By Rebecca Lester, Washington University in St. Louis

“No one expects a grown woman in her 40s to have an eating disorder. That’s for teenagers, right? Well, guess what – it happened to me.”

Alexa, a 44-year-old real estate agent, was telling me about her struggle with non-purging bulimia, which has come to control her life. We spoke in 2024 at a coffee shop as part of my ongoing research on eating disorders.

The names of my research subjects have been changed for this article to protect their identities.

“I didn’t understand what was happening for a long time,” Alexa said. “It didn’t even occur to me that it could be an eating disorder.”

She is not alone. A 2023 study estimated that over 9 million American women over 40 develop eating disorders. Some had eating disorders earlier in life and experience a resurgence at midlife. Others develop them for the first time in their 40s or older.

I am an anthropologist and licensed therapist who has researched and treated eating disorders for the past 30 years. I have also recovered from an eating disorder myself. I wrote a 2021 book about how contemporary clinical approaches to eating disorders can harm people and keep them sick. One of the things I uncovered in my research is that older women with eating disorders often fly completely under the radar, leading to increased health risks and even death.

My research leads me to conclude that this is due to health care providers’ misunderstanding of the cultural and existential factors affecting women in midlife, which can make this a time of increased risk of developing an eating disorder.

By the numbers

The numbers around eating disorders at midlife are sobering: Rates of eating disorders among middle-aged women have increased in recent years. As many as 13% of American women over 50 have eating disorder symptoms, slightly more than the percentage diagnosed with breast cancer.

One study found that 71% of women ages 30 to 74 wanted to be thinner, although 73% of them were at clinically normal weight for their height and age. Research shows that although anorexia, an eating disorder characterized by the severe restriction of calories, becomes less common after age 26, bulimia, where patients binge and then purge food from their bodies, doesn’t reach its peak until age 47. Binge eating disorder, or habitually eating excessive amounts in one sitting, can continue to plague women into their 70s.

Lack of treatment

Despite the prevalence of eating disorders in older women, they are often the least likely to get help.

In fact, flagrant symptoms of an eating disorder can be missed in these middle-aged people. At 52, Janelle, a schoolteacher, has struggled with anorexia for the past four years. Because she is petite, her slight frame hasn’t raised any alarms for medical professionals.

“My doctor told me I couldn’t possibly have an eating disorder because I’m too old,” Janelle told me. “I know I’m anorexic. I was anorexic as a teenager, so I know exactly what this is. My doctor just said I should consider myself lucky because a lot of women my age actually gain weight.”

This doctor’s response is emblematic of problems in eating disorder treatment more generally in the U.S. Though tools to assess patients for eating disorders are available, most physicians and even psychiatrists receive little, if any, training in their use. Learning to identify and respond to eating disorders requires that they go through additional – and costly – specialized training.

As a result, many hold erroneous popular stereotypes about these conditions, and so women with eating disorders aren’t getting the help they need.

Beyond stereotypes

In the popular imagination, eating disorders center on things young women supposedly care about; namely, being thin and attractive – specifically, attractive to men. This stereotype is a holdover from 19th- and 20th-century understandings of hysteria, which was thought to particularly afflict young women who craved but also feared male sexual attention.

According to this paradigm, middle-aged women are thought to be out of the sexual game, so to speak, so they ought to be immune to illnesses that focus on appearance.

This perception of eating disorders is not only wrong, but also dangerous because clinicians often don’t recognize these issues in women who don’t fit this stereotype.

In reality, eating disorders are deadly conditions that emerge from a convergence of genetic susceptibility, psychological factors, family environments, life events and cultural values. And they affect people of all genders, sexual orientations and races across the socioeconomic spectrum and the lifespan.

Although the drive for thinness often is the most obvious feature of these conditions, what I have found in my 30 years of research on this topic, including talking to over 200 patients with eating disorders, is that these illnesses are at heart about desperately trying to feel worthy of existing.

A concern with body shape, then, often reflects a much deeper existential crisis that can arise during times when a person’s identity is shifting as their body is changing. One of those times is adolescence. Another is middle age.

Seeking identity in middle age

Outwardly, eating disorders in middle age look a lot like eating disorders at any other age. But the body concerns and identity dilemmas associated with middle age are different from those that plague adolescence and young adulthood.

