On today’s episode, Dr. Karen Nelson is joined by Dr. Amanda Delsman - licensed clinical psychologist here at Melrose. For women over 40, eating disorders can be surprising or frustrating - whether it’s a first diagnosis or a relapse from a previous diagnosis. But there is always hope - Karen and Amanda will take you through the journey of finding recovery over 40.
On today’s episode, Dr. Karen Nelson is joined by Dr. Amanda Delsman - licensed clinical psychologist here at Melrose. For women over 40, eating disorders can be surprising or frustrating - whether it’s a first diagnosis or a relapse from a previous diagnosis. But there is always hope - Karen and Amanda will take you through the journey of finding recovery over 40.
For a transcript of this episode click here.
Dr. Karen Nelson:[00:00:00] Eating disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that we'll find the opportunity for healing. Hi there, I'm Dr. Karen Nelson, licensed clinical psychologist at Melrose Center, welcoming you to Melrose Heals: a conversation about eating disorders. A podcast designed to explore, discuss, and understand eating disorders and mental health. On today's episode, I'm joined by Dr. Amanda Delsman, licensed clinical psychologist here at Melrose. For women over 40, eating disorders can be surprising or frustrating. Whether it's a first diagnosis or a relapse from a previous diagnosis, there is always hope. Amanda and I will take you through the journey of finding recovery over 40. Now, before I begin, I invite you to take a deep breath and join me in this space.
[00:01:00] Well, today I have the pleasure of being joined by Dr. Amanda Delsman. I get to say welcome back.
Dr. Amanda Delsman: Thank you. It's great to be here.
Dr. Karen Nelson: So excited to have you with me. Amanda and I are going to be talking about eating disorders in women over 40. So we know that many women, um, may be diagnosed with an eating disorder kind of earlier in life, we also want to take some time to really capture and attune our attention to women who potentially are either first diagnosed with an eating disorder over the age of 40 or potentially have experience a relapse of their eating disorder. So we're just going to be wandering around that conversation today. But before we get started, as always, I would love it if you could introduce yourself, and tell us about your role here at Melrose.
Dr. Amanda Delsman: Sure. I'm Dr. Amanda Delsman. I'm a licensed psychologist here at Melrose, and I do initial assessments, individual therapy, and I'm also involved in our binge eating disorder group program.
Dr. Karen Nelson: What we [00:02:00] know about kind of a typical presentation of an eating disorder is that someone may be diagnosed earlier or younger or help us know more about that.
Dr. Amanda Delsman:Typically we see people coming in for intake assessments, especially with anorexia, earlier on, like in adolescence and in their early 20s. For the other diagnoses of bulimia and binge eating disorder, those tend to fly under the radar a little bit more, and so we're usually seeing people present to treatment at a little bit older age. It's just not as visible as anorexia or ARFID, for example. ARFID stands for Avoidant Slash Restrictive Food Intake Disorder. It's slightly different from the other eating disorders in that there's not a body image component involved there, and oftentimes we see ARFID develop much younger. You know, parents can look and say, “Hey, my kid has been a very, very picky eater for many years.”[00:03:00]And then when we're seeing people who are over 40 come in for the first time, oftentimes folks in that category have had eating disorders for quite a while, maybe even since they're like early teens, preteens, or late teen years and early 20s, they just never sought treatment or never got the help.
Dr. Karen Nelson: Absolutely. I like that you're kind of identifying some of these age brackets, and what often comes up for me is cultural images, right?About who potentially might be suffering with an eating disorder. Do you think there's a perception of a certain age or type of person?
Dr. Amanda Delsman: Absolutely. I mean, even just in my life in general, when I'm talking to friends or, you know, friends of the family or things like that and I say I work in eating disorders, they all assume I work with kids.
Dr. Karen Nelson: Good point.
Dr. Amanda Delsman:And so I will often dispel the myth and say,“Actually eating disorders don't discriminate by age.” We see them in people of all ages and [00:04:00] my oldest clientele currently are in their mid 70s.
Dr. Karen Nelson: Same.
