Eating Disorders In Middle Age Bring Unique Challenges, Treatments

Health Issue Midlifers May Be Ashamed To Admit

While young women are often the faces of eating disorders, diseases such as anorexia, bulimia and binge eating can affect any age -- and recent data suggest the numbers are rising among middle-aged women. The issue is in the spotlight in the U.S. during National Eating Disorders Awareness Week, which runs through March 3.

Post 50 women with eating disorders, known as "EDs," may face unique emotional and physical issues. “Women at mid-life now have unprecedented opportunities and also unprecedented stresses,” Merryl Bear, director of Canada's National Eating Disorder Information Centre, told the Toronto Star. “There’s an increased fear of aging and societal pressures to change one’s body to bring it closer to the societal ideal.”

From 2001 to 2010, the rate of EDs among the middle-aged increased by 42 percent, said Holly Grishkat, Ph.D., regional assistant vice president and director of The Renfrew Center in Radnor, Pa., an eating disorder treatment center.

An Australian study published in 2008 also revealed a rise in eating disorders in older adults, particularly with binge eating and food restriction. The study found that in adults between 55 and 64, binge eating increased from 1.7 percent in 1995 to 7.4 percent in 2005, and strict dieting or fasting increased from zero percent in 1995 to 9.7 percent in 2005.

While concerning, these numbers may largely reflect individuals with histories of eating problems, rather than new cases, experts say. Many who face eating disorders in midlife have confronted them in the past. In fact, 94 percent of middle-aged women who are anorexic developed the disorder when they were younger.

"It’s rare -- not impossible, but rare -- for a woman 50 or beyond to develop an eating disorder for the first time," said Dr. Margo Maine, clinical psychologist and co-author of "The Body Myth: Adult Women and the Pressure to Be Perfect." "Most in their 50s and 60s are women who had eating disorders when they were younger."

That doesn't mean middle-agers' experiences with eating disorders are the same, however. Since EDs are frequently associated with younger women, older adults may be ashamed to admit that they have these disorders. As one middle-ager confided on a message board: "People always refer to bulimia as an adolescent disease; I feel like such a failure that I’m almost 50."

Grishkat believes shame is a significant component of eating disorders in middle age. "I think women who are coming out with it in midlife feel like 'I should be the role model here and not the one with the disorder,'" she said.

Older women often remain silent during group therapy sessions with younger women, Grishkat added.

Acknowledging these struggles, Renfrew has created a program called "30-Something And Beyond," which is specifically for adult women who suffer from EDs. This in-patient program places women with roommates of a similar age and in therapy groups that focus on issues more likely to affect middle-agers. (Renfrew also provides outpatient, midlife-focused therapy groups.)

Through this program, Renfrew can focus on triggers that are specific to its middle-aged patients.

One such trigger is loss, which "tends to be a big underlying factor for eating disorders," Grishkat said. Midlifers may be dealing with a range of loss, from ailing and dying parents to children moving out, to divorce -- factors that may not resonate with the younger generation.

One post 50 who has dealt with loss and an eating disorder is Mary Sponhaltz, who discussed her experience with The Eating Disorder Center of Denver. Sponhaltz struggled with anorexia in the wake of her father's death from cancer. Over three years, Sponhaltz tended to her father, leaving her husband and children for long periods.

“I was already worn thin emotionally and losing weight drastically when he was alive because I wasn’t taking care of myself," Sponhaltz told The Eating Disorder Center of Denver. "But once he died, the eating disorder kicked in. It numbed me so I wouldn’t have to feel.”

Aging is another potential trigger. Physical changes in midlife may cause or reignite eating disorders. As psychiatrist Anne E. Becker -- director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital and president of the Academy for Eating Disorders -- recently told Harvard Women's Health Watch:

As our society values youth and as baby-boomers reinvent what it means to be middle-aged, there are growing social forces that can undermine older women's self-esteem and potentially lead to body dissatisfaction — for example, if you think the surface of your skin or the contours of your body aren't supposed to match your chronological age. That, combined with health concerns about obesity, can make people feel bad about their bodies and, in turn, could result in eating strategies that undermine well-being.

In an Austrian study of 475 women between 60 and 70 years old, published in the International Journal of Eating Disorders in 2006, 45 percent of the women indicated that their self-esteem depended on their shape and weight. The same study revealed that "over 60 percent [of the women] stated 'moderate' or 'low' satisfaction with weight and shape."

This pressure to maintain youth may stem from the culture in which post 50s grew up. Dr. Blake Woodside, director of Toronto General Hospital's in-patient eating disorder program, told the Toronto Star that the increase in midlife eating disorders can be traced to the '60s, when ideals changed and the "thin is in" culture materialized.

Whatever the cause, eating disorders can have serious side effects, including osteoporosis, heart problems and gastrointestinal issues. In a recent interview with Life Goes Strong, an online site for midlifers, Dr. Emmett Bishop, MD, FAED, CEDS -- founding partner and medical director of adult services at the Eating Recovery Center -- outlined some specific health issues that middle-agers with EDs may face:

Older individuals have much less resilience when it comes to physical damage from eating disorders. A lot of things can go wrong with vital organs, bone density can be impacted, dental health can suffer, and as tissues become less elastic, I've seen people aspirate from purging. A whole host of medical issues can arise as people abuse their bodies over time. Eating disorders are the deadliest mental illnesses and premature death is very common.

Older women also face somber statistics when it comes to EDs and death. Senior women comprise 78 percent of all deaths caused by anorexia, and the average age that women die from the disease is 69.

But middle-agers with EDs shouldn't give up. "There's hope," Grishkat said. "Even if you've had [an eating disorder] for 30 years, our data show that the women in midlife and older tend to be more determined and ready for recovery than a lot of the younger women."

If you're struggling with an eating disorder, call the National Eating Disorders ( helpline at 1-800-931-2237.

To learn more about National Eating Disorders Awareness Week, click here.

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