What it's like to be middle-aged and have an eating disorder

Eating disorders are commonly associated with teenage girls. But the onset of perimenopause can be a trigger for some women 

Dr Art Malone: "The longer you’ve been dealing with an eating disorder, the more it’s ingrained in your brain, in your daily habits, and your internal psychology.” 

Eating disorders are generally associated with teenage girls and those in their early 20s. However, they are not unique to this age group; women also experience eating disorders in midlife.  

“It’s not so much that women are developing an eating disorder in middle age, it’s more the case that midlife women with an eating disorder likely have a long history of having, at the very least, disordered eating, or more commonly, a long-standing eating disorder going back to adolescence. But with 5% of middle-aged women experiencing this, it is what we consider fairly common,” says Dr Art Malone, consultant psychiatrist with the HSE Adult Eating Disorder Service at St Vincent’s University Hospital.

In midlife, women can face specific life transitions that can trigger or amplify eating disorders, explains Harriet Parsons, psychotherapist and training and development manager with Bodywhys, the Eating Disorders Association of Ireland. #

“Their role in the family may be changing with children growing up and leaving home, they may be facing retirement, or a change in their relationship, whether that’s divorce or bereavement, and of course, at this age in people’s lives they will naturally encounter bereavement more frequently — parents, older siblings or partners.” 

Another key life event at this time in a woman’s life is menopause, which typically starts with perimenopause between the ages of 45 and 55. 

Menopause is a significant change moment for midlife women. There is an element where their bodies may feel out of control as hormone levels fluctuate.

Because of the physical toll eating disorders can have on the body, they are considered among the most deadly mental disorders. The three most common eating disorders are anorexia nervosa, where a person will restrict their food intake dramatically; bulimia nervosa, when someone will gorge on food and then purge it by vomiting or using laxatives; and binge eating disorder, where someone will consume excessive amounts of food, beyond the point of feeling full.

There is no one cause for eating disorders, says Malone. “Multiple factors or bumps along the road contribute to someone experiencing an eating disorder. That means there is no standard person that comes in the door to us.” 

While there is no one cause, people who experience eating disorders will often fit into different groups with key characteristics. “The most common is generally someone who has a tendency to be anxious about non-specific things and is prone to depression,” says Malone.

Anxiety and depression are common perimenopause symptoms

Common symptoms of perimenopause are anxiety and depression, which means that women at this time, particularly those who have experienced an eating disorder earlier in their lives, can be at a heightened risk of relapse, says Catherine O’Keeffe, author of All You Need to Know About Menopause. “Menopause is a significant physical and emotional change where women experience rising anxiety and dips in mood, while at the same time, the decline in oestrogen means their body shape can change and they can gain weight around their middle. In today’s society, there is so much pressure on women to look young and thin, and at this psychologically difficult time, it can be a trigger to engage in disordered eating.” 

For many women, the eating disorder acts as a coping strategy, says Malone. “With eating disorder treatment, we’re focused on giving them new tools. We don’t focus on their weight, or devising a healthy meal plan, or taking the eating disorder away, it’s about working on a person’s individual goals and values, looking at their challenges, and helping them become better at supporting themselves.”

Recovering from an eating disorder in middle age is more difficult than if you are younger and first presenting with an eating disorder, explains Malone. 

“For younger patients, we typically see them feeling better and well enough to be discharged by around 18 months. But with the older group, the treatment can be significantly longer. 

"The longer you’ve been dealing with an eating disorder, the more it’s ingrained in your brain, in your daily habits, and your internal psychology.” 

Stigma and shame

Psychologically, it can be difficult for women in midlife to present for treatment — they may feel shame accessing these services for something that is still considered a younger person’s disorder. 

“Women in midlife have a different stigma to overcome if they seek treatment, they may feel anxious if they see younger people in the waiting room, but they need to know that everyone with an eating disorder is worthy of treatment,” says Malone.

Women in middle age with an eating disorder are very much a missed generation. Up until recently there were no publicly available services for eating disorders.

"These treatments are relatively new in Ireland, and so when these women may have been experiencing an eating disorder in their teenage years, the treatment options were not available.” 

But they are available now, with five specialist eating disorder teams around the country. And a support organisation like Bodywhys can be a good starting point for anyone who thinks they need help.

Parsons recommends anyone who is experiencing an eating disorder to visit their GP first and speak to them about it. “This the first step, talk with your GP, get physically checked. The GP can then refer them on to their local AMHS where they will receive a clinical assessment and treatment will be determined based on their level of risk.”

 Even if someone is feeling anxious about accessing treatment, Malone urges anyone who is experiencing an eating disorder in middle age to get a physical checkup. “The physical consequences of an eating disorder in middle age include anaemia, osteoporosis, gastrointestinal problems, and cognitive issues. There will be a lot of wear and tear on the body, particularly if someone has been experiencing this for most of their lives. That physical check up is so important.

"This is a treatable problem and older women shouldn’t feel like they’ve missed the boat, they will be treated with respect. But my advice is to seek treatment as early as possible.”