May 07, 2013
By Michael Craig Miller M.D.
Harvard Medical School
Most people who develop eating disorders — an estimated 90% — are female. And they're typically adolescents and young women. But eating disorders also affect older women. Until fairly recently, however, we didn't know the extent of eating disorders in this older age group.
Recent research indicates that increasing numbers of adult women are having eating disorder symptoms. In women over 45, and even in women over 65, rates of strict dieting, fasting, binge eating and purging are up significantly. Many of these women report being preoccupied with food or feeling guilty about eating.
Mental health professionals who specialize in this area report seeing more older women asking for help for eating disorders. Some of them have struggled with disordered eating for decades, while for others the problem is new.
Meanwhile, rates of eating disorder symptoms in younger women appear to be about the same.
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Which Eating Disorders Affect Older Women?
The term "anorexia" is derived from two Greek words, usually translated as "without appetite" — but that is something of a misnomer. Patients do not lose their appetite; they struggle to subdue it. They are afraid of gaining weight and convinced they are too fat, at the same time, even when significantly underweight. As a result, they starve themselves to the point that they put their lives at risk.
All of the complications of anorexia can be harder to manage in an older person. Life-threatening complications are cardiac arrhythmias, kidney failure and liver failure. Starvation not only severely damages the body, but also harms the brain — causing changes in thinking, emotions, and behaviors that may be difficult to reverse. People with anorexia nervosa may restrict their food consumption. Or they may binge and purge. Some women exercise excessively in an effort to lose weight. Many lose weight by forcing themselves to vomit or by using laxatives, diuretics or enemas.
Bulimia nervosa is characterized by a cycle of binge eating followed by some type of action to avoid weight gain. Researchers estimate that one to three women out of 100 will develop bulimia nervosa at some point in their lives. Binge eating involves consuming extreme amounts of food within a restricted time frame — usually within a couple of hours. While on a binge, a patient may eat an entire cake rather than one or two slices, or a full gallon of ice cream rather than a bowl.
Many women with bulimia binge and purge. They vomit or use laxatives or diuretics. But they're not as preoccupied with maintaining a low body weight, as are women with anorexia. Some with bulimia don't purge. Instead, patients may exercise excessively or stop eating for a day or longer.
People with this disorder binge regularly, usually in secret. They feel a high degree of guilt or shame. Unlike people with bulimia, they don't follow a binge with a purge, so they may be overweight or obese. Their eating disorder may remain unrecognized.
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What Triggers Eating Disorders Later in Life?
Many older women do not fit the strict definitions for eating disorders, yet they deserve treatment. Eating disorders may emerge or reappear during middle age for various reasons.
- Grief. Mourning for people you've lost can take away your appetite. Restricting food or purging can be a way to deal with distressing feelings. For example, the comedian Joan Rivers has written about the sudden onset of bulimia in her 50s after her husband's death by suicide.
- Divorce. In addition to triggering grief and loss, divorce can spur a woman to view her body unfavorably in comparison with other singles or an ex-spouse's new girlfriend.
- Heightened awareness of aging. Working alongside younger women can trigger insecurity. This is especially true in work and social environments where youthfulness and appearance are particularly valued.
- Medical illness. If a short-term illness results in weight loss, a woman may get compliments on her slender appearance and continue to restrict food after she has recovered.
Eating disorders take a physical toll on the body, and the impact is more apparent with age. Dental problems, arrhythmias (irregular heartbeat) or osteoporosis (a common complication of eating disorders) may prompt a woman to seek treatment. In an older body, forceful vomiting may result in a medical emergency, such as a stomach rupture or tear in the esophagus.
Disordered eating and attempts to hide it take a great deal of time and effort. Sometimes an unrelated health scare, death of a loved one or other event sparks a realization that it takes too much mental and physical energy to maintain these behaviors. So a woman may finally decide that enough is enough — and seek treatment.
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Your doctor will start by doing a thorough medical examination. This is important because certain medical conditions may cause rapid weight loss, interfere with appetite or make eating difficult — and these can be confused with an eating disorder.
The clinician may also ask a patient about:
- Any past or current changes in weight
- Her history of eating disorders diagnoses or behaviors
- The use of medications to control her weight (such as diuretics, laxatives, enemas, ipecac, insulin, thyroid medication, stimulants, street drugs or supplements such as cleanses or "skinny pills")
- Any emotional difficulties she is having
After taking a history and performing a physical, a clinician may also order certain tests, such as:
- An electrocardiogram to check for arrhythmia
- Laboratory tests to check for metabolic imbalances
- Bone density scan (People with eating disorders are at risk for low bone density.)
The goal of treating an eating disorder is to help a patient achieve a healthy weight, exercise level and eating pattern; to eliminate binge eating and purging; and to address any contributing emotional problems or distorted thinking. This usually requires the help of a mental health professional, a nutritionist and other clinicians.
The good news is that the treatments for eating disorders, which include a combination of psychotherapy, support, nutritional rehabilitation and medication, are well researched and well known. That should be a source of hope for women who want help.
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Michael Craig Miller, M.D Michael Craig Miller, M.D., is Senior Editor of Mental Health Publishing at Harvard Health Publications. He is an assistant professor of psychiatry at Harvard Medical School. Dr. Miller is in clinical practice at Beth Israel Deaconess Medical Center, where he has been on staff for more than 25 years.