When you think about an eating disorder, one image that naturally comes to mind is a rail-thin teenage girl pushing away from the dinner table and making a beeline to the bathroom. And rightly so, since the vast majority of the estimated eight million Americans suffering from disordered eating problems are between the ages of 12 and 25.  However, health professionals nationwide are seeing a growing trend in eating disorders that's rising up from the ranks of women in their 30s, 40s, 50s, and beyond. In this episode of Second Opinion, we'll explore the phenomenon of eating disorders in older adults, examine the causes and symptoms, and look at what you can do to break free of these persistent and potentially deadly health problems.
 
At any  age, an eating disorder stems from feelings that your life is out of control. Compulsive food management, whether it's extreme dieting, purging, or binging, gives you an emotional "fix"  that puts you back in control – but only until the next crisis comes crashing down. Many experts are now pointing to a collection of stress factors that commonly occur in midlife as powerful catalysts for the onset – or reemergence – of eating disorders in later-life.  These include:

• Relationship problems
• Divorce
• Parenting troubles
• Death of a parent
• Career difficulties
• Financial strain
• Empty-nest syndrome
• Emotional and physiological changes brought on by menopause
• Fears associated with aging
• Desires to look younger and slimmer than your age may allow

While the rise in midlife eating disorders is disturbing, experts are heartened that growing numbers of older adults are seeking professional help to deal with their eating problems.  Unlike many younger people with eating disorders, those from the "baby-boomer" generation seem to be much more open to recognizing that when they have a problem it's smart to get help.

According to Donald McAlpine, M.D., a psychiatrist and the director of eating disorders services at Mayo Clinic in Rochester, Minn. (and a member of our panel of experts), "Denial, so common in younger women with anorexia nervosa, seems to be less common in older women. Denial is replaced by thoughts such as, ‘You've got to help me with this, it's ruining my life.' Older women, worn down by years of symptoms, may be more motivated to seek help. Motivation for change often leads to a more successful outcome in treating the illness."

For people of any age who suffer from eating disorders, counseling and psychotherapy can be a valuable source of assistance with becoming more self-content, more self-confident, and more knowledgeable about developing healthy strategies for coping with the issues that underlie disordered eating behaviors.

Not Just a Teen Thing

While 90 percent of those who develop eating disorders are females between the ages of 12 and 25, they can afflict people of all ages and both genders from all ethnic, cultural, economic, and educational backgrounds. What may surprise you is how prevalent disordered eating problems have become among older segments of the female population.

• While eating disorders usually develop in adolescent and young adult females, they can begin in some women during their 30's, 40s, and beyond.
• Some females first develop eating disorders in their teens, recover, and then relapse in middle age.
• Some studies suggest that nearly 80 percent of anorexia-related deaths occur in women who are over the age of 45.

Eating Disorders at a Glance

An eating disorder is a serious psychiatric illness – an intense preoccupation with weight or food  that can lead to extreme disturbances in eating patterns and behaviors, as well as dire medical consequences. The three best-known eating disorders – anorexia nervosa, bulimia nervosa, and binge eating disorder – are variations on a theme that also have their own unique characteristics.
 
Anorexia nervosa

People who intentionally starve themselves have an eating disorder known as anorexia nervosa. The disorder, which usually begins around the time of puberty in young people, involves extreme weight loss – at least 15% below a person's ideal body weight. People with the disorder may look emaciated but are convinced they are overweight. Many must be hospitalized to prevent starvation, dehydration, and other complications. In severe cases, anorexia can lead to death.

Research suggests that about 79 percent of the deaths related to anorexia occur in women over the age of 49.

Bulimia nervosa

People with bulimia nervosa consume large amounts of food and then purge their bodies of excess calories by vomiting,using laxatives or diuretics, taking enemas, or exercising obsessively. Some combine of all these forms of purging. Because many people with bulimia "binge and purge" in secret and maintain normal or above-normal body weight, they can often conceal the eating disorder from others for years.

Experts believe that the onset of bulimia is common in middle-aged women.

Binge Eating Disorder

Like bulimia, binge eating disorder is distinguished by episodes of uncontrolled eating. This disorder differs from bulimia in that binge eaters do not purge their bodies of excess food. People with binge eating disorder feel that they lose control of themselves when eating. They eat large quantities of food and don't stop until they're uncomfortably full. Usually, they have more difficulty losing weight and keeping it off than people with other serious weight problems. Most people with the disorder are obese and have a history of weight fluctuations.

About 1% of women – including 30% of those who seek treatment to lose weight – have binge eating disorder.

Signs of an Eating Problem

Increasing awareness of the dangers of eating disorders – heightened by ongoing medical research and widespread media coverage – has encouraged many people to seek help. Unfortunately those with eating disorders often deny they have a problem and don't get treatment on their own. However, friends and family can learn to recognize a problem and encourage treatment. Here are some of the warning signs:

• Preoccupation with food, weight, or exercise
• Continual dieting, fasting, or restricting food
• Persistent, negative comments about the way they look
• Expressions of shame and guilt about eating behavior and body weight
• Use of diet pills, laxatives, and/or diuretics for the purpose of weight loss or perceived figure enhancement
• Linking successes or failures in life to weight
• Constant comments about their own, or other people's weight
• Belief that reaching a "perfect" weight is essential to be happy
• Wearing baggy clothes or changes in clothing style
• Loss or disturbance of menstrual periods
• Increased mood changes and irritability
• Frequent excuses not to eat
• Heightened interest in preparing food for others
• Social withdrawal or avoidance of social situations involving food
• Excessive or fluctuating exercise patterns
• Obsessive eating rituals, like eating only from a certain plate
• Trips to the bathroom after meals
• Disappearance of large amounts of food
• Obsessively reading fitness or beauty magazines