This isn't about any teenager: Wives, new mothers, professional women, and empty nesters are developing eating disorders.
Women in their 20s, 30s, 40s, and 50s are showing signs of anorexia or bulimia. The problem often begins so subtly that neither she nor her family realizes what's happening, experts say. Yet the problem can be life-threatening.
With anorexia, the disorder may begin quite simply with a diet. Bulimia involves binging and purging, either through vomiting or laxatives -- with getting thin as the goal.
The women are often living productive lives and want to fight midlife weight gain. Or there may be an emotional crisis that triggers it. Depression springs from a divorce, a death, a child who has left home. Her self-esteem may be suffering. She may feel lonely.
Typically, it's fueled by concerns about body image and weight -- every woman's struggle to live up to society's standard.
"Some have struggled with these problems for 20 years or more ... for others, it seems to start at menopause, or when there is loss of spouse, a crisis," says David Herzog, MD, director of the Harvard Eating Disorders Program at Massachusetts General Hospital in Boston.
"We see women become anorexic while trying to lose pregnancy weight," he tells WebMD. "It can even start during the pregnancy, this struggle with weight issues. The women become obsessed with body image, they've been on a series of diets and weight-loss programs. But at some point, the wish to lose weight becomes overwhelming, an obsession."
Much is due to our "culture of extremes," Herzog says. "We tend to not do things in moderation. That's where [these women] get into difficulty. There is no middle ground. They want to be perfect. They don't want to be average."
However, certain inherited traits seem to make some women more vulnerable to eating disorders, explains Walter H. Kaye, MD, professor of psychiatry at University of Pittsburgh School of Medicine. Kaye is compiling an international study of women with eating disorders to determine whether a gene or genes might predispose some to develop anorexia.
Could It Be Genetic?
Numerous studies during the last decade have suggested that genetics plays a role, Kaye tells WebMD. "Eating disorders are known to run in families. Studies show that identical twins are more likely than [fraternal] twins to have eating disorders."
The genetic predisposition likely creates certain personality traits -- tendency toward anxiety, obsession, perfectionism -- that make some people particularly susceptible to eating disorders," he explains. "A genetic link just makes sense, since lots of people in this society diet but relatively few people end up with an eating disorder."
The important issue: "These can be dangerous disorders, people can die from them," says Kaye. "Getting people to a doctor is very important."
That's not always easy, since many women with eating disorders don't see themselves as having a problem, he says. "That can cause tension and a difficulty that is not easily resolved. You can force a 14-year-old girl to get treatment, but that's very hard with a 60-year-old woman. It often becomes a struggle because the family is very concerned. Some kind of confrontation may be necessary."
When should you be concerned? "When someone has a drastic change in body size, that should be clue," says Herzog. Other signs include:
- A dramatic change in eating patterns
- Declining invitations to dine socially
- Often leaving the table for the bathroom
- Severe change in mood
Just remember: While certain diets may seem "extreme" -- such as raw food or vegetarian diets -- they are generally not life-threatening, says Herzog. "Also, some women are genetically very thin, have a higher metabolism, and they won't gain when others might. Not everyone has the same metabolism."
Kaye encourages women to contact him if they believe they may qualify for his study of anorexia.
Published July 13, 2004.