By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Why are mid-lifers and seniors developing eating disorders?
Eating disorders have traditionally been thought of as diseases of adolescence and young adulthood. Recently we think we are seeing an increase in eating disorders in middle age and older adults. Are people first developing an eating disorder as adults and if so why?
The first eating disorder to be recognized and studied was anorexia. When someone weighs less than 85% of the “average” weight for their height and age they stand out. Consider also that those average weight charts cited in some of the research may date from 1959 when most people here in the U. S. were smaller than we are now.
Bulimia was not recognized as a separate disorder until very recently and the closer we look the more eating disorders we find. Currently, a very large number of eating disorders are lumped together under the heading Eating Disorders Not Otherwise Specified (EDNOS). When the DSM-5 comes out next year (2013) there will be a whole new way of categorizing eating disorders and our understanding is likely to change.
Anorexia has long been thought of as a disease that first starts in adolescence or early adulthood. We thought it was brought on by a distorted body image or the influences of media emphasis on thinness. Anorexia is often a life long illness with relapses and can be fatal. We thought if you got out of your teen years without this illness you were home free.
We also thought that eating disorders were mostly a problem for women because of the emphasis of society on valuing women for their bodies. So when men began to be diagnosed with eating disorders this made us question what we knew about eating disorders. That change in thinking came slowly.
One study from a large European service reported in what they called a “definitive” study, that there were no cases of eating disorders that developed after age 26. I have left the name of the author of this report out from a sense of kindness. The trouble with the study was that they ended up, after looking at ten years of cases, with only eleven patients they were able to interview. Among those eleven were only one man, one person with Bulimia Nervosa and one person with EDNOS. They conclude that no one gets an eating disorder as an adult.
A study by a U. S. nonprofit of clients who were in treatment for an eating disorder in their midlife reported on a sample of 100 clients (Kally, Cumella, 2008.) They found significant incidences of late onset of an eating disorder and differences in why they may occur.
Kally & Cumella considered the question “Could these later life presentations just be people who always had the disorder but never got diagnosed and were just now reaching treatment?”
They conclude that eating disorders can and do first develop in midlife and beyond but for different reasons than those reported in samples of younger people.
They looked at three factors, background factors that predisposed the person to an eating disorder, the immediate precipitator or trigger for the episode and factors that maintain the disorder once it is established. What they found strikes me as having implications for eating disorder sufferers of all ages as well as pointing us in the direction of why more men are receiving the diagnosis these days.
The largest contributing factors they found (in my words not necessarily theirs) were a history of abuse or neglect, not just as children but at any age, and critical non-affirming people in their support system. Respondents reported that factors in the home they lived in were more important than some general societal message.
This agrees with the things many children have told me. They developed eating problems because a parent or sibling called them fat not because of some celebrities appearance. Family pressure to look a certain way, parents who controlled food or abuse substances, along with a history of abuse or neglect were some of the background reasons or risk factors for developing an eating disorder.
It takes more than a background risk factor to cause an eating disorder.
Most of the sample talked about a specific triggering event and the triggers were different for older onset cases. Children developed symptoms as a result of their family of origin problems. Those who develop eating disorders later were often triggered by events in their family of choice. So if you were abused or neglected as a child or your parents divorced you might get through the event without developing a psychiatric diagnosis. But if that sort of event happened to you as an adult, you get a divorce, then you might develop an eating disorder. People with the risk factor might show increased sensitivity to the same sort of event happening at a later point in their life.
There are more differences between early onset and late-onset eating disorders.
Adolescents are more likely to be triggered by their body image. This is the result of a natural process of growth and development. The body changes and it can be uncomfortable. This is more likely if those in your house are unsupporting or critical.
Adults develop eating disorders because of changes in the family they have created. Divorce, separation, and relationship conflicts are all triggers. As the rate of divorce increased so did the rate of adults with an eating disorder. Adults also can be triggered by health and medical issues. There was a time when there was no such thing as being too heavy. A baby who was chubby was referred to as healthy. As people live longer and become heavier we see more and more negative effects of excess weight.
Men also are feeling the effects of a shift in societal views. Overweight men are now expected to lose weight. People of both sexes have the increasing problem of weight gain caused by medications. More than ever before people are facing medication caused weight gain.
Children who were forced to diet early in life are more likely to develop a binge eating or overeating disorder in adulthood (Rubenstein, et al., 2010.) In adulthood, the number of men who develop eating disorders begins to catch up with the number of women (Keel et al., 2010.)
The eating disorder conclusion.
Young people develop eating disorders because of a faulty or poor body image. Adults, as they get older, develop eating disorders because they do not like the changes in their bodies and in their life that aging cause.
What are your thoughts about why mid-lifers and seniors are developing eating disorders?
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