Written by: Sam Zachow, Admissions Coordinator
One of the prevailing images of someone who suffers from an eating disorder is often an affluent female, oftentimes young and already thin. So, you might be surprised to learn that eating disorders can affect all populations across the lifespan and are often linked to a major life event. Since so much of the research on eating disorders focuses on adolescents and young adults, it’s time to examine the less studied groups of middle aged and older adults.
Rates of eating disorders in adults over 40 are steadily increasing. For people assigned female at birth, changes in hormone levels due to perimenopause can lead to onset or worsening of eating disorder behaviors. In some cases, symptoms existed in adolescence and early adulthood, but did not meet the full criteria for an eating disorder. In others, behaviors did not begin their onset until middle age. For the former, seeking treatment may not have been possible because of time or financial constraints.
Dieting and body image dissatisfaction remain significant risk factors for this age group, but stress around common transitions in this time of life can also precipitate eating disorder behaviors. Examples include:
The end of a marriage or long-term relationship can create a lot of complicated feelings. These may include lowered self-confidence and increased body dissatisfaction.
Death of a parent, sibling, or peer
Grief, loss, and thoughts of one’s own mortality may create emotional distress that leads to seeking control, or experiencing a lack of control, around food and exercise.
Illnesses can be traumatic and come with a great deal of emotional distress and physical changes to the body. One may try drastic measures to alter the shape of their body after experiencing an illness.
Signs of aging
As we age, are our bodies naturally change. Graying hair, weight gain, wrinkles, and other natural changes may be troubling to one’s self-image.
Empty nest syndrome
Being a parent is a big part of a person’s identity. When that role is no longer part of day-to-day life, it can be confusing. Rigidity around food and exercise may become a way to fill the void.
Case Example: Josephine, 45, has always struggled with disordered eating and compulsive exercise. Her behaviors have varied in severity over her life. She has looked into treatment at points but struggled to find the time to commit to it as a single mother of two. Her behaviors have escalated since her children left the home, but less parental responsibility offers her the time to engage in treatment.
Eating disorder behaviors in older adults present similarly as those in younger patients. Like their middle-aged counterparts, widowhood, illness, marriage problems are common precipitators, as well as difficult relationships with children. Body dissatisfaction remains high among this group as well.
However, there are unique ‘stage of life’ considerations. For older adults, eating disorders thrive in secrecy and shame.
Because weight loss or gain may be attributed to another medical condition or medication, it becomes easier to keep disordered behaviors a secret.
Older adults may not have access to a strong support network. They often live alone. They may be widowed, have strained relationships with their children, and have lost close friends. If they struggle with mobility issues or illness, it may be difficult to make connections in their community. Their only support may be their healthcare providers.
Eating disorders are already stigmatized. Because we are exposed to images of the thin, affluent female when we hear “eating disorder,” being diagnosed with an eating disorder as an adult can be even more stigmatizing for older adults. Minimal information and research is available on eating disorders in older adults, and they are often met with disbelief when they talk about their symptoms to healthcare providers.
As the ability to be independent declines so can a crisis of identity. Like children and adolescents, food may be one of the few factors in life an older adult feels they can control. Disordered behaviors around food may also be used to bring attention to oneself if they are feeling lonely or unsupported.
Case Example: Christopher, 75, recently lost his wife of 45 years. He feels lost and alone. He has three children, but they are working adults and he does not want to burden them with his troubles. Food becomes his comfort, and he begins binge eating.
There is work to be done to address eating disorders in these populations. Providers and researchers must continue to learn about their unique life factors and needs. Moreover, it is essential they learn the warning signs. Collectively, it is imperative we educate ourselves and reduce stigmatization to make sure middle aged and older adults get the care they deserve.
US News. Health Day. Why Midlife Can Bring Risk of New Eating Disorders. Accessed 7/5/23. https://www.usnews.com/news/health-news/articles/2023-01-23/why-midlife-can-bring-risk-of-new-eating-disorders
Journal of Psychosocial Nursing and Mental Health Services. Edward Camilla and Marta Harris. Eating Disorders Across the Lifespan. Accessed 7/5/23. https://www.researchgate.net/publication/7141324_Eating_Disorders_Across_the_Life_Span
Eating Disorder Hope. Disordered Eating Across the Lifespan. Accessed 7/5/23. https://www.eatingdisorderhope.com/blog/disordered-eating-across-lifespan
Psychiatric Times. Fragiskos Gonikadis and Dafni Karapavlou. Eating Disorders in Late Life: Implications for Clinicians. Accessed 7/5/23. https://www.psychiatrictimes.com/view/eating-disorders-late-life-implications-clinicians