In fact, middle age is a particularly vulnerable time, especially for women. “We view puberty and menopause both as high-risk periods for disordered eating,” says Cynthia M. Bulik, PhD, who is the founding director of the University of North Carolina (UNC) Center of Excellence for Eating Disorders in Chapel Hill, and author of Midlife Eating Disorders. “Pretty much universally, treatment programs have reported an increase in the number of women at midlife presenting for treatment,” Bulik says. That said, men are also at risk for the same eating disordered behaviors as women. The National Eating Disorders Association estimates that men account for 36 percent of people with binge eating disorder, 25 percent of people with anorexia nervosa, and 25 percent of people with bulimia nervosa. In older adults, an eating disorder can be a relapse or continuation of disordered eating patterns that first surfaced decades earlier. Or the problem can be brand-new. In either case, these illnesses can not only threaten an individual’s health but also bring distress, shame, and secrecy that threaten their relationships. There are no side-by-side comparisons of the incidence of eating disorders in different age groups. What we do know, according to a study published in the International Journal of Eating Disorders, is that an estimated 13 percent of U.S. women ages 50 or older currently have symptoms of an eating disorder. Research also shows that although rates of anorexia nervosa plateau around age 26, bulimia nervosa cases don’t peak until around age 47, and rates of binge eating disorder don’t peak until after age 70. Unfortunately, many older adults — and in some cases their doctors — don’t realize that eating disorders can occur at their age, leaving the illness unacknowledged and untreated. This, despite the fact that eating disorders have one of the highest mortality rates of any mental illness. We asked Bulik to explain which adults may be most vulnerable to developing an eating disorder at midlife and offer tips for detecting a problem and how to get help if needed. Everyday Health: Many people tend to think of adolescent girls when they think of eating disorders. What causes someone to develop an eating disorder in their forties, fifties, or later? Cynthia Bulik: Genetic factors are often at play among people with eating disorders, but your environment also plays a role. Your genes don’t change over time, but your environmental triggers may. Many factors that happen in midlife can trigger eating disorders:
Transitions, such as divorceEmpty nest or troubled nestBoomerang children, or children who return home after living on their ownLoss of parents, a partner, or another loved oneJob lossUnexpected decline in health
For women, there’s the impact that menopause has on one’s shape and weight. Most designers don’t change the way they design clothes for women whose shapes are changing. So women are constantly trying to fit themselves into clothes that were designed for how their bodies looked 20 years ago. We’re also seeing a societal expectation of not aging. In attempts to fend off aging, people may start engaging in extreme practices, such as intense exercise or cosmetic surgery, to try to maintain a youthful look. These behaviors can be the first steps toward a full-blown eating disorder. Having an adolescent daughter can be another trigger because it may remind women of what they used to look like. EH: What proportion of women in middle age have struggled with eating disorders in the past and are in effect relapsing, and what proportion are first-time cases? CB: About one-third of women had an eating disorder when they were younger and experience a midlife relapse. About one-third have been ill since adolescence, or they have hovered around a subthreshold condition in which they never fully recovered and then became more ill in midlife. And somewhat less than one-third have a new-onset eating disorder. EH: What eating disorders are most prevalent at midlife? CB: Officially, BED is the most prevalent. It’s complicated because many people with BED don’t even realize that they have a diagnosable and treatable condition. They have binge eating episodes, as well as shame and distress associated with them, without realizing that they are not alone and that effective treatments do exist. EH: How do the health consequences of eating disorders differ for younger people versus older people? CB: On the outside, the symptoms of midlife eating disorders often look the same as young-onset eating disorders, but there are significant differences. Eating disorders at any age take a toll on every bodily system. This is dangerous when you are young, but even more dangerous when your body is older and more vulnerable to the complications that can come with eating disorders. Gastrointestinal, cardiac, bone, and dental health all take an even greater hit in a maturing body. For instance, women who have had an eating disorder since they were young can have severe osteoporosis or bone loss. EH: How do eating disorders affect a person’s relationship with their spouse or partner? CB: Eating disorders can be very damaging to relationships. Many partners say that it feels like there are three people in the relationship — the person with the disorder, themselves, and the eating disorder. Many are extremely worried about their partner but don’t know what to do to help and fear that whatever they do will exacerbate the problem. The secrecy and deception that often accompany eating disorders may also make partners wonder if they can trust their loved one who has an eating disorder. For example, one might think, If they’re lying about what they eat, what else are they lying to me about? EH: How do treatments differ between teens and older adults, and which treatment is the most effective for older adults? CB: Sadly, this is a question to which we do not have a clear answer. At this stage, the treatment literature does not completely distinguish between youth and people in midlife, with the exception of recommending family-based treatment for youth with anorexia nervosa. At UNC in Chapel Hill, we have developed a treatment called UNITE, which stands for Uniting Couples in the Treatment of Eating Disorders. This treatment uses a cognitive behavioral couples therapy approach (meaning it focuses on changing unhelpful thoughts and behaviors) tailored to eating disorders to bring partners together in the recovery journey. Partners love it because it gives them a guidebook in how to help, and people with eating disorders benefit by having someone to hold them accountable and support and encourage them when their motivation for recovery wanes. For individuals who are not in committed relationships, individual psychotherapy continues to be the approach of choice. EH: If people read this and recognize these signs in themselves, what should they do? CB: It’s important to understand that these symptoms are not going to just go away. The best thing to do is go to your primary care physician for help. You need a thorough medical and mental health assessment, because in midlife it’s even more important to rule out other potential problems that might be masquerading as an eating disorder. One common problem, however, is that some primary care physicians will say things like, “Oh, you’re too old for that.” So you’ll need to find a doctor who is knowledgeable, understanding, and accepting, and will get you into the proper kinds of treatment. If you live close to a specialty clinic, such as in a university setting, that’s a good place to get treatment. But be sure to ask whether the clinic delivers evidence-based care for eating disorders. For people who don’t live close to a university-based center, online help is becoming increasingly available. RELATED: 5 Ways to Manage Eating Disorder Triggers Outside the Treatment Center
Resources We Love
Several organizations can connect you with a health professional who specializes in treating eating disorders. National Eating Disorders Association (NEDA) This organization offers a helpline to connect people with eating disorders or their loved ones with resources, support, and treatment options. Reach the helpline by calling or texting 800-931-2237, or join an online chat with a helpline volunteer. NEDA also has a tool that can help you find treatment based on where you live in the United States. National Association of Anorexia Nervosa and Associated Disorders (ANAD) This association allows people with eating disorders to get help via its helpline, peer support groups, or recovery mentors. Reach its helpline by dialing 888-375-7767. ANAD also offers a treatment directory to help connect you with a professional treatment center in your area.
