By Valerie Martin

I work as an eating disorder (ED) therapist because I was lucky enough to experience recovery and get my life back, and I wanted to spread that possibility to other people struggling. Because of my background and profession, I sometimes underestimate the extent of misinformation (or total lack of information) about eating disorders among the general public. In honor of National Eating Disorders Awareness Week, I want to explore one of the most common myths about eating disorders: that they are an affliction of young, white, affluent females. Since that’s a lot of myth to tackle in one post, I’m going to focus specifically on the “young” portion.

Although women ages 15-24 comprise the largest age group with ED (for this group, it is in the top four leading causes of ‘burden of disease’ regarding years of life lost through death or disability), the prevalence among women in mid-life and beyond is overlooked and seems to be growing. An ABC News report from June 2012 states, “Whether there is more awareness and diagnoses remains unclear, but many clinical experts said they have seen a spike in women over 40 seeking treatment in recent years.” As with eating disorders in general (and other mental illnesses), it is a safe assumption that the prevalence is actually higher than statistics show, since they do not capture the many individuals who struggle with eating disorders but do not seek treatment. Furthermore, in this age group, it is also probable that those considering treatment could be even more hesitant due to shame because “it’s supposed to be a young person’s problem.”

Eating disorder expert Carolyn Ross, MD, MPH discusses denial as a dangerous reality among older women with eating disorders:

“The general stigma of having an eating disorder is amplified by the misperception among health care providers and the public that older women don’t struggle with these problems. As a result of inadequate training, mid-life eating disorders have been overlooked and misdiagnosed as stress, a medication issue or some other problem. Believing that treatment will be geared toward younger women or that they won’t fit in at a treatment center, there is a serious risk that older women will leave treatment quickly if we do not react with the same sense of urgency and take them as seriously as we take adolescents with these problems.”

The “Desperate Housewives Syndrome” of the mid-2000’s

I remember the first time I came across a consumer “news” article about the rise in eating disorders among mature and older women, probably about eight or nine years ago. The ladies of Wisteria Lane had fairly recently become a pop culture sensation, and the article referred to “Desperate Housewives Syndrome” as a tongue-in-cheek description of the phenomenon that medical and treatment professionals were experiencing: mothers and grandmothers seeming to emulate Teri Hatcher and the other waif-thin “mature” women on Desperate Housewives (and its contemporaries), some of them with full-fledged eating disorders. Even before seeing this article, as a person newly in recovery, I remember seeing these actresses on-screen and feeling angry and scared, thinking, “There is no way that this woman has birthed two children who are now teenagers! This is sending such a ridiculously unrealistic message and expectation to real women with real bodies.” Some might call my attitude judgmental, and I’ll admit that I struggle with this topic (it’s come up again with the recent “too-fat-too-thin?” Biggest Loser debates), but I really have a hard time believing that those bodies are at their natural healthy weight, and when it’s pretty clear that a 45-year-old has gone to great lengths to appear to have the body of a 20-year-old, it seems like a dangerous precedent to set for other women.

It isn’t about being thin – and it is

Just for a moment, I need to visit another myth—that eating disorders are ultimately the desire to be thin and attractive, gone rampant. For the majority of my clients, whether they’re 19 or 49, either a co-occurring mental illness or trauma, or both, are significant underlying causes. Many have experienced childhood sexual abuse, while others may have grown up in invalidating or inconsistent family systems (frequently with an alcoholic parent), and still others have been sexually assaulted as adults. Additionally, women in mid-life often undergo one overwhelming life transition after another—whether it’s caring for or losing parents, divorce, financial strain, empty nest, menopause, diagnosis of physical illnesses, fear of aging and death—the list goes on. When these women start restricting what they eat, or self-medicating with bingeing (and potentially also purging), they may not always have the insight into the root or underlying causes for the behaviors. They might truly feel that “my life would just be better if I were thin and attractive.” And in our culture, sadly, sometimes that feels true. But I think it’s critical to remember that, even when people in the throes of the illness may not yet be aware that it goes deeper than that, it inevitably does.

With that said, there is undoubtedly a growing cultural expectation of women to stay young, attractive, and thin at any cost. Technology continues to advance, and between $300 skin creams, Botox, increasing availability of plastic surgery, and unrealistic Photoshopped representations at every turn, it’s no wonder that today’s mature women feel more pressure than ever to defy the process of aging: 40 was the new 30, and now it seems that 55 is the new 40. In the past decade, we’ve gone from the fictional Desperate Housewives to the supposedly “Real” Housewives, including Bethany Frankel of Skinnygirl fame. It’s no longer just the celebrities who are expected to be a size 4 three months post-pregnancy—now it’s all of us.* So, couple that growing pressure with the fact that many women have untreated psychological issues (often stemming from difficult life transitions) like anxiety, depression, trauma, addiction, and codependency, and you have a perfect recipe (fat-free, of course) for the onset of—or relapse into—an eating disorder.