Dr. Amanda Delsman: And so it's something that can strike throughout the lifespan, maybe develops early on and continues to kind of rear its head throughout the years. Or might not develop until later in life. Maybe there's been disordered eating present for a period of time and then becomes a clinically diagnosable eating disorder later in life, so I think our kind of mainstream society does have the impression that eating disorders are limited to young white girls.
Dr. Karen Nelson: That's right.
Dr. Amanda Delsman: Right?
Dr. Karen Nelson:That's right.
Dr. Amanda Delsman:And as you have so wonderfully done on your podcast, we've called out that's not the case, that we see eating disorders across genders, across cultures, across ages. And I think that people's likelihood of presenting for treatment and seeking help is impacted by those cultural factors for sure. And that might be part of the reason why there's that myth that we see eating disorders more in cis women or that we see them more in the younger population, but that doesn't mean [00:05:00] that's the incidence rate.
Dr. Karen Nelson: I think as we kind of explore and describe, again, that perception of someone who may be potentially struggling, and then how that perception can potentially impact someone's maybe desire or even knowing that there's treatment out there or available or that it's appropriate to get treatment. Yeah, there was an interesting study in 2019 that indicated by the age of 40, one in five women has dealt with an eating disorder, which is twice the proportion identified in women at the age of 21. And so we just know that as we move through those adult years as women, many women potentially have either accessed treatment, or you and I both see, also Amanda and I joke we're the mature women's specialists here at.
Dr. Amanda Delsman: I do feel like it's important to note that we both fall into the over 40 category.
Dr. Karen Nelson: I know. Why’d [00:06:00] you call me out, girl?
Dr. Amanda Delsman: So sorry.
Dr. Karen Nelson: I am 32.
Dr. Amanda Delsman:You are. Can confirm.
Dr. Karen Nelson: I am very, very proudly in my mid 40s. And I think, being able to name that both Amanda and I have had experience working with children, but we also now in our practice really have started to specialize in adult women. Even very specifically working with women in retirement, post retirement, midlife stages, during parenting stages, or pregnancy. And so those spaces of accessing eating disorder treatment are so important.
Dr. Amanda Delsman:Absolutely. I think working with a population of cisgender women, there are some unique aspects of the work in that, I mean, when we say over 40, we're talking about like four decades worth of things there, so we're referring to people who come from different generations, who were exposed to different messaging about mental health generally [00:07:00] and, you know, what it meant to have a mental health struggle and to seek treatment, but also different messages around bodies and what bodies are supposed to look like. And so, and I'm working with somebody who's in their 70s, and they're talking about their struggles with body image compared to somebody who's in their 40s. Even though they're technically kind of midlife and above, they've just heard really, really different things. And so it's important to be aware as a therapist of what are those cultural messages that this person has been exposed to and how might that be informing how they're thinking about themselves? And it's not just body related, it's also food related. So you and I both know that the messages around food are messed up.
Dr. Karen Nelson: That's right. To say it mildly.
Dr. Amanda Delsman: Exactly. And that the diet industry has been really genius in that, you know, every 5 to 10 years they decide something else is bad.
Dr. Karen Nelson: That’s right.
Dr. Amanda Delsman:And so then there's new messages around what's bad. So sugar is the devil right now. For people who are in their 60s and 70s, they can remember when it was eggs that were the devil and [00:08:00] fat that was the devil. And
Dr. Karen Nelson: Carbs have been called out.
Dr. Amanda Delsman: And sugar for a while. Yeah, they've been kind of around for a while. And it changes. When you look at the history of kind of the diet industry and the messages that have been put out there about food, about bodies, it has been ever shifting, so folks who are in their 40s and above, it's confusing.
Dr. Karen Nelson: That's right.
Dr. Amanda Delsman: They're so rattling around in their heads that as a therapist, we have to help them recognize that those thoughts are there, those beliefs are in there and maybe in there pretty deeply, and then trying to excavate that and find a really new way of relating to their bodies and food can feel hard. It's so doable though, and it's really rewarding work.
