Experts fear a rise in midlife eating disorders (Image: Getty)
Eating disorders are on the rise among midlife women. Clinics are reporting a sharp increase in eating disorders among women in their forties, fifties and sixties. Latest figures suggest that around 3-4% of midlife women currently have an eating disorder, while about 15% report having experienced one at some point in their lives.
“We’ve seen a noticeable rise in eating disorders among midlife women (aged 40-60) in the UK, particularly over the last five years since the pandemic, this pattern has continued,” says Dr Joanna Silver, Lead Psychological Therapist at Orri, a specialist eating disorder treatment clinic in London that offers outpatient, day care and virtual programmes.
Research into specialist adult eating disorder services suggests referrals have risen by 21% since the Covid-19 pandemic. “It’s difficult to say whether more people are developing eating disorders, or whether more people are now seeking help,” Dr Silver admits. Eating disorders are serious mental health conditions that can affect people of any age. Conditions such as anorexia nervosa and bulimia nervosa can have severe consequences for both physical and emotional health.
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Psychologist Dr Joanna Silver has seen rising numbers of middle-aged women with eating disorders (Image: Courtesy Dr Joanna Silver)
Anorexia nervosa is characterised by an intense fear of gaining weight and a distorted body image. Someone with anorexia may severely restrict food intake, exercise excessively or use laxatives in an attempt to keep their weight as low as possible. Bulimia nervosa involves cycles of binge eating followed by purging behaviours such as self-induced vomiting or the misuse of diuretics or laxatives.
Eating disorders in midlife
Although eating disorders are often associated with teenagers, they can also emerge later in life. A study published in the International Journal of Eating Disorders involving 703 women found that midlife women were more likely to develop binge eating disorder than anorexia nervosa. In binge eating disorder, individuals consume large quantities of food but do not engage in purging behaviours.
Other conditions seen in midlife include Other Specified Feeding or Eating Disorders (OSFED), which include atypical anorexia and orthorexia. Atypical anorexia involves severe food restriction similar to anorexia nervosa, but without the significant weight loss usually associated with the condition. Orthorexia describes a rigid obsession with eating only foods perceived as healthy or clean.
Difficulties with control, anxiety and body image can make people more susceptible to eating disorders. In midlife, triggers may include hormonal changes during perimenopause and menopause, relationship shifts and major life transitions.
“Eating disorders in midlife don’t tend to come out from nowhere,” explains Dr Silver. “There may have been something in the past, and then it rears its head again. Usually when there’s been a big life change – children leaving home, career stress, caring for elderly relatives, bereavement, relationship changes, divorce, or worries about ageing. The pandemic was also a stressful time when many people felt disconnected and out of control.”
Emotions and food
Although eating disorders revolve around food, they are rarely just about eating. “While eating disorders may look like they’re about food, they’re actually a way of managing feelings,” says Dr Silver. “It’s all about controlling emotions through food. That’s a pattern many women may have fallen into in their teens – and then it comes up again for them in midlife.”
Restricting food, binge eating or purging can become ways of coping with difficult emotions, particularly when life feels overwhelming or unpredictable. Women who struggle to express emotions may be especially vulnerable. “Women who find it hard to express their emotions, who believe it is weak to cry, or ask for help, are also more susceptible. They may have grown up in a family where they learnt to suppress feelings, to avoid conflict, and emotions were never discussed.”
Eating disorders revolve around food… but they’re rarely just about eating (Image: Getty)
Eating disorder signs to look out for
- Increased isolation or withdrawal from social activities;
- Avoiding situations that involve food;
- Spending excessive time thinking about food or exerciseWearing baggy clothes;
- Moving food around the plate without eating;
- Frequent bathroom visits after meals;
- Physical symptoms may include fatigue, low mood, pale skin, thinning hair or reduced energy.
Personality patterns
There is no single personality type linked to eating disorders, but certain traits appear more frequently. “There is a link, for example, between perfectionism and people who have eating disorders,” says Dr Silver. “Also, people who are high achievers. I see a lot of the women who are well put together, they have successful jobs, children, relationships, and to the outside world they look healthy – but, inside they’re struggling, because they put these huge expectations on themselves.”
She adds that women who prioritise the needs of others may also be at greater risk. “Also, women who always look after everyone else’s needs, the type that everyone turns to with a problem, are also more at risk.”
However, personality traits alone do not cause eating disorders. “But people can be perfectionists or high achievers, and they don’t have eating disorders. It’s more likely a combination of genetics and your environment. It’s about being a vulnerable person, in the wrong place, at the wrong time.”
Research supports this idea. A review published in the Journal of Clinical Psychology in 2022 found that personality traits such as neuroticism were linked with a higher risk of disordered eating behaviours including binge eating and emotional eating.
“Upbringing and early relationships with caregivers also shapes how we relate to other people – and to food,” says Dr Silver. “Family attitudes towards weight, dieting and appearance can leave a lasting impression.”
Comments about body shape, even when meant jokingly, can also have an impact. “For example, seemingly harmless comments, and often said in jest, such as ‘a second on the lips, a lifetime on the hips’ or ‘you can never be too thin’ can also have an impact.”
For some women, traumatic experiences may also play a role. Childhood trauma, including sexual abuse, has been linked to higher risks of binge eating and purging disorders.
Neurodivergent conditions are being linked by research to eating disorders (Image: Getty)
Eating disorders and neurodivergence
Emerging research suggests a connection between eating disorders and neurodivergent conditions such as autism and attention deficit hyperactivity disorder (ADHD). A study published in the Journal of Eating Disorders in 2024 found people with autism or ADHD may have a higher risk of developing eating disorders and may experience symptoms for longer.
Research from the PEACE Pathway for Eating Disorders and Autism suggests that around 35% of people experiencing an eating disorder may be autistic.
“Some people with autism and ADHD struggle with impulse control and emotional regulation, which can make eating disorder behaviours feel protective and soothing when they feel overwhelmed,” says Dr Silver.
“With autism there is also a link with a very specific type of eating disorder: Avoidant and Restrictive Eating Disorder (ARFID).”
ARFID involves a very limited diet, but unlike anorexia it is not driven by body image or weight concerns.
“This is where people will have a very limited range of foods – not to change their body, or control their weight – but, due to sensory sensitivities, such as discomfort with certain textures, smells and the feeling of fullness.”
She adds that ARFID is sometimes misdiagnosed. “A lot of people with ARFID get misdiagnosed with anorexia, which means they don’t get the treatment they need. It is really important for clinicians to recognise if someone is neurodivergent, as treatment may need to be adapted so that their needs are met.
“We’re definitely learning more and this has real implications for more tailored and effective care.”
Signs something may be wrong
“Eating disorders aren’t always obvious,” says Dr Silver. “Some people with an eating disorder maintain a normal weight.” Changes in behaviour may provide clues that someone is struggling. “If you’re concerned about someone, it can help to say things like – ‘I’ve noticed you don’t seem to be going out much lately. Do you want to talk about how you’re feeling?’ Speaking gently and not being critical can make it easier to encourage someone to seek help.”
Treatment and support
“Eating disorders can have severe consequences for both physical and mental health,” says Dr Silver. “They can affect the heart, hormones, brain and function and overall wellbeing.” If left untreated they can also affect relationships, work and quality of life. However, recovery is possible. “So, it’s crucial to get help. Recovery may take time, but it is possible.”
Where to seek help
Speak to your GP, who can refer you to an eating disorder specialist or multidisciplinary team. For support contact BEAT, the UK eating disorders charity. For information on outpatient, day care and virtual treatment options, contact a specialist eating disorder treatment clinic Orri via orri-uk.com
