Dynamics differ for older women with eating disorders

Diagnosing and treating an eating disorder in an adult woman poses many challenges. Most of these women live at a high-functioning level and have mastered the art of juggling the responsibilities of adulthood, so to the outside world they look to have it together. When confronted with the suggestion that they might need to step back to take care of their problem, that becomes a tough sell.

“The idea that they can take time for themselves? Well, that just doesn't compute,” says Margo Maine, PhD, who treats women with eating disorders at an outpatient practice in West Hartford, Conn.

Adult women with eating disorders have constituted an “invisible” population for some time, says Maine. When she was researching her book The Body Myth: Adult Women and the Pressure to Be Perfect a decade ago, “There was pretty much no research out there,” she says. “Nobody knew how many adult women had an eating disorder.”

Now some numbers have emerged. Research covering the period from 1999-2009 found that 25% of all residential and inpatient treatment admissions for eating disorders were for women over age 45. A 2012 study found 13% of women over 50 reporting eating disorder symptoms, a figure exceeding breast cancer prevalence in that age group.

Older women experience many potentially triggering life transitions, much as adolescent and young adult women do, but these often don't get the same amount of attention because “they don't have the graduations, confirmations, and big birthday parties to celebrate them,” says Maine, co-founder of the Maine and Weinstein Specialty Group.

Rarely a first-time issue

Here is some of what the field knows about the older female cohort with eating disorders. While it is not true that every woman who develops eating disorder symptoms had a full-blown eating disorder earlier in life, most at least had symptoms at some point in time. “Very few develop this later for the first time,” says Maine.

Life crises around relationships, parenthood, work challenges and family illness often serve as a precipitating factor to the onset of symptoms. “The way they often will manage anxiety is through their body,” says Maine. “They don't have another way to take time for themselves.”

This is why Maine believes it is important to address with adult women that when they are experiencing a developmental transition, they need to remain mindful of their eating patterns, sleep, exercise and other lifestyle issues.

Adult patients with eating disorders don't tend to exhibit discrete symptoms of anorexia or bulimia, which can make a diagnosis all the more challenging. “It is usually a combination of symptoms, or subclinical symptoms getting more intense,” Maine says. Treatment can be even more of a challenge given the busy lives that these women lead, so Maine believes intensive outpatient and outpatient programs should schedule some hours in evenings and on the weekend.

Maine adds that if a woman received treatment earlier in life for an eating disorder and was able to stay in treatment for a period beyond fulfillment of initial goals, the additional coping skills she would have built could serve as a protective factor against a recurrence in older adulthood.

According to Maine, data on the prevalence of eating disorders in adult men are considerably more sparse than the data on women.

A revised version of Maine's 2005 book will be out this May, titled Pursuing Perfection: Eating Disorders, Body Myth, and the Pressure to Be Perfect.