Late-onset refers to first diagnosis of an eating disorder given in post-puberty stages of life. Eating disorders have traditionally been regarded as illnesses which primarily affect adolescents. While it’s true that adolescence represents a peak period of onset, anyone of any age, cultural background or gender, may experience an eating disorder.
Research indicates an increasing numbers of middle-aged and post-menopausal women in industrialised countries practice disordered eating behaviours. (Slevec & Tiggemann, 2011). It is estimated that 4.5 percent of women above the age of 45 are practicing disordered eating habits. (Keel et al 2009).
Furthermore, one study in Western Australia found that 25% of patients from a community sample experienced onset of their eating disorder after the age of 30 (Fursland, Allen, Watson, & Byrne, 2010).
This would suggest a number of factors contributing to this stage of onset. Where disordered eating patterns occur in this cohort, there is significant evidence of associated risk factors and co-morbid health characteristics such as depression and anxiety, and a decreasing activity and physical health status and changes in quality of life health risks relating to ageing. (Lapid, Prom et al, 2010). (Fairweather-Schmidt et al. 2014).
While there is a growing awareness that maladaptive eating attitudes and behaviours are common in women of various ages and stages of development, research into late onset of eating disorders in general remains limited and is particularly true of males with late onset of eating disorders. There have been recorded cases of delayed onset of eating disorders in men after age 40 (McCormack, Lewis et al. 2014), within the limited body of research into males with eating disorders, but typically studies tend to focus on younger males and frequently rely on comparisons with females (Striegel-Moore et al., 2009).
Research has highlighted stressful changes in mid-life such as marriage, pregnancy, menopause and divorce as potential triggers for older woman (Drobnjak et al. 2014; Bueno et al. 2014; Fairweather-Schmidt et al. 2014). While studies have identified gender-specific risks for men which include involvement in sport (Bratland-Sanda & Sundgot-Borgen, 2013) and pre-morbid obesity (Crosscope-Happel et al., 2000;) , certainly very little research has been conducted into specific risk factors for males in midlife.
Older people with persistent eating disorder symptoms require a different approach and a different environment to engage with treatment. At present specialist treatment services and community based recovery support programs for people with late onset or enduring illnesses are limited.
Over the last decade a greater understanding of eating disorders and disordered eating as issues that affect older adults has begun to emerge. Yet there is much to learn about this phase of eating disorder development, particularly in the following areas:
- What are some typical stages of life where eating disorders may appear later in life?
- What are the characteristics of late onset ED, are they any different to eating disorders which present in the ‘typical’ stages of life such as puberty or middle adolescence?
- Have those with late onset been misdiagnosed previously?
- What are some potential contributing factors to the growing prevalence of late onset eating disorders and are they the same as those contributing to the growth in pre-adolescence onset of eating disorders?
With the average age in our population increasing, further studies into vulnerable segments of middle aged individuals are important. Research into these areas would help to develop prevention and treatment strategies as well as offer support to improve quality of life and mental health concerns.
Bratland-Sanda S, Sundgot-Borgen J (2013) Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment. Eur J Sport Sci 2013, 13(5):499-508.
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Drobnjak, S., Atsiz, S., Ditzen, B., Tuschen-Caffier, B & Ehlert, U (2014) Restrained eating and self-esteem in premenopausal and postmenopausal women. Department of Psychology, Division of Clinical Psychology & Psychotherapy, University of Zurich, Switzerland.
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Slevec JH, Tiggemann M (2011) Predictors of body dissatisfaction and disorder eating in middle-aged women. Clin Psychol Rev 2011, 31:515-524.
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