For many reading this article, the title will likely sound a bit strange. Topics like ‘older women’ and ‘eating disorders’ don’t usually appear in the same sentence, at least in most of the literature where we read about either one. Yet, there likely exists a whole population of women who are daily falling through the cracks of our society – women who are virtually unknown, even to professionals who have dedicated their careers to helping women who suffer from eating disorders. These professionals work with women, yes, but typically young women who are under the age of 25 or 30. So where are the women I speak about? If they’re not in eating disorder support groups, or in out-patient treatment programs, like their younger counterparts, where are they? The answer is simple: they are usually suffering silently, alone, and with great shame about living with a ‘young person’s’ disease.

Based on my experience within my own psychotherapy practice, and on discussions I’ve had over time with colleagues, and friends, and by reading the very few articles written about this topic, I have a growing belief that eating disorders are being experienced by far more older women than any of us may have realized, or even thought about, at least until very recently. We might wonder why this phenomenon is only just being recognized, and even still, by so few people, including the so-called experts working in this field.

But before I discuss why I believe this phenomenon is occurring, let me first define the term ‘eating disorder’. There are three main forms of eating disorders recognized by medical and psychological experts: anorexia nervosa, bulimia nervosa, and binge-eating disorder. Anorexia nervosa is characterized by one’s engagement in self-starvation practices. That is, where there is a refusal to eat enough food to maintain sufficient food to support life. (Most people who fall into this category, have experienced extreme weight loss and, are at least 15% below their normal body weight.) Bulimia nervosa typically involves repeated episodes of overeating, which is followed by varying inappropriate methods of ridding their body of the food. These methods can involve purging (i.e., forcing themselves to throw up), the use of laxatives, and/or are engaged in excessive exercise routines. (Those who suffer from anorexia may also habitually over-exercise.) Finally, binge-eating disorder involves repeated episodes of overeating to the point where the individual experiences a painful feeling of fullness, but they do not typically engage in any activities that would result in ridding their body of the excess food. All three of these disorders put their sufferers at great risk of experiencing a range of serious health consequences, including death.

Older women who suffer from eating disorders belong in two etiological groups: 1) those who engaged in disordered eating patterns early on in life, perhaps in their late teens and/or early twenties, and have either recovered and later relapsed or have never ceased their disordered eating behaviors at all, and 2) those who began their dysfunctional eating patterns much later in life. In both cases, there are some common triggers that might help us understand why these older women might succumb to, or continue, this disordered pattern with food.

One possibility might be that for older women, unlike for young women in their teens and/or early twenties, the support structure that typically acts as a monitoring system (i.e., concerned parents), is no longer a part of their lives, at least in the roles held previously. The woman is an adult now and, therefore, is more able to successfully hide her ‘habit’ in the midst of a busy life filled with any number of competing responsibilities. “Just strange eating habits”, her family members or friends might innocently conclude. At this point in her life, it’s now her choice whether she reaches out for help, and not her parents’, and it seems that for many older women, they are choosing to stay silent, deciding instead to handle it themselves.

Another possibility is that for women who have lived with their eating disorder for several decades, it may have become an integral part of their identity, such that in its absence, they wouldn’t quite know how to manage – their emotions, their stress, or even their lives. Even knowing they are at risk of experiencing serious physical and emotional damage – and most do – they would rather cling to whatever forms of relief or safety their eating disorder has offered them over time. The thought of the alternative, that is, to give it up is, for many, something they would rather die than do. And, as the statistics reveal, many do just that.

At this point, one may ask a perfectly understandable question: why would women, who we believe should fall into the category of being ‘older and, therefore wiser’, engage in disordered eating patterns? There are several answers, but they need to be understood within a larger sociological context, that is, where all women in our society, regardless of their age, are daily (if not hourly) subjected to a standard for beauty that has been deeply ingrained into our cultural fabric. And, due in large part to this established norm, many women begin to struggle with their bodies, and thus their self-image, at increasingly younger ages. Their efforts to conform to this very exclusive and unrealistic standard often ignites an internal war within women between their ‘selves’ – their emotional selves and their physical selves. And, for many, this war can continue for the rest of their battle-weary lives.