Dr. Karen Nelson: Well, I think too, the importance of having that specialized team, you know, having a therapist, you know, you and I have been in this work for a very long time. And so we just kind of appreciate the nuance that, you know, when you and I are sitting with a client who potentially is [00:09:00] 21 and has been very newly diagnosed, maybe has been struggling with some eating disorder behavior for a year or two, we just have different ways of potentially treating or I don't want to say treating, but we just know that therapy, right, is going to be different than with someone who's 55 and has potentially spent a lifetime engaging with symptoms or, I don't know, thoughts on that or what comes up for you?
Dr. Amanda Delsman: Totally. Yeah, absolutely I think it's different. Um, life stage stuff is super different.
Dr. Karen Nelson: It’s so big. Yeah.
Dr. Amanda Delsman:So somebody who's in their early twenties is, you know, maybe emerging from the family system for the first time or, you know, perhaps in school and kind of navigating like, who am I and what does my future hold? And there's a lot of like forward thinking that can feel really scary or, um, individuating that can feel hard. Someone in their 50s has been through a lot of that and, you know, people who are in midlife are in that [00:10:00] sandwich place, right?
Dr. Karen Nelson: That’s right.
Dr. Amanda Delsman:Many people, not all, um, but many people have parents who are aging and, you know, maybe struggling with health concerns that they need some support around, maybe have children of their own. I find that working with folks age 40 and above, one of the hardest parts of that is just getting them to believe that, like, it's okay for them to take time for themselves, um, helping them to see that they are worth getting treatment. So many times, um, I'll hear women say, like, “Oh, I’m too old, it's too late, you know, is this even going to be helpful? I don't really have time.” They might be managing a career and kids and parents and a partner and it's a lot. And so trying to find that time and that energy can feel like another job instead of it being something that is just nourishing and helpful and, and self care.
Dr. Karen Nelson: Women who potentially had a diagnosis early on received treatment and now are back, so potentially have [00:11:00] experienced a relapse. Is that, you know, really common? Do we see that a lot? Maybe thoughts and feelings that come up for women that we see that may be returning to therapy midlife after having previously received eating disorder therapy. Thoughts on that?
Dr. Amanda Delsman: Absolutely. Yeah. So the first thing to understand about eating disorder recovery, no matter what age you're at, is that relapses can and do happen.
Dr. Karen Nelson: That's right.
Dr. Amanda Delsman: And so it's, it's, I don't want to say it's expected.
Dr. Karen Nelson: It’s part of the healing.
Dr. Amanda Delsman:So much as it is just part of the process for many folks. Um, and, and so I think the, the first thing to do is if you find yourself in a relapse is to not judge yourself for being in a relapse is, is to, um, recognize, “Okay, here I am. I'm, I'm at this stage in, in my journey and now might be a good time to get some help again.” We often in treatment will differentiate between a lapse and a relapse. So a lapse might be maybe you've had [00:12:00] a period of time without symptoms, whether that be a couple months or many years. Whatever, a period of time and you notice some symptoms have returned and it's kind of like, “Oh, okay,so for the past couple of days, I haven't been eating breakfast,” or “Ooh, I had my first binge in a couple of years.” No need to panic at that stage. Important to notice and then to use your skills to get back on track. So if you've done treatment before, you probably in that course of that treatment did some sort of like relapse planning, some sort of reflecting on here are all the skills that I have learned. Here's what I could do if I'm struggling again. Now's the time to dig that sheet of paper out.
Dr. Karen Nelson: That's right. Get your plan out.
Dr. Amanda Delsman:Get your plan out to review it, to do the things that are on the plan. And if you didn't do a relapse plan when you went through treatment the first time, then do one now and, and reflect on, “Okay, what was helpful when I was in treatment [00:13:00] before? What do I know worked for me? What can I do now that can help me get back on track?”And then do those things.
Dr. Karen Nelson: That's right.
Dr. Amanda Delsman:And sometimes that's not enough. Sometimes the lapse continues. And turns into what we might call a relapse. And that's where maybe the behaviors and the symptoms have been present. I mean, I hate to put timelines on this for people because I don't want to, you know, make it hard for people to access treatment when they need to, but if it feels like you've been doing what you can and it’s,it's just not enough, um, that's a good time to return to treatment. Um, if it's been going on for several weeks, and you're just struggling to get your footing or if you just generally feel like I don't got it in me to do this alone, and I want some support, absolutely call, and, and get back into treatment.
