Eating disorders in adulthood

No. An eating disorder in adulthood can appear without having suffered from it in youth. These types of disorders can appear at any age. However, it is common for the age of onset to be during adolescence, as this is the stage of greatest risk for developing these disorders.

It's not the norm, but yes, some cases can occur. In many cases that begin after age 30, we find a similar personality pattern in terms of perfectionism, self-criticism, low self-esteem, or impulsivity. While these individuals may never have required professional help, when we examine their context during the transition from adolescence to adulthood, we find altered patterns of eating, relationships, and physical exercise that are considered risk factors for the potential development of an eating disorder at some point.

The causes of an eating disorder in adults are the same as in young people: lack of self-esteem, lack of social skills, a social environment very focused on the physical.

There is no difference in the causes, whether one is an adolescent or an adult. Eating disorders are not due to a single cause; individual, social, and family factors can contribute to them. Some people are more vulnerable to certain risk factors that may lead to developing the disorder, but it is always multifactorial, with several causes potentially contributing, such as genetic predisposition, maladaptive responses to severe stress, loss of family members, bullying , harassment, or physical, psychological, or sexual abuse, etc.

The risk factors are the same as in young adulthood; in fact, we shouldn't trivialize them. While they may not have caused problems during adolescence, we shouldn't ignore them or assume they won't affect us anymore. These risks include, for example: dieting without professional supervision, constantly posting about our bodies in pursuit of perfection, using social media to promote eating disorders, not talking about emotional or relationship problems, normalizing impulsive behavior, and maintaining unhealthy habits related to sleep, diet, and exercise.

Recovery is possible with proper treatment, a positive attitude, and a lot of self-discipline. It's generally more difficult for adults because they tend to have struggled with eating disorders for longer, and the habits are more deeply ingrained. That's why it's harder to break those habits and adopt healthy ones, although that doesn't mean those habits can't be changed.

Yes. The greatest likelihood of a successful recovery is related to early detection of the disorder, preventing it from becoming chronic, and starting specialized psychotherapeutic and psychopharmacological treatment as soon as possible. It can appear in adulthood, but if the disorder has only been present for a short time since treatment began, these cases have a recovery rate similar to that of a young person, around 70-80%.

Yes, the percentage of cases is the same as in younger age groups. 90% of those affected are women and 10% are men.

An eating disorder can develop as a way of silently coping with these problems. Not knowing how to act can lead the mind to develop an eating disorder.

There are no studies that directly link eating disorders to situations of gender-based violence, but we can observe in some cases of eating disorders, within the context of multiple causes, the presence of abuse and mistreatment—whether physical, psychological, or sexual—that the person has not been able to manage adaptively and for which they have not sought help. Therefore, they have become trapped in a pathological response to these problems, in this case, through an eating disorder.

The first step is to go to your primary care center. There, your doctor and nurse will be able to assess your case and refer you to specialized eating disorder centers for confirmation of a possible diagnosis, if necessary. They will also be able to provide you and your family with all the important information you need to know about eating disorders, including warning signs and how to manage symptoms until you receive specialized treatment.

The important thing is to seek specialized help and share the problem with a trusted support network. Accepting that we have a problem and allowing ourselves to be guided by specialized professionals is the first step toward recovery.

How to access specialized public care for eating disorders in Catalonia

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Treatment depends on the stage of the eating disorder the person is in. If they have had the disorder for many years, undergone numerous treatments, and have already been diagnosed with a chronic condition, then treatment will focus on improving their quality of life. However, if it is a new disorder, it must be treated to prevent it from becoming chronic.

It's important to distinguish between an adult eating disorder and a chronic eating disorder. Some authors suggest that an eating disorder is considered chronic when there are seven consecutive years of the disorder with multiple relapses and no complete remission of symptoms. However, the increasingly early onset of the disorder and the severity of cases necessitate longer-term treatments, sometimes exceeding ten years, combining periods of hospitalization with outpatient follow-up until full recovery is achieved and chronicity is avoided. But it is true that, in adulthood, if the condition persists for more than seven years, we can consider treatments that support the highest possible quality of life even if the problem remains.

