This year, National Eating Disorders Awareness Week runs through February 27.  And while many of us think of eating disorders as primarily affecting teenage girls and young women, psychologist Cecilia Ford makes it clear that our demographic—that is, women over 40—is vulnerable, too.

Eating disorders, long the bane of younger women, have come of age.

The Baby Boom generation was the first to suffer from eating disorders in epidemic proportions. Though ‘anorexia nervosa,’ as it was named, was known to physicians and psychiatrists even in the 19th century, this disorder—along with its evil twin, bulimia nervosa (binge/purge disorder)—wasn’t widespread until the late 20th century. I distinctly recall, for example, a cover story in a magazine circa 1977 heralding the phenomenon of a mysterious new ‘diet’ disease that was popping up more and more. When I wrote my dissertation in 1981, it was the first on the subject to be submitted to the university.

Essentially, then, ours is the first generation to go through midlife since the onset of this epidemic. The news is not good.

Eating disorders are becoming increasingly common in older women. Some have suffered from disorders since their youth, while others don’t begin disordered eating behavior until later in life, when they may develop a preoccupation with preserving a youthful, fit appearance. Some have essentially never been free of an eating disorder and have more or less adapted to a lifetime of habits ranging from unhealthy to debilitating to deadly. Many women in midlife have managed to ‘pass’ for years with a serious eating disorder ‘in the closet.’ Others, who might not fit the official diagnoses for anorexia or bulimia nervosa, suffer from idiosyncratic issues (officially known as ‘eating disorders not otherwise specified’). These could include yo-yo dieting, abuse of pharmaceuticals, excessive exercising, or adherence to rigid diets, purportedly for health reasons.

In my clinical experience, eating disorders tend to be extraordinarily tough to beat, and even patients who may be years beyond them can relapse in times of extreme stress. I’ve had several patients who were anorexic as teenagers, presumably fully recovered, who relapsed when their marriages broke up. The experience of being abandoned by a husband rekindled the feelings of stress, loss of control, and separation anxiety that often precipitate eating disorders in the first place. Other ‘recovered’ patients have managed to maintain their health, but have done so partly by redirecting their focus on eating and thinness in more positive directions: becoming personal trainers, chefs, or even eating disorder counselors. In fact, I think it’s helpful to look at these issues along the alcoholism model: one is recovering or recovered, never cured. The danger of relapse is very real.

Given this danger, it’s important that friends and family stay alert to signs of a possible problem. Teenage girls aren’t the only ones who may be sneaking off to the bathroom after meals, or finding way to avoid meals altogether. Likewise, women who may have resolved their eating issues in the past should be aware that they could reappear when stress is high.

Finally, there are the women who remain in the grip of disordered eating habits that might not fit a formal diagnosis but are nevertheless unhealthy and disruptive.

There’s a growing movement to challenge the assumption that there’s an ideal female form we should all aspire to, and that’s worth cheering. But challenging one’s own perceptions and distortions about the body, built up and reinforced over a lifetime, can be difficult. For some, it may require professional help. Fortunately, there’s been a proliferation of therapists, support groups, and organizations to help meet patients’ needs. ANAD, the National Association of Anorexia Nervosa and Associated Eating Disorders is a good source of information and has a referral network.

If you think you might be part of the widespread group of women grappling with this, or know someone who might be, it’s not too late to get help.

Cecilia M. Ford, Ph.D., has been a psychologist in private practice in New York City since 1987. Her current areas of focus are chronic illness and depression, eating disorders and body image disorders, sexuality and relationships, and parenthood and careers. She is a member of the WVFC Medical Advisory Board.

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  • Tami September 15, 2010 at 6:49 pm

    Dr. Ford,

    Would you be able to point me to the cover story circa 1977 in a magazine that heralded the phenomenon of a mysterious new ‘diet’ disease….? Please feel free to contact me direct by email.

    Many Thanks