For many women, eating disordered behavior is adopted as a way to cope with stress. And, as women age, they can face an inordinate amount of stress in their lives, for example, to rise to, and maintain, this cultural standard for beauty. Central to this standard is the ‘requirement’ that women remain youthful, if not in years, in appearance. In other words, if you can’t be young, the next best thing is to look it. However, as aging begins to leave its inevitable mark, many women become painfully aware that their bodies are moving farther and farther away from this norm, and all its inherent expectations. At the same time, they also realize that any opportunities to recapture their youthful image, including the thinness that is typically associated with this image, are becoming increasingly unrealistic and unachievable. And, if their self-esteem and self-worth are indelibly linked to their physical appearance, then adopting an eating disorder is one way for them to cope with the stress of this new reality.

At mid-life, women often experience a variety of losses – again, often triggering feelings of stress and anxiety. For example, children may be leaving home, and in the absence of their children to care for, they may feel they have little, or no, value. They may also be facing separation or divorce, which can bring all sorts of fears to the fore, including the fear of being alone, or perhaps worse, of dating again after many years – and now, in a much older body. In addition, these women may hope to, or need to, [re] enter the work force and, therefore, fear competing with much younger, and more attractive, women for jobs. They may also feel over-extended in terms of their personal responsibilities, not only within their own family unit, but also in their extended families, where some members may be sick and require endless hours of care. And, with retirement lurking ever closer, they may be experiencing a fear of economic insecurity. And the list goes on. Any one of these stressors, or the many others that I haven’t included here, can potentially act as triggers for the development of an eating disorder.

One of the major concerns about eating disorders, of course, is the physical and emotional health risks associated with them, which include damage to vital organs such as the heart and brain, depression, and even suicide. These side-effects are obviously serious at any age, but for the older woman they pose an even greater risk. As our bodies age, they aren’t nearly as resilient as they once were. Consequently, long periods of abusing one’s body, as is the case when one engages in eating disordered behaviors – particularly when the body is already experiencing the effects of age – can have catastrophic consequences. But this is not news, of course, and as I noted previously, most people who struggle with eating disorders understand, at some level, the potential long-term consequences of their actions.

So, if understanding the consequences doesn’t help, what will it take to stop this self-destructive cycle before it’s too late? It seems like a simple question, really. One could say that the onus of responsibility lies with the women themselves, just as it does with any other person who suffers from an addiction. So we may believe they need to begin by telling the truth about what’s going on for them. In other words, by simply making a decision to move out of their self-imposed isolation and begin sharing their painful struggle with others whom they trust (i.e., their family physician, best friend, life partner), they will likely feel the burden of their shame begin to slip away. This is an important – no, vital – first step. But, admittedly, it’s a difficult one, especially if those they choose to open up to don’t recognize that, at this stage in a women’s life, suffering from an eating disorder could even be a possibility. Under these conditions, how can we expect these women to feel safe enough to share their painful secret? But, on the other hand, how can others become aware of the problem if women won’t speak up? Clearly, there’s no easy answer.

One would imagine that the treatment of eating disorders for older women would be similar to the types of treatments currently offered to younger women: individual and/or group therapy often coupled with specific medications, such as various forms of anti-depressants that have had a positive effect in the treatment of these disorders. But the impact of a cultural ‘blindness’ surrounding this issue can have detrimental effects on treatment as well. For example, if older women are asked to join group therapy where most of the group members are significantly younger than they are, it could undermine any attempt to help them. Instead, it could actually increase the level of shame they’re already feeling about themselves, and their disease, since they may believe they should be ‘beyond’ such behavior. Moreover, many of the younger members of the group may agree, thus, creating a dichotomous and, therefore, destructive ‘us’ versus ‘them’ climate within the group itself. But, if group therapy is believed to be an effective treatment modality, which it can be, then there should be an option for older women to be placed in groups with other women who are in a similar life phase. The types of issues they’ll need to address in group therapy will be somewhat different than the ones younger women need to talk about.

