Tag Archives: middle age

Recovery and Advanced Maternal Age: A Story of Hope

I’m in the process of interviewing professionals and recovering women for my book, Good Enough Mama: Taking Care of Yourself and Your Recovery During Pregnancy and Postpartum. And I’m being blown away by the amazing women I am meeting. So I’ve decided to share some of the experience, strength, and hope they are offering in their stories.

But first, a bit on Advanced Maternal Age (and how it relates to eating disorders):

There are many reasons why women are delaying having a baby until later in life, including: effective contraception, gender equality, women reaching higher educational

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image from Everydayfamily.com

levels, cultural value shifts, divorce or partnering later in life, lack of childcare support, an absence of supportive family policies in the workplace, economic hardship, job instability or work in male dominated fields that are not supportive of or understanding of motherhood.*

Along with reaching higher educational levels, many recovering women want to do personal growth work and solidify their eating disorder recovery prior to becoming a parent. However, delaying childbirth until after age 35 can further inhibit fertility for women that may already have fertility problems leftover from their eating disorder history.

Twenty million women and 10 million men have an eating disorder at some point in their lives, according to the National Eating Disorders Association. Fertility problems, though they can be overcome, are among the potential long-term consequences of such conditions, with some studies suggesting that eating disorders account for about 18 percent of patients seen in infertility clinics, says Dr. Leslie A. Appiah, associate professor in the University of Kentucky College of Medicine’s Department of Obstetrics and Gynecology. **

OK, enough with the stats. I’d like to get to the stories of hope because the purpose of this blog (and the upcoming book) is sharing hope: hope that recovery is possible, hope that motherhood is possible, hope in the knowledge that you are not alone.

So without further ado, let me introduce you to Sheira Kahn, MFT. Sheira is a marriage and family therapist in private practice with two decades of experience in treating eating disorders and three decades of her own recovery. For those of you struggling with hope that you can still be a mom later in life: She had a baby at age 50.

Here is her recovery story:

When I was a teenager and I was bulimic. The house where lived was filled with turmoil that I literally couldn’t stomach. Thankfully, when I moved out, I stopped purging. However, hatred of my self and my body persisted. I still hated my body and I hated every bite of food that I ate. The mental part of the disorder persisted. I was in pain and I knew that I didn’t want live that way. So I joined a meditation school where they taught us about how to work with the critic. And since my critic was always criticizing me about my body, I did what they said to reduce your critic. Every time my inner critic was loud and mean, I practiced. And my relationship with my body changed, because there was less hatred being channeled from a critic toward myself. Then, a book on hunger and fullness signals taught me how to listen to my stomach, not my critic, when making food decisions.

What inspired and motivated you to get into recovery?

I was in so much pain. I wanted the pain to be reduced. I think with some people, the coping mechanism (of the disordered eating) works to keep them numb to the pain, so  they keep doing the coping mechanism. But for me I was in pain. It wasn’t a hard decision for me. I felt so bad. I thought recovery was going to make me feel better, so I threw I threw myself into it.

Did you always know that you wanted to be a mom or did that desire come later?

I always did growing up and then, in my 20s, I thought I didn’t. And then it came back. And then it came back very, very strongly. I assumed that would happen for me, as it seemed to happen so easily for other people. I had no idea that it that I would have to go through a lot actually to become a mom.

What happened?

For me it was a combination of factors. I wanted to be partnered.  I married someone that I had fallen in love with when I was 21. He wanted to have kids, and I didn’t. Then I changed my mind, but then he had changed his mind! That relationship wasn’t working out for several reasons. Then I got married again. I was in my I was 40’s when we started trying, so I was on the late side as far as far as fertility. It might have happened if I had felt safer in the relationship. However, I didn’t feel safe in the relationship to bring in a child. I believe this influenced my already shaky fertility. However, I knew I really wanted to have a baby, and I was ready to do whatever I needed to do. I was ready to have a baby or have a family, even without a partner who is willing to do it. I just knew that I had to go for it.

By that time there were some things in place that showed me I could be successful being a mom. I felt healed enough in myself. I had a sense of inner strength and I had support. I was making good livelihood on my own at that point, so I knew I’d be able to provide for a baby.

What happened in the decade between 40 and 50?

Three things during that decade: internal readiness, emotional clearing, and practical steps.

