When Lisa Knopp was 54, she began tightly restricting what and how much she ate. A whisper, a shadow, or a flicker is what she wanted to become. When she finally realized that the severe restricting that had left her sick and small when she was 15 and 25 had returned when she was deep into middle age, she was full of urgent questions. Why did she respond to that which overwhelmed or threatened her by eating so little? How could she heal from a condition that is caused by a tangle of genetic, biological, familial, psychological, economic, spiritual, and cultural forces? Are eating disorders and disordered eating in older women caused by the same factors as those in younger females? Or are they caused, in part, by the sorrows and frustrations of aging in a culture that sees midlife and beyond as a time marked by increasing deterioration, powerlessness, dependency, and irrelevance?

Knopp’s focus on eating disorders among older women makes Bread unique among “anorexia memoirs.” Most experts agree that about 10 percent of those with eating disorders are older women, though the number is surely higher, since most women who restrict, binge, or purge don’t meet the narrow diagnostic criteria for anorexia nervosa, bulimia nervosa, or binge-eating disorder. And, too, many in this group disguise or misread their symptoms as being due to a health condition or changes associated with aging. For teenagers, symptoms usually manifest as a result of problems in their family of origin. But for older women, symptoms are more likely to manifest as a result of changes in the family they created, including divorce, infidelity, relationship conflicts, an empty nest, financial strains, a child with medical, emotional, or legal problems, and the demands of caring for a sick or aged parent, as well as their own health problems and fear of aging.

In her search for answers, Knopp read the research on eating disorders and imaginatively reentered those dark periods when she was self-starving. Bread, which is at once an illness, food, and spiritual memoir, will convince readers, both those who suffer from a conflicted relationship with food, weight, and self-image and those who do not, that eating disorders and disordered eating are about more than just food and weight. Indeed, they speak of our deepest hungers and desires and the various ways in which we can nourish and fill ourselves.

Over the past decade, there have been substantial and rapidly changing developments in the treatment of eating disorders. Grounded in the most recent literature, The Outpatient Treatment of Eating Disorders balances general and pathology-specific research to emphasize outpatient treatment. The contributors provide an overview of the full range of eating disorders and offer clinical recommendations for a comprehensive treatment plan for patients with these disorders.

These distinguished contributors present case studies and hands-on treatment models based on cognitive behavioral techniques. Using three vignettes-a woman with anorexia nervosa, a woman with bulimia nervosa, and a man with binge eating disorder-the authors offer practical approaches, including extensive nutritional information for dietitians, for treating these three major forms of eating disorders. Designed for all health care workers who deal with eating disorder patients, this indispensable guide will be useful for psychiatrists, other physicians, psychologists, social workers, exercise physiologists, and dietitians as well as those who suffer from eating disorders.

Contributors: David W. Abbott, U of North Dakota; Roslyn Binford, U of Minnesota; Carol Brunzell, Fairview-University Medical Center; Scott Crow, U of Minnesota; Mary Hendrickson-Nelson, HealthPartners of Minnesota; Susan Jack, Fairview-University Medical Center; Pamela K. Keel, Harvard U; Melissa Pederson Mussell, U of St. Thomas; Carol Peterson, U of Minnesota; Claire Pomeroy, U of Kentucky; LeAnn Snow, U of Minnesota; Stephen A. Wonderlich, U of North Dakota; and Martina de Zwaan, University Hospital, Vienna.