With respect to individual therapy, there are a number of modalities being used in the treatment of eating disorders. The most common of these are cognitive-behavioral (CBT) and psychodynamic therapies. The goal of CBT is to help the individual ‘rewrite’ any forms of irrational thinking, misperceptions, dysfunctional thoughts, and faulty learning that may exist. And, if therapy is successful, the individual will ideally choose less self-destructive patterns of behavior, regardless of whether the original triggers for the disordered eating behaviors continue to exist.

Psychodynamic therapies, on the other hand, aim to help the individual gain insight into the ways in which their past experiences, typically ones in childhood, influence their present behavior. Gaining insight, according to psychodynamic therapists, is a necessary condition to changing behavior patterns in any significant and long term manner. Thus far, both CBT and psychodynamic therapies have been shown to be relatively successful in the treatment of eating disorders. Therefore, there is little reason to believe they wouldn’t prove equally effective with this population as well, but, again, only as long as the therapists who work with them have a deep understanding of the issues specific to these older women.

But, first things first: there’s little point in discussing treatment methodologies if there’s no cultural awareness of the problem in the first place. In the absence of this awareness, these sorts of discussions will remain theoretical, at best. On the other hand, if societal awareness is created, and it translates into positive action, then it will permit these women the freedom to reach out for help in the absence of the kind of shame that has rendered them to a life of silent suffering.

If you, or someone else you know, is struggling with an eating disorder, you may want to review the following informative websites:

• The National Eating Disorder Information Centre: http://nedic.ca
• The National Association of Anorexia Nervosa and Associated Disorders (ANAD): anad.org
• Hopewell Eating Disorders Support Centre of Ottawa: hopewell.on.ca

For many reading this article, the title will likely sound a bit strange. Topics like ‘older women’ and ‘eating disorders’ don’t usually appear in the same sentence, at least in most of the literature where we read about either one. Yet, there likely exists a whole population of women who are daily falling through the cracks of our society – women who are virtually unknown, even to professionals who have dedicated their careers to helping women who suffer from eating disorders. These professionals work with women, yes, but typically young women who are under the age of 25 or 30. So where are the women I speak about? If they’re not in eating disorder support groups, or in out-patient treatment programs, like their younger counterparts, where are they? The answer is simple: they are usually suffering silently, alone, and with great shame about living with a ‘young person’s’ disease.

Based on my experience within my own psychotherapy practice, and on discussions I’ve had over time with colleagues, and friends, and by reading the very few articles written about this topic, I have a growing belief that eating disorders are being experienced by far more older women than any of us may have realized, or even thought about, at least until very recently. We might wonder why this phenomenon is only just being recognized, and even still, by so few people, including the so-called experts working in this field.

But before I discuss why I believe this phenomenon is occurring, let me first define the term ‘eating disorder’. There are three main forms of eating disorders recognized by medical and psychological experts: anorexia nervosa, bulimia nervosa, and binge-eating disorder. Anorexia nervosa is characterized by one’s engagement in self-starvation practices. That is, where there is a refusal to eat enough food to maintain sufficient food to support life. (Most people who fall into this category, have experienced extreme weight loss and, are at least 15% below their normal body weight.) Bulimia nervosa typically involves repeated episodes of overeating, which is followed by varying inappropriate methods of ridding their body of the food. These methods can involve purging (i.e., forcing themselves to throw up), the use of laxatives, and/or are engaged in excessive exercise routines. (Those who suffer from anorexia may also habitually over-exercise.) Finally, binge-eating disorder involves repeated episodes of overeating to the point where the individual experiences a painful feeling of fullness, but they do not typically engage in any activities that would result in ridding their body of the excess food. All three of these disorders put their sufferers at great risk of experiencing a range of serious health consequences, including death.

