Eating Disorders At Midlife 

More Older Women Struggling With Anorexia, Bulimia 

"You can never be too rich or too thin."

It was a mantra that defined more than a generation of adult women. But now, experts say, some have taken the phrase to its literal extreme - at least the "too thin" part.

The problem is eating disorders such as anorexia or bulimia, which were once confined mostly to teenage girls but now plague a growing number of women of the baby boom generation.

"Anorexia and bulimia are no longer disorders reserved for young women," says Dr. Patricia Saunders, a psychologist specializing in older women with eating disorders at the Graham Windham Services to Families and Children in New York City.

"They are becoming increasingly prevalent in older women, sometimes recurring after years of remission, and sometimes occurring for the very first time after age 45," she says.

Because the trend is so new, experts say there are no reliable studies to document how many older women are falling victim to the problem.

"Anorexercise" a New Factor

Anorexia is characterized by dramatic weight loss due to excessive or compulsive dieting, often coupled with self-induced vomiting and chronic use of laxatives. Bulimia causes excessive binge eating, followed by purging or vomiting, and frequently, the use of laxatives. Both can occur independently or simultaneously.

A relatively new expression of eating disorders is what some experts are calling "anorexercise," and it is attracting a substantial number of older women. It involves calculating every calorie that is consumed, and then devising a workout designed to burn those exact number of calories - and doing it within 12 hours or less after eating.

"Some women will get up at 5 a.m. to run, just to burn off what they ate the night before," says reproductive psychiatrist Dr. Shari Lusskin, an associate professor at New York University School of Medicine.

"And they can go to some very unhealthy extremes in using exercise to control their weight," she says.

While no one is certain what causes eating disorders, many believe hormones may play a role, particularly since the number of women affected far outweighs the number of men. According to the National Institutes of Mental Health, some 7 million American girls and women battle eating disorders every day, compared to 1 million boys and men.

And much like the hormone fluctuations that occur during puberty - when young women are at risk for eating disorders - similar changes take place during perimenopause, a time when older women appear vulnerable as well.

"Hormonally speaking, perimenopause is puberty in reverse," says Dr. Saunders. "But it's the fluctuations and the changes, not necessarily the direction the hormones are going, that might influence the brain chemistry involved in eating disorders."

In addition, middle age ushers in some life-altering changes for many women, including the departure of grown children and possibly divorce. Without that family support system, some women are left feeling isolated and out of control of their daily lives - setting the stage for eating disorders, experts say.

"They attempt to gain some control back by controlling what they eat," Dr. Saunders says. "And given the right circumstances, some women cross the line from dieting to an eating disorder before they even realize what is happening."

Depression May Contribute

Sometimes, undiagnosed depression is to blame, Dr. Lusskin says.

"Because eating and depression can be so intimately entwined, it's likely that at least some older women with an eating disorder are really suffering from an undiagnosed depression, with a basic thread of unhappiness that ran through their lives for a long time and probably didn't come to the forefront until they hit middle age," she says.

Some experts also say you cannot underestimate the changing cultural influences of the past 30 years and the role they play in how women think about their bodies today. A real culprit is the evolution of a style culture that pushed "thinness" to an unrealistic ideal.

"Yesterday's Hollywood idols - women like Marilyn Monroe, Rita Hayworth, and Lana Turner - offered women a realistic image of body shape and size. It may not have been easy, but it was attainable," Dr. Saunders says.

Today, by comparison, the message women get from fashion magazines, movies, and TV is that "size two is the ideal and the thinner you are, the more desirable you will be," she says.

Indeed, a recent study by professor Dr. Laurie Mintz at the University of Missouri-Columbia found that women who viewed advertisements featuring typically thin and beautiful women for just three minutes came away with increased feelings of depression.

The good news is that older women generally respond to treatment for eating disorders faster than younger women, and are generally more motivated to seek the help they need.

Treatment for all age groups includes counseling, medication, and, for older women, having a spouse involved in treatment.

Most important, say experts, is to join a support group. Studies show that sharing your feelings with others facing a similar problem plays a major role in helping women of all ages overcome eating disorders.

Always consult your physician for a diagnosis.

October 2003

Eating Disorders As a Midlife Crisis

"Anorexercise" a New Factor

Depression May Contribute

Causes and Symptoms of Anorexia Nervosa

Online Resources

Causes and Symptoms of Anorexia Nervosa

The cause of anorexia nervosa is not known. Anorexia usually begins as innocent dieting behavior, but gradually progresses to extreme and unhealthy weight loss.

Social attitudes toward body appearance, family influences, genetics, and neurochemical and developmental factors are considered possible contributors to the cause of anorexia.

Persons who develop anorexia are more likely to come from families with a history of weight problems, physical illness, and other mental health problems, such as depression or substance abuse.

Further, often persons with the disorder come from families that are challenged by appropriate problem solving, being too rigid, overly-critical, intrusive, and overprotective.

Persons with anorexia may also be dependent, immature in their emotional development, and are likely to isolate themselves from others. Other mental health problems such as anxiety disorders or affective disorders are commonly found in persons with anorexia.

Symptoms may include:

The following are the most common physical symptoms associated with anorexia:

Persons with anorexia may also be socially withdrawn, irritable, moody, and/or depressed. The symptoms of anorexia nervosa may resemble other medical problems or psychiatric conditions.

Always consult your physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)    

Centers for Disease Control and Prevention (CDC)

HealthierUS.Gov

National Eating Disorders Association

National Institutes of Health (NIH)

National Women's Health Information Center

Office of Research on Women's Health