As women age, their metabolism slows down, their bodies don’t work the way they used to, and they visibly begin to wear their life experience. Questions of mortality and the meaning of life can come to the fore. It’s often a time of shifting dynamics within families. For those who have children, middle age is typically the time when those children are becoming more independent or leaving home. This is also a time when aging parents may require care.

At the same time, for women in particular, the pressures to remain fresh, fit and firm despite aging are monumental. The popularity of treatments like Botox, dermal fillers, Ozempic and the massive anti-aging industry have exploded as this over-40 market has been cultivated.

“We’re supposed to look 30 forever,” said Shelly, a 51-year-old marketing professional struggling with anorexia. “You’ve heard of the ‘middle-age spread’? There’s no way I’m going to let that happen to me.”

A woman’s worth

Progress in gender equality notwithstanding, women’s social worth in modern Western culture is still disproportionately determined by appearance and sexual and reproductive capacities.

It is not surprising, then, that looks and youth become the focus of existential distress for many women over 40. As older women struggle to secure a sense of value in a youth-obsessed world, food and eating can become a focus of attention that ultimately becomes destructive.

This doesn’t mean these women are vain or superficial. Rather, they have picked up on what their culture values, and they have internalized the message that thinness is a way to attain that.

“Our culture doesn’t value older women the way other cultures do,” observed Kaytlin, a 47-year-old office manager struggling with disordered eating. “The idea that older women should be revered for their wisdom and influence is foreign to us. Instead, we become invisible.”

My hope is that dispelling some of the erroneous assumptions that have driven both public perception and clinical practice about these illnesses will help women get the care they need.

This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Rebecca Lester, Washington University in St. Louis

Read more:

• Mounting research documents the harmful effects of social media use on mental health, including body image and development of eating disorders
• Friday essay: ‘I was unseen, even to myself’ – as many as half of people with anorexia are autistic. Fiona Wright is one of them
• Eating disorders are about emotional pain – not food

Rebecca Lester does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Feature Image: Changes in identity in midlife can increase the risk of developing an eating disorder. muratseyit/E+ via Getty Images

The post Middle age is a time when women are vulnerable to eating disorders appeared first on The Cincinnati Herald .

By April Smith

Did you know that anorexia is the most lethal mental health condition? One person dies from an eating disorder every hour in the U.S. Many of these deaths are not from health consequences related to starvation, but from suicide.

Up to 1 in 5 women and 1 in 7 men in the U.S. will develop an eating disorder by age 40, and 1 in 2 people with an eating disorder will think about ending their life. About 1 in 4 people with anorexia nervosa or bulimia nervosa will attempt to kill themselves, and those with anorexia have a risk of death by suicide 31 times higher than peers without the disorder.

In fact, nonsuicidal self-injury, suicidal ideation, suicide attempts and suicide deaths are all more prevalent among those with any type of eating disorder compared to those without an eating disorder.

Why might that be?

I am a clinical psychologist who studies eating disorders and self-harm, and I have spent the past 15 years researching this question. We still don’t have the answer. But new work on perception of the internal state of the body points to some promising possibilities for treatment. And what we’re learning could help anyone improve their relationship with their body.

Eating disorders and interoception

To understand why people with eating disorders are at risk of dying by suicide, I first want to ask you to do a little thought exercise.

I’d like you to really think about your body: Think about your hair, face, arms, stomach, chest and legs. What words and feelings come to mind? Are there any things you wish you could change? Feel free to close your eyes and try this out.

I’m guessing as you did this thought exercise, you probably weren’t thinking, “Every part of my body is amazing. Five stars, wouldn’t change a thing!” In fact, many people tend to have pretty negative and highly critical thoughts about their bodies.

Here’s another question for you: What do you do with things you don’t like? For instance, what do you do when you encounter someone you dislike, a food you can’t stand or an overwhelming list of chores? Do you care for or accept them? Probably not. Most people tend to avoid, despise or criticize the things they don’t like. This allows them to separate and disconnect themselves from these loathed things.

But when you think negatively about and try to avoid your body, you end up disconnecting from it and losing the ability to understand what’s going on inside your body. You start to see it not as your body but as an object.

