中年暴食症康复：应对内心的混乱

大家好，欢迎收听玛丽安·兰德医生的饮食失调康复播客。这是一个帮助您在与食物、饮食和身体形象问题上找到内心平静的播客。我是玛丽安·米勒医生，持证婚姻与家庭治疗师、饮食失调治疗师和暴食辅导教练。

Hello and welcome to Doctor. Maryann Land, an eating disorder recovery podcast. This is a podcast to help you find peace with food, eating, and body image issues. I'm Doctor. Maryann Miller, licensed marriage and family therapist, eating disorder therapist, and binge eating coach.

我非常高兴能与您分享故事、嘉宾访谈以及许多技巧和策略，以鼓励并帮助您从食物和身体形象问题中恢复过来。非常感谢您今天的收听。

I'm thrilled to share with you stories, guest spots, and many tips and strategies to encourage you and help you recover from food and body image issues. Thank you so much for listening today.

大家好，欢迎回到播客。我是玛丽安医生，饮食失调治疗师、神经多样性人士，也是一位坚信我们需要诚实地谈论康复现实的人，尤其是当这些现实与主流康复叙事所描述的应有样子不符时。今天，我想讨论一个我在工作中越来越频繁遇到的话题，一个很少被以应有的深度和关怀来探讨的话题：中年时期的暴食症，以及如何应对常常伴随而来的内心混乱。如果您正在收听，并且正处于三十多岁、四十多岁、五十多岁甚至六十多岁，仍在与暴食症作斗争，请听我说。

Hey, everyone, and welcome back to the podcast. I'm Doctor. Maryann, eating disorder therapist, neurodivergent human, and someone who believes we need to talk about the realities of recovery honestly, especially when those realities don't match what the mainstream recovery narrative says they're supposed to look like. Today, I want to talk about a topic I see coming up more and more in my work and one I rarely hear discussed with the depth and care it deserves, bulimia in midlife, and how to manage the internal chaos that often comes with it. If you're listening to this right now and you're in your thirties, forties, fifties, or even sixties still struggling with bulimia, please hear me.

您并不孤单。您没有落后。您仍在应对这个问题并没有什么可耻的。事实上，中年时期往往是暴食症的潜在驱动因素，如完美主义、掩饰、感官超载、创伤反应、悲伤、关系痛苦，开始以更响亮、更不容忽视的方式显现出来。因为您已经承受了太多太久，您的身体和大脑终于要求被倾听。

You are not alone. You are not behind. And there is nothing shameful about the fact that you're still navigating this. In fact, midlife is often when the underlying drivers of bulimia, like perfectionism, masking, sensory overload, trauma responses, grief, relational pain start showing up in louder, more undeniable ways. Because you've held so much for so long and your body and brain are finally asking to be heard.

对你们中的一些人来说，暴食症可能已经存在了几十年。对另一些人来说，它可能是最近才出现或重新出现的，也许是在一段长时间的白指关节式的准康复期甚至多年的完全压抑之后。中年时期可能会释放各种被压抑的情绪、未满足的需求和未解决的痛苦。您角色的变化，无论是为人父母、照顾老人、结束一段长期关系，还是对职业生涯产生疑问，都可能引发巨大的身份转变。而将所有事情处理好、保持一切井然有序的压力可能会让人感到难以承受。

For some of you, bulimia may have been present for decades. For others, it may have emerged or reemerged recently, maybe after a long stretch of white knuckled quasi recovery or even years of full suppression. Midlife can shake loose all kinds of suppressed emotion, unmet needs, and unresolved pain. Changes in your role, whether you're parenting, caregiving for elders, leaving a long term relationship, or questioning your career can bring up enormous identity shifts. And the pressure to hold it all together, to stay on top of things can feel unbearable.

对许多人来说，暴食-清除循环成了一种既令人羞耻又感觉必要的应对工具。说实话，它提供了结构、解脱感、控制感，然后混乱的螺旋就开始了。这种混乱往往不仅仅是行为上的。它是内在的。它可能让您感觉自己的思绪嘈杂且无休无止，好像您一直在追踪卡路里、体重、身体形象或下一次的失误。

For many, the binge purge cycle becomes a coping tool that feels both shameful and necessary. It gives structure, to be honest, relief, a sense of control, and then the spiral of chaos begins. That chaos often isn't just behavioral. It's internal. It can feel like your thoughts are loud and relentless, like you're constantly tracking calories, weight, body image, or the next slip up.

焦虑可能令人窒息。围绕食物的紧迫感可能像一种强迫症，淹没了其他一切。然后是内疚，羞耻的螺旋告诉您，您年纪太大了不该这样。您到现在应该更懂事了。您到底怎么了？

The anxiety can be suffocating. The urgency around food can feel like a compulsion that drowns out everything else. And then there's the guilt, the shame spiral that tells you, you're too old for this. You should know better by now. What's wrong with you?

