What triggers midlife eating disorders?
When Claire Turnbull’s grandmother died aged 93, her family found diet pills and diet shakes in her kitchen. To Turnbull, it was no surprise. Though her grandmother was never formally diagnosed with an eating disorder, it was obvious she lived with one her whole life.
“She never got over it. She was always visibly semi-dieting, always doing funny things around food,” Turnbull says.
When most of us picture a typical person with an eating disorder, chances are it’s not a nonagenarian. It’s far more likely to be an adolescent girl, painfully at war with a ravaged body. But contrary to the many myths about eating disorders, they affect people of all ages, genders and body sizes.
Young women do make up a large proportion of those suffering from eating disorders including anorexia nervosa, bulimia and binge eating disorder. But there’s a trend for these to show up in midlife and older women and this overlooked group is starting to become the focus of attention.
Evidence suggests up to 13% of women over 50 have disordered eating patterns. Other studies note it’s likely this is an underestimate since older women are often underdiagnosed. A recent study of women over 60 diagnosed with binge-eating behaviour found a majority reported the onset of their illness came in midlife or later.
Experts in this field say it’s no surprise this is coming to light. Specialist eating disorder dietitian Amy Judd says she’s noticed more older women seeking treatment both in her private practice and her work in the public health system.
“When you look at women across the spectrum, we see puberty and menopause as two specific time periods that are associated with lots of changes to your body that can happen outside your control. They’re periods when we might see an increase in vulnerability to either developing an eating disorder or having a relapse of symptoms if you’d had one previously.”
It’s in the genes
Another myth many of us have grown up with is that eating disorders are driven by family dysfunction or a search for control: if I can’t manage other things in my life, the story goes, I’ll control my body. In the1980s and 1990s, TV movies about tortured, overachieving teens or such celebrity tragedies as that of singer Karen Carpenter, who died from complications of anorexia, helped fuel such beliefs.
We now know it’s not that simple. Although personality traits such as perfectionism, obsessiveness and a tendency to form habits quickly are common among sufferers, taking a diet “too far” won’t tip everyone into illness. Some people are especially vulnerable, and that’s now understood – particularly in the case of anorexia – to be down to more than psychology. It’s in our genes.
Dr Roger Mysliwiec is an Auckland-based eating disorders specialist who’s worked in this area for more than 30 years. “From research over the past two decades, including genetic studies, we have a much better understanding about the neurobiological underpinnings [of eating disorders],” he says. “In essence, we can say this is a metabo-psychiatric disorder: it is not just a psychiatric illness; there are metabolic factors that contribute to its cause and maintenance. In order to have what I would call true anorexia nervosa, one also needs to have at least some of these genes.”