Dr. Karen Nelson: If we're seeing a woman who has arrived at Melrose who has been undiagnosed, she's been engaging with eating disorder behavior for, for many, [00:14:00] many years, and the thing that can happen is those behaviors can almost feel normalized.
Dr. Amanda Delsman: Their patterns can be pretty deeply entrenched and normalized, as you said, where it's like, “Well, this is just how I am.”
Dr. Karen Nelson: That's right.
Dr. Amanda Delsman:And so they might over identify with the symptoms is kind of how I would talk about that in psychobabble. And so helping them to recognize that, “Hey, that's not actually, you know, quote unquote normal or typical and wouldn't be what we would recommend.” Um, it can be really hard, and people who are in their 40s and above do have more of their identity developed, and sometimes it's in kind of a twisty way, where they might over identify with a role, like they might over identify with their career, or over identify as a parent, or a caretaker, or identify with their eating disorder to the point that then when you're working on these things, a lot of the work has to go deeper than just the eating disorder symptoms. We have to work on some of that identity stuff because we're removing a part of it.
Dr. Karen Nelson: [00:15:00] Absolutely. Well, I think too, several years ago I was working with a woman and, you know, we had talked about, she said, “Karen, I've kind of built my life around being the thin one, the, the exerciser, the marathon runner.” And she's like, “I, I feel confused to know, like, what, what is the eating disorder? What is me? What did I actually really want to do and what did the eating disorder tell me I had to do?” And I'm so glad you brought up the complexity of that. We're just going to nurture and be really curious with you. Never are we ever judging or shaming the behaviors, ever. We're saying, let's make sense of that. I wonder how that has shown up for you.
Dr. Amanda Delsman:And I think too, there has to be some acknowledgement of, “Hey, these eating disorder symptoms and that identity, like, it got you here.”
Dr. Karen Nelson: That's right.
Dr. Amanda Delsman:Maybe it got you through some trauma. And so, so, you know, as part [00:16:00] of the process of recovering from the eating disorder, it's often a grief process. It's often, uh, acknowledging like, hey, you, you did me some things that were good and helpful and you're not doing me good and helpful things overall anymore, and I need to say goodbye.
Dr. Karen Nelson: Beautiful.
Dr. Amanda Delsman: And that's hard.
Dr. Karen Nelson: So scary.
Dr. Amanda Delsman:And people in their 40s and above are likely doing grief processes around other things as well, like we just have lived more life at this stage so we've suffered other losses whether that be a death of a loved one or a divorce or an end of a relationship or,you know, kids moving out of the home or whatever it might be be there's loss. And the grief process can snowball. And then when you're also saying goodbye to something that has been your coping skill, the thing that has gotten you through other hard times, it's scary.
Dr. Karen Nelson: That's right.
Dr. Amanda Delsman:It's really, really scary. And so a lot of times the work is about acknowledging that fear. How I would describe it is letting go of trying to control it. We do have to move [00:17:00] toward it.
Dr. Karen Nelson: That's right.
Dr. Amanda Delsman: And approach it. And not avoid.
Dr. Karen Nelson: And feel it.
Dr. Amanda Delsman: And feel it. And experience it. And get down and dirty with it.
Dr. Karen Nelson: That's right.
Dr. Amanda Delsman: And you know, hate every second of it, maybe, until we don't anymore. And then that's what people tend to find. It's what I find in my own, just being a human, is that when I allow myself to do that, it sucks for some time, and then it doesn't.
Dr. Karen Nelson: That's right. Well, I think also, too, some classic, almost like definitions of an eating disorder is in an attempt to maybe control something when something else feels out of control to maybe numb out or distract from emotion. And so, yeah, therapy can be challenging because we're asking you no longer do those behaviors that have potentially kept you safe or numbed you out, but now, especially if you're working with Amanda or I, we're going to walk right into that emotion.
Dr. Amanda Delsman:Oh, yeah. As soon as I see you start to cringe away, I'm like, “Oh, let's do it.”
