FAQ on eating disorders in adults

Eating disorders are often thought of as a problem of troubled teens or young women in college. But that's far from the only truth. Adults — even older adults — also can have eating disorders, whether it's anorexia, bulimia, binge-eating disorder or a nonspecific eating disorder.
Donald McAlpine, M.D., a psychiatrist and the director of the adult outpatient eating disorders services at Mayo Clinic, Rochester, Minn., treats people with eating disorders. Here, he discusses how eating disorders affect adult women.
The typical image of someone with an eating disorder is an adolescent girl or a young woman. But can adult women have eating disorders, too?
It's true that eating disorders usually affect younger women, peaking in the late teens or early 20s. However, eating disorders also affect woman in their 30s, 40s, 50s and beyond.
These women typically fall into three categories:

* Women who have secretly struggled with an eating disorder their entire life without seeking treatment
* Women who were treated for eating disorders when they were younger and develop a recurrence when they get older
* Women who first develop an eating disorder as an adult

Are women more likely to have an eating disorder as an adult if they had one as a teen or young woman?
Most women who receive appropriate treatment get well enough that they no longer meet the criteria for being diagnosed with an eating disorder. However, many women will continue to have some degree of lingering signs or symptoms of an eating disorder that can flare up under stress. These may include bingeing and purging, such as vomiting, or renewed efforts to restrict eating with significant weight loss.
Are the characteristics of eating disorders different for women in their 30s and beyond?
There are several differences in eating disorders depending on age, including:

* Common triggers. Young women with bulimia nervosa are often driven by excessive concern with weight, shape and body image. Older women, on the other hand, may be driven to binge and purge to cope with unpleasant mood stages. Of course, women at any age can struggle with poor body image, even women in their 60s and 70s. Eating disorders in women in their 40s and beyond are often triggered by such life events as the death of a loved one, divorce, remarriage, traumatic illness or signs of aging.
* Denial. Denial is very common in younger women with anorexia nervosa but seems to be less common in older women. Older women may more readily acknowledge that an eating disorder is harming their life and seek help. Older women who are worn down by years of symptoms may also be more motivated to seek help. Motivation for change often leads to a more successful outcome in treating the illness.
* Identity and coping. Years of daily eating disorder symptoms can become deeply engrained. Women who have had symptoms for years may ironically find it difficult to live without this eating disorder identity or coping style, as uncomfortable or emotionally painful as it may be.
* Health effects. Eating disorders have dangerous health effects at any age. But older women — those in their 60s and beyond — are especially at risk. In fact, most people who die of the effects of anorexia are older than age 65 — not young girls. Older women with a long history of eating disorders may have developed much more serious health problems. In addition, they may have other health conditions that make them more vulnerable to problems from eating disorders.

How does the treatment for eating disorders of older women differ from that of younger women?
It's common for older women to tell me that when they were younger — and still in denial about their illness — that they bluffed their way through treatment. They would return to eating disorder behaviors as soon as they were done with treatment because they never truly were that motivated to overcome their eating disorder. Now older and wiser, these women may do better with treatment because they no longer have that youthful sense of immortality and they're more aware of the consequences of their disease, such as osteoporosis. For these reasons, they're often more motivated to overcome their eating disorder.
We still have a long way to go, but treatment programs have progressed substantially in the last two decades. Cognitive behavior therapy for eating disorders — focusing on self-monitoring, homework assignments and goal setting — was in its infancy in the early 1980s. Women treated for eating disorders in midlife may find that the treatment they had 20 years ago offers much greater benefit to them now. And since their initial treatment, new medications have been approved for eating disorders.
Women discouraged by unsuccessful treatment when they were younger should seek help again. Much more is now known about eating disorders and their treatment.
How likely is it that if a mother has an eating disorder, her daughter also will? What can parents do about this?
Parental attitude about food and their values about what constitutes a healthy weight definitely have an impact on children. It's not uncommon for mothers with eating disorders to seek help because they don't want to pass on their unhealthy attitudes about eating to their children, who also can mimic disordered eating behaviors.
As a parent, be on the lookout for warning signs of eating disorders in your children, which may include:

* Excessive weight loss
* Excessive exercise
* Skipping meals
* Being extremely fussy about food
* Frequent trips to the bathroom after meals
* Laxative use

Also, watch for extreme concern about shape, weight and body image. And listen to what your children are saying about issues related to food, body image, dieting and exercise. That can provide important clues about whether their own attitudes are healthy or not.
What about adult men? Don't they get eating disorders too?
Yes, males of all ages, whether adolescents or older adults, can have eating disorders, just like women of all ages. Adult men with eating disorders often have a history of being obese. They also may be striving for a more athletic or muscular build, sometimes known as reverse anorexia because they want to build broader shoulders and arms. Men are less likely than are women to engage in vomiting as a way to purge, and instead may turn more often to compulsive exercise, weight-loss supplements or weight-enhancing supplements. Like women, they also can benefit greatly with appropriate treatment.