weight in her early 20s, following an unpleasant breakup with a boyfriend. At her worst, she weighed just slightly over 30kg.

"The longer you've had it (an eating disorder), the harder it is to treat because it becomes a part of your life," said Dr Ung, who estimated that about a third of the "chronic" patients never get out of their eating disorder. From experience, the doctors said it is tougher to treat older patients.

And unlike teens, older patients tend to be more set in their ways, said Dr Wang.

Dr Ung added: "Older anorexic patients may not want to give up their lifestyle because they've been looking thin for so long. For treatment to work, they must have the desire to recover."

Treatment typically includes a multi-disciplinary approach. Hospitalisation may be needed for those who are extremely underweight or malnourished.

Medication, psychotherapy and family therapy - where family members are involved - can also help.

For the sake of her daughter, Cecilia, now undergoing therapy, is desperately trying to get out of her eating disorder.

"I don't want my problem to follow through to my daughter," she said.

Where you can get help

The SGH Eating Disorders Programme is available at SGH LIFE Centre. For appointments, call 6321 4377. For general enquiries, call 6222 3322.

Taken from TODAY, Health – Tuesday, 25-Aug-2009