Internal Readiness

There was an internal readiness that I didn’t achieve until I was 48 years old. I came from a family where there was emotional trauma. There was extreme disconnection: fighting, antagonism, conflict, and fear between my parents. That set me up to have very few skills for building long term relationships. It gave me a layer of fear. When there are emotional injuries like this, it’s like a layer in your body. It felt like a layer of beliefs that went along with this fear. I thought that I would never be able to have a family. Or that it could happen for other people, but not me. I saw it happening for other people, and I believed it couldn’t exist for me. There was all this evidence that had confirmed the belief I held: Sheira doesn’t get to have family. I had been divorced once and then was getting divorced a second time. I had miscarried…

(Don’t worry! Remember this is about hope. The story doesn’t end here! Stay tuned next week for part two where we get to the Hope part of Experience, Strength, and Hope)

Sheira Kahn, MFT, is a marriage and family therapist in the bay area who gave birth to a beautiful baby girl at age 50. To read more about her professionally, you can visit her website here

References:

*Mills M, Rindfuss, RR, McDonald P, Te Velde E,“Why do people postpone parenthood? Reasons and social policy incentives,” ESHRE Reproduction and Society Task Force: Hum Reprod Update, 17(6):848-60, Nov/Dec 2011.

** Medaris Miller, Anna “The Lasting Toll of An Eating Disorder: Fertility Issues,” US News and World Report, March 31, 2016.

 

Midlife Mid-Drift

I had one of those moments today. As I was pulling on my jeans, I could feel they were too tight. My midriff was mid-drifting. And that first automatic thought – “I’ve gained weight!”- was quickly followed by a shitload of culturally conditioned fat-shaming judgements. The good news is that then I took a deep breath. And remembered this voice comes in when I am suffering in some way that needs tending. That I have over twenty years of eating disorder recovery behind my back (and in my stomach). That this fearful voice doesn’t pop up very much any more and I have another way of being with myself now. Compassionate-Curious-Recovery-voice kicked back in.

Might these jeans be tight because they just came out of the drier?

If you did gain weight, so what?

Here’s how the rest of that conversation went down:

Anxious-part-of-self: What do you mean so what? SO WHAT? My body is supposed to stay the same. This is my recovery body and it’s not supposed to change.

Compassionate-Curious-Recovery-Self: Interesting. Where did you hear that? Actually, your body has changed many times over the past two decades. Most people’s bodies do. Who told you your body is supposed to stay the same? I think I remember your very first recovery mentor telling you twenty years ago (when I was a young adult and she was middle-aged) two things:

1) The size of your body is not your business.

2) The only constant is change.

When I work with women on body image suffering, often there is a correlation with the uncertainty that come with the life-passage transformations such as young adulthood, marriage, pregnancy, postpartum, middle age, and elderhood- and body image. Life transitions can be challenging, and the culture we live in doesn’t have a container for women traveling through these rites of passage. We do have a body-shaming culture that tells us there is something wrong (with our bodies) and it is our responsibility to fix/change them (our bodies). In the absence of community, and of rituals that assist us in crossing these thresholds, a fearful body-shaming voice can come in to keep us “safe.” Safe from what? Safe from the scary changes of the unknown by assuring us that If you can keep your body from changing, then this (life-change) will not be distressing. Safe from having to go through it alone. Safe from facing all the mixed messages in a culture that feels ambivalent at best, and actively disdainful at worst, about supporting women through the rites of passage into adulthood, motherhood, middle age, and becoming a crone. But in practicing hating our bodies, we miss out on appreciating how wise they are in leading and guiding us through these life transformations.

Midlife Mid-Drift (and other women’s body/life changes)

In perimenopause, the ovaries produce less estrogen, which can cause the body to store extra fat (because fat cells can produce estrogen, which offers the body a safety net). Interesting. Thus the thickening around the middle. Pretty smart, body!

In adolescence, a hormone called GnRH (gonadotropin-releasing hormone) is released, and then forms two new hormones that signal the body to gain weight and become fertile. Smart body!

In pregnancy, weight gain is distributed in all kinds of useful ways, including: increased

jadebeall mothers belly

Photo by Jade Beall, A Beautiful Body Project, http://www.jadebeall.com

blood, breast tissue, fat stores for future breast feeding, amniotic fluid, the placenta, oh, and the actual baby! Wise body. 

Just like postpartum, when the stomach carries shapes and marks that show it grew to hold a child. Successful body!

My body is  changing again.  It’s what happens for women throughout the life cycle. By the way, when I was researching reasons why a woman’s body changes in adolescence, the perinatal period, and midlife, guess what popped up on Google? You got it: 10 Ways to Diet That Away. (“That” being the inevitable changes in your body.)