那种声音，那种内化的羞耻感，并不属于你。它是你被教导去相信的东西。它源自一种惩罚女性和男性，尤其是肥胖女性、衰老女性、神经多样性女性，以及所有性别中那些不够无限讨喜、顺从、高效和克制的人的文化。当我们能看清羞耻的本质——一种控制形式时，我们就能开始缓慢、温柔地解开它。并且我确实想强调，我们不能忽视所有性别中正在经历中年贪食症的人们。

And that voice, that internalized shame, it's not yours. It's something you were taught to believe. It comes from a culture that punishes women and men, especially fat women, especially aging women, especially neurodivergent women, especially people of all genders for not being endlessly palatable, pleasing, productive, and contained. When we can see that shame for what it is, a form of control, we can begin to unravel it slowly, gently. And I do wanna emphasize that we cannot overlook people of all genders who are experiencing bulimia in midlife.

也许你在催吐，因为那是你行为模式的一部分。也许你在用过度运动作为补偿行为。它的表现方式多种多样。相信我，无论它经历什么，无论你经历什么，那种感觉都糟糕且非常混乱。我知道，因为那曾是我饮食失调康复之路的一部分，我有一种有些人称之为运动型贪食症的情况，那时我以为自己超级健康。

Maybe you're purging because that's part of the pattern that you do. Maybe you're using overexercising as a compensatory behavior. There's so many ways that can manifest. And believe me, regardless what it goes through, what you go through, it feels horrible and very chaotic. I know because that was part of my eating disorder recovery path is that I had what some people call is exercise bulimia, where I thought I was like super healthy.

但实际上，我会暴食，然后过度运动、过度运动、再过度运动来补偿暴食行为。结果，我经常受伤。我有慢性损伤，最终我的背部受伤严重到完全无法运动。所以，我们也要指出那些常被忽视的方面。中年贪食症可能看起来不同。

But it really was I would binge, and then I would over exercise, over exercise, over exercise to compensate for the binge eating. So as a result, I injured myself all the time. I had chronic injuries, and I eventually injured my back so badly that I couldn't exercise at all. So let's also name what often isn't said enough. Bulimia in midlife can look different.

正如我提到的，你可能不是在传统意义上催吐。你可能在使用其他形式的补偿。禁食可能是其中之一。像我经历过的过度运动、限制饮食，或者强迫性沉思。天哪。

You may not be purging in the traditional sense, as I mentioned. You may be using other forms of compensation. Fasting can be one. Overexercising, like I went through, restriction, or obsessive rumination. Oh my gosh.

那是我一直沉迷的事情——我会不停地计算卡路里并在脑子里反复思考。就像是饮食失调劫持了我的大脑，我无法全身心陪伴我的未婚夫，后来成为了我的丈夫。我很高兴那不再是我生活的一部分。当你挣扎时，你可能会在暴食期和所谓的‘饮食良好’的长期间交替。你甚至可能觉得自己病得不够严重，不足以被重视，尤其是如果你在工作、家庭或社区中功能水平很高。

That's something that I engaged at all the time is that I would just be constantly counting calories and thinking in my mind. And it's like the eating disorder hijacked my brain, and I wasn't able to be present with my fiancee turned into my husband. I'm so glad that that's not a part of my life anymore. When when you are struggling, you might alternate between periods of binge eating and long periods of quote, good with food. You might even feel like you're not sick enough to count, especially if you functioned at a high level in your job, your family, or your community.

我以为自己只是在保持健康。我不知道自己正深陷饮食失调之中。但贪食症并不总是符合刻板印象。它不在乎你多大年纪、体重多少、你的生活从外面看起来如何，甚至你的身体从外面看起来如何。它是一种应对机制，一种在感觉难以承受时生存下去的方式。

I thought that I was just being healthy. I didn't know that I was in the thick of my eating disorder. But bulimia doesn't always match the stereotypes. It doesn't care how old you are, what you weigh, or what your life looks like from the outside, even what your body looks like from the outside. It's a coping mechanism, a way to survive what feels too much.

而你值得获得支持，句号。现在我想转向这次对话中至关重要的一点，这一点在大多数治疗模式中常被忽略。当你身为神经多样性者并在中年挣扎于贪食症时，会发生什么？这一层为康复经历增添了如此多的深度和复杂性。对你们中的许多人来说，可能直到最近才发现自己是神经多样性者。

And you deserve support, full stop. Now I want to shift into something that is crucial to this conversation, something that is often ignored in most treatment models. What happens when you're neurodivergent and struggling with bulimia in midlife? This layer adds so much depth and complexity to the experience of recovery. And for many of you, you might have only recently discovered that you're neurodivergent.

