How Can We Address the Needs of People in Midlife with Eating Disorders?

Introduction by Cynthia Bulik, PhD

One of the benefits of being in my position is that I hear from people all over the world who have important perspectives to share on the state of eating disorders treatment. This last week, I received the piece below from Ellen W. who describes in detail what it is like to be a fortysomething woman in an eating disorders treatment facility with mostly young girls. She eloquently describes the isolation of the experience and how it fails to address the needs specific to her time of life. Although I discussed many issues related to eating disorders in this population in Midlife Eating Disorders, the field has not yet addressed how best to treat individuals with eating disorders in midlife. As stated over and over again, the evidence base for the treatment of eating disorders (especially anorexia nervosa) in adults is weak. Ellen W. raises the important point that even though you are an adult at 18, the issues that you face on a day-to-day basis are likely to be very different from a 40+ year old person.

Very real issues exist that complicate developing accessible programs for midlife individuals. If only a few midlife individuals present for treatment at a time, it is hard for hospitals or treatment centers to finance age-specific programming for small numbers of patients. If tailored programs exist in one part of the country for midlife individuals, not everyone can afford to travel for treatment. Internet-based groups would be wonderful to try so that we could treat people around the country, but licensure issues often prevent us from working across state lines, and privacy and safety issues are not always easily addressed. By presenting Ellen W.’s writing, I hope to encourage more people to think about how we can better address the needs of individuals in midlife (and other neglected groups!).

I am grateful to Ellen for sharing her feelings and for agreeing to present her experience on Exchanges.


by Ellen W.

Disclaimer: Eating disorders are no longer a white teenage or college girl’s illness. There are many forgotten demographics out there that deserve to have a voice as well.

I am writing this from a treatment center where I am surrounded by peers at least half my age. No stranger to the treatment circuit, I have become accustomed to the gap in demographics that have ranged from adolescents to mostly 20 to early 30somethings. This is because most treatment centers classify 18 and over “adult.”

While much more attention has been brought to eating disorders among men as well as the LGBTQ community, I have come across very little information on how the treatment experience plays out in midlife where those over 40 are lumped in with patients twice their junior.

One of my male peers said he feels even more isolated as a middle-aged man in what is classified as a young women’s disease. Not surprisingly, I relate to him the most.

Despite the age gaps, I can attest to being treated respectfully as well as supported. I can also attest to being reluctant to speak up in group settings due to the vast different phases of life. I can certainly provide feedback to the young patients based on my own life experiences, yet I do not expect them to relate to parenting or marital issues, chronic unemployment, fear of menopausal weight gain, etc.

As a parent patient, I also shy away from discussing in groups my young child as the well-intentioned feedback I tend to receive often results in such guilt-provoking responses such as “do it for your daughter,” or “she is why you are here.” So, I usually reserve my parenting issues for individual therapy or for the rare but welcomed one or two other moms who I have met in treatment.

In discussing my daughter, I am attuned to the fact and by no fault of their own that this age group simply cannot fathom what I go through in terms of guilt and fear of judgement for being in treatment and away from my child. Of course, I should do it for my daughter. That, to me, is a no brainer. And most times I am doing it for her as I struggle with a lack of internal motivation.

Yet, I do feel that a double standard or bias exists for younger patients without children who “deserve” to do it for themselves. As a mother, I would never provide feedback to young women such as “do it or your parents. They’re worried.” This just reinforces the guilt cycle. I will also never provide feedback on situations I haven’t experienced. Sympathize, yes. But I tend to hold my tongue if I haven’t been in that exact or related situation where my feedback may do more harm than good if I completely miss the mark.

The point I am driving home is that since the adult resurgence of my eating disorder, I have long felt a need for a treatment facility for the 35 and over population. I would be much more comfortable relating to men and women in my age bracket going through similar life experiences instead of feeling like I’m always one of the oldest clients who has to censor myself due to my unwillingness to open up to a census whom I could technically parent.

In general, more awareness needs to be brought to how to treat eating disorders in midlife. I’ve seen articles here and there that have shed light on eating disorders amongst my age group as well as the possible causes which were spot on: separation, divorce, empty nest, ageism, loss of job, changing bodies, menopause, etc. Yet, there hasn’t to date been any information that sheds light on how therapy plays out on a middle-aged person sandwiched in a youth-filled treatment center.

Sure, by law, 18 and over is considered an adult but the generation gap in treatment can reinforce isolation as the midlife patient struggles to find someone to connect with or use groups to their advantage when feedback often backfires.

That is why I am hoping more attention is brought to the importance of treatment centers or even units dedicated to those 35 and over. Having been around this block far too many times to admit, I wonder how I would respond therapeutically and emotionally to a more-age appropriate facility. Even more pressing, I wonder how many more adults in midlife suffering with eating disorders would seek treatment, knowing that they would be being among similarly aged peers.

Thank you for bringing this to the attention to all eating disorder sufferers, their loved ones, treatment centers and the general public.

I am now off to group wondering if I will talk today.