Eating disorders in midlife women
Much of the existing research on body image and eating disorders has focused on adolescent and young adult women. Relatively little attention has been paid to exploring body image concerns and eating problems in middle-aged women (40-65). And yet, eating disorders are increasingly being identified in older age groups and it is important to gain an understanding of eating pathology in middle aged and older women.
Regardless of age, women are urged by physicians to avoid the societal surge in obesity by staying physically active and maintaining an average weight. In doing so, physicians believe that women will live longer and healthier lives by decreasing the risks of adult-onset diabetes, cardiovascular disease, and some cancers. However, clinicians and researchers also identify that eating disorders appear in women in all stages of life. In fact, several studies have reported substantial increases in inpatient admissions of middle-aged women over the last decade, suggesting that eating disorders may be on the rise in this population (Cumella & Kally, 2008a).
Emerging epidemiological and clinical reports of women during midlife suggest that eating disorders present in one of three ways; a chronic presentation of an earlier-onset disorder without a period of recovery; a relapse of a remitted disorder that occurred earlier in life; or a late-onset presentation, with no past history (Gagne et al., 2012).
Qualitative reports suggest that midlife women, similar to their younger counterparts, may use disordered eating behaviours to cope with sociocultural pressures, developmental challenges, and psychological distress (Kally & Cumella, 2008).
Body dissatisfaction has been shown to be remarkably constant across the adult female lifespan. Findings consistently indicate that midlife women desire to be thinner, diet despite being a healthy weight, and engage in avoidant behaviour associated with body image (McLean, Paxton, & Wertheim, 2011). Sociocultural pressures to be thin may be compounded in midlife by age-related concerns about the body. In particular, the media tends to depict older women and the aging process in quite critical, negative terms, sending the message that aging leads to a loss of attractiveness and desirability.
The transition into middle age is associated with biological changes similar to, in certain respects, the developmental stresses of puberty, including natural weight gain. Life transitions in middle age may constitute a form of stress that can combine with predisposing risk factors to trigger eating disorders (Midlarsky & Nitzburg, 2008).
Research also indicates that loss is an important variable in the development and maintenance of eating problems in women in midlife. Struggling to deal with issues such as death of a loved one, divorce, a loss of youthfulness, a change of appearance, physical deterioration, and the empty nest syndrome have all been implicated as precipitants of an eating disorder (Forman & Davis, 2005). If one is not able to process grief effectively they may draw on other, less adaptive, strategies and behaviours to cope which may include developing symptoms of an eating disorder or body image problem.
While developmental factors are likely to contribute to body dissatisfaction and disordered eating in midlife, some of these may operate in a protective fashion. Having children, being in a stable, long-term relationship and having a secure career may divert attention away from body image and eating, or reduce pressure to attain the thin ideal appearance (McLean et al., 2011). Women who are accepting of the physical aging process may be somewhat protected from thin idealised media, while those who are anxious about aging may be more vulnerable to the media’s negative effects.
In some midlife women, making time for themselves, taking care of their needs, and not feeling guilty for doing so, are associated with lower levels of body image and eating concerns (McLean et al., 2011). An attitude conducive to caring for the body, and engaging in such practices, may be incompatible with body dissatisfaction, which is characterised by body disparagement and resisting physical needs such as hunger. Applying appropriate self-care implies acceptance of the body in its current state and responding to its needs.
Future research needs to identify factors that may protect middle-aged women against the development of body dissatisfaction and disordered eating. These protective factors could then become the focus of prevention efforts in clinical and community settings.
Furthermore, investigations of eating pathology among men and women over the age of 65 are needed to see if body image variables remain the best predictors of eating pathology in these older age groups, or whether the dynamics of eating pathology change from middle to older adulthood.
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Cumella, E. J., & Kally, Z. (2008). Profile of 50 women with midlife-onset eating disorders. Eating Disorders: The Journal of Treatment & Prevention, 16(3), 193-203.
Forman, M., & Davis, W. N. (2005). Characteristics of Middle-Aged Women in Inpatient Treatment for Eating Disorders. Eating Disorders: The Journal of Treatment & Prevention, 13(3), 231-243.
Gagne, D. A., Von Holle, A., Brownley, K. A., Runfola, C. D., Hofmeier, S., Branch, K. E., & Bulik, C. M. (2012). Eating disorder symptoms and weight and shape concerns in a large web-based convenience sample of women ages 50 and above: Results of the gender and body image (GABI) study. International Journal of Eating Disorders, 45(7), 832-844.
Kally, Z., & Cumella, E. J. (2008). 100 midlife women with eating disorders: A phenomenological analysis of etiology. Journal of General Psychology, 135(4), 359-377.
McLean, S. A., Paxton, S. J., & Wertheim, E. H. (2011). A Body Image and Disordered Eating Intervention for Women in Midlife: A Randomized Controlled Trial. Journal of Consulting & Clinical Psychology, 79(6), 751-758.
Midlarsky, E., & Nitzburg, G. (2008). Eating disorders in middle-aged women. Journal of General Psychology, 135(4), 393-407.
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