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Flying under the radar: first hospitalisation with anorexia nervosa at age 54

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“Is it better to walk 10 hours or cut myself … I found it reinforcing to feel a ‘lightness’ … I was surviving like a beast.. I would easily fall into a deep depression if I got better”, recounted a 54-year-old woman with a 40-year history of eating disorder, admitted to hospital for the first time with complications of her illness.

Anorexia nervosa is an often recalcitrant condition, remarkably immutable to change, due to the effect of behaviour reinforcement.1 There is also a growing literature about women with this disease presenting later in life. Body image dissatisfaction is an enduring issue for many women, with one study finding that 3.8% of women aged 60–70 years meet the criteria for having an eating disorder.2

The Diagnostic and statistical manual of mental disorders, fifth edition, has broadened the criteria for anorexia nervosa to allow for persistent behaviours that resist weight gain even in the absence of distorted body image. With this criterion, a recent study found that the prevalence of anorexia nervosa in the Australian population was about 0.46%.3 Earlier research had shown that more people with anorexia nervosa were surviving in the community than were being cared for in primary care or mental health facilities.4