Misunderstood at Midlife

"The women who had eating disorders fell into three distinct categories," says study researcher and clinical psychologist Cynthia Bulik, PhD, author of the new book Midlife Eating Disorders: Your Journey to Recovery. "Most of them developed disorders in adolescence, recovered, and then relapsed; others never recovered; and some actually developed anorexia or bulimia for the first time later in life." But there was one common thread uniting most of the women in the study: Their illness was generally overlooked by doctors.

While it seems unlikely that signs of disordered eating would baffle physicians, the worrisome truth is that they can. "Women get tremendously positive feedback if they've lost weight or maintained a low weight," says clinical psychologist Margo Maine, PhD, coauthor of The Body Myth. One of Maine's former patients, a 42-year-old woman who'd weathered almost a decade of disordered eating, was met with an enthusiastic reaction when her doctor noticed her dramatic weight loss. "So how does your husband like your new body?" he asked. Maine, who speaks regularly at eating disorder conferences and medical conventions about the prevalence of adult eating disorders, says doctors are often surprised: "You don't know how many of them say, 'Well, I don't treat people with eating disorders.' I tell them, 'Oh, yes, you do. You're just not asking the right questions.'"

According to Maine, doctors need to inquire not only about a woman's attitude toward her body and food but about life changes or crises that might be the cause of noticeable weight fluctuations. "When you enter a different chapter or encounter new hurdles—marriage, divorce, kids, empty nest, aging parents—your sense of self can become disorganized," she adds. "One easy way to deal with that is to diet or overcontrol some aspect of your body." Bulik agrees—and says the pressures women feel are further compounded by the prevailing societal mind-set that it is not okay to age. "There's this whole '50 is the new 30' and '70 is the new 50' attitude," she says. "The burden to stay forever young is only intensifying."

For Denise Folcik, a mother of four, bulimia was sparked by a desire to reclaim her pre-baby figure after having her last child. But when she suffered a crushing case of separation anxiety as her 16-year-old daughter grew distant, no longer turning to Folcik for advice and not wanting to spend time together, she became anorexic. It was an easier condition than bulimia to conceal from her family—until the afternoon she blacked out while driving her daughter to the mall, having eaten only 200 calories' worth of food the entire day. "It's ironic because when I was close to my lowest weight, my doctor congratulated me on how wonderful I looked," says Folcik, now 52.

The fact that Folcik's weight didn't dip dangerously low is key to understanding why eating disorders in older women can go unnoticed. Anorexia doesn't always manifest in emaciation, and bulimics or binge eaters can clock in at healthy weights or even be overweight. Furthermore, past a certain age, one of the classic symptoms of adolescent anorexia—loss of menses—doesn't apply. "When I sought treatment for depression, my doctor wasn't watching out for an eating disorder," says Mary Curtis, 52, a life coach in Florida, who began bingeing and purging at 36. "Nobody noticed how little I ate or that I went to the bathroom right after a meal. It was surprisingly easy for me to get away with."

Yet a missed diagnosis can have serious health implications; bone loss and heart problems that can occur with eating disorders at any age are exacerbated in older women, whose bodies are less resilient. Research also shows that women who lose considerable amounts of weight and gain the pounds back may have increased risk for heart disease.

Next: Finding a treatment plan as an adult woman


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