When Eating Disorders Strike Adult Women

Featured Article, Healthy Aging, Healthy Living
on February 26, 2014

Wendy Levine, 58, can hardly recall a time without anorexia nervosa. At 16, she started dieting to lose a few extra pounds. Since then, for almost 45 years, Wendy’s life has been consumed by the unrelenting pursuit of thinness.

“My eating disorder has been a cheater, a liar, a robber. It has cheated me out of so much of my life,” says Wendy, who has been in and out of hospitals since her late twenties. “It is a life-sucking, life-threatening illness.”

Wendy has clung to her eating disorder as a way to feel in control during tumultuous times. But ironically, it was the eating disorder that wrought havoc on all aspects of her life: her career, her relationships, her health.

“I’m doing better, but I’m still trying to silence the demons inside my head,” says Wendy, who hopes to conquer anorexia once and for all before her 60th birthday.

Eating Disorders: Not Just a Teenage Problem

We think of eating disorders as a uniquely teenage phenomenon, but there are many adult women just like Wendy who are battling eating disorders.

“Where we used to treat a population of predominately 18 to 24 year olds, now, 24 percent of the women I treat are women over the age of 30,” says Bonnie Brennan, MA, LPC, a Certified Specialist of Eating Disorders and the clinical director of Adult Partial Hospitalization Program at Eating Recovery Center.

As eating disorders continue to rise among the general U.S. population, more and more adult women are seeking treatment for  eating disorders. But it’s an issue that often gets swept under the rug, says Margo Maine, a clinical psychologist specializing in eating disorders and author of the book The Body Myth: Adult Women and the Pressure to Be Perfect.

“There’s this belief that eating disorders only happen in younger people, and so we have under-investigated eating disorders in older women until quite recently,” Dr. Maine says.

When we think of eating disorders, we tend to think of the prototypical bulimic or anorexic. But, Dr. Maine says, we need to broaden our definition of what constitutes an eating disorder. “Some adult women have full-blown anorexia or bulimia, but most exhibit a conglomeration of symptoms that doesn’t fit the criteria for either of these diagnoses,” Dr. Maine says.

This “gray zone” is referred to as eating disorders not otherwise specified (EDNOS), or atypical eating disorders, and they are no less serious than anorexia or bulimia; atypical eating disorders can have a profound, devastating impact on all aspects of an individual’s life. Atypical eating disorders can encompass any of the following signs: preoccupation with food, weight and body; extreme fears of being fat; isolating from normal activities in order to avoid food; noticeable and concerning weight loss; using the bathroom regularly following eating; and compulsive exercise, among others.

The Breaking Point

What might propel an adult woman down the path of an eating disorder? The answer to this question is complicated, fraught with many psychosocial and biological considerations. But there are a few common threads uniting all females, young and old, who suffer from eating disorders.

Adulthood is replete with transitions—the stressors of motherhood, of divorce, of demanding careers, of becoming empty nesters, of caring for aging parents.

“Eating disorders tend to emerge during times of transition,” Dr. Maine notes.

When life becomes overwhelmingly complex or chaotic, restricting food intake might help some women reclaim a sense of control or stability. “It’s a coping mechanism. Food seems like the one thing they can control,” says Brennan.

Life stressors can provoke old disordered eating habits from adolescence to surface anew, Brennan adds. “Oftentimes, there’s been a history of an eating disorder, and stressful life events later in adulthood can trigger a relapse,” she says.

Then, of course, there are the myriad physical changes a woman might experience throughout her life, many of which can be quite upsetting or shocking. Childbirth and menopause can alter the body in a way that feels quite foreign, while fertility issues can make a woman feel as though her body has betrayed her. “During aging, a woman might feel that she’s becoming older and less attractive,” Dr. Brennan notes.

We think of puberty as being the most self-conscious period in a woman’s life, but in reality, women are susceptible to warped body image at any age. And, in today’s society, the pressures are more taxing than ever. Women are expected to do it all—to be successful businesswomen, good mothers and loving wives, all while maintaining a svelte, youthful physique.

“Our cultural standards around weight, shape and image are unreasonable,” Dr. Maine says. “American culture doesn’t honor or respect older women. Because of that, women want to stay looking young—and looking young includes having a thin, small body.”

Missed Warning Signs

Unfortunately, although atypical eating disorders are the most prevalent among adult women, they frequently go unnoticed. In many cases, sufferers of EDNOS aren’t noticeably emaciated; they’re often at a healthy weight. Because of this, it might be easier for a woman to disguise her illness. Furthermore, healthcare providers frequently fail to pick up on crucial warning signs that a patient might be hiding an eating disorder. When an adult patient loses a dramatic amount of weight in the span of a year, doctors might praise the weight loss rather than raising an eyebrow.

“Doctors are so focused on the obesity epidemic that they are usually thrilled when people lose weight,” Dr. Maine says. “They don’t ask those important questions about whether there’s an underlying eating disorder.”

Additionally, adults are less likely than teens to get confronted by friends and family about their eating issues. “With adult women, I’m amazed at how little the people in their lives have talked to them about their eating disorder,” she says. “It’s more likely that with younger people, the issue is going to be talked about—teens have parents and teachers and doctors and peers to intervene,” Dr. Maine says.

When adults do ultimately seek treatment for their eating disorder, it is usually accompanied by extreme guilt—and reluctance.

“It’s usually somebody who has been very functional in their eating disorder and might be a little more resistant to treatment,” Dr. Brennan notes.

Among her adult patients, Dr. Maine notices a common narrative of regret, shame and embarrassment. “There’s that kind of embarrassment for having a so-called “teenager’s problem—the belief that they should know better,” Dr. Maine says. “They are unsure that they can even benefit from treatment.”

Just because they are older, however, doesn’t mean that adults with eating disorders have less chance of a full recovery. Dr. Maine assures us that there is hope for anyone suffering from an eating disorder, as long as they seek the proper medical treatment. “When working with adults, I’m amazed at how much change they can make, even though some of them have been struggling with eating disorder symptoms for 25 to 30 years,” Dr. Maine says.

Wendy Levine agrees. Looking ahead, she is hopeful that she can silence the demons in her head once and for all. “I want people to know that [anorexia] is a treatable and curable illness, as long as it’s caught early and people get the right treatment,” Wendy says. “They can overcome it.”

For more information about eating disorders or to find help and support, visit www.MyNEDA.org or contact NEDA’s live helpline: 800-931-2237.