“Eating disorders only happen to teenage girls.”
So goes the old stereotype. The prevalent thought is that eating disorders are only a problem for adolescents girls, right?
Eating disorders like anorexia nervosa, bulimia nervosa, binge eating disorder and a host of others can happen to anyone – any gender, any race or ethnicity, and importantly, any age. And yet, all too often the focus on eating disorders is put squarely on adolescents – sometimes to the detriment of adults who are struggling with eating disorders and preventing them from finding avenues to get help.
There is some basis for the “adolescents only” stereotype, to be clear. Most eating disorders first appear in adolescents from age 12 – 25, and even many adults who receive their first diagnosis after those ages have been living with the disorder for years, as we’ll see shortly. No matter the age a person first experiences an eating disorder, however, the effects of that eating disorder can be just as devastating at any age. Even more troubling, the stigma against seeking help for mental health disorders, still so common in the United States, may make it harder for an adult to admit they need help than it is for an adolescent.
Here, we’ll discuss some of the challenges adults face when it comes to eating disorder treatment and remind the community not to forget about adults in recovery.
Eating Disorder Behaviors May Have Been Hidden During Adolescence
One of the difficulties for the loved ones of a person with an eating disorder is spotting the behavioral and physical signs of that disorder. This is because most disordered eating behaviors bring a sense of shame and guilt, and the person with the eating disorder will take great pains to avoid being “caught.” This can show up in many ways; a person with anorexia nervosa might wear baggy clothes to avoid revealing how much weight they have lost, for example, or a person with binge eating disorder might secretly put the food wrappers from their latest binge eating episode in the trash separately so no one can see the evidence.
Sometimes people can successfully “pass” or hide their eating disorder for years. Especially after adolescents leave home for college or work, there is no one watching their eating patterns day-to-day, which helps disguise disordered eating behaviors. In situations like this, it’s possible to avoid difficult conversations about eating patterns until the problem has manifested in a physical consequence like malnutrition. Adults who reach this point may need medical interventions as part of their eating disorder treatment.
There May Be Behavioral Changes Due to Natural Weight Gain
It’s completely natural to gain weight as you age. Everyone’s metabolism slows as they grow older, and the ability to eat what you like without putting on weight fades with time. Other factors such as pregnancy also naturally cause people to gain weight. In an ideal world, people would be more open to the idea of HAES (Health At Every Size), meaning the concept that a person’s health is not determined by their BMI or body size. However, fear of gaining weight and the sense of being able to control something about one’s body are still very prevalent contributing causes of nascent eating disorders.
A person who’s struggling with body image and fear of gaining weight naturally ages, their natural tendency for weight gain can prompt new behaviors. Many of these are precursors to those found on disorders like anorexia nervosa or bulimia nervosa. One of the most eminent of these is a newfound devotion to an exercise regime. Exercise, of course, is essential to physical health, but it can become compulsive and ultimately destructive in the context of eating disorders. One clear sign that an adult is becoming at risk is an excessive exercise routine that persists through bad weather, injuries, and pain, and precludes social interactions.
Dieting Becomes More Common After a Person’s Twenties
Of all the behavioral symptoms of eating disorders, the most common might be frequent dieting and counting calories.This focus on weight gain prevention or weight loss becomes more common in adults over 30.Except for ARFID (Avoidant Restrictive Food Intake Disorder), most people with an eating disorder have tried several different fad diets and weight loss techniques. With the natural tendency to gain weight in adulthood taken into accord, this tendency toward dieting becomes even more pronounced.
The diet industry also aims to exploit this tendency. In combination with traditional and social media’s influence on what an “ideal” body should look like, major diet companies play up the supposed health risks of having a larger body, which can stoke deep concerns and fears of gaining weight in people who are at risk for developing an eating disorder. And which ages are the diet industry’s prime targets? Women over 30 years old. People who have not previously been at risk for an eating disorder can be made so by the diet industry’s specific message and targeting.
Binge Eating Disorder Is About as Common in Adulthood as in Adolescence
Binge eating disorder is an outlier from more commonly well-known disorders like anorexia nervosa and bulimia nervosa, and it challenges many laypeople’s conception of what an eating disorder is. Unlike anorexia nervosa and sometimes bulimia nervosa, people with binge eating disorder usually don’t lose large amounts of weight – in fact, they are often overweight or obese. Binge eating disorder is much more common in men than other eating disorders – about half of all sufferers are men, compared to much smaller percentages for other disorders.
Binge eating disorder is also more common in adulthood than other kinds of eating disorder. Many of the adults admitted into eating disorder treatment centers suffer from this disorder, and often it has gone undiagnosed for years. Binge eating disorder patients have often been publicly dieting for much of their lives by the time they seek treatment, and one sign of binge eating disorder is frequent dieting without significant weight loss. Treatment can be more difficult to obtain for adults with binge eating disorder because of still-present biases against their age and the type of eating disorder in the medical community.
Selective Eating Disorder Might Be Overlooked in Childhood
Selective eating disorder, the less formal name for ARFID (Avoidant Restrictive Food Intake Disorder), is when a person develops a pathological avoidance of a certain food or food group. Much more than personal preference or religious restriction, people with ARFID will avoid these foods to the point where their nutritional balance breaks down. They may even become malnourished. Unlike other eating disorders, a fear of gaining weight or establishing control over their weight is not the reason for the disorder. Instead, ARFID usually stems from an irrational fear of choking, becoming poisoned, or another “impure” quality of the avoided food.
Very often, ARFID is dismissed as “picky eating,” especially among young children. After all, who hasn’t known a toddler who won’t eat a sandwich with the crusts still attached? Unfortunately, that dismissal can continue into a person’s adulthood. It can become quite easy for an adult to mask a case of ARFID by claiming to be a picky eater, and often none will be the wiser. To help underrepresented adults with ARFID get treatment for their eating disorder, medical and psychological professionals to be wary of extremely picky eating – and be ready to make a diagnosis despite their preconceived notions.
Treatment Is Available for Adults as Well as Adolescents
The idea that eating disorders only happen in teenagers isn’t the only stereotype we need to break. The idea that treatment is only needed for adolescents and young adults is another trope that needs to be broken. There are specialized adolescent treatment programs, of course, but not as many are aware that adult-focused treatment programs are also available. These programs are specialized; of course, the treatment program will take into account a client’s disorder(s), medical needs, emotional needs, and various other aspects of their situation when making a personalized treatment plan. However, treatment centers can take adult-specific issues into account as well.
Many adults cannot take 30 or more days off to spend in residential treatment, which requires clients to live in the eating disorder treatment center during their treatment. There might be work, school, or childcare responsibilities that can’t be put off, although severe cases of any form of eating disorder should take precedence. In those situations, day treatment programs are ideal for adults with eating disorders. Most if not all of the therapeutic techniques used in day treatment are identical to those used in residential treatment.
The staff at adult-focused treatment programs will usually have specialized training in accommodating the treatment needs of adult clients, especially those over 30, into middle age, and in seniors. While compassion and a non-judgmental approach are a given, the psych team and the nutritionists and dieticians will likely have to work closely together to develop a treatment plan. It should include meal plans and therapeutic techniques appropriate to the client’s age and medical needs.
Don’t forget about eating disorders in adults. If you’re struggling with disordered eating and you’re over 25, or if you know someone who is, don’t lose hope. There is a light at the end of the tunnel – and adult eating disorder treatment can help you reach it.