Eating disorders are a type of illness characterized by a severe disturbance in eating behaviors and thoughts and emotions related to food and eating. People with eating disorders typically become preoccupied with food and their body weight. They also tend to experience distortions in body image.
Eating disorders affect people of all ages and social and cultural backgrounds. It is estimated that about 9% of Americans suffer from an eating disorder. Studies have shown that approximately 0.80% of adults will be affected by anorexia nervosa in their lifetime, 0.28% will be affected by bulimia nervosa, and 0.85% will be affected by binge eating disorder.
Although we see eating disorders in virtually every population, the types and presentation of eating disorders will vary. How an eating disorder presents in childhood is markedly different than how it may present in a geriatric client.
Eating Disorders in Childhood
When we think of eating disorders, we often think first of teenage girls. Disordered eating is seen in younger children as well and the rate is increasing. While we don’t know exactly what causes an eating disorder, we do know that eating disorders are hereditary. If a first-degree relative has an eating disorder, the child is 7-12 times more likely to develop disordered eating than a child who does not. Children with chronic illnesses or mental health issues are also at increased risk.
Eating disorders seen in childhood include:
Pica – Persistent ingestion of non-food or non-nutritional substances.
Avoidant/Restrictive Food Intake Disorder – Lack of interest in food or a sensory aversion to certain foods. This avoidance or restriction may lead to significant weight loss.
Rumination Syndrome – Both voluntary or involuntary regurgitation and re-chewing of partially digested food that may be re-swallowed or spat out.
Anorexia Nervosa – In children, this disorder may manifest as a preoccupation with food and weight, restricting food, hoarding or hiding food. Younger children are less likely to use compensatory behaviors such as purging, laxative use, or exercising excessively.
Bulimia – Overeating followed by purging is less common among younger children. An eating disorder may not be immediately identifiable in children. Lack of growth is often an early sign that further assessment is warranted.
Eating Disorders in Teens
Eating disorders most often begin to emerge in the pre-teen or teen years. Teens, especially teen girls, are the group most often associated with eating disorders. Research has found that teen girls are more likely to develop a clinical eating disorder than boys. However, when comparing sub-clinical disordered behavior such as binge eating, laxative abuse, and fasting for weight loss, the behaviors are nearly as common among boys as they are among girls.
The most common types of eating disorders among teens are:
Anorexia Nervosa – A disorder characterized by significant weight loss and difficulty maintaining a body weight appropriate for height and age resulting from restriction of food or use of compensatory behaviors such as excessive exercise, purging, or laxative abuse.
Bulimia Nervosa – A potentially life-threatening eating disorder characterized by cycles of bingeing and purging to compensate for the effects of excessive or binge eating.
Binge-Eating Disorder (BED) – A severe, life-threatening eating disorder characterized by recurrent episodes of eating large amounts of food (quickly and to the point of discomfort. BED is the most common eating disorder in the United States.
Teens are at the greatest risk due to the pressures that they face as they mature. Some contributing factors include:
- Societal pressures – Society places a great deal of emphasis on thinness and unrealistic, “ideal” body images. The pressure to conform is intense and can contribute to a sense of not being thin enough or not measuring up. Pressure also comes from peers and the pressure to fit in with whatever trend happens to be in favor.
- Preferred teen activities – Certain activities appealing to teens can be associated with disordered eating. Modeling, performing and athletics emphasize being lean and fit. For some teens, this can lead to feeling the need to control their weight through unhealthy means or struggle with body image.
- Genetics – Eating disorders are thought to be hereditary. If a teen has a first-degree relative with an eating disorder, they are at increased risk for disordered eating as well.
- Personality – There is some evidence to suggest that personality traits such as perfectionism, anxiety, or rigidity might contribute to the development of disordered eating.
Early signs to be aware of include skipping meals, making excuses for not eating or eating in secret, preoccupation with food or weight, regularly going to the bathroom right after eating, or persistent worry or complaining about being “fat.”
Eating Disorders in Adults
Most eating disorders have their roots in adolescence but there is increasing evidence to suggest that eating disorders can develop in adulthood.
A study of Canadian women found that women ages 45 to 64 were more likely to binge eat, experience guilt about eating, and be preoccupied with food compared with younger women.
Another study conducted by a large eating disorders program found that 13% of women over 50 exhibited symptoms of an eating disorder.