Older women who suffer from eating disorders belong in two etiological groups: 1) those who engaged in disordered eating patterns early on in life, perhaps in their late teens and/or early twenties, and have either recovered and later relapsed or have never ceased their disordered eating behaviors at all, and 2) those who began their dysfunctional eating patterns much later in life. In both cases, there are some common triggers that might help us understand why these older women might succumb to, or continue, this disordered pattern with food.

One possibility might be that for older women, unlike for young women in their teens and/or early twenties, the support structure that typically acts as a monitoring system (i.e., concerned parents), is no longer a part of their lives, at least in the roles held previously. The woman is an adult now and, therefore, is more able to successfully hide her ‘habit’ in the midst of a busy life filled with any number of competing responsibilities. “Just strange eating habits”, her family members or friends might innocently conclude. At this point in her life, it’s now her choice whether she reaches out for help, and not her parents’, and it seems that for many older women, they are choosing to stay silent, deciding instead to handle it themselves.

Another possibility is that for women who have lived with their eating disorder for several decades, it may have become an integral part of their identity, such that in its absence, they wouldn’t quite know how to manage – their emotions, their stress, or even their lives. Even knowing they are at risk of experiencing serious physical and emotional damage – and most do – they would rather cling to whatever forms of relief or safety their eating disorder has offered them over time. The thought of the alternative, that is, to give it up is, for many, something they would rather die than do. And, as the statistics reveal, many do just that.

At this point, one may ask a perfectly understandable question: why would women, who we believe should fall into the category of being ‘older and, therefore wiser’, engage in disordered eating patterns? There are several answers, but they need to be understood within a larger sociological context, that is, where all women in our society, regardless of their age, are daily (if not hourly) subjected to a standard for beauty that has been deeply ingrained into our cultural fabric. And, due in large part to this established norm, many women begin to struggle with their bodies, and thus their self-image, at increasingly younger ages. Their efforts to conform to this very exclusive and unrealistic standard often ignites an internal war within women between their ‘selves’ – their emotional selves and their physical selves. And, for many, this war can continue for the rest of their battle-weary lives.

For many women, eating disordered behavior is adopted as a way to cope with stress. And, as women age, they can face an inordinate amount of stress in their lives, for example, to rise to, and maintain, this cultural standard for beauty. Central to this standard is the ‘requirement’ that women remain youthful, if not in years, in appearance. In other words, if you can’t be young, the next best thing is to look it. However, as aging begins to leave its inevitable mark, many women become painfully aware that their bodies are moving farther and farther away from this norm, and all its inherent expectations. At the same time, they also realize that any opportunities to recapture their youthful image, including the thinness that is typically associated with this image, are becoming increasingly unrealistic and unachievable. And, if their self-esteem and self-worth are indelibly linked to their physical appearance, then adopting an eating disorder is one way for them to cope with the stress of this new reality.

At mid-life, women often experience a variety of losses – again, often triggering feelings of stress and anxiety. For example, children may be leaving home, and in the absence of their children to care for, they may feel they have little, or no, value. They may also be facing separation or divorce, which can bring all sorts of fears to the fore, including the fear of being alone, or perhaps worse, of dating again after many years – and now, in a much older body. In addition, these women may hope to, or need to, [re] enter the work force and, therefore, fear competing with much younger, and more attractive, women for jobs. They may also feel over-extended in terms of their personal responsibilities, not only within their own family unit, but also in their extended families, where some members may be sick and require endless hours of care. And, with retirement lurking ever closer, they may be experiencing a fear of economic insecurity. And the list goes on. Any one of these stressors, or the many others that I haven’t included here, can potentially act as triggers for the development of an eating disorder.

