The Scary Rise in Adult Eating Disorders

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More grown women are suffering from anorexia, bulimia, and other dangerous eating behaviors,

Usually she just had a cup or two of plain pasta. Sometimes, as a treat, a diet soda. But whatever she ate or drank, Susan* kept it to around 500 calories a day. A year passed, and anytime she tried to eat more, her stomach would clench until she vomited. Her skin turned blotchy, her eyes became sunken, her hair started falling out. Yet, she felt numb.

Susan had overcome a turbulent upbringing, married a great guy, and set up house in a small, idyllic Pacific Northwest town. Life was good…until two years ago, when her out-of-control, alcoholic father ended up in the hospital. Once again, his crises cast a dark shadow on her life, and Susan’s old emotional demons returned. Her insides twisted every time the phone rang—would it be the doctor? the police?—and little by little, the constant drama of dealing with her dad squelched her normally healthy appetite.

By June 2011, the 5’4″ Susan had lost over 40 pounds and weighed in at less than 100. She found excuses not to join her family at the dinner table, focusing instead on privately planning out every morsel that went into her mouth. Her husband grew frantic until, finally, Susan went to a doctor, who was at a loss. He ruled out a series of gastrointestinal conditions, then said, “And you’re too old for anorexia.”

Susan was 43.

Eating disorders leaped into the national conscience in the 1970s and ’80s, when the number of diagnosed cases exploded. The patients were adolescent girls, many of whom became anorexic or bulimic as a means of controlling their bodies—and, by extension, their lives—as they made their way through puberty. So many girls fell victim that eating disorders were branded a teenage disease. (And experts continue to see a troubling number of cases among teen girls, says Ovidio Bermudez, M.D., board member of the National Eating Disorders Association.)

Yet lately doctors have noticed a disturbing spike among a different group: women in their late twenties, thirties, and forties. At the Renfrew Center’s 11 treatment locations, the number of patients over age 35 has skyrocketed 42 percent in the past decade. Likewise, a couple of years ago at the Eating Recovery Center in Denver, an estimated 10 percent of patients were over age 25; today, a whopping 46 percent are over 30. And when it opened in 2003, the University of North Carolina’s Eating Disorders Program was designed for adolescents—now half of its patients are over 30 years old.

Just like their younger counterparts, adult eating disorders deliver a mind-body punch that kills more people than any other mental illness. Patients of all ages can suffer impaired brain function, infertility, dental decay, or even kidney failure or cardiac arrest. But while the teen and adult diseases share physical symptoms, and both can be tied to deep psychological roots, their catalysts are quite different, says psychotherapist Jessica LeRoy, of the Center for the Psychology of Women in Los Angeles. “As women get older and their lives evolve, so do their stressors and triggers,” she says. These can nudge the door open for an eating disorder. But research on the adult-onset versions is lacking—and without sufficient tools and awareness, women like Susan are being misdiagnosed.

When her physician failed to pinpoint a cause, Susan and her husband sought several more opinions about her ever-shrinking size. The other doctors also ignored the possibility of an eating disorder, though one did suggest she seek psychiatric care. Susan went back home, where she lived in fear and confusion, her health rapidly deteriorating. Finally, a friend whose teenage daughter was anorexic recognized her symptoms and urged the family to consult an eating disorder specialist. After two years of starving herself, Susan checked into a clinic, where she needed to be hooked up to a feeding tube to survive.

For decades, the eating disorder lexicon had two main entries: anorexia and bulimia. But modern research reveals that these fall woefully short of encompassing the many facets of disordered eating. In the early ’90s, the American Psychiatric Association introduced a new diagnostic category: eating disorders not otherwise specified (EDNOS). A catch-all label that includes dozens of subdiagnoses, EDNOS applies to patients who don’t meet the exact criteria for anorexia or bulimia but still have very troubled relationships with food or distorted body images. Today, EDNOS diagnoses significantly outnumber anorexia and bulimia cases. “The atypical has become the typical,” says Ovidio Bermudez, M.D. (Learn more about atypical eating disorders.)

On any given day, nearly 40 percent of American women are on a diet. The weight-worry gun is loaded early: By the time they reach age 10, 80 percent of girls fret that they’re fat. Their main “thinspiration,” according to experts: the ultra-slim starlets glorified in popular culture.

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