Help for Adult Women with Eating Disorders

Written by Lynn Ginsburg

Many adult women have eating disorders. Discover how eating disorders therapy works and how to engage in healthy eating.

Most everyone thinks of anorexia, bulimia, and other eating disorders as conditions only young women face, but new evidence shows that many women over 35 suffer from these afflictions throughout their lives.

When I was about 14 years old and just beginning my initiation into the mysterious rites of passage toward becoming a woman, one of the very first "secrets" I learned was how to diet. Here was a way, or so I thought in my innocence, that I could eat whatever I wanted and make up for it later by dieting it all off. How clever were these older women who taught us youngsters how to have our cake and eat it too! As it turned out, not only did I enjoy dieting, with all its deprivations and strict rules, but I had a real talent for it. When I embarked upon a diet, my willpower was resolute and unshakable. But when the diet was over and I'd reached my preferred number on the scale, I couldn't wait to run into the kitchen and start scarfing down all the foods I'd forbidden myself during the diet. That was how I discovered firsthand what so many women have known throughout the ages—forbidden fruits do taste sweeter.

Dangerous Hidden Secrets of Dieting

By the time I'd gotten older, into my late 20s and early 30s, this routine, which had started out as an innocent game, had developed sinister overtones. Now I know the name for what I was doing: yo-yo dieting, which is the practice of losing pounds and regaining them over and over again, moving up and down in weight like a spinning toy on a string. I managed to keep my weight more or less stable into my 40s using this method—it just meant I was perpetually on a diet.

When I looked around at most of the women I knew, both older and younger, I saw a secret society whose members seemed to have the same unspoken agreement (which I personally didn't recall signing) that looks counted above all else. And I realized that the wish I'd long been secretly harboring—that there would be some age limit on this crazy way of looking at food and my body, some point at which I would finally be old enough to opt out of the whole insanity—was not going to come true. I was going to either have to find my own way out or this could easily go on for the rest of my life.

I now know that I was hardly alone in continuing to face serious food and body issues well into midlife. Conventional wisdom in the medical community used to posit that eating disorders were something that happened only to younger girls, and that most women in their mid-30s would certainly have outgrown them. But now those who specialize in the treatment of eating disorders have come to understand that there is no age limit. Eating disorders can and frequently do occur in women that age and beyond. In fact, for the most part, as happened with me, these are eating disorders that women developed as adolescents or young women and never resolved.

This new definition of eating disorders as a condition that can affect any woman at any age may come as a huge relief to the leagues of older women who thought they were all alone, suffering from a disorder they should have outgrown. The good news? When it comes time for treatment, older women bring a mature perspective on life and a resourcefulness to the process that younger women don't yet possess.

Defining eating disorders

The most common eating disorders include anorexia nervosa—in which a person consumes too little food and suffers extreme weight loss—and bulimia—in which a person repeatedly forces herself to vomit after eating, typically after binge eating. Bulimics may also use laxatives to purge themselves. A more general category is binge eating disorder, which, according to Diane Mickley, MD, director of the Wilkins Center for Eating Disorders in Greenwich, Connecticut, shares features with bulimic behavior, such as binging, placing too high a value on food and body issues, and having increased anxiety around food. The general category known as "EDNOS" (Eating Disorders Not Otherwise Specified) includes a wide variety of eating behaviors that don't otherwise have a name but have one thing in common: spending an inordinate amount of time and energy obsessing about food and body. Overexercising, overemphasizing thinness, obsessive thinking, repeated "cleansing," yo-yo dieting, and other forms of excessively restricted eating fall into this catchall category.

One of the worrisome new eating disorders to which women in midlife and beyond may be especially susceptible is orthoexia nervosa, which is defined as a "fixation on righteous eating." This occurs when an obsession with healthy eating begins to dominate a person's thoughts and life to the point where the behavior itself becomes unhealthy. According to Tacie Vergara, clinical supervisor at the Renfrew Center's Thirty-Something and Beyond Group (an inpatient eating disorders program in Philadelphia and other East Coast locations), orthoexia "can start for older women when they've got a life crisis—fear of mortality, a cancer diagnosis, or maybe their husband just got diagnosed with a cardiac problem," Vergara explains. "It starts out as a healthy impulse to eat better, but before you know it, it's out of control."

Whatever the eating disorder, experts agree that most of these conditions don't just come out of nowhere in midlife. "The vast majority of affected people have their first onset in adolescence," says Mickley. "Some may have had longtime food and weight concerns; they may have had low-grade problems that hid out under the radar for a long time. But it's extremely rare for an eating disorder to manifest for the first time in middle age."