A Recovery Reminder

If you are in recovery from an eating disorder, or any form of body image hatred (aka if you live in this culture), DO NOT visit Dr. Google for your answers to questions about life transitions. Dr. Google will always tell you that losing weight is the answer to complex life problems. Stop dieting, start rioting, and find your people. Find your support team of friends, professional help, and spiritual sustenance to help midwife you through your life transitions. Listen to the wise, fiercely compassionate and sometimes as* kicking part-of-you-that-knows and act on that voice. Now is not the time to let the weight on your stomach go. Now is the time to let the weight of holding up unrealistic expectations of who-you-are-supposed-to-be vs. who-you-actually-are go. Or, as Brené Brown so eloquently states about midlife:

I think midlife is when the universe gently places her hands upon your shoulders (or your midriff), pulls you close, and whispers in your ear:

I’m not screwing around. It’s time. All of this pretending and performing – these coping mechanisms that you’ve developed to protect yourself from feeling inadequate and getting hurt – has to go.

Time is growing short. There are unexplored adventures ahead of you. You can’t live the rest of your life worried about what other people think. You were born worthy of love and belonging. Courage and daring are coursing through you. You were made to live and love with your whole heart. It’s time to show up and be seen.
That about sums it up: Show up and be seen, midlife midriff mid-drift-ing over your jeans and all.

Motherhood, Body Image, and Disordered Eating in Middle Age

I remember going to my first ObGyn visit when I was pregnant. The Doctor put “AMA” in my chart. Having worked in treatment settings for eating disorder recovery for many years, I thought she meant “Against Medical Advice,” the term clinicians use when a client is choosing to leave treatment despite their providers’ recommendations. I quickly said to my Doctor:

“I just want you to know am willing to implement any medical advice that you give me regarding my pregnancy!”

She gave me a blank stare.

I explained that I noticed she had written “AMA.”

She smiled. That means “Advanced Maternal Age.”

“Oh.” Long pause. “Oh.”

Being a mother of “advanced maternal age” is becoming more and more common in developed nations, as women work toward completing higher education, solidifying their careers, finding the right partner, and doing personal growth work prior to having children. The Center for Disease Control and Prevention reports:

Delayed childbearing in the United States is evident in the 3.6-year increase in the average age at first birth between 1970 and 2006…The dramatic increase in women having their first birth at the age of 35 years and over has played the largest role in the increased average age of first-time mothers…many other developed nations have observed increases in average age at first birth with some now averaging near 30.0 years of age. 1

What does this phenomena have to do with disordered eating and body image?

Although data regarding body image in middle aged and older women remains sparse, a study published just this past month in the International Journal of Eating Disorders suggests that body dissatisfaction and drive for thinness do not diminish with age. In a survey of 715 women just out, of which 76.5% were married with children, 4.6% met full diagnostic criteria for an Eating Disorder and 4.8% met criteria for Subthreshold Eating Disorder (SED). 2 Together, that makes roughly 10%. So that means 71 of those women with children are suffering with disordered eating.

And yet the myth persists that eating disorders primarily affect adolescents. Why?

There is a reason why the myth that eating disorders affect young women in adolescence exists. According to the National Association of Anorexia and Associated Disorders (ANAD): Over one-half of teenage girls…use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.3 Adolescence is a huge rite of passage for a woman. When a rite of passage is not celebrated, ritualized, or supported, the growth required to complete crossing the threshold of this rite of passage goes underground. Mary Pipher, author of Reviving Ophelia: Saving the Selves of Adolescent Girls (2005), writes:

“I think anorexia is a metaphor. It is a young woman’s statement that she will become what the culture asks of its women, which is that they be thin and nonthreatening…Anorexic women signal with their bodies “I will take up only a small amount of space. I won’t get in the way.” They signal, “I won’t be intimidating or threatening. (Who is afraid of a seventy-pound adult?)” 4

Similar to adolescence, both parenting and middle age are rites of passage in a woman’s life. When not honored, seen, and embraced, these can also turn into eating disorders and body image distress. Ageing women also face the cultural taboos of not taking up too much space, speaking too loudly, or being seen and valued. They face the task of loving themselves and embracing aspects of the beauty of mortality, power, and wisdom that western media culture is terrified of in women: wrinkles, thick middles, saggy boobs, gray hair. I remember reading one article on “objectification theory” in my doctoral research that linked media and female body image obsession with western culture’s fear of mortality. Female body objectification may veil unconscious existential fears. 5 Other stress factors that affect women in middle age that are similar to adolescence are hormonal changes. However, middle age women also face different stressors such as: medical scares, death of a parent or a spouse, divorce, and career challenges. 6 Margo Maine, co-author of The Body Myth: Adult Women and the Pressure to be Perfect, writes:

