Anorexia in Adults (cont.)

MEMBER QUESTION:
What is the recommended treatment for adult anorexia? Is it more aggressive than in teens?

STROBER:
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.

MODERATOR:
How does age factor into the aggressiveness of the treatment?

STROBER:
That's a good point. It really is the duration of illness because duration and age tend to be highly associated. Remember that adult-onset anorexia, true adult onset, where you have no symptoms prior to age 20, is extremely rare -- it's very rare. There are cases of adult-onset weight loss but one has to determine if that is truly anorexia nervosa or some other psychiatric illness in which weight loss is a symptom or an acute stress reaction. Pure adult onset of anorexia nervosa is something that is seen very infrequently.

MODERATOR:
What might trigger someone who has had "control" over the illness for a number of years -- what might cause a relapse?

STROBER:
Any significant life stress, regardless of its nature, can provoke an intensifying of symptoms. So for example, a sudden move, a change in job, a stress in a relationship, anything that causes the individual to feel threat of security can produce a regression in behavior and flourishing of symptoms that previously were more controlled.

MEMBER QUESTION:
How is recovery gained if you have been trying since your early teens? It feels hopeless sometimes.

STROBER:
It's a difficult question to answer. The fact with anorexia nervosa is that if you have the illness without interruption, into your midadult years, the chances of full recovery lower significantly. I would not say that recovery is not possible, but our clinical experience would suggest the odds do fall considerably as the time spent ill increases. The best we can say is that if the person is motivated and can tolerate the discomfort and the feelings of insecurity that will come with weight gain and can use the treatment, then one should always assume there is the possibility of recovery.

MEMBER QUESTION:
I'm a recovering anorexic. I suffered between the ages of 20-23 -- a bit older than the "typical" anorexic. Now I have almost adopted the traits of a binge eater, I think because my body is so excited to get these foods. I deprived myself of for so long, so I stuff myself full of them to the point of sickness. Is this common? Any suggestions on emotional and mental exercises I can do to overcome this? I want to eat according to my own hunger, not out of excitement!

"Bulimia nervosa in adulthood is not infrequently preceded by anorexia nervosa."

STROBER:
It is not uncommon. Roughly 30% of people with anorexia nervosa develop binge eating and binge eating is something that can be treated. There are both psychological therapies and medications that have been shown to be effective in treating binge eating. Cognitive behavior therapy, interpersonal psychotherapy and antidepressant pharmacotherapy have been shown to be helpful in binge eating, although cognitive behavior therapy is seen by most authorities, or is believed by most authorities, to be the most effective approach to controlling binge eating.

MEMBER QUESTION:
How does bulimia in adulthood relate to this?

STROBER:
Following the previous question, bulimia nervosa in adulthood is not infrequently preceded by a period of anorexia nervosa, which can be either severe or mild. The majority of cases of bulimia nervosa occur without any history of anorexia nervosa, so for some a period of starvation will increase the risk of subsequently developing binge eating, presumably due to the effects of starvation on feeding behavior.

MEMBER QUESTION:
I have a question about my younger brother who is 45 years old. (I am 48.) He appears to be mildly to moderately anxious and depressed. He is obsessed with eating the right foods. He's underweight and by his own observation, "unable to absorb nutrients properly." I have been in psychotherapy for six years and have uncovered and am successfully dealing with underlying dependency issues with our parents. My brother refuses to consider therapy even though my parents, sister and myself have expressed concern. It does appear that he is starving himself. He will rarely eat out and is extremely obsessed with his diet. What are your thoughts about this please?