WebMD Live Events Transcript
Think anorexia is only for teenage girls? Think again. Some experts believe that
more than 10% of anorexics are over 40. What drives an adult to starve herself
or himself? And what help is available? Michael Strober, PhD, joined us to
answer questions about adult anorexia on Aug. 2, 2005.
The opinions expressed herein are the guests' alone and have not been
reviewed by a WebMD physician. If you have questions about your health, you
should consult your personal physician. This event is meant for informational
Welcome to WebMD Live, Dr. Strober. Thank you for joining us today. Please share some of your background and expertise with us.
I am director of the Eating Disorders Program at the Lynda and Stewart Resnick UCLA Neuropsychiatric Hospital and professor of psychiatry at the David Geffen School of Medicine at UCLA and the Semel Neuropsychiatric Institute. I have been at UCLA since 1975 and I received my PhD in clinical psychology at University of Pittsburgh.
My interests and research involvement has been in the area of eating disorders and mood disorders and I have expertise in a variety of different areas including the long-term study of eating disorders, the treatment of eating disorders and the biology and genetics of these conditions. My interest in treatment and my expertise spans both psychotherapy and pharmacotherapy.
When we think of anorexia, probably most people think of young teen girls. But that picture isn't entirely accurate, is it?
Yes, on the one hand, and no on the other. Most cases of anorexia develop between the ages of 13 and 17. It's rare to develop it after the age of 20. At the same time, the illness can be chronic and the course of the illness tends to be fairly protracted, so many people with anorexia nervosa will have symptoms of the illness continuing well into adulthood.
Roughly 3%-5% of people who develop anorexia nervosa will have its illness in its full form for decades, meaning the symptoms will be present acutely well into adult life. So when you consider that the course of the illness tends to be fairly protracted, it is not at all unusual for people who have anorexia nervosa to be of adult age. In my experience, when the illness actually seems to unfold after the age of 20 it is usually foreshadowed by milder symptoms developing during the teenage years.
Do you see a lot of new cases of adult anorexia -- or are people just struggling a lot with recovery and relapse? This is the case with me.
|"People who fully recover from the illness...tend to have a very, very low risk of relapsing." |
Most of the cases of adult anorexia nervosa involve people who have had the illness since their adolescence who have continuing symptoms or symptoms that wax and wane over time.
likely that a woman who had anorexia in her
teens will relapse during a hard
time in her adulthood?
People who fully recover from the illness, meaning that they have no residual symptoms, and who maintain that recovery for a period of time, tend to have a very, very low risk of relapsing. If they have mild symptoms that persist over time and then exposed to a major stressful life event, there is a risk of having a relapse, although it is impossible to determine what that risk is, which means you can't quantify it in any way. I think it is fair to say that if you reach a period of recovery, where symptoms are no longer present, and that period of recovery is sustained, then the risk of relapse is significantly lowered, even in the face of stressful life events.
What is the recommended treatment for adult anorexia? Is it more aggressive than in teens?
I would not say the treatment is necessarily any more or less aggressive. The answer to the question depends on how long the illness has been present and how aggressive you attempt to address the illness depends in part on the age of the individual, how long they have been ill and how severe their illness is.
When adults have been ill for extended periods of time, the likelihood of recovery is significantly less and there are significant risks of very aggressive treatment. It can cause an intensification of fear, and feelings of threat, such that the treatment can actually be destabilizing and provoke extreme panic which can lead to further aggression. So for adults who have been ill for prolonged periods of time and who are very symptomatic, the recommended approach may be attempting to stabilize the illness rather than attempting anything more aggressive, given that the likelihood of significant change in patients who have been severely and chronically ill through adult life is not high.