Dr. Karen Nelson: Let's get it. Let's get it. Okay, but here, like, all [00:18:00] kidding aside, we're with you right there.
Dr. Amanda Delsman: Yeah. I'm not gonna let you do that alone.
Dr. Karen Nelson: Amen.
Dr. Amanda Delsman: Mm hmm. Yeah.
Dr. Karen Nelson: Like, I will walk right with you into that. All the fear, the shame, the criticism, the grief, like, that is the power of therapy.
Dr. Amanda Delsman:Mm hmm.
Dr. Karen Nelson: And, as a therapist, right, like you said, we just are really attuned to our patients. Looking at some of the statistics of rates of eating disorders, an interesting statistic I'd love to get your feedback on it, is that anorexia actually becomes less common as women get older. But a really interesting fact is that the rates of bulimia do not drop until well into, uh, the age of 40 for women.
Dr. Amanda Delsman:Yeah. I think based on the research and, and just my own clinical experience, I think the behaviors involved in anorexia when we're talking about that level of restriction, at some point the body just like takes over and is like, “Enough of this, we are just not gonna do [00:19:00] this.” And so people might return to more sustaining levels of eating or binging might start and then maybe purging can follow that sometimes, or they might compensate for the binging with restriction so it just doesn't look as typical of anorexia. I think too, especially in cis women, if they are doing things like starting families, it's, you have to nourish your body to carry a pregnancy. And so sometimes life stuff shifts enough that doing that level of restriction isn't something that is attainable or just isn't wanted anymore either. A lot of times when I might be doing an intake with somebody who we think has binge eating disorder because their current symptom is just binging, just, quotes, binging. Um, and I'll do the intake. I'll be like, so tell me about your history with eating. And we go back and they'll talk about their adolescence and early 20s. And it's [00:20:00] clear to me, “Oh, you probably had anorexia then.” It's kind of shifted over the years. It's not that they had one diagnosis, stopped that, and then developed a different eating disorder. It's all the same. It just manifests differently across the lifespan for them. And so I think that that's probably part of what we're seeing in terms of the numbers with the specific separate diagnoses.
Dr. Karen Nelson: That progression of eating disorder behaviors, you and I have talked a lot about this, how we do often see the movement of maybe I earlier in my teen or early adolescence, I was restricting, and then as I've kind of progressed through my life cycle, those behaviors may shift and change.And I think again with women over 40 because oftentimes what I hear as I'm doing intakes is potentially the, as we spoke, the kind of normalization, but if in my early 20s I was severely restricting and now [00:21:00] I've kind of progressed into this space where maybe there's more passive restriction, meaning, you know, I'm not really doing it on purpose, but I maybe have some generalized fears about food, um, maybe if I overeat every once and again, I might engage in purging. I have a strict exercise regimen. Oftentimes what they share is like, it is different and potentially even better than what it's been. And they still very much so could benefit from treatment.
Dr. Amanda Delsman:That's why this is a mental health disorder. It's not just a behavioral, “Hey, quick, make a change.” It's, “Hey, we got to dig in a little deeper here and see what's going on.”
Dr. Karen Nelson: I think, again, kind of we were just talking about sometimes misperceptions are a shame. Like, maybe, am I too old? You know?
Dr. Amanda Delsman: Yes, yes.
Dr. Karen Nelson: Is it even worth it?
Dr. Amanda Delsman:Right. And so, yeah, so they might be like, “Okay, I finally have the time, but now I'm 65, and I don't know where to go next from here. I don't know if this is even worth it. I hear that a lot from people who are over [00:22:00] 65 and women in particular who have spent their lifetime taking care of everyone else, that they're kind of like, “Well, what's the point? You know, I'm too old, or I'm too set in my ways, or how is this ever going to change?” That kind of thinking can in and of itself be a barrier to the treatment. And so really helping women to understand, like, “Hey, you know, change can happen at any time.”
Dr. Karen Nelson: That's right. And you're worth it.
Dr. Amanda Delsman: And you're worth it. You’re worth the time. You're worth the effort.
