Women in Midlife With Eating Disorders
External realities, internal struggles: Choices, responsibility, taking control.
Posted Mar 18, 2020
An estimated 13 percent of women over 50 engage in eating disorder behaviors. According to DSM-5 criteria, around 3.5 percent of older (over 40) women and around 1–2 percent of older men have diagnosable conditions (Mangweth-Matzeka).
Triggers for midlife onset are often related to issues that come with aging, loss, menopause, and dissatisfaction with choices made in life and love. Middle age is also often a wake-up call to the reality that life has an endpoint. Unrealized goals, dreams, disappointments and, unfulfilled work and romantic pursuits hit hard for many people.
“Midlife crisis” was coined for a reason. Many respond through efforts to fix the problem and other attempts to return to days of youth—purchasing a muscle car, redecorating a house, getting face, eye, butt lifts. But for those who have lived the first half of their lives feeling unfulfilled in significant areas, stepping into middle age is psychically and existentially threatening. Finding an exogenous way to cope feels like the best solution, especially when an acknowledgment that the true fix cannot be bought is denied or avoided.
Eating disorders for people of all ages can be a distraction as well as an attempt to cope with internal states and regrets or a way to resist life-altering decisions or feelings.
Women, in particular, are at risk for eating disorders during middle age as a solution to what often ails them internally or has been imposed upon them. Menopause, changing body, difficulty in experiencing sexual arousal and orgasm are triggers in response to cultural expectations, which emphasize youth and beauty. Some of these same cultures are repressive, giving contradictory messages of valuing beauty while at the same time coercing, intimidating or forbidding women from having goals or interests outside of the home and from expressing fashion and sexual freedom.
Women who develop eating disorders in response to a lack of fulfillment and satisfaction in their own life or who are inexorably controlled by a beauty-bound culture are perpetuating cycles of repression and objectification through self-repression and self-objectification. So who, in the end, is responsible?
Contradictions abound. On the one hand, the “Me Too” movement forced awareness and responsibility; progress overall for the adherence to boundaries and respect in and out of the workplace. On the other hand, women in many developed and developing countries are facing a decline in the loss of personal, work, and civil rights.
Misogyny and gender discrimination exist in America—ask any woman. As a born and bred New Yorker, I rarely experienced gender discrimination in New York City. I moved to the south about seven years ago and I still haven’t come to terms with the sexism I have experienced. In the recent past, I lived for about a year in middle California. I personally experienced as much sexism as I do in the American South. It is real, shockingly so.
Yet, adults are responsible for their own well-being. Adults are responsible for for taking charge of their bodies and lives. Asking middle-aged women with eating disorders what they want in life or what will fulfill them and, conversely, what they regret or felt they gave up on along the way is often met with a deafening silence, or a response like, “Huh, I don’t know,” or “No one ever asked me.” Sometimes, my response is, “Have you ever asked yourself?”
What is it that a middle-aged woman with an eating disorder feels that compels her to empty or rid her body of food? Why is it that she treats her body with callousness and disrespect? Is this a symbolic repetition of prior abuse so that she metes out on her body what she feels has been done to her or what she has perpetuated in her own life, something for which she deserves punishment? Is the lack of fulfillment with food a metaphor for the lack of fulfillment in her own life? For what is the longing? What is missing? Is she raging past the sadness, regret, or loneliness she feels by efforts to vomit it away? What is the comfort she really seeks? Does she prefer to vomit up her food or restrict her eating rather than embrace feelings that are vulnerable?
Men with and without eating disorders suffer from their own misguided decisions and regrets; they too carry burdens of traditionally feeling responsible for the roles of protector and provider, the one family members count on to find solutions and carry the weight. This too has its price. Less likely that a man in midlife will develop an eating disorder. More likely, they will negatively respond through behavior or surreptitiously respond to the burden they feel has been placed upon them.
Middle age is a catch-your-breath moment, a take-a-step-back-and-assess period for many. Most adjust, take charge and regain the momentum they had in years past, which enabled them to take risks. The next decades, when there is more life behind than there is ahead, also can be filled with risks, adventures, joy, passion, work, and love.
National Association of Anorexia and Associated Disorders. Eating Disorder statistics. 2020 www.anad.org
Mangweth-Matzeka, B., & Hoekb, H. Epidemiology and treatment of eating disorders in men and women of middle and older age. Current Opinion Psychiatry. 2017. Nov. 30(6): 446-451