Recent research on eating disorders in mature women

Though the “Desperate Housewives Syndrome” article I mentioned was published almost a decade ago, research on older women with eating disorders has been slow to follow. Thankfully, in mid-2012, Cynthia Bulik, Ph.D., and her team at the University of North Carolina published the most comprehensive study to-date on this population with some important findings:

• 13% of American women 50 or older experience symptoms of an eating disorder
• 60% report that their concerns about weight and shape negatively affect their lives
• 70% are trying to lose weight
• 79% said their weight or shape affected their self-perception
• 36% spent at least half of the last five years dieting

The study’s authors write that these behaviors and attitudes put women at a higher risk for “full blown-eating disorders.” One surprising statistic was the 8% of participants who reported purging (in the absence of binge-eating) within the past five years. “The purging number screams out desperation in my mind,” writes Bulik. “It’s an extreme behavior. Even after age 50, they’re desperately trying to control their weight. What really surprised me is that even in the 75-84 age group, they were still endorsing purging.”

Also the author of Midlife Eating Disorders: Your Journey to Recovery, Bulik states, “Eating disorders affect quality of life, and this has a tremendous impact on society. It can affect productivity at work, well-being at home, and it can have very serious economic impacts” on families, as many insurance companies are reluctant to pay for care. Bulik also describes that these disorders have the potential to be even more dangerous in older women due to bodies losing resiliency with age.  The study’s average participant was 59 years old, and although some acknowledged having an ED at a younger age, others did not develop the issue until they were older.

ED treatment for middle-aged and senior women

With the research still fairly unclear about the most effective treatments for eating disorders overall, it’s no surprise that clinicians and medical professionals are still learning about how to best tailor ED treatment for mature and older women. While I’m of the belief that we’re all much more alike than we are different, it would be naïve to assume that this age group will respond exactly the same to certain treatments as the 15-24 age group.

Dr. Carolyn Ross discusses that the most effective treatments for eating disorders—especially with the reduced physical resiliency of this age group—is an integrative medicine approach combining both traditional and natural therapies, “such as plant-based diets, yoga, meditation and psychosocial support.” She emphasizes focusing on boosting key nutrients (B-vitamins, zinc, Omega-3 fatty acids, etc.) early in treatment as the primary “medicine” to support both physical and mental health, as well as movement and touch therapies and mind-body therapies.

Hopefully with increased knowledge about the risk of eating disorders among women in mid-life and beyond, further research studies will focus on which treatment methods are most effective with this specific population.

Some additional recommendations

I also wanted to include several recommendations (some self-help and some more treatment-focused) that may resonate with more mature women struggling with eating disorders:

• NEDA just hosted a live webinar on February 20, 2014 titled Eating Disorders At & Beyond Mid-Life, which is now available to view and listen to.
• Midlife Eating Disorders by Cynthia Bulik, Ph.D.
• Eating in the Light of the Moon by Anita Johnston, Ph.D. is chock-full of metaphor and folklore about wise women, nourishment, the earth, and the body.
• It is extremely helpful for these women to have at least one other peer in the treatment group and at least one member of their treatment team of a similar age so they can relate more closely with their unique experience.
• An inner child focus (such as dialogue journaling with the inner child) is effective at any age, but older women may be even more disconnected from this part of themselves than their younger peers. This approach can also help reduce barriers among women of different ages as it brings the focus to the wounded child in each woman.
• Women of all age can benefit from ritual and ceremony, of course, but more mature women are often more willing to get immersed in these experiences sans eye-rolls.

Clearly, eating disorders do not only affect the young. Since this post focused on the age facet, please check out NEDA’s diversity page for more info on how eating disorders truly do not discriminate, no matter if we’re talking about race, gender, size, class, or sexual orientation.

If we keep challenging stereotypes and myths like this by disseminating the facts, people who are struggling will be more likely to reach out for help, and more likely to receive coverage for treatment.  While perusing the resources at NEDA’s website, take a moment to see if there are any events in your community or other ways you can be involved in National Eating Disorders Awareness Week, February 23-March 1, 2014.

*If you clicked that Skinnygirl link, you’ll see that it’s also the baby who should be excited to become a “future Skinnygirl”!

Image by SalFalko via Flickr under a Creative Commons license.