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Anorexia and bulimia are diseases that involve alterations in brain chemistry. The choices women make for the direction of their lives, however, can help them overcome brain chemistry.

Anorexia and bulimia are psychiatric disorders, and there is a strong psychological component in both conditions. It's a not weakness of willpower or a quirk of character, however, that makes someone anorexic or bulimic.
Both anorexia and bulimia seem to involve alterations in the production of a hormone known as brain-derived neurotrophic factor. This complex protein has a number of functions in the brain. Among those functions is to stimulate the growth of neurons that produce and respond to the reward chemical dopamine. If you don't have enough dopamine in your brain, you don't feel the "joy" that most people feel after everyday activities, especially eating. More and more eating is needed for the brain to register "enough." People who have either anorexia or bulimia may also have problems with hyper-sexuality, hoarding, gambling, shopping, or "punding," which is a prolonged feeling of purposelessness.

On the other hand, exercise and starvation seem to increase the production of brain-derived neurotrophic factor. The lack of the factor causes the need to eat (with or without purging). But people also learn that they feel better when they work out extremely hard or starve themselves. Moreover, the effects of brain-derived neurotrophic factor , or not having enough of it, are mediated through another protein called neuropeptide Y. People who have anorexia or bulimia experience literal, physical pain when they don't eat. But they also experience freedom from compulsion to eat when they don't eat. That's why binging is following purging and people who develop anorexia also tend to develop bulimia. But can be done about it?

Cassandra seems to have been on the right track. Participating in iron woman triathlons gave her a lasting sense of satisfaction that made her feel better even when she was not running, biking, or swimming on a course on Hawaii or Crete. She felt better about herself all the time because of exercise choices—far more than if she had tried to work off the calories she felt compelled to consume on by spending hours on an elliptical trainer or an exercise bike.

Cassandra's symptoms emerged about the time she was completing off the major items on her personal "bucket list," getting the kids through school, earning a doctor's degree, owning a house, achieving a position of respect. These activities no longer provided the dopamine boost her brain was looking for, so she developed an unmanageable attraction to food.
 
Some women in midlife, of course, develop the opposite problem, anorexia. Both bulimics and anorexics of either sex need medical care . However, the choices people can make to keep their condition under control center on finding goals and activities that are even more meaningful than eating  (if they are bulimic) or worth looking fat (if they are anorexic).

Human will is a powerful force. Love is a powerful force, too. Women in midlife usually have had experiences that have led them to make sacrifices for others. The key to overcoming eating disorders may be the willingness to make sacrifices for themselves, finding goals in life that are even more important than self-image or the sensation of food. It's still important to get all the help that can be found, but understanding the nature of the disease can lead to the choices that overcome it.