Treatment centers are seeing this phenomenon as well as they are treating more and more adult patients, both men and women. While it is unclear as to exactly why these disorders emerge in adulthood, there is some evidence to suggest that social and physical changes that occur in adulthood and mid-life may play a role.
- Aging – With the body undergoing so many physical changes, people may become preoccupied with masking the signs of aging, weight, and body image.
- Grief and Loss – Midlife is a time when the loss of loved ones becomes more frequent. Grieving a loss can diminish appetite. Restricting, bingeing or purging may be a way to deal with uncomfortable feelings.
- Medical Issues – An illness that results in weight loss may have the effect of reinforcing the weight loss via compliments about one’s slender appearance. The person may continue to restrict to avoid regaining the weight.
- Risk – The person may have had a long-standing eating disorder that went untreated. With age, the ability to deal with the physical and emotional symptoms may prompt the person to seek out medical care.
Older individuals can present with the same types of eating disorders as teens and younger adults. However, it has been noted that the symptoms of older women may not meet the strict standards set forth by the DSM-V. It is also important to rule out medical issues that may mimic an eating disorder or result in marked weight loss.
Special Concerns with Eating Disorders in Elderly Adults
An eating disorder can develop at any age but in the elderly population, it can be easily overlooked. Fearing that they have a “teenager’s” issue, they may be embarrassed to be forthcoming with information.
They may not realize the extent of their symptoms and risks. There may be medical issues masking the eating issues and their presentation may not fit the standard profile of a client with an eating disorder.
Whether it is a newly-emerged eating disorder or one that went undiagnosed, an eating disorder in an older adult carries a significant risk for co-morbidity and mortality. A thorough mental health assessment is critical and must include a medical assessment to rule out or identify any co-occurring medical or other issues that could impact treatment.
The greatest concern for elderly adults with eating disorders is the toll it can take on the systems of the body. The most commonly diagnosed eating disorders in the elderly, anorexia and bulimia, place a tremendous strain on the body and can result in cardiac issues, electrolyte imbalances, GI distress, or dental problems.
This is of particular concern for the bulimic elderly client. The force of repeated purging can have significant detrimental effects on the cardiac and GI systems. Due to the medical fragility that comes with advanced age, the management of any eating disorder in this population should be multidisciplinary and include both medical and psychiatric care.
In Summary
Eating disorders are among the most complicated conditions to treat. Successful treatment begins with a thorough assessment. Understanding the nuances among different groups and knowing what to look for means a more accurate assessment and ultimately better client-centered care.
Sources:
- G, A. (2023, December 18). Eating Disorder Statistics. National Association of Anorexia Nervosa and Associated Disorders. https://anad.org/eating-disorder-statistic/
- Udo, T., & Grilo, C. M. (2018). Prevalence and correlates of DSM-5–Defined Eating Disorders in a nationally representative sample of U.S. adults. Biological Psychiatry, 84(5), 345–354. https://doi.org/10.1016/j.biopsych.2018.03.014
- Campbell, K., & Peebles, R. (2014). Eating Disorders in Children and Adolescents: State of the Art review. Pediatrics, 134(3), 582–592. https://doi.org/10.1542/peds.2014-0194
- Peebles, R., Wilson, J., & Lock, J. (2006). How Do Children with Eating Disorders Differ from Adolescents with Eating Disorders at Initial Evaluation? Journal of Adolescent Health, 39(6), 800–805. https://doi.org/10.1016/j.jadohealth.2006.05.013
- Statistics & Research on Eating Disorders – National Eating Disorders Association. (2018b, February 19). National Eating Disorders Association. https://www.nationaleatingdisorders.org/statistics/
- 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. The International journal of eating disorders, 45(7), 832–844. https://doi.org/10.1002/eat.22030
- Samuels, K. L., Maine, M. M., & Tantillo, M. (2019). Disordered Eating, Eating Disorders, and Body Image in Midlife and Older Women. Current psychiatry reports, 21(8), 70. https://doi.org/10.1007/s11920-019-1057-5
- Rumination syndrome. (2019, November 19). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/rumination-syndrome
Dawn Ferrara is a Licensed Professional Counselor and a doctor of Psychology with additional certification in the telemental health field. She is passionate about helping people find solutions that work and believes that every person has the power to be successful. Her practice is in South Louisiana.