That ability to recognize, interpret and respond to internal signals in your body actually has a name: interoception, also known as the sixth sense. It refers to your ability to recognize, interpret and respond to a variety of bodily sensations, such as emotions, hunger and fullness, temperature and pain.

Interoception can be divided into various components, and interoceptive accuracy, or how accurately you notice various internal sensations, can be measured in various ways. These include psychophysiological measures like a heartbeat perception test, which compares a person’s perceived number of heartbeats without taking their pulse to their actual number of heartbeats over a period of time. People with greater discrepancies between their perceived and actual heartbeat counts are thought to be worse at sensing cardiac sensations and thus have worse interoception.

Interoception and health

My research over the past decade has found that the worse your interoception is, the more disconnected you are from your body and the less aware you are of what’s going on inside it. And the more disconnected you are from your body, the easier it becomes to harm yourself, whether that be through an eating disorder or suicidal behaviors.

Interoception is crucial to understanding and caring for your body. For instance, you need to be able to perceive hunger and fullness in order to properly nourish yourself. If you were unable to perceive pain, you might end up hurting yourself. And you need to be able to understand the emotions you’re feeling in order to respond adaptively to different situations.

Research suggests that interoception is integrally related to mental and physical health, and impaired interoception is considered a risk factor for various mental disorders. For example, if you are unable to sense when you’re hungry or full, that could lead to restrictive or binge eating. Conversely, if you are hyperaware of your internal sensations, such as your heart rate and breathing, that could lead to panic disorder symptoms.

As you lose connection with your body, it becomes easier to harm your body as an object you’ve grown to loathe. Research from my team has found that people who have attempted suicide have worse interoception than people who haven’t, and people who have attempted suicide multiple times have worse interoception than those who have only attempted suicide once. People with more recent and lethal suicide attempts have worse interoception than those with more distant or less lethal attempts.

Impairment in interocepton is more strongly associated with suicidal ideation and suicide attempts than other risk factors like hopelessness, gender and post-traumatic stress.

Reconnecting with the body

But many people weren’t always this disconnected from their bodies.

I have two young kids who are learning what their bodies can do and are finding their bodies more and more amazing. My 7-year-old son and his friends are delighted when they do gymnastics, standing on one foot or walking across a balance beam. And my daughter, almost 3 now, loves her round tummy: She proudly sticks it out and plays it like a drum. Young kids haven’t yet learned to talk to their bodies in the harsh way many teens and adults do. They haven’t begun to disconnect from their inner senses.

To reduce self-harm, I encourage you to try to regain a sense of connection and care for not only your body but also the bodies of those you love. This isn’t easy, but researchers are studying multiple ways to improve interoception.

For instance, my team has developed a training program to improve interoception called Reconnecting to Internal Sensations and Experiences, or RISE. First, we educate participants about interoception and the importance of cultivating awareness of internal sensations for improved mental and physical health.

Then we teach them to bring attention to their muscles through progressive muscle relaxation techniques and to hunger and fullness cues through mindful and intuitive eating.

After that, we introduce participants to the concept of body functionality by asking them to think of what their bodies can do rather than evaluating their bodies on appearance. For instance, rather than thinking, “I’m getting fat” or “I’m too old” or “I’m too slow,” they can think, “My legs helped get me out of bed today” or “My arms allow me to hug those I love” or “This scar demonstrates my body’s ability to heal.” This is important because body image is linked to multiple aspects of interoceptive awareness.

Finally, we teach participants about recognizing their emotions and changing their behaviors. Emotional awareness is a core component of interoception, so we ask participants to think about where they feel those emotions in their body, how they can distinguish between certain emotions, and how they can more effectively respond to stress.

Consumer culture doesn’t tend to promote listening to your body, so relearning how to do this may take time and dedicated practice. But I believe the rewards can be literally lifesaving.

This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: April Smith, Auburn University

Read more:

• Do you eat with your eyes, your gut or your brain? A neuroscientist explains how to listen to your hunger during the holidays
• 8 ways to manage body image anxiety after lockdown
• Why do people die by suicide? Mental illness isn’t the only cause – social factors like loneliness, financial ruin and shame can be triggers

April Smith receives funding from the Department of Defense and the National Institute of Health. 

Feature Image: An increased disconnect from your body can make it easier to harm yourself, whether by disordered eating or suicide. Maskot/Maskot via Getty Images

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