Dr. Karen Nelson: I previously had the pleasure of chatting with you about body image, so I mean, we got to talk about body image in our 40s and above. Right. And as we start to age, just some of those body changes that are happening. I'd love to hear your opinion on body image in women over 40 and how that potentially might either re trigger or trigger eating disorder behavior.
Dr. Amanda Delsman:Absolutely. Yeah, so I think, I don't know that we called this out specifically yet, but there are kind of different groups of [00:23:00] people who come in at the age of 40 or above. There are those like we've been talking about who maybe have had an eating disorder for a long time and who are just seeking treatment for the first time or perhaps they had treatment when they were younger and had a, you know, recovery for a period of time and then were re triggered into a relapse. And then there's a third category of people who weren't diagnosed with an eating disorder or maybe wouldn't have even met criteria for an eating disorder, but then develop it later in life. And so much of what can trigger relapse or trigger the onset of an eating disorder can be body image related and you bring up a really great point that in midlife,cis women are experiencing a lot of physiological changes, hormonally. Gravity is a thing.
Dr. Karen Nelson: Dang girl. Haha!
Dr. Amanda Delsman:Haha! There, you know, there's just aging and they don't look the way they looked 20, 30, 40 years ago. And so I see this really interesting phenomenon where a [00:24:00] person who's over 40, tends to have the understanding that it's not going to be what it was when I was 20, but there's so much societal pressure that for around youth, like holding on to your youth and retaining youth, and then it also turns into this pressure about health, that it's not just about how your body looks, but how is it, you know, are you healthy? And as we talked about in our episode, and I know you've talked about with Dr. Funk in the episode on health at every size, is that too often, health gets equated with weight or with thinness, and so people can often start out with the best of intentions and say, “You know what? I want to focus on my health. I'm going to eat better,”or “I'm going to exercise more." Or kind of buy into the messages that are out there. And then they can evolve into disordered patterns of restriction, over exercise, and then like so on and so forth. Restriction begets binging and then here we are, right? But I think these [00:25:00] messages that we receive about like, “Hey, hold on to your youth as long as you can.” For women who are in the workforce and who are trying to continue to build their career, um, there's a fear often around, like, being overlooked because of age, and so trying to hold onto youth or look younger, and thinness is again equated with looking younger, and so trying to lose weight to do that.
Dr. Karen Nelson: We're literally just naming some of these stressors and all of the emotion that is attached to that. I mean, just absolute fear, right? If I'm working at a facility where, you know, I'm fearful that I'm going to be replaced by the next generation, that I'm no longer relevant, that my body is just biologically changing.My body, you know, most women, you know, do experience some weight gain during menopause, but we often don't talk about that. That is just my body doing its work as a cis woman, right?
Dr. Amanda Delsman:Absolutely. And there was an article that was released earlier this year that did say, "Hey, medical field, we've been doing it [00:26:00] wrong.” Women are supposed to gain weight. Cis women are supposed to gain weight during perimenopause and menopause. It's normal and natural as part of the lifespan development. And we need to stop telling women, “Oh, but you should change how you're eating or you should change what you're doing with exercise because it's unavoidable.”
Dr. Karen Nelson: That’s right.
Dr. Amanda Delsman: It's part of the process.
Dr. Karen Nelson: Some of those normalized body changes, women feel like they're failing their body or like I've done something wrong. If my body, which we know natural weight gain often does happen during menopause, but if I'm told any weight gain is bad.
Dr. Amanda Delsman: Right.
Dr. Karen Nelson: Well, now we're walking right into an eating disorder because, okay, so I have to prevent this thing that is just naturally happening in my body. And, and so now I potentially might be engaging in restrictive type behaviors, over exercise, you know, maybe purge behavior, just really risky, risky experiences. When you think about a woman just living and surviving in our culture, how [00:27:00] might they potentially combat some of those messages?
Dr. Amanda Delsman: Well, I think, and as we sort of talked about in the previous podcast episode, one of the things that can be really helpful is just to limit exposure. So, um, thinking about curating your social media feeds by not, looking, not searching the diets, not clicking on the ads, um, and instead searching like funny cat videos or something that you can, you can shape the algorithm in your favor, you know, by limiting your exposure on social media, but also considering other places you're getting that message.So if you're watching a lot of live television and seeing all the commercials, like right now the commercials for Ozempic are
Dr. Karen Nelson: Right.
