If you assume that eating problems are primarily the province of the age group most likely to join a Justin Bieber fan club, you’re right—but what you may not know is that experts are reporting a surge of these illnesses among women several decades older. For instance, at the Renfrew Center, a group of 10 eating-disorder clinics nationwide, close to 20 percent of the women in both the outpatient and residential divisions are now part of the facility’s Thirty-Something and Beyond program. Similarly, a few years ago the eating-disorders program at the University of North Carolina at Chapel Hill typically treated at most two midlife patients at a time; today one in two patients is a woman 35 or older, says director Cynthia Bulik, PhD.
Only a minority of midlife women eligible for treatment have issues that would meet the very precise definition of an eating disorder found in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the psychiatric bible. Instead of anorexia or bulimia, such women are far more likely to suffer from what’s called disordered eating—diet patterns that disrupt a person’s life but are not as extreme, and usually not as dangerous, as diagnosed eating disorders. “These problems exist on a continuum,” says Bulik. “There isn’t a magic line that divides disordered eating from an eating disorder.”
People who suffer from disordered eating are often obsessed with their weight, but there are exceptions. Those with the malady called orthorexia shun foods like meat, carbs, dairy, anything with preservatives or artificial flavors and often nonorganic fruits and vegetables, in the name of improving their health. “It starts out with good intentions and becomes a joyless obsession that takes over people’s lives,” says Martina Cartwright, PhD, RD, a biomedical and nutrition consultant in Scottsdale, Arizona. And then there are the excessively picky eaters, who have an aversion to all but a very limited number of foods. Many picky eaters feel strongly about consistency and texture in the foods they consume. “Some can’t eat tomatoes because the seeds are a big discontinuity. Even a chicken-breast sandwich can raise alarms, because the thickness of the chicken varies,” says Nancy Zucker, PhD, director of the Duke Center for Eating Disorders in Durham, North Carolina.
Most experts believe that disordered eating seldom shows up for the first time in midlife. Even if a 35- or 45-year-old woman reports she has never suffered from these problems, “if you take a really good history, you’ll find they have had some kind of disordered eating in their past, like fad dieting or the need to meet a specific weight goal for ballet or sports,” says Holly Grishkat, PhD, a psychologist with Renfrew’s clinic in Radnor, Pennsylvania.
Midlife eating problems are increasing “exponentially,” says Kathryn Zerbe, MD, director of the Oregon Psychoanalytic Institute in Portland and the author of Integrated Treatment of Eating Disorders: Beyond the Body Betrayed. The question is, Why now? “In our mothers’ generation, there was acceptance that your body wasn’t going to look the same at 50 as it did at 25,” Zerbe says. “Today there’s not. For some women, an obsession with a rigid diet is a way of trying to skirt the issue of aging and mortality.” Kimberli McCallum, medical director of McCallum Place, a treatment center in St. Louis, agrees: “Eating disorders can be a maladaptive way to cling to what your body looked like 20 years ago.” But disordered eating can also become a way of dealing with a midlife search for meaning, says Edward Tyson, MD, an Austin, Texas, physician who specializes in eating disorders. That’s sometimes the case with orthorexia. “It can become almost like a religious cult,” Tyson says. “Maybe you can find all of life’s answers in the head of a lettuce that’s brought down on the back of a yak from the Himalayas by a Buddhist monk.”
Here, four women with disordered eating patterns tell their stories in their own words. Those using only first names prefer to remain anonymous.
The "Healthy" Eater
Brit, 40: St.Louis; associate professor of philosophy and psychology