Not Just for Kids

Psychiatrist Ann Kearney-Cooke has been treating eating disorders for 23 years. About 10 years ago, the therapist, who is based in Cincinnati, Ohio, began to notice a disturbing new trend: the average age of her patients kept getting older. "We traditionally think of anorexia and bulimia as affecting those of college or high school age, and that was the case 20 years ago," she says. "Now about half my patients are women in midlife."

She's not the only one seeing that trend. In Philadelphia the Renfrew Center Foundation, which specializes in treating eating disorders, reported a 25% jump in patients older than 35 over the past two years; today those women account for nearly a quarter of its patients. At the Remuda Ranch in Wickenburg, Ariz., the percentage of patients 40 or older has nearly quadrupled, from 3% in 1990 to more than 11% last year.

Like their teenage counterparts, victims of midlife eating disorders tend to suffer from low self-esteem and perfectionism, according to those who treat them. But the triggers for their problem have a distinctly midlife flavor--divorce, an empty nest or the death of a spouse, parent or child. About half those affected are women who struggled with food-related issues in their youth. "This generation of women was brought up to be superwomen, and whether it's the supermom or the woman with the incredible job, both are expected to be beautiful," says Kearney-Cooke, a co-author of Change Your Mind, Change Your Body: Feeling Good About Yourself After Age 40 (Atria Books; 268 pages). Societal pressure to remain thin well into one's 40s and 50s adds to the stress. "Thirty or 40 years ago, a woman who had a few children was expected to be 15 to 20 pounds heavier than she is now," observes Kearney-Cooke. "Many have difficulty dealing with issues related to aging, and there's a sense of 'I can't control my hormones, and I may have memory lapses, but if I don't eat and lose a pound, that's something I can control.'"

Donna Smith, 41, of Springfield, Pa., acknowledges that her eating disorder sprang from a need to rein in her sometimes out-of-control life. Smith, a bookkeeper and part-time yoga instructor, had struggled with bulimia as a teenager and resorted to it occasionally as an adult. But the disorder returned with a vengeance three years ago when her estranged father resurfaced after a 20-year absence, then died. Smith coped by resuming her old self-destructive ways. By the summer of 2003, she carried less than 100 lbs. on her 5-ft. 3-in. frame. Only after she was hospitalized for bulimia did she agree to enter Renfrew's eight-week outpatient treatment program.

Five years earlier, Smith might have been surrounded by girls half her age, but Renfrew had recently created a recovery program called Thirty-Something and Beyond. Clinical supervisor Holly Grishkat developed the program after the center was bombarded with calls from women who wanted help but did not want to be in a program filled with adolescents. "Older women are dealing with very different issues than the younger girls," says Grishkat.