Here I want to highlight two aspects that I think are important to distinguish from chronic illness. The first is that being chronic doesn't mean we should lose hope of recovery. Sometimes the term binds us to the idea that we will never recover, and although that may be true to some extent, it's best not to think that way, as this leads us to the second point I wanted to make, which is thinking of chronic illness as the impossibility of living a full life.

The treatment of eating disorders depends more on the progression and duration of the disorder than on the person's age. It also depends on the support resources available, both from the individual's environment and their own resources, which can either facilitate or complicate the suggested and individualized treatments.

Treatments for eating disorders in adults are individualized and involve a multidisciplinary approach. Although clinical guidelines exist with common approaches depending on the type of eating disorder, each treatment must be individualized, as the same treatment may be effective for one person but not for another with the same disorder. Treatments are developed considering the individual's environment and resources, adopting a holistic approach that involves several professionals who establish an individualized therapeutic plan.

The refusal to admit an adult with an eating disorder usually stems from two assumptions:

The first is a lack of awareness of the illness and its severity. In this regard, it is crucial to assess the risks of the illness and the possibilities for outpatient treatment if there is no immediate risk to the person's life. At this stage, they can continue to receive support until they establish a bond with the healthcare provider, accept the problem, and develop treatment strategies for their recovery. If there is a risk to their life, involuntary hospitalization will be considered by the specialists treating them, either through the emergency department or from the specialized outpatient services. This decision will be ratified by the forensic doctor and judge, who will monitor the case in coordination with the therapists at the hospital where the person is admitted.

The second scenario is when suicidal ideation exists because the person has lost all hope of recovery. These cases are usually accompanied by comorbidity with a depressive disorder , which must be treated concurrently with the eating disorder for recovery. In any case, we will proceed as in the first scenario and arrange for involuntary hospitalization to save the person's life.

In both cases, it is very important to listen with understanding and empathy, not to judge or blame the person with moralizing speeches about what is right and wrong.

The guarantees of success do not depend on age, but on other factors such as the resources of the person's environment (especially family support), the time since the disorder began (the shorter the better), personal resources to accept the problem and compliance with the treatments suggested by experts (psychotherapy and psychopharmacological).

The duration of the disorder can affect its complexity and lengthen therapy, but it is not the only factor in how quickly a case progresses toward recovery. Other factors can lead to a poor outcome, such as a lack of family support, continued exposure to stressors, or intrinsic factors specific to the individual, such as comorbidity with other mental health problems.

The risks of prolonged illness are both physical and psychological. Physically, these include cardiovascular problems such as bradycardia, which in its most severe form could lead to cardiac arrest, osteoporosis, oral health problems, chronic throat irritation, infertility, hypertension, high cholesterol, and parotid gland inflammation. Psychologically, these include persistent sadness, which can lead to depression, persistent anxiety, constant irritability, insecurity, low self-esteem, distorted thinking, and behavioral changes, among other less common issues.

Yes, it's an important issue. The longer you have the disorder, the greater the risk of it becoming chronic. Considering that the average recovery time is six years, there's no need to worry if it's difficult; it's a long-term treatment that gradually takes hold in the affected person. As I mentioned before, it involves creating new habits and trying to change the unhealthy ones that contribute to the eating disorder. That's why it's so important to step outside your comfort zone, to do things that make you uncomfortable and that you won't like at first and will try to avoid. These are the things that will determine your well-being in the future. Every change begins with a moment of dissatisfaction, discomfort, and challenges that we gradually overcome.

Relapses are common to some degree in all recovery processes from this disorder. The multidisciplinary team will teach the individual strategies to recognize the early signs of a potential relapse. Gradually, they learn to become aware of these signs and know how to respond when they appear, without experiencing constant anxiety and fear of relapsing. Eventually, they stop dwelling on relapses and instead anticipate and prevent them by seeking help at the right time. They learn that each relapse is a step forward and a learning experience that strengthens them on the road to recovery.

How to prevent relapses in eating disorders?

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Antipsychotics may be the primary treatment for anxiety and underlying behavioral disturbances associated with the disorder. You don't need to be experiencing psychosis for your therapist to prescribe them; these medications are also effective against other symptoms such as anxiety, behavioral disturbances, and distorted thinking, and may even be the preferred treatment in some cases. It's also important to consider the potential for other mental health disorders to co-occur with the eating disorder, which may necessitate the use of psychopharmacological treatment to address them.

