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Misinformation about eating disorders abounds. One of the most common myths is that eating disorders largely affect young, white girls.

But EDs don’t discriminate. They affect people of any age, race, religion size, shape and sex.

Today, I want to focus on an often neglected group: women in middle age. Even when it’s recognized that middle-aged women struggle with eating disorders, the talk almost always turns to cultural pressure. While there is increasing pressure for women to stay young and be slim, eating disorders are more complex than the desire for a certain silhouette.

As I said yesterday, eating disorders are a complex interplay of genetics, biology and environment.

Below, Enola Gorham, LCSW, CEDS, clinical director of adult services at the Eating Recovery Center, shares her insight on eating disorders in middle age. She discusses why more middle-aged women are seeking professional help for eating disorders, why EDs affect them, the unique challenges of treatment and more.

Q: I’ve read that more and more middle-aged women are seeking help for eating disorders. Why do you think that is?

A: There has most likely always been a large group of women who have had eating disorders, but were never diagnosed because doctors and therapists were not trained in the disorder. Recent attention to eating disorders has resulted in most doctors and high school counselors being “on the lookout” for symptoms of eating disorders in their younger populations. The older women, those who have had this disorder long before it was a “looked-for” diagnosis, often just struggled with it.

Many women spent time working with their doctors trying to find a medical reason for their eating issues. Doctors simply did not look for eating disorders in older/adult women. A doctor’s training would have him or her look to IBS or other medical issues. Also, bulimia has only been listed as an official diagnosis since the 1980s, so it is a relatively new diagnosis. The eating symptoms of individuals who previously suffered from this disorder likely would not have been identified as an eating disorder.

We now are seeing more older women seek treatment because the diagnostic criteria is understood by more doctors, and doctors are increasingly looking beyond the “classic” young girl population as the only ones who can develop eating disorders. Also, there are many women who have had eating disorders for a long time, and “continue” to be in treatment as they enter middle age. In addition, there are those that have never had treatment, knew they needed it, but were focused on their families, their children and so on, and did not get treatment for themselves until something became acute.

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

A: We are seeing that there are some personality traits that predispose people to use management of food to try to relieve some other issue in their lives. Perfectionist, persistent, type A and anxious women have the traits that set them up for trying to manage food and finding that it helps them to feel better emotionally. Because of their perfectionist, persistent traits, they will engage in food management behaviors even more and will end up triggering a vicious cycle of trying to manage emotions with food management.

If they also have co-morbid disorders such as obsessive-compulsive disorder (OCD) or depression, they become even more trapped in trying to apply their food management rules to make themselves feel better.

Most middle-aged women have most likely been doing some version of trying to manage uncomfortable emotions with food for most of their lifetimes. They might get treatment at middle age because someone recognized the disorder, they recognized the disorder in themselves and finally can spend time getting help or their family is negatively affected and they can no longer ignore the problem.

I think it is a minority of women who “start” their eating disorder in middle age. This could happen from a major life stressor, like trauma, which places them in a hyper vigilant, controlling/protecting stance. In this case, they begin to use food to manage the resulting emotions. A life transition – such as kids leaving home or parents dying – could also cause a middle-aged woman to turn to using food management, which then becomes a process she cannot stop.

Q: What are the biggest myths about eating disorders in middle age?

A: Eating Recovery Center’s patients range in age from 10 to 81. The popular notion of an “eating disordered patient” is: young, white and affluent. However, the truth is far from this misconception. I think the previous notion of “young, white and affluent” had to do with after school specials, and the large number of studies on eating disorders that were conducted on younger girls with anorexia, due to the fact that anorexia was easier to visibly notice in younger girls and it was easiest to do ongoing work with younger girls due to concerned parents bringing them into treatment.

Q: Do eating disorders manifest differently across age such that people in middle age may show different signs and symptoms or their course may be different? Are there unique challenges to treating EDs in middle age?

A: Middle-aged women can be very hard to treat because, first, they are invested in the idea that their eating disorder is actually a medical problem, and they struggle to see how this is a psychological problem.

Second, they also can be caught in the belief that eating disorders only impact young girls, so they are fearful that the treatment will not apply to them, or that they will not fit into eating disorders treatment environments.

Middle-aged women may have had the illness for a very long time, and it is a very ingrained coping mechanism, so for many, it can be hard to even imagine stopping. Also, if they have been relatively functional in life — well employed, a parent, etc. — they may struggle with why they need to do the hard work to get well, and quickly give up and return to the illness.

Finally, the illness may have cost them a great deal in their life, and it is just too hard for them to take an accounting of this, and easier to stay ill.

The illness itself does not tend to be different, except that as we age, we all have less of an ability to bounce back physically, so natural aging issues can make the illness more complex and treatment needs to address more areas of physical issues. In addition, because the illness may have impacted a woman’s life for a longer time, they will likely have more mental and emotional “clean up” to do.

Q: What would you like readers to know about treatment?

A: 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 is to ensure that patients are medically and psychiatrically safe.

At Eating Recovery Center, we then individualize nutritional, medical and psychiatric interventions, and work with patients in individual and group therapy sessions to help them learn how to accept themselves, their thoughts and their feelings, and live a valued life beyond their eating disorder.

Q: Anything else you’d like readers to know about EDs in middle age?

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

Thanks so much to Enola Gorham for speaking with me!

Do you have any questions about EDs in midlife? Any other questions about eating disorders?