你可能和我一样是自闭症患者。你可能患有ADHD，或者与PDA特征产生共鸣，即普遍性驱动力。抱歉，是普遍性自主驱动力。又或者，即使从未有过正式诊断，你也一直感觉自己的大脑运作方式与众不同。

You might be autistic like me. You may have ADHD or resonate with a PDA profile, which is pervasive drive. Sorry. Pervasive drive for autonomy. Or maybe you've always sensed that your brain works differently even if you've never had a formal diagnosis.

这种认识既让人解脱又令人迷茫。它能解释很多问题：为什么你难以适应刻板的日常，为什么某些食物难以下咽，为什么感官过载会让你陷入崩溃和暴食循环，为什么你在社交场合掩饰需求而后私下崩溃。如果

That realization can be both liberating and disorienting. It can explain so much why you've struggled with rigid routines, why certain foods feel impossible, why sensory overload pushes you into shutdown and binge cycles, why you mask your needs and social situations and then fall apart later in private. If

这个

this

与你的经历产生共鸣，你不是在臆想。越来越多证据表明，许多饮食失调症（包括暴食症）与神经多样性存在深刻交集。例如，如果你有ADHD，可能会在冲动控制、情绪调节和时间感知方面挣扎，这些都影响饮食模式。你可能无意间错过正餐，直到夜晚身体发出信号才暴食。如果你是自闭症患者，可能通过饮食仪式自我安抚或规划日程，但当常规被打乱时又会不知所措。

is resonating with you, you are not imagining it. There is growing evidence that many eating disorders, bulimia included, intersect with neurodivergence in profound ways. For example, if you have ADHD, you might struggle with impulsivity, emotional dysregulation, and time blindness, all of which can affect your eating patterns. You might skip meals without realizing it, then binge at night when your body finally gets your attention. And if you're autistic, you might use food rituals to self soothe or structure your day, but then become overwhelmed when those routines are disrupted.

我深有体会。你可能因感官需求反复吃相同食物，或因社交伪装避免在他人面前进食。当我们忽视神经多样性与饮食失调治疗时，实则是将那些对不包容世界的合理适应性反应归咎于人。神经多样性人群的康复（尤其是中年阶段）必须有所不同，需要以你的感官特征、调节策略、自主需求、伪装经历、神经系统阈值，以及与结构和灵活性的关系为核心。

I can relate to that. You might eat the same foods over and over for sensory reasons, Or you might avoid eating in front of others because of social masking. When we ignore neurodivergence and eating disorder treatment, we end up blaming people for behaviors that are actually logical adaptive responses to a world that doesn't accommodate their needs. Recovery for neurodivergent humans, especially in midlife, must be different. It has to center your sensory profile, your regulation strategies, your need for autonomy, your history of masking, your nervous system thresholds, and your relationship with structure and flexibility.

举个例子：神经典型康复方案可能强调严格按时间表执行三餐两点。但对具有波动性内感受（即身体感知）或执行功能挑战的神经多样性人群，这种计划可能完全难以实施甚至引发症状。何不转而构建真正适合你神经系统的内在信号与外部支持体系？何不将暴食视为信号而非症状？

Let me give you an example. A neurotypical recovery approach might emphasize eating three meals and two snacks per day on a pretty rigid schedule. And for a neurodivergent person with fluctuating interoception, that's body awareness, or executive functioning challenges, that plan might feel completely inaccessible or even triggering. Instead, what if we focused on building internal cues and external support structures that actually work for your nervous system? What if we treated your bingeing as a signal, not a symptom?

何不探索用非食物方式满足相同需求？多巴胺刺激、舒适感、规律性、共同调节。在中年阶段，这项工作愈发重要，因为你不再需要迎合他人定义的成功或价值。你累了，已经无需再向谁证明。

What if we explored non food ways of meeting the same needs? Dopamine stimulation, comfort, routine, co regulation. In midlife, this work becomes even more important because you're no longer trying to fit into someone else's version of success or worth. You're tired. You've done enough proving.

现在，工作转向了关于真相，关于你需要感到安全、踏实、被支持和自由。在这种背景下，康复不是关于顺从，而是关于与自己、与你的需求、与你的身体协作。是关于缓慢而温柔地用关怀和同情取代混乱。不是完美的关怀，不是始终如一的关怀，而是调谐的关怀。

And now the work becomes about truth, about what you need to feel safe, grounded, supported, and free. Recovery in this context is not about compliance. It's about collaboration with yourself, with your needs, with your body. It's about slowly, gently replacing the chaos with care and compassion. Not perfect care, not always consistent care, attuned care.