No. Whether an eating disorder becomes chronic depends more on the response to suggested treatments than on age. Even in an adult, personal resources and environmental support can contribute to a rapid and positive response to treatment.

We must always maintain a hopeful and resilient perspective on this disorder, while remaining mindful of its seriousness, as we know that up to 5% of people with anorexia nervosa may die from its effects. We also know that 70-80% make a full recovery , and although 20-30% may develop chronic conditions, they can still achieve a reasonable quality of life.

An eating disorder disappears when you can lead a normal life: social gatherings without cancellations, meals without schedules or overthinking, without medication (although this may disappear a little later, since it is possible to have depressive symptoms after an eating disorder, it is a consequence).

We know it's gone when we've recovered our energy, when a meal doesn't dictate our plans, when we don't look at a restaurant menu before going to see what we can eat, etc.

However, it's important to keep in mind that, in life, whether you have a mental health problem or not, there are always low moments, and having one of those moments doesn't mean you haven't recovered.

Several authors state that full recovery occurs after five years with complete remission of all physical and psychological symptoms, when the person regains their vital and social functioning. This will always be determined by consensus among the entire therapeutic team, the individual, and their family.

You need to focus your mind on something else: distract yourself and do things that fill your day. Also, when these thoughts arise, it's important to ask yourself: Do I need energy to do this? Is what I'm thinking true? Food is a means to lead a healthy life and have the strength to achieve our goals. If things seem very bleak, another option is to talk to someone close to you who doesn't have an eating disorder and listen to their perspective.

Through psychotherapy, you're given strategies to cope with these situations, for example, by taking your mind to pleasant places a few minutes beforehand, places that give you strength and release you from the pressure of that moment. Sometimes anxiety can be so intense that you need medication to help regulate your thoughts and provide a different, non-recurring focus on eating or compensatory movement; in other words, relaxing the body relaxes the mind. Medication is like a crutch for someone recovering from a fracture; we'll use it for a short, necessary period, and then we'll stop taking it.

Given that we're in recovery, the ideal is to lead as normal a life as possible, and that also makes us more motivated to recover. Therefore, depending on the phase we're in and as we progress in recovery, our normal life gradually increases. For example, if the eating disorder prevents us from completing a full university course, it's okay to drop a few subjects, and as the treatment takes effect, we'll be stronger and able to take them all, which should also encourage us.

It's important to be aware of our limitations and not push ourselves if we know there are certain things or situations we can't handle. In short, listen to ourselves.

Yes, understanding that there are exposures we should avoid, exposures to certain conversations (especially regarding food, body image, and physical exercise). We should focus on strengths that make us feel good. Sometimes we might think we can no longer do this or that because cognitively we're sad, unmotivated, and have lost our enthusiasm, but we have to remind ourselves that this isn't the case, that we can recover what we were good at/what made us happy and well, and strive and focus on that and little by little regain control of a healthy life.

One of the most helpful things is explaining how you feel. This allows others to empathize with you and makes you feel more comfortable in social situations. Also, talking about your worries is always good for venting and putting things into perspective.

I would say it's the ABCs of psychotherapy. Simply talking about it with trusted people begins the path to acceptance and recovery. The problems leave you, they become lighter when shared, and they cease to be an unbearable burden, like carrying a backpack full of stones that slowly drains you and prevents you from moving forward. Explaining your problems also empowers you, and you take control of them to begin solving them.

There are various psychotherapeutic strategies that can help you change these thoughts, so that one day you can look in the mirror and say, "That's enough," and from there, discover how to love yourself in the body you have. Your self-perception is influenced by different factors: your own personality, perhaps very demanding, perhaps with low self-esteem, the social influence of certain standards of perfect bodies, and other factors that need to be examined to provide the best solution. A psychotherapist will be able to guide you through the exercises most appropriate to these factors so that you can overcome them .

Yes, it's normal to think that without the eating disorder, you're nothing. The thing is, that feeling isn't real. You develop an eating disorder partly because you don't know who you are or what you want, and the excess of external stimuli confuses you. Recovery is about finding that identity outside of the eating disorder, becoming strong, and continuing on that path: YOUR PATH.

Yes, but that also has to motivate you to move forward, recover, and get back to your old self!