Women in their 30s, 40s and beyond face increasing pressure to look slender and youthful despite years of childbearing, hormonal changes at menopause and the demands of careers, parenting and caring for aging relatives…Some researchers call it the ‘Desperate Housewives effect,’ referring to the cultural influence of the hit TV series, in which improbably thin women in their 40s prance around in short shorts. 7

It is an interesting journey being “advanced maternal age.” Sometimes I look at young(er) women or young(er) mothers and I think You look so not tired. Or Wow your stomach looks so not stretched. I remember that. That feels like a long time ago. Or I envy younger moms who are more likely to have their grandparents be present for their children’s growing up. My child will already never meet one of his Grandpas. He died before my baby was born. However, there are gifts I have being “middle aged” that I couldn’t have come by earlier in my journey. I had not yet solidified my eating disorder recovery in my twenties. I had not earned a doctoral degree in Psychology in my twenties. I had lots of ideas and lots of difficulty with follow-through. I thought being earnest would pay the rent. The concept of income needing to match or be greater than outgoing expenditures was not a concept I truly understood or felt applied to me. Because I now have financial clarity, I don’t have to “deprive,” “restrict” or  “binge” or “purge” with money, like I used to do with food in my twenties. Interestingly, though I hated my (flatter) stomach in my twenties, I now love my (stretched) stomach in my early middle age. I also have much more capacity to pause and come back to difficult interactions in relationships rather than avoid, hide, or leave. I would not have been ready for marriage in my twenties. I would not have had the “distress tolerance” skills to go toward a young child and stay emotionally present through individuation-attempting tantrums. I would have been inadvertently shaming or stuffed the discomfort with food. I can tolerate it now. I would not have been a good, or frankly even good-enough, mother in my twenties. I wasn’t ready. I remember studying for the Psychologist licensure exam learning that the executive function of the brain (the part that fully understand cause and effect and is able to therefore pause impulsive actions) is not fully developed until the late twenties, or even 30. Does that mean all women should only have children after age 35? Or that only women over 35 are good (enough) mothers? Of course not. And not all women are able to. One always has the potential to become a good (enough) mother. In fact, the eating disorder recovery process mirrors the journey of becoming a good enough mother to one’s self: allowing and embracing imperfection, listening to and honoring emotions, communicating clearly, getting enough sleep, eating in a balanced way, practicing mindfulness or spirituality, connecting with support. And THAT is always possible and always a work-in-process, regardless of one’s chronological age.

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Dr. Linda Shanti McCabe is a Mom and Licensed Clinical Psychologist who works with women recovering from Eating Disorders, Body image difficulty, Depression/Anxiety, Perinatal Mood Disorders, and New Mommy “boot camp.”You can read about her work professionally at www.drlindashanti.com

Resources:

1. T.J. Mathews, T.J. and Brady E. Hamilton, “Delayed Childbearing: More Women Are Having Their
First Child Later in Life,” Center for Disease Control NCHS Data Brief, Number 21, August 2009. http://www.cdc.gov/nchs/data/databriefs/db21.htm

2. Mangweth-Matzek, Barbara, Hoek, Hans W. et al, “Prevalence of eating Disorders in Middle-Aged Women,” International Journal of Eating Disorders2014; 47:320-324.

3. National Association of Anorexia Nervosa and Associated Disorders websitehttp://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/

4. Pipher, Mary, Reviving Ophelia: Saving the Selves of Adolescent Girls (2005).

5. Grabe, Shelly, Routledge, Clay, Cook, Alison, Anderson, Christie, and Arndt, Jamie “In defense of the Body: The Effect of Salience on Female Body Objectification”, Psychology of Women Quarterly, Vol 29, 2005.

6. Harding, Anne Eating disorders: Not just for the young, CNNHealth.com, June 27, 2012. http://www.cnn.com/2012/06/26/health/mental-health/eating-disorders-not-just-for-young/

7. Barton, Adriana, “Are middle-aged women succumbing to ‘Desperate Housewives syndrome’?” The Globe and Mail, March 6, 2013.http://www.theglobeandmail.com/life/health-and-fitness/are-middle-aged-women-succumbing-to-desperate-housewives-syndrome/article578178/

8. Tiggemann M., “Body image across the adult life span: Stability and change,”Body Image 2004; 1:29-41. 9. Slevec JH, Tiggemann M., “Predictors of body dissatisfaction and disordered eating in middle-aged women,” Clinical Psychology Review 2011; 31: 515-524.

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