Eating Disorders in Adults: A Silent Struggle

By Rebecca Boswell, PhD

When most people think about eating disorders, images of teenagers and young adults often come to mind.

And while it is true that most eating disorders begin in childhood and young adulthood, they can affect people of all ages, including those middle-aged and older.

In fact, according to the National Eating Disorders Association (NEDA), rates of eating disorders and body dissatisfaction occurring later in life are on the rise.

If you or a loved one are struggling with an eating disorder, help is available.

The Penn Medicine Princeton Center for Eating Disorders provides inpatient treatment for adults, adolescents and children as young as 8 who suffer from eating disorders, including anorexia nervosa, bulimia nervosa, avoidant-restrictive food intake disorder, and binge eating disorder.

Often Overlooked

According to NEDA, studies show that upward of 7% of women and 1% of men aged 40 and older meet the diagnostic criteria for an eating disorder.

What’s more, the number who experience disordered eating and body image issues but don’t meet the diagnostic criteria for an eating disorder is even higher.

As NEDA notes, one study found that 73% of middle-aged women experience dissatisfaction with their weight, which is a risk factor for the development of an eating disorder.

However, too often eating disorders in middle-aged and older adults are overlooked.

Triggers

Eating disorders are often rooted in the desire for control and in older adults can be triggered by a range of psychological, social, and physical factors. Here are some common triggers:

• Life changes. Divorce, retirement, children leaving home, loss of friends and loved ones. These changes typically occur in midlife and beyond and can create emotional upheaval, leading some people to turn to unhealthy habits as a coping mechanism.

• Societal pressures. Though body image concerns are often associated with younger people, adults in their 30s, 40s and 50s, especially women, may still feel societal pressure to stay slim. Social media, dating apps and celebrity culture increasingly focus on maintaining a youthful appearance, which can fuel insecurities in middle-aged and older adults.

• Age-related body changes.  Menopause and other age-related body changes can lead to weight gain, reduced muscle mass, and other signs of aging that can trigger body dissatisfaction. Fear of aging can prompt restrictive eating or over-exercising.

• Chronic illness. Chronic illnesses, such as diabetes, cardiovascular disease, and digestive disorders, often require dietary changes. For some, these necessary restrictions can spiral into disordered eating behaviors. Additionally, certain medications can affect appetite or alter weight.

• Depression and anxiety. Mental health concerns, which may occur later in life partly due to isolation or physical decline, are strongly linked to eating disorders. Depression can lead to either a loss of appetite or the use of food as a comfort mechanism, while anxiety may cause obsessive-compulsive behaviors around food.

In addition, for those who experienced an eating disorder earlier in life, there is a risk that the disorder will reoccur when they hit middle age and beyond. Further, biological factors such as genetics and hormonal and neurotransmitter imbalances may also be triggers for eating disorders.

Warning Signs

Whether you’re 15 or 55, signs of an eating disorder generally include physical, emotional, and behavioral changes related to food, body image, and eating habits. These signs can include:

• Preoccupation with food and body image. Persistent thoughts about food, dieting, calories, or body shape that interfere with daily activities.

• Distorted body image. Feeling overweight or obsessing over perceived flaws in one’s body, even if they are underweight or their appearance hasn’t significantly changed.

• Low self-esteem and mood swings. Depression, anxiety, irritability, or extreme mood swings, often tied to body image or eating habits.

• Guilt or shame about eating. Feeling intense guilt or shame after eating. 

• Dieting and restrictive eating. Skipping meals, eating in very small portions, or adhering to strict food rules. Avoiding entire food groups, for example.

• Excessive exercising or feeling guilty, anxious or irritable if a workout is missed.

• Binge eating. Eating large quantities of food in a short period, often in secret, and feeling a loss of control during these episodes.

• Purging. Compensating for eating through vomiting, excessive exercise, or misuse of laxatives, diuretics, or enemas.

• Social withdrawal. Avoiding meals with others, eating in isolation, or making excuses to avoid social gatherings involving food.

• Ritualistic eating habits. Engaging in rigid meal routines, such as cutting food into tiny pieces, eating only certain foods, or consuming food in a specific order.

• Hoarding or hiding food. Storing food in unusual places or hiding wrappers or evidence of binge eating.

• Physical signs, such as rapid or extreme weight loss or notable weight gain, especially in a short period; digestive problems; fatigue or weakness; dizziness or fainting;  changes in hair and nails; dental issues and irregular heartbeat.

Seek Professional Help

Recognizing the signs of an eating disorder early is crucial to helping someone recover.

However, many healthcare providers and family members don’t expect eating disorders to emerge later in life, making diagnosis and treatment difficult.

Additionally, adults may have fewer social supports or might feel ashamed to seek help, perceiving eating disorders as a teenage problem. They may also be more isolated, making it harder for others to notice the warning signs.

If you or someone you know exhibits signs of an eating disorder, consider reaching out to a mental health or medical professional for guidance.

No matter your age, the Princeton Center for Eating Disorders combines psychosocial treatment, nutritional support, family involvement and the latest advances in clinical care – together with an atmosphere of understanding, safety, respect and support – to promote the recovery process.

In addition, Penn Medicine Princeton House Behavioral Health offers outpatient care through its Emotional Eating Track, geared toward individuals who are having difficulty managing the symptoms of a mood disorder and use food to regulate emotions.

For more information about the Princeton Center for Eating Disorders and Princeton House Behavioral Health, call (888) 437-1610, option 3, or visit princetonhcs.org/eatingdisorders. 

Rebecca Boswell, PhD, is Director of Penn Medicine Princeton Center for Eating Disorders and Administrative Director of Psychiatric Services at Penn Medicine Princeton Medical Center.