Disorders in Midlife

By 
Lauren Muhlheim, PsyD, CEDS
 
Updated on August 16, 2021
 Medically reviewed by 
Rachel Goldman, PhD, FTOS
Table of Contents

 Prevalence
 Causes
 Risks
 Treatment
 Getting Help

Eating disorders are most often thought of as afflicting teenage girls and
young women. In reality, this is not the case. Many women and men don't stop
worrying about weight and shape as they age. The fact is that eating disorders
are equal opportunity offenders, crossing cultural boundaries and leaping the
borders of age and gender.

Despite this, very little research has been done to better understand eating
disorders in midlife (commonly defined as the period between 35 and 55
years). While the symptoms of each eating disorder may not differ much by
age, the context in which people in midlife experience them is quite unique.
 Verywell / JR Bee

Prevalence
There are more midlife adults with symptoms of eating disorders than those
with an official eating disorder diagnosis, as is the case for other age groups.
But research specifically dedicated to disordered eating behaviors and eating
disorders in midlife is significantly lacking compared to younger populations.

Eating Disorders in Midlife Women

It's only been in recent years that eating disorder research has included
women in midlife. Research shows that around 3.6% of women aged 40 to 50
years experience an eating disorder every year. Based on DSM-5
criteria, other specified feeding and eating disorders (OSFED; 1.7%) is the
most common eating disorder found in this age group, followed by binge-
eating disorder (BED; 1%), bulimia nervosa (0.4%), and anorexia
nervosa (0.2%).

According to midlife eating disorder specialist Dr. Holly Grishkat, midlife or

older women living with eating disorders essentially fall into three categories:

 Those who have struggled with an eating disorder for years without
seeking treatment
 Those who had an eating disorder as a teen or young adult and
recovered, only to relapse in midlife
 Those who develop an eating disorder for the first time in midlife

Grishkat says that most midlife women who struggle with later-life eating
disorders actually had an eating disorder their entire lives, followed by those
who had an eating disorder when they were young.

Many people with eating disorders tend to suffer in silence, making it difficult
for researchers to estimate how many people are affected by these disorders.

Watch Now: Common Signs of an Eating Disorder

Eating Disorders in Midlife Men

Historically, studies have examined eating disorders from an entirely female
focus, neglecting men entirely. Because of this, very little is known about the
prevalence of midlife eating disorders in men.

Lifetime prevalence rates for 45- to 59-year-old men based on supplemental

data from the U.S. National Comorbidity survey were 0%, 1.3%, and 2.7% for
anorexia nervosa, bulimia nervosa, and BED, respectively. The 12-month
prevalence rate for eating disorders in midlife for older males was estimated
between 0.2% and 1.6%. 

Among young males, a version of muscle dysmorphia tends to be more

common than anorexia—it appears to be the same with middle-aged men,
too. One study 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.

Causes
The causes of eating disorders in older adults are not well-documented or
understood. The main reason being that there is a general misconception that
eating disorders only affect teenage girls. However, there is growing evidence
to show that eating disorders aren't exclusive to people under the age of 30.

Research has found that eating disorders can be triggered by periods of

reproductive hormone change, such as puberty. Like
puberty, perimenopause is also a time characterized by shifts in hormone
levels. Because of this, some researchers hypothesize that the hormone
fluctuations that occur in perimenopause could also be a risk factor for the
development or maintenance of eating disorders in midlife in women.

Additionally, body image issues, a common feature of eating disorders, seem

to become more complex with age, particularly in cultures in which youth is
often presented as a standard of beauty. Age-related weight gain and
changes in body composition—including an increase in body fat, reduced skin
firmness, fat redistribution and changing body shape, and decreased
metabolism—can also cause many women (and presumably men, too) to feel
dissatisfied with their appearance, which can lead to unhealthy eating habits.
 Is the Media to Blame for Causing Eating Disorders?

In addition to the hormonal changes, there are also some definite stressors
unique to midlife that can prompt the emergence (or re-emergence) of an
eating disorder:

 Relationship problems (such as divorce or infidelity)

 The death of a partner or spouse
 Retirement or loss of a job
 Empty-nest syndrome
 Caring for aging parents
 Lacking adequate savings for retirement
 Grief (including that brought on by the death of a parent, adult child, or
friend)
 Dealing with increased illness
 Lack of enthusiasm for life
 Attempts to get attention from family members
 Growing old/facing death

 Why Do Some People Get Eating Disorders?

Risks
The older you get, the tougher it is for your body to bounce back from the
devastating effects of eating disorders, making them even more dangerous to
older adults. And for those who have been chronically ill with an eating
disorder for many years, the effects may be heightened. The full range of
potential medical consequences associated with eating disorders include:

 Osteoporosis
 Increased risk of high blood pressure
 Increased risk of diabetes
 Heart problems such as arrhythmias, heart disease, and heart failure
 Anemia
 Cognitive problems
 Electrolyte abnormalities
 Kidney issues
 9 Essential Facts About 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% of midlife women who met the
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. They include:

 Cognitive-behavioral therapy (CBT): Often considered a first-line

treatment for eating disorders, CBT challenges unrealistic thoughts
about food and appearance and helps you develop more productive
thought patterns. In particular, CBT-oriented interventions that address
age-related changes to the body, self-worth, body acceptance, and self-
care have some basis in research for effectiveness in treating eating
disorders.
 Group therapy: Working in a group setting, making connections, and
sharing experiences allow someone struggling with an eating disorder in
midlife to see that they are not alone. When used in combination with
individual therapy, group therapy can be an excellent source of
treatment and support for those with bulimia or binge-eating disorder.
 Family-based treatment (FBT): Sometimes referred to as the
Maudsley method, FBT is designed to aid recovery from an eating
disorder with the help of family and loved ones, including parents,
partners, and children—often as a supplement to and in conjunction
with individual therapy. Two popular FBT programs for adults are
Uniting Couples in the Treatment of Anorexia Nervosa (UCAN) and
Neurobiologically Enhanced With Family/Friends Eating Disorder Trait
Response (NEW FED TR). Both are designed to treat midlife adults with
anorexia nervosa.
 Interpersonal therapy: This type of psychotherapy can help you gain
insight into issues such as role transitions, loss, and unresolved
 relationships that may underlie disordered eating and an excessive
focus on body image.
 Nutritional therapy: A registered dietitian can help you learn (or
relearn) the components of a healthy diet and motivate you to make the
needed changes.

Because eating disorders are mental illnesses, your treatment team should
include a mental health professional such as a psychologist or psychiatrist, as
well as a primary care physician and registered dietitian.
 Best Eating Disorder Support Groups of 2021

Getting Help
People in midlife living with an eating disorder may find added barriers to
treatment and recovery both internally and externally. A middle-aged person
may be more reluctant to acknowledge and seek help due to the misbelief that
older people do not (or should not) get eating disorders. There may even be
added shame and embarrassment related to experiencing what is often
mistakenly perceived as “an adolescent problem.”

Additionally, diagnosis may not be as prompt among providers who are not
used to seeing eating disorders in this age group, but help is available, and
recovery is possible.

If you or a loved one are coping with an eating disorder, contact the National
Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237. 

For more mental health resources, see our National Helpline Database.

A Word From Verywell

If you or a loved one is experienced an eating disorder in midlife, it's important
to know that you're not alone. There are others just like you struggling with
eating disorder symptoms in all stages of recovery.

While recovery can be a physical and mental challenge, it is possible with the
right support. If you or someone you know is experiencing some or all of
the symptoms of any eating disorder, please consult with a physician,
dietitian, or mental health professional for assessment and treatment.

7 Sources