Eating disorders don’t discriminate. People of all ages and backgrounds can have an eating disorder — including the middle-aged!

Historically, eating disorders have been more common in young women ages 12-25, according to Johns Hopkins. However, today more middle-aged adults (ages 40-something and older) have been diagnosed with eating disorders than in the past.

This blog post explores why rates of eating disorders are rising among the middle-aged, how to recognize an eating disorder in a middle-aged loved one and where to seek help for an eating disorder in you or someone you love.

Who Gets Eating Disorders?

Eating disorders aren’t just a problem for young women. For example, in the past, we’ve written on this blog about how eating disorders affect men. They too struggle with body image and body dysmorphia, even if it’s not talked about as much.

Similarly, eating disorders are not only a problem among youth but also affect middle-aged and older adults of all genders, sexualities and backgrounds. Below, we explore some of the real causes of eating disorders, beyond the stereotypes and assumptions that are often made about the eating disorder-affected population.

Causes of Eating Disorders

The National Eating Disorders Association (NEDA) states that there are multiple causes of eating disorders: “Biologically, studies of families have found that having a first-degree relative (like a parent or sibling) with an eating disorder increases a person’s risk of developing an eating disorder.”

Other mental illnesses can also play a part in the development of an eating disorder. “Issues like anxiety, depression, and can also run in families and have been shown to increase the chances a person will develop an eating disorder,” according to NEDA.

Anxiety disorders, in particular, are linked to the development of an eating disorder, since they can lead to rigid and inflexible thinking as well as perfectionism. These patterns of thought and behavior may lead a person to strive for an unattainable standard of beauty, label foods as “good” and “bad” and engage in other disordered eating habits that can lead to an eating disorder when left untreated.

NEDA also lists the following additional risk factors as important predispositions to developing an eating disorder:

• History of dieting. A history of dieting, or being in negative energy balance (burning more calories than one is consuming), can contribute to the development of an eating disorder. This is why not only dieting but also intense sports, growth spurts and even illness can trigger the development of an eating disorder: all these events may lead a person to eat fewer calories than they expend.
• Type I diabetes. Diabetes, and in particular Type I diabetes, is a surprising risk factor for an eating disorder. According to recent research, one-quarter of women diagnosed with Type I diabetes will go on to develop an eating disorder. The most common pattern is skipping insulin injections to control weight, known as diabulimia — a condition that can be deadly.
• Bullying and/or weight stigma. As much as 60% of people affected by an eating disorder said bullying contributed to the development of their disorder, according to NEDA. Similarly, society harbors a stigma against people who are overweight, and spreads the harmful message that “thinner is better.” This messaging affects us all, whether we realize it or not — and when combined with other risk factors, can lead people to develop eating disorders.

Eating Disorders Among the Middle-Aged

You would think that rates of eating disorders would decline as we get older since our lives tend to be more settled when we are in middle-age than when are in our 20s and 30s. However, eating disorders just don’t go away when you reach a certain age. There’s no one “magic number” where the diagnosis of an eating disorder suddenly disappears!

The Washington Post looked at the phenomenon of eating disorders in the middle-aged and found a number of previous studies that named startling statistics. For example, one 2012 study estimated that 13% of American women ages 50 and older have eating disorder symptoms. Another study conducted in 2017 found that 3.5% of women ages 40 and older have a diagnosable eating disorder — yet most are not receiving treatment.

In fact, some eating disorders — like bulimia and binge-eating disorder — peak in middle age and even older, suggesting that they are not a young woman’s problem at all, but rather, a problem deeply affecting middle-aged adults! One study, according to the Post, even suggested that rates of bulimia continue to rise until approximately age 47, and rates of binge-eating disorder do not plateau until the 70s.

Why People Get Eating Disorders in Middle Age

So, why do we continue to believe that eating disorders are a problem exclusive to younger women when so many middle-aged women suffer from them? And more importantly, why do so many middle-aged women get eating disorders?

Many women may have struggled with unhealthy views about food and patterns of deprivation throughout their life. There may also be mental trauma or psychological issues from the past that have not been dealt with. When these problems lead to disordered eating habits, disordered eating may build up over time until a person eventually develops a full-blown eating disorder.

