Midlife Eating Disorders Presentation and Treatment

Midlife Eating Disorders Presentation and Treatment Eating Disorders Print Eating Disorders That Occur in Middle-Aged Adults By Lauren Muhlheim, PsyD, CEDS facebook twitter linkedin Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy. Learn about our editorial policy Lauren Muhlheim, PsyD, CEDS Medically reviewed by Medically reviewed by Steven Gans, MD on January 08, 2019 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on August 06, 2019 More in Eating Disorders Symptoms Treatment Diagnosis Awareness and Prevention In This Article Table of Contents Expand Prevalence Characteristics Causes Risks Treatment Support View All Back To Top Eating disorders are most often thought of as afflicting teenage girls and young women. In reality, this is not the case. Eating disorders affect people of all ages and genders as well as all ethnicities, body sizes, and socioeconomic statuses. One group that is often neglected in both research and media portrayals of people with eating disorders is middle-aged and older adults. In most cases, middle-age is defined as above 40 years old. Research shows that this age group suffers from eating disorders as well. Illustration by JR Bee, Verywell Prevalence There are essentially three courses that lead to midlife eating disorders.   Early Onset of Chronic Disorder. Some people with midlife eating disorders had the first onset of their eating disorder in adolescence or young adulthood and have been continuously and chronically ill through adulthood.Early Onset Relapse of Disorder. Some people with midlife eating disorders have been in remission from an eating disorder that began in adolescence or young adulthood but have suffered a relapse.First Onset of Disorder. Some people with midlife eating disorders have their first onset at age 40 years or later. The first two presentations appear to be the most common routes to midlife eating disorders. Estimates vary widely in the percentage of midlife eating disorders that present in a person who never had an eating disorder earlier in life. There are more midlife adults with symptoms of eating disorders than those with a full-blown eating disorder diagnosisâ€"this is the case for other age groups as well. Due to the relative overfocus on anorexia affecting teenage girls, midlife is a neglected age in research on eating disorders. The few studies that exist point to eating disorders in this age group being more common than previously thought. According to one study, in any given year, the percentage of middle-aged women with an  eating disorder was 3.6 percent. Other specified feeding or eating disorder (OSFED) was the most common (1.7 percent), followed by binge-eating disorder (BED) (1 percent), bulimia nervosa (0.4 percent), and anorexia nervosa (0.2 percent). Male Midlife Eating Disorders Even less is known about middle-aged men with eating disorders, but we do know eating disorders occur in this group. Men with eating disorders are understudied and typical eating disorder assessments often do not adequately capture male eating disorder symptoms. It is estimated that the prevalence of eating disorders in middle-aged and older-aged people is around 3 to 4 percent among women and 1 to 2 percent in men. Among males, a version of muscle dysmorphia tends to be more common than anorexiaâ€"it appears to be the same with middle-aged men, too. A review of case reports of middle-aged men with eating disorders showed a significant percentage engaged in excessive exercise, which can be very risky in this population because it can contribute to falls and fractures. Characteristics Fewer midlife individuals present for treatment with bulimia nervosa relative to individuals in younger age groups. A disproportionately high percentage of people with midlife eating disorders are diagnosed with binge eating disorder (BED), a disorder that appears to develop later in life than anorexia and bulimia. Research has shown that people with BED often first present for treatment in their forties. Body Image Body image issues, a common feature of eating disorders, seem to become more complex with age. Body changes that occur with menopause and aging include decreased muscle mass, increased fat, changing body shape, reduced skin firmness, breast changes, and graying hair. Since our culture tends to value the appearance of youth as the ideal form, physical changes related to age can increase anxiety about looking and feeling older and less attractive. Underrepresentation of older people in the media reinforces the message that aging is not desirable. Research has demonstrated that middle-aged people engage in increased speech that endorses the idea of youth as the standard of beautyâ€"they might make comments about looking saggy or wrinkly. This may be considered parallel to “fat talk” in younger people, or statements that disparage different body types and endorse thinness. Causes As with eating disorders that occur at other ages, midlife eating disorders are likely caused by a multitude of factors, including genetic, biological, and environmental. Hormonal changes are believed to play a role. Preliminary research has implicated estrogen’s role in activating eating disorder genes in adolescence. Like puberty, perimenopause is a time characterized by shifts in hormone levels, so some researchers hypothesize