Dr. Amanda Delsman:So frustratingly insane. Um, and so, you know, taking a break from the radio, taking a break from television, taking a break from social media, um, just limiting the stimulus field can be really helpful there. Also surrounding yourself with people who, um, maybe aren't having those conversations all the time. [00:28:00] I think there's this, this thing that can happen, especially among cis women, where there's like a bonding around tearing down your body. So, you know, you show up at a party and somebody says, “Oh, you look amazing.”And you're like, “Nah, you know, if I could just lose 20 pounds,” blah, blah, blah. And then the other person kind of chimes in with like, “Oh no, you look great. It's me that needs to lose the weight.” And there's this like weird backward bonding thing that can happen in female circles that is just unhelpful. Um, and so breaking that cycle, talking to your friends and family about how those conversations aren't helpful and how you're trying to not be focused on your body as much, um, or focused on in a negative way on your body as much. Um, I think also shifting focus from appearance to body function, um, and that's where then, you know, the messages about health can get a little dicey, so then reminding yourself of what the research really says on health, that it's not about weight, it's about behaviors, and asking [00:29:00] yourself if you're engaging in healthy behaviors, which include feeding your body. We gotta eat, you know, getting good rest, and so prioritizing sleep, um, drinking water, getting some movement, but doing it in a way that doesn't make you more prone to injury. I think that's another thing that we often overlook in women over 40 is that, um, anytime a person has gone through a period of restriction, especially post the age of about 25, um, they are now at risk of osteopenia and osteoporosis, so even if they are not currently restricting, um, they may have really poor bone health. And that's from previous episodes of restriction and dieting. So when I'm saying restricting, I don't just mean anorexic restriction. I mean any kind of under eating, which would include dieting. And so for any of our patients who have eating disorders, they've likely had a history of dieting, um, and, and they're at risk for some medical complications that can come up.Um, bodies that are 40 plus aren't as [00:30:00] resilient as younger bodies, and so some of the past damage that has been done starts showing up, um, and that's something else to kind of be thinking about in this process.
Dr. Karen Nelson: So important, you know, um, we just know that having an eating disorder, kind of in midlife, there's these very real kind of medical issues that can happen, right? You know, I'm so glad you brought up, you know, bone loss, you know, just kind of, um, the, not getting enough, you know, particularly iron or vitamin B, vitamin D. We know that there can be heart problems associated with, you know, significant restriction or purging, you know, lung conditions, gastrointestinal issues, diabetes. I mean, this isn't just not a big deal, right?
Dr. Amanda Delsman: That's right. And it's all cumulative.
Dr. Karen Nelson: That's right.
Dr. Amanda Delsman:So, you know, for people who have had a history of disordered eating or eating disorder, and they're finally kind of coming to treatment for the first time, or maybe they're returning to treatment, um, they're just at higher risk. These [00:31:00] behaviors have been around for longer. The body is older and so it can't mask that damage like it used to in the younger years.
Dr. Karen Nelson: That's right. Well, let's talk a little bit about getting help. You know, if you're listening today and, and kind of noticing and maybe resonating with some of the things that we're talking about, if you have a loved one, you know, who is an older adult and you know, you may be worried about them, you know, any, any kernels of wisdom of how do we start that conversation? Or what does that potentially look like?
Dr. Amanda Delsman:Yeah, I think if you are a loved one of someone that you are concerned has an eating disorder, um, you know, it's always important to be loving and gentle and compassionate in that conversation no matter what age the person is. Um, and so to try to refrain from it being critical or blaming or shame, like the person's likely very much already engaging in enough self blame and self [00:32:00] shame that if you kind of try that route, you're just adding crap to the crap pile.
Dr. Karen Nelson: That’s right, haha. That’s a good way to say it. Well, I also I say all the time, you cannot shame someone into recovery.
Dr. Amanda Delsman: Exactly.