For women who did not struggle with food, weight or body image prior to middle age, the pressures of aging can sometimes contribute to an eating disorder. It’s normal for our bodies to change as we get older, yet some people may find it more difficult to cope with these routine changes than others. If a person is especially distressed by changes in weight or body image as they age, they may turn to unhealthy habits — like disordered eating — in an attempt to reverse or stop these changes altogether.

Middle Age and Eating Disorder Relapses

Eating disorders may also continue to affect women in middle age who thought they were “done” dealing with their eating disorder. If a woman suffered from anorexia or bulimia when she was young, yet did not fully cope with her disorder, she may find herself relapsing during the stress of the changes that occur during middle age.

As perimenopause and menopause start to kick in, women’s bodies undergo a lot of stress. Their bodies change; they feel like they can’t eat like they used to or else they will gain weight. They get night sweats and mood swings. These physical changes alone can serve as the stressor that triggers an eating disorder relapse. 

Or, stressful live events unique to middle age may compound on the patient and trigger a relapse. Things like divorces, sudden life changes, a child or a parent’s death and terminal illness can all contribute to an eating disorder relapse in a middle-aged patient — even if she thought her eating disorder had been “cured” in her youth.

Treating Eating Disorders in Middle-Aged Patients

One of the best types of treatment for an eating disorder is at an outpatient treatment facility. Outpatient treatment is unique in that a person can still maintain their daily routine while getting support for their eating disorder. They can talk about their struggles in a safe environment and receive counseling, family counseling, medication management (if needed) and the support of others struggling with similar challenges. They also learn about meal prep and nutrition…. And, they can partake in all of these options while continuing to work, study, see friends and do all of the things they would do in their ordinary life.

For patients who need more intensive care, but who do not want to commit to inpatient treatment, Intensive Outpatient Programs (IOPs) and Partial Hospitalization Programs (PHPs) offer positive solutions for treatment. During these programs, patients meet with psychiatrists, clinicians and hospital staff 3-5 days per week to learn skills related to coping with negative emotions, thoughts and behaviors that contribute to their eating disorders.

Oftentimes, these outpatient programs are specific to patients with eating disorders, so they will meet with groups of other patients who also suffer from similar problems. A major benefit of IOPs and PHPs is that the patient is always supervised by hospital staff while at the program, so loved ones do not need to worry that they will engage in self-harm or eating disorder behaviors if they are allowed to go without hospitalization. Instead, hospital staff will supervise them while they are at the program, and check-in with them about behaviors that occur outside the program, to ensure they are making progress in their treatment.

Types of Therapy for Eating Disorders

Any type of outpatient treatment for an eating disorder will draw on multiple types of therapeutic approaches. Many focus on one approach (for example, seeing a therapist who specializes in CBT) while others may combine multiple approaches.

Several types of psychotherapy therapy can be used when treating eating disorders. Here are three of the most popular approaches:

The first is Acceptance and Commitment Therapy (ACT). This is where patients are challenged to change their actions rather than their thoughts like traditional therapy. For a patient with an eating disorder, this may begin with stopping eating disorder behaviors, rather than beginning with addressing negative thought patterns.

The second form of therapy is Cognitive Behavioral Therapy (CBT). This therapy focuses more on addressing the patient’s self-limiting and/or distorted beliefs about how their body, shape and weight, which in turn helps the patient stop using negative coping strategies (like eating disorder behaviors) to deal with those thoughts and emotions that arise as a result.

Thirdly, Interpersonal Psychotherapy (IPT), while less popular, may also be used to treat an eating disorder in a middle-aged patient. According to NEDA, “IPT is associated with specific tasks and strategies linked to the resolution of a specified interpersonal problem area. The four problem areas include grief, interpersonal role disputes, role transitions and interpersonal deficits.” IPT functions based on the belief that helping a person deal with problems in their relationships with others will help them feel more positively about themselves.

Growing older is difficult. In your middle age, you’re expected to have your whole world together and to be someone that is “too mature” to struggle with eating disorders. However, that mentality is part of the reason why many adults entering middle age struggle to come to terms with or get diagnosed with an eating disorder.

Expectations are high for adults to “be okay” and in a world where body image ties in tightly to how we see ourselves – and how other people may see us – that means that adults are still struggling to love themselves and the bodies they’re in.

Eating disorders aren’t disorders that only happen to teenagers. If you feel as though you are having issues with eating that might be a sign of dealing with an eating disorder, don’t let your age stop you. Get help at a facility like The Meadowglade where we understand exactly what you’re going through!