Why eating disorders strike in middle age

Eating disorders aren’t just experienced by teenagers. They can also happen to a person later on in life.

During adulthood, we experience many changes and go through a number of important life stages. These can act as triggers for eating disorders, which arise as a way for a person to take back control.

An eating disorder often develops as a misplaced and unhealthy coping mechanism. It becomes increasingly important to someone as it can feel helpful in managing overwhelming emotions and difficult circumstances.

Perimenopause and the menopause

Perimenopause or menopause can be times of change where symptoms of an eating disorder can develop or become exacerbated.

study published in The European Menopause Journal showed that, similar to puberty, perimenopause, which is the name given to the stage leading up to the menopause in a woman’s life, may be a high-risk period for the development or return of eating disorders. As such, any preconceptions that middle aged women are somehow immune to these conditions are simply not true.

During perimenopause, a woman can experience immense physical and hormonal changes. It can also coincide with other major life developments, such as children leaving home, a marital breakdown or looking after adult parents. The cumulative burden of these events can be overwhelming. An eating disorder can provide a  feeling of being in control or even having a sense of purpose.

The effects of a negative body image

As the body changes in mid-life, this can also become a trigger. An eating disorder can provide a woman with a sense of control as their body alters and feels under threat.

Social media can aggravate this negative body image. This can lead to body dissatisfaction, low self-esteem and identity confusion across the ages. All risk factors for developing an eating disorder.

The worrying fact is that if an eating disorder does take hold, older women may be more likely to suffer from related medical complications, such as osteoporosis, gastrointestinal and cardiac issues and irreversible dental problems.

Recovering from an eating disorder in adulthood

Regardless of age, eating disorder symptoms and behaviours remain largely the same and have an equally devastating impact on a person’s quality of life.

However, middle-aged women dealing with the symptoms of an eating disorder may not reach out for support. They may feel a stigma, or have the notion that eating disorders are considered to be a ‘teenage issue’. This can prevent them from accessing the specialist support that they need. It can also increase the possibility of medical complications and lead to the development of more enduring eating disorders that are less responsive to treatment.

When it comes to treating an adult with an eating disorder, resources focus on the younger age group. These are at highest risk, but it’s important we don’t develop ’blind spots’ when it comes to older patients and those who do not fit the stereotypical mould.

Eating disorders are severe mental disorders with a complex array of risk factors specific to each person. We cannot treat people with a ‘one-size-fits-all’ approach.

The more we can understand someone’s unique condition and what has contributed to the development of the illness, the greater the chance of a full recovery.

Lorna Richards

About Lorna Richards

I work as a consultant psychiatrist specialising in adult eating disorders within Priory's Life Works Hospital. I have been involved in the development of national guidelines, policy, professional standards and training in my roles as executive committee member for the Section of Eating Disorders (now Faculty) and the London Division, both part of the Royal College of Psychiatrists. I am also a regional specialty representative for eating disorders. I was a member of the Clinical Reference Group for NHS England, commissioner of national specialist services and was the author of the Guideline for Commissioners of Eating Disorders Services published by the Joint Commissioning Panel for Mental Health.