Dr. Karen Nelson: I mean, often they're just going to run the other way, and so that space of nurturance, not almost like accusatory language is what I usually recommend. Like, we're not going to accuse them like, “What are you doing? What's the matter with you?” We're really wanting to approach them out of care.
Dr. Amanda Delsman: Absolutely.
Dr. Karen Nelson: Are you okay? I see you.
Dr. Amanda Delsman: Yeah.
Dr. Karen Nelson: I just maybe I noticed these things.
Dr. Amanda Delsman:100%. And I think if, especially if you are in the position of being very close to that person, reminding them that it is okay for them to take the time.You know, if you're a partner of somebody who's struggling to say, “Hey babe, I got you, like I see how much you're doing for our family or in the world and I can pick up the slack,” um, or, or [00:33:00] reminding people, you know, if you're a friend of somebody who is really, um, into their career and feeling like they just can't take a break from work, reminding them, like, “Hey, work will survive, but you might not.”
Dr. Karen Nelson: That's right.
Dr. Amanda Delsman:And so, what do we gotta do? How can I help you? You know, I'll help you navigate that and talking to people or filling out forms or whatever it might be because it can be a lot to start to consider how do I take this time? How do I take this break? And knowing that I've got the support of the people around me, that I'm not a burden to them for taking this time to focus on treatment, um, is more likely to help me go do it. Um, and oftentimes people come into treatment for the first time because people around them are concerned that they'll, you know, they'll have external motivation before they'll have internal motivation. So saying like, “I really, you know, my kids kind of sat me down and said. We're worried about you, mom. We want you to [00:34:00] get some help.”Like, ooh, man, that can hit a lot differently. And so it can be like, “Okay, I want to do this for my kids.” Over time, the person will develop, um, hopefully develop motivation that's internal about, like, I want to get better just for me, um, but external motivation is often enough to at least start the process. And for people who, if you yourself think you're struggling, but you're not sure where to get started, you know, I mean, obviously you can call Melrose Center.
Dr. Karen Nelson: Always, always.
Dr. Amanda Delsman:952-993-6200
Dr. Karen Nelson: That’s right.
Dr. Amanda Delsman: Set up an intake. So that's one option. Something to know is that eating disorders happen. Like most people either have had an eating disorder or know somebody who's had an eating disorder, so a lot of times people feel really alone or, or, um, like it's just me. This is just something I got to figure out on my own. Um, and that's just not the truth.
Dr. Karen Nelson: That's right.
Dr. Amanda Delsman:That you know, there are people here who help who can help. There are lots of others who struggle just like you. And so [00:35:00] taking that brave,courageous step at making that call. This opportunity that we have as humans to figure ourselves out, and decide to move in a new direction. Decide to move towards something different, and so it's okay to come ask for some help with that.
Dr. Karen Nelson: For sure. I mean, we just want to really encourage people that, the, you absolutely do not have to suffer alone, and we just really identify kind of the courageousness of being able to reach out and say like, "Hey, I'm struggling. I'm trying to get by.” And the eating disorder will take you nowhere good. It just really won't. And so finding that energy to make the call can be really, really important.
Dr. Amanda Delsman: It's so neat to see people just live their lives versus like have this, you know ominous shadow of an eating disorder, you know, over the over them all the time.
Dr. Karen Nelson: So true. Well, Amanda, I've absolutely adored our [00:36:00] conversation. I just appreciate all of your wisdom and insight and just appreciate you being here with me today.
Dr. Amanda Delsman: Thank you so very much for having me back. It's been such an honor and I just feel really grateful to be a part of this.
Dr. Karen Nelson: To learn more about Melrose Center, please visit melroseheals.com. If you or a loved one are suffering from an eating disorder, we're here to help. Call 952-993-6200 to schedule an appointment, and begin the journey towards healing and recovery. We'd love to hear your feedback on our episodes, the topics we cover, and anything you'd like to hear me discuss on the show. Our email address is melrose@parknicolette.com. I look forward to hearing from you. Melrose Heals, a conversation about eating disorders, was made possible by generous donations to the Park Nicolette Foundation.