Picture someone with an eating disorder and you’ll likely think of a teenage girl who starves herself or binges and purges to avoid gaining weight.
Although eating disorders are most common among teenage girls and young women, older adults also have these illnesses, including people who first develop an eating disorder later in life as well as those who have dealt with the disorder for decades.
Exactly how many older adults have an eating disorder is unknown. One study found that 3.8 percent of women ages 60 to 70 met the criteria for an eating disorder. A review of 48 case reports of people age 50 or older who had an eating disorder found the average age of developing the disorder was about 68.
Stressful life events and depression can trigger eating disorders in older adults. Changes in family relationships, death of loved ones, bereavement, medical illnesses, becoming less socially active, feeling less in control of life, and an aging physical appearance also may contribute.
The symptoms and health consequences of eating disorders in older adults are similar to those in younger people. However, older adults are more likely to have coexisting medical illnesses or cognitive problems that could mask or exacerbate the eating disorder or complicate treatment.
For example, an older person might frequently experience dysphagia (difficulty swallowing), and therefore might limit how much or how often they eat.
Types of disorders
Of the eight types of eating disorders defined by the American Psychiatric Association, older adults are most likely to have anorexia nervosa, bulimia nervosa, or binge eating disorder.
Anorexia nervosa. People with anorexia severely restrict the amount of food they eat, and as a result, they weigh substantially less than what is “normal.”
To determine a person’s normal weight, doctors calculate the body mass index (BMI), which is based on weight and height. According to the Centers for Disease Control and Prevention, a BMI of 18.5 to 24.9 indicates a healthy weight. The BMI of a person with anorexia nervosa could range from approximately 17 (mild anorexia nervosa) to less than 15 (extreme anorexia nervosa).
But simply being underweight doesn’t mean a person has anorexia nervosa. To be diagnosed with anorexia, you also must have a distorted view of your body weight and shape.
People with anorexia see themselves as fat, even when they are dangerously thin. They typically have an intense fear of getting fat, but dieting usually doesn’t help reduce this fear.
In fact, a person may get even more worried about being fat even as they lose weight. In people with anorexia, self-esteem is often tied to their weight—losing weight is viewed as admirable, and gaining weight is a failure.
Other symptoms of anorexia include brittle hair and nails; dry, yellowish skin; lanugo (growth of fine hair all over the body); lethargy; and constipation. People with anorexia may develop muscle wasting/weakness, thinning bones, low blood pressure, and organ failure.
Anorexia nervosa can be fatal. Per decade, approximately 5 percent of people with the disorder die, either from complications of starvation or from suicide.
Bulimia nervosa. People with bulimia nervosa have episodes of binge eating (consuming unusually large amounts of food in a short time, usually two hours or less), followed by actions to compensate for overeating.
A person diagnosed with bulimia usually experiences such episodes once a week for about three months. During these episodes, the person feels they can’t stop eating once they start, nor can they control what or how much they eat.
Vomiting is the most common way a person with bulimia compensates for binge eating. They also may misuse laxatives, diuretics, or enemas; fast; or exercise excessively. Like those with anorexia, people with bulimia base their self-esteem on their body shape or weight.
Symptoms of bulimia nervosa include irregular menstrual cycles, stomach problems such as acid reflux, dehydration, worn or decaying teeth as a result of frequent vomiting, and electrolyte imbalances. Rare but potentially fatal consequences of bulimia are heart problems, stroke, and tears of the esophagus. People with bulimia are also at risk of suicide.
Binge eating disorder. People with binge eating disorder experience episodes of binge eating that they feel they can’t control, but unlike people with bulimia, they do not engage in behaviors to compensate for their overeating.
Other specified eating disorder. This diagnosis applies to people who have the symptoms of an eating disorder, but do not fully meet the official criteria for any specific disorder. For example, this diagnosis might be given to a person who has the symptoms of anorexia but has a normal body weight, or to a person who binge eats, but does so less than once a week.
Researchers haven’t studied the effectiveness of treatments specifically for older people with eating disorders. In general, doctors recommend psychotherapy to help people with an eating disorder understand their illness, gain weight, and improve their eating habits.
A family-based psychotherapy called the Maudsley Approach works well for adolescents with eating disorders, but its effectiveness in older adults hasn’t been studied.
Other forms of psychotherapy used to treat eating disorders include:
• Cognitive behavioral therapy, which focuses on changing the thoughts, beliefs, and values that perpetuate the eating disorder
• Dialectical behavior therapy, which teaches skills to use to replace poor eating habits, such as mindfulness, becoming more effective in relationships, and tolerating distress
• Acceptance and commitment therapy, which emphasizes identifying one’s core values and committing to create goals to fulfill those values, while acknowledging that pain and anxiety are a normal part of life
Medication is also used, usually in combination with psychotherapy. The antidepressant fluoxetine (Prozac) is the only medication specifically approved to treat a specific eating disorder, bulimia nervosa.
Because people with eating disorders frequently have symptoms of depression, antidepressants are often used as treatment, including citalopram (Celexa), sertraline (Zoloft), venlafaxine (Effexor), and duloxetine (Cymbalta).
In some cases, people with an eating disorder might be prescribed antianxiety medications such as the benzodiazepines alprazolam (Xanax) or lorazepam (Ativan).
Signs of an eating disorder
If you think you or someone you love might have an eating disorder, ask the following questions:
• Do you force yourself to vomit because you feel uncomfortably full?
• Do you worry you have lost control over how much you eat?
• Have you recently lost more than 14 pounds in a three-month period?
• Do you believe you are fat when others say you are too thin?
• Would you say that food dominates your life?
A small study found that a person who answers “yes” to two or more of these questions is very likely to have an eating disorder.
Other signs of a possible eating disorder include eating in secret or being afraid to eat in front of other people, disappearing after eating, making excuses for not eating, maintaining unusual food rituals such as cutting food into very small pieces or chewing each bite excessively, and exercising compulsively.
People who have an eating disorder may also experience symptoms of depression, anxiety, and obsessive-compulsive disorder.
Anyone who suspects they may have an eating disorder should ask their doctor for a thorough evaluation. Because the complications of an eating disorder can be particularly dangerous for older adults, prompt diagnosis and treatment are essential.
If you think you or a loved one might have an eating disorder, the National Eating Disorders Association offers a helpline at 800-931-2237.
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Jeff Bauer is a healthcare journalist with expertise in psychiatry. He has served as editor of Current Psychiatry, a leading peer-reviewed clinical journal for psychiatrists and other mental health practitioners, and as educational content director for the U.S. Psychiatric and Mental Health Congress, the nation’s leading independent mental health continuing education conference.