Yes, your body changing is a natural part of life that you must accept and adapt to. You can continue to enjoy life, and I'd even say more, as you gain experience; the key is adapting and loving yourself.

Tools for changing harmful thoughts are part of multidisciplinary psychotherapy applied on an individual basis. Each case must be studied individually through a holistic and detailed assessment. The person's strengths and weaknesses, resources, and support systems are recorded, and specific plans and personalized exercises are designed based on these findings. For example, if low self-esteem and emotional management are identified as the primary cause, exercises focused on these two fundamental issues will be proposed. In other cases, the approach might involve separating from a harmful environment and developing new, healthy habits and relationship patterns. The specific tools used depend on the individualized assessment of each person.

Exercise and nutrition often go hand in hand. When you reach a point where your relationship with food is so good that you don't need supervision, it can be a good time to start exercising, always following specific guidelines for moderation and focusing on enjoying the activity rather than the results. It's advisable to start gradually and initially with the support of a trusted person who can help curb any inappropriate behavior. Don't be afraid, but be cautious.

In my personal experience, I made several attempts to return to sports during my recovery. However, they all ended in obsession, so I stopped because I knew it wasn't healthy. It's easy to identify: if you feel like you're exercising to compensate, if you feel bad if you don't, or if you start to see it as an obligation, something isn't working properly.

Binge eating is usually the result of prior restriction. Therefore, it's a good idea to have five meals a day, not skip any, and eat enough at each one to avoid the binge eating that would occur if we didn't eat properly.

Cravings for sweets arise when the body has been deprived of food or hasn't had enough for a normal day. This causes us to need more glucose, and the body craves it in the form of sweets, carbohydrates, etc. With proper treatment and a healthy diet, these constant cravings for sweets eventually subside.

The risks arise from malnutrition, which is exacerbated in this case because the already scarce nutrients must be divided between the fetus and the mother. Problems for the fetus can range from premature birth and malformations to miscarriage, while for the mother, the inherent risks of anorexia are amplified. Furthermore, due to the body's strain in attempting to carry the pregnancy to term, generalized health problems can occur, potentially endangering her life. Nutritionists, doctors, and nurses are skilled at designing the best diets, but it is crucial to ensure that all necessary nutrients are consumed. Regular blood tests are also recommended to objectively assess the health of both the mother and fetus, and hospitalization may be necessary if required.

Don't pressure her. The person will eventually realize it, either through changes in her mood, a lack of desire to see friends, or because she won't have the energy to do anything.

Yes, we can help her emotionally, by communicating with her and seeing what's wrong, always remembering that problems with food are just the tip of the iceberg.

The root of eating disorders

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This question is key because only by acknowledging that there is a problem and accepting help can the road to recovery begin. We would like to have a magic wand that tells us exactly what to say at every moment so that the person opens their eyes and sees the problems and their severity, but often, no matter what we say, we can't get the person to change their attitude. And it is at this point that you despair, feel powerless, or even feel anger, which can lead you to blame yourself or the person or other people close to you for what is happening. These are the attitudes we must avoid; it is very important to listen with understanding and empathy, and not to judge or blame the person with moralizing speeches about what is right and wrong, with phrases like: "Don't you realize the damage you are doing to yourself and to others?", "You are in the prime of your life. With how intelligent you are, don't you see that this is going to end badly for you?" Alone, without friends… Is that what you want?”, “You need to hit rock bottom to realize it, when it’s already too late!”, “You don’t realize how thin/fat you are.”

Approach her with great patience and empathy, and with genuine concern, show her you're there for her. Be persistent, but in a gentle and calm tone. Show her you want to help because you know her and you don't see her doing well, due to mood swings or a feeling that she might be suffering (without making physical references). Be patient, just listen, and wait for the moment when she opens up to you, as this doesn't happen overnight.

The important thing is to seek specialized help and share the problem with a trusted circle of people you can rely on.

It's important to have a lot of communication, understanding, and kindness. Try not to pressure them, just listen. In short, don't focus on the problem with food, as that will create anxiety, distress, and exhaust the person affected.

Depending on your condition and age, it's important that you live with someone. If you live alone and have no other option, it's important that your therapist supervises you and that this person takes charge of your treatment: this will make you stronger and lead to a more solid recovery, but for this to happen, you must be aware of your illness and have a desire to recover.