Midlife eating disorders

Research on eating disorder, shows that the average age of onset for anorexia and bulimia is around 18 years of age ^[1]. While eating disorders are typically considered disorders of adolescence, this does not mean that midlife eating disorders are not a possibility.

How common are eating disorders in midlife?

It is difficult to determine the exact prevalence of eating disorders in midlife, as there has been limited data collected to determine prevalence. Other potential reasons could be that those with severe eating disorders who don’t find recovery will, most likely, pass away before the age of 40, while those who do receive treatment for their eating disorer earlier in life may enter partial recovery and no longer meet the diagnostic criteria.

Individuals who have an age of onset after 40 are rare, however, more reaserch and more awareness could lead to a higher understanding of what eating disorders in this age group look like.

Based upon the limited data available, the prevalence of anorexia nervosa in women aged 40 and above is 1.9 to 5.8 cases per 100,000 people, and for bulimia nervosa, the prevalence in midlife is 1.7 cases per 100,000 people ^[2]. There is even less data available regarding eating disorders in middle aged and older men, but the limited research suggests a prevalence rate 0.2% to 1.6% ^[3].

It is important to understand that prevalence estimates can vary based upon the way eating disorders are defined. For example, prevalence rates are lower if an eating disorder is defined based upon a person meeting clinical diagnostic criteria. However, if we consider people who show some symptoms of disordered eating but do not meet criteria for a disorder like anorexia nervosa or bulimia nervosa, prevalence rates are higher.

For instance, research with middle-aged women has found that 73% of this group experiences depression symptoms related to weight and body dissatisfaction, and 62% of those aged 50 and older report that eating and weight concerns “occasionally to often” affect their lives negatively.

Finally, 13% of middle-aged women experience at least one core eating disorder symptom ^[2]. While showing just one symptom would not fulfill diagnostic criteria for an eating disorder, the truth is that a significant number of middle-aged adults, women especially, struggle with some form of disordered eating.

Warning signs of midlife eating disorders

The specific signs and symptoms of eating disorders in midlife can vary based upon the specific disorder a person experiences. Symptoms of anorexia nervosa, for instance, will differ from those of bulimia nervosa or binge eating disorder. However, the general signs below can indicate an eating disorder ^[4]:

• Fixating on body weight, dieting, and calorie content of food
• Focusing on body weight, dieting, and food control above all else
• Avoiding certain food groups, such as those high in carbohydrates
• Being hesitant to eat in front of other people
• Severe mood swings
• Withdrawing from usual hobbies and social activities
• Skipping meals or eating extremely small portions at meals
• Following fad diets
• Being extremely concerned about bodyshape and weight
• Checking the mirror for flaws in appearance
• Dry skin and hair
• Complaining of being cold all the time
• Dental problems, like cavities
• Noticeable weight changes
• Frequently struggling with gastrointestinal problems like constipation or upset stomach
• Growing fine hair on the body to keep warm

What causes eating disorders in midlife?

There is not one single cause of midlife eating disorders. Instead, a variety of factors can increase the risk that someone will develop an eating disorder. Risk factors for midlife eating disorders include ^[2]:

• History of an eating disorder in young adulthood
• Anxiety and stress surrounding the aging process, and the related desire to maintain a youthful appearance
• Dissatisfaction that arises from weight gain and body changes during middle adulthood
• Social pressure from diet culture
• The normalization of disordered eating patterns

Complications of eating disorders in older adults

While eating disorders can come with serious consequences at any age, older adults who struggle with eating disorders face unique challenges. First, if they have engaged in a lifetime of disordered eating, they may not recognize their behaviors as problematic. Furthermore, an eating disorder in middle or older adulthood can become a part of a person’s identity, making it less likely that they will seek treatment ^[2].

Other complications surround the health-related consequences of midlife eating disorders. Compared to younger adults, middle-aged and older adults with eating disorders may experience more dramatic health problems resulting from disordered eating. They may more quickly develop physical health problems, such as gastrointestinal issues, cardiovascular problems, osteoporosis, hearing loss, dental problems, and injuries from over exercising ^[2].

Older adults with eating disorders, especially those who have struggled with a distorted body image for most of their lives, are at risk of mental health disorders like depression and anxiety. They are also at higher risk of substance abuse ^[2].

Treatment for midlife eating disorders

The best treatment plan for each person will depend upon their individual needs, but in many cases, treatment involves one or several of the following options:

• Therapy: Talk therapy can be beneficial in helping individuals with eating disorders change unhealthy behaviors and learn adaptive coping strategies. Cognitive-behavioral therapy (CBT) that has been adapted specifically for treatment of eating disorders can be beneficial, as it can help patients to address perfectionism, low self-esteem, and relationship problems that are exacerbated by midlife development.

Another form of psychotherapy, called interpersonal psychotherapy (IPT), can reduce the use of unhealthy coping mechanisms. IPT does so by helping middle-aged adults to navigate changing roles in relationships with spouses, parents, and adult children. Given the importance of relationships, couples counseling and psychoeducation for both patient and family can also be beneficial ^[2].

• Medication: Therapy is typically the first line of treatment for eating disorders, but some people may take medications. Given the high co-occurrence of depression and eating disorders, some patients may benefit from antidepressant medications, including SSRIs and tricyclics (TCAs) to assist with mood regulation. Also, there is some research to suggest that SSRIs, particularly fluoxetine, can be beneficial for reducing binge eating and purging behaviors ^[5].
• Self-Help: Self-help strategies can also be effective for managing midlife eating disorders. This can include connecting with peer mentors who have also struggled with disordered eating, learning coping techniques for anxiety, watching videos to hear others’ recovery stories, and practicing self-care through relaxation training, proper sleep, and journaling ^[6].

An eating disorder professional can help you to determine the best form of treatment to meet your needs. Patients with severe medical complications may require inpatient hospitalization before transitioning to a lower level of care. Your treatment team may include a multi-disciplinary group of professionals, including counselors, psychiatrists, medical doctors, and dietitians.