that the changing hormones of menopause would be a corresponding risk period. Age-related weight gain that normally occurs with menopause is believed to increase the  risk for the onset of eating disorders in midlife. Many women (and presumably men, too) feel unhappy about the physical changes that occur and they may take steps to control their weight. Unique psychosocial stressors that occur in midlife can also play a role in triggering eating disorders in those who may be predisposed: Widowhood and bereavementMedical illness (surgery)Partner-related problems (infidelity and divorce)Parenting-related transitions (children leaving home)Residential moveRetirementImmigration Risks The medical risks for individuals with midlife eating disorders appear  to be even greater than those for younger people with eating disorders. The full range of potential medical consequences associated with eating disorders include: Hormone disruptionProblems with the digestive systemHeart problemsWeakening bonesElectrolyte abnormalities Midlife women with eating disorders may be up to six times more likely to experience medical problems related to their eating disorder than younger people with eating disorders. The most common medical problem for women ages 50 years and older with eating disorders is osteoporosis. For those who have been chronically ill with an eating disorder for many years, the effects may be heightened. Elderly people with eating disorders may be frailer and more prone to bone fractures. For those with low weights, the risk of death appears to increase with age. In one study, the mortality rate for people with midlife eating disorders was three times greater than it was for younger people with eating disorders. Treatment There is a great lack of research on the  treatment of eating disorders in midlife patients. One study showed that only 27 percent of midlife women who met criteria for an eating disorder diagnosis received any treatment. Given the similarity in presentation and course between eating disorders in midlife and young adulthood, there is a  good reason to believe that the treatments developed in younger populations would be effective in older populations; anecdotal evidence supports this hypothesis. However, there are some innovative treatments that may be better suited for middle-aged adults with anorexia nervosa. Find Relief With the 9 Best Online Therapy Programs Cognitive Behavioral Therapy Cognitive behavioral therapy (CBT) is the treatment that has been most studied for adult eating disorders. CBT-oriented interventions that address age-related changes to the body, self-worth, body acceptance, and self-care have some basis in research for its effectiveness. Treatment should provide psychoeducation about the effect of changing hormones in midlife. CBT has been supported as treatment of all eating disorders and is considered the treatment of choice for patients with bulimia nervosa and binge eating disorder. Other Treatment One individual treatment developed for adults with anorexia nervosa is the Maudsley Model for Treatment of Adults With Anorexia Nervosa (MANTRA). It has been tested in adults with anorexia nervosa in the United Kingdom and has some preliminary support. It addresses factors such as personality traits that are known to maintain the anorexia in the individual. Support Even though midlife adults are usually living independently from their parents, relevant family members can take part in their eating disorder treatment. In many cases, it can be helpful to incorporate familyâ€"including parents, partners, children, and significant othersâ€"into the treatment of middle-aged adults with eating disorders. For instance, a couples-based intervention, Uniting Couples in the Treatment of Anorexia Nervosa (UCAN), is designed to supplement individual therapy for adults with anorexia nervosa. This treatment focuses on helping couples work together toward recovery from anorexia nervosa. Another program is Neurobiologically Enhanced With Family/Friends Eating Disorder Trait Response (NEW FED TR), which is a five-day intensive treatment program that is undergoing trials in the United States. This treatment approach centers caregivers and loved ones as an integral part of treatment, creating a team that works to fight the eating disorder together. Getting Help People in midlife with eating disorders are often not diagnosed promptly and may be dismissed by providers who are not used to seeing eating disorders in this age group. Middle-aged people with eating disorders may also be reluctant to acknowledge their problems due to the misbelief that older people do not (or should not) get eating disorders. They may have shame and embarrassment over having what they perceive to be “an adolescent problem.” Therefore, it is all the more important that middle-aged people with eating disorders receive the help they need to recoverâ€"oftentimes, they will not seek it themselves. A Word From Verywell If you have a midlife eating disorder, or someone you love has one, it is important to get help. Even if you feel like you are not being taken seriously by a health care provider or that your problem is not severe enough to warrant help, you deserve treatment. Eating disorders can be successfully treated, even among older adults or among people who have been sick for many years. You are never too old to recover.