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Diagnosis of Eating Disorders in Older Women Increases as Awareness Grows

When it comes to eating disorders, the conventional wisdom -- or the belief that anorexia, bulimia and other related disorders are a "teenage girl's disease" -- isn't so wise. In fact, it's just plain wrong.
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When it comes to eating disorders, the conventional wisdom -- or the belief that anorexia, bulimia and other related disorders are a "teenage girl's disease" -- isn't so wise. In fact, it's just plain wrong. While it is true that the majority of eating disorders (95 percent) first display in young women between the ages of 12 and 25.8, eating disorders affect individuals of all ages. In fact, the patients admitted to Eating Recovery Center ranged from 9 to 81 years old in 2011.

The emergence of eating disorders in older women has individuals, families and even medical, psychological and dietary professionals scratching their heads. They're often incredulous that the serious symptoms and behaviors they're observing in their loved one or patient is actually an eating disorder, asking themselves: "How could this be an eating disorder? They're too old!" Because eating disorders don't discriminate by age, no one is too old for an eating disorder.

I asked my colleague Enola Gorham, LCSW, CEDS, clinical director of adult services at Eating Recovery Center, to answer several common questions about the topic of eating disorders in older women.

Question: Are more middle-aged women getting eating disorders? Or are we just getting better at diagnosing these illnesses?

Answer: There has most likely always been a large group of women who have had eating disorders, but were never diagnosed because doctors and therapists weren't trained in identifying the disorder. We're now seeing more older women with eating disorders seek treatment because the diagnostic criteria is understood by more doctors and other practitioners, who are increasingly looking beyond the "classic" young girl population as the only ones who can develop the illness.

Previously, many women spent time working with their doctors trying to find a medical reason for their eating issues, and doctors simply didn't look for eating disorders in older/adult women. In fact, their training would have compelled them to look to irritable bowel syndrome (IBS) or other medical issues and the eating-related symptoms of women suffering from anorexia, bulimia or other related disorders likely wouldn't have been identified correctly as an eating disorder.

Some mature women continue to be in treatment as they enter middle age, while others have never had treatment despite knowing they needed it. For this latter group, a common excuse for avoiding treatment during their younger years was a laser focus on their families, children and/or jobs. Seeking treatment at middle age is a byproduct of finally having time to spend getting help, or because their families or careers were negatively affected and the problem could no longer be ignored.

Q: Why do eating disorders affect women in middle age?

A: It appears that only a small minority of women "start" their eating disorder in middle age; rather, most women have had the disorder long before it was a looked-for diagnosis and simply struggled with their illness on their own. In some instances, however, an eating disorder could result from a major mid-life stressor or trauma that propels individuals into a hyper-vigilant, control/protect stance. A life transition -- such as divorce, kids leaving home or parents dying -- can also trigger a middle-aged woman to turn to food management as an emotional coping mechanism, particularly among those with "type A" personality traits of perfectionism, persistence and anxiety.

Q: What are the unique challenges to eating disorders treatment in middle age?

A: Middle-aged women can be a difficult patient population to treat for several reasons. If they have had the illness for a very long time and it has become an ingrained coping mechanism, it can be hard for them to even imagine stopping. Many of these women are so highly invested in the idea that their eating disorder is actually a medical problem that they struggle to see how it is a psychological problem for which treatment would be beneficial. Also, if these mature women have been relatively functional in life -- i.e. educated, well-employed, married, parent -- they may struggle to understand why they even need to do the hard work to get well. Older patients themselves can also subscribe to the belief that eating disorders only affect young girls, so they're fearful that treatment won't apply to them, or that they won't "fit" into structured eating disorders treatment environments due to their age. Finally, this population often has more awareness regarding how much their illness has cost them in their lifetime. It can be incredibly painful to take an accounting of the damage, which may result in the belief that it's "easier" to stay ill.

Generally speaking, the illness itself doesn't tend to be different, except that as we age, we all have less of an ability to bounce back physically. Therefore, natural aging issues can make eating disorders more medically complex and treatment plans should address these physical issues. Though the specific life circumstances of a young patient and an older patient may differ, treatment is essentially the same for older women as it is for younger women. Based on the acuity of the illness, the first priority of treatment is always to ensure that patients are medically and psychiatrically safe.

Regardless of age, the sooner an individual enters treatment, the better her chances are for a positive outcome and lasting eating disorders recovery. If you think a loved one may be struggling with an eating disorder, urge them to get an eating disorders assessment from a qualified professional sooner rather than later.

Have more questions about eating disorders in older women? Chat live with a Master's-level therapist here.

For more by Kenneth L. Weiner, M.D., FAED, CEDS, click here.

For more on eating disorders, click here.

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