这可能意味着设定与节食文化对话的界限，或减少用餐时的感官输入，或在每个包、抽屉甚至车里备有备用零食，或将休息视为一种抵抗。让我们再谈谈另一点。中年时期的悲伤是真实存在的。真的，让我告诉你。你可能在为与身体作战的岁月而悲伤，为那些从未理解你的人而悲伤，为因强迫行为和仪式而失去的时间而悲伤，或为你的痛苦长久未被承认而悲伤。

And that might mean setting boundaries with diet culture conversations, or reducing sensory input at mealtimes, or having backup snacks in every bag and drawer and even in your car, or leaning into rest as resistance. And let's name something else. Midlife grief is real. Boy, let me tell you. You might be grieving the years you spent at war with your body, grieving the people who never understood, grieving the time lost to obsession and rituals, or grieving the realization that your pain went unacknowledged for so long.

有时，当言语无法表达时，贪食症是你的身体表达那种悲伤的方式。但我想让你知道的是，无论你与贪食症斗争了多久，你都可以痊愈。不是那种光鲜的Instagram康复方式，也不是那种仅仅爱自己身体的方式，而是真实的、具体的、混乱的、渐进的、不完美的方式。你可以学会用同情来回应混乱。

And sometimes bulimia is your body's way of expressing that grief when there are no words. But here's what I want you to know. You can heal no matter how long you've been struggling with bulimia. Not in the glittery Instagram recovery way, not in the just love your body way, but in the real embodied, messy, incremental way, an imperfect way. You can learn to respond to the chaos with compassion.

你可以建立不依赖伤害的调节策略。你可以练习放下羞耻感，哪怕只是一瞬间。你可以建立不需要解释你的应对方式或掩饰痛苦的关系。而且，是的，你可以在中年康复，尤其是在中年。因为这个阶段的康复不仅仅是关于症状的减少。

You can build regulation strategies that don't rely on harm. You can practice letting go of shame even for just a moment. You can build relationships where you don't have to explain your coping or mask your pain. And, yes, you can recover even in midlife, especially in midlife. Because recovery at this stage isn't just about symptom reduction.

它是关于重新获得你的能量、你的注意力、你的柔软、你的愤怒、你的快乐、你的智慧。是关于决定你不再接受惩罚，你已经受够了退缩、麻木和沉默自己，你想要的是和平，而不是完美。如果你正在寻找尊重所有这些的支持——感官混乱、暴食清除循环、晚期诊断、倦怠、中年悲伤——我想亲自邀请你加入我的暴食康复会员计划。尽管名称中有暴食，但许多成员是神经多样性者，正在从贪食症、强迫性进食和限制中康复。这个空间旨在帮助你毫无羞耻地连接你的身体和需求。

It's about reclaiming your energy, your attention, your softness, your rage, your joy, your wisdom. It's about deciding that you are no longer available for punishment, that you are done shrinking, numbing, and silencing yourself, that you want peace, not perfection. If you're looking for support that honors all of this, the sensory chaos, the binge purge cycle, the late diagnosis, the burnout, the midlife grief, I want to personally invite you to join my binge eating recovery membership. Even though binge eating is in the name, many members are neurodivergent and recovering from bulimia, compulsive eating, and restriction. This space is designed to help you connect with your body and your needs without shame.

你可以在我的网站doctormaryannmiller.com上了解更多，点击暴食标签。非常感谢你在这里。感谢你选择真相，感谢你继续为自己、为你的故事、为更温柔的可能性而出现。下次见。

You can learn at my website, doctor Maryann Miller dot com, and click on the binge eating tab. Thank you so much for being here. Thank you for choosing truth, and thank you for continuing to show up for yourself, for your story, for the possibility of something gentler. Until next time.

感谢你在玛丽安博士的播客上与我共度时光。如果你还没有关注我，请在Instagram上关注doctormaryannmiller。如需在食物、饮食、身体形象问题方面获得进一步支持，请访问doctormaryannmiller.com。如果你喜欢这个播客，如果你能关注、评分或评论，我将非常高兴，因为这能帮助更多听众。非常感谢你今天收听。

Thanks for hanging out with me on doctor Maryann Land. If you're not following me already, please do so at doctor Maryann Miller on Instagram. For further support with food, eating, body image issues, go to doctormaryannmiller.com. If you enjoyed this podcast, I'd be thrilled if you gave it a follow or rated or reviewed it as it helps so many more listeners. Thank you so much for listening today.

下次我们在玛丽安医生的地盘见。

I'll see you next time in Doctor. Maryann land.