One of the major concerns about eating disorders, of course, is the physical and emotional health risks associated with them, which include damage to vital organs such as the heart and brain, depression, and even suicide. These side-effects are obviously serious at any age, but for the older woman they pose an even greater risk. As our bodies age, they aren’t nearly as resilient as they once were. Consequently, long periods of abusing one’s body, as is the case when one engages in eating disordered behaviors – particularly when the body is already experiencing the effects of age – can have catastrophic consequences. But this is not news, of course, and as I noted previously, most people who struggle with eating disorders understand, at some level, the potential long-term consequences of their actions.

So, if understanding the consequences doesn’t help, what will it take to stop this self-destructive cycle before it’s too late? It seems like a simple question, really. One could say that the onus of responsibility lies with the women themselves, just as it does with any other person who suffers from an addiction. So we may believe they need to begin by telling the truth about what’s going on for them. In other words, by simply making a decision to move out of their self-imposed isolation and begin sharing their painful struggle with others whom they trust (i.e., their family physician, best friend, life partner), they will likely feel the burden of their shame begin to slip away. This is an important – no, vital – first step. But, admittedly, it’s a difficult one, especially if those they choose to open up to don’t recognize that, at this stage in a women’s life, suffering from an eating disorder could even be a possibility. Under these conditions, how can we expect these women to feel safe enough to share their painful secret? But, on the other hand, how can others become aware of the problem if women won’t speak up? Clearly, there’s no easy answer.

One would imagine that the treatment of eating disorders for older women would be similar to the types of treatments currently offered to younger women: individual and/or group therapy often coupled with specific medications, such as various forms of anti-depressants that have had a positive effect in the treatment of these disorders. But the impact of a cultural ‘blindness’ surrounding this issue can have detrimental effects on treatment as well. For example, if older women are asked to join group therapy where most of the group members are significantly younger than they are, it could undermine any attempt to help them. Instead, it could actually increase the level of shame they’re already feeling about themselves, and their disease, since they may believe they should be ‘beyond’ such behavior. Moreover, many of the younger members of the group may agree, thus, creating a dichotomous and, therefore, destructive ‘us’ versus ‘them’ climate within the group itself. But, if group therapy is believed to be an effective treatment modality, which it can be, then there should be an option for older women to be placed in groups with other women who are in a similar life phase. The types of issues they’ll need to address in group therapy will be somewhat different than the ones younger women need to talk about.

With respect to individual therapy, there are a number of modalities being used in the treatment of eating disorders. The most common of these are cognitive-behavioral (CBT) and psychodynamic therapies. The goal of CBT is to help the individual ‘rewrite’ any forms of irrational thinking, misperceptions, dysfunctional thoughts, and faulty learning that may exist. And, if therapy is successful, the individual will ideally choose less self-destructive patterns of behavior, regardless of whether the original triggers for the disordered eating behaviors continue to exist.

Psychodynamic therapies, on the other hand, aim to help the individual gain insight into the ways in which their past experiences, typically ones in childhood, influence their present behavior. Gaining insight, according to psychodynamic therapists, is a necessary condition to changing behavior patterns in any significant and long term manner. Thus far, both CBT and psychodynamic therapies have been shown to be relatively successful in the treatment of eating disorders. Therefore, there is little reason to believe they wouldn’t prove equally effective with this population as well, but, again, only as long as the therapists who work with them have a deep understanding of the issues specific to these older women.

But, first things first: there’s little point in discussing treatment methodologies if there’s no cultural awareness of the problem in the first place. In the absence of this awareness, these sorts of discussions will remain theoretical, at best. On the other hand, if societal awareness is created, and it translates into positive action, then it will permit these women the freedom to reach out for help in the absence of the kind of shame that has rendered them to a life of silent suffering.

If you, or someone else you know, is struggling with an eating disorder, you may want to review the following informative websites:

• The National Eating Disorder Information Centre: http://nedic.ca
• The National Association of Anorexia Nervosa and Associated Disorders (ANAD): anad.org
• Hopewell Eating Disorders Support Centre of Ottawa: hopewell.on.ca