Body & Mind: Not Just for Kids

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That's certainly true of Karen, 47, a human-resources manager in Los Angeles who developed serious bulimia after her husband died in 1991. Karen, who prefers not to reveal her full name, admits she has never had a healthy relationship with food and that, as a new widow, she found herself going on binges that lasted days, followed by days and even weeks of fasting. It took her years to get help. She looked for a program in which others could identify with her issues of loss and aging. This summer she turned to San Diego's Puente de Vida, a private, six-bed facility that requires at minimum a 30-day stay, which costs $30,000. During her time there, Karen says, three of the six women were her age or older. "I didn't want to be with a lot of teeny-boppers who might look at me and think, 'What's that old lady doing here?'" she says.

While Karen didn't mind a mixed-age program, facilitators at Renfrew say older women can be less forthright in such groups and tend to mother the younger girls instead of focusing on their own needs. "Women with eating disorders are very good at taking care of everyone but themselves," says Grishkat.

They're also very good at hiding their problems. Despite the rising number of midlife women seeking help for eating disorders, some experts think that large numbers go undetected not only because patients are secretive but also because doctors are oblivious. "Some doctors have a stereotype of who develops an eating disorder," says Cindy Bulik, director of the eating-disorders program at the University of North Carolina at Chapel Hill. "I know patients whose doctors said, 'You can't have bulimia. That's a young white woman's disease.'" The tendency to overlook the disorder is exacerbated by the fact that many mature patients can't be neatly classified as anorexic or bulimic. Most older patients at Remuda Ranch are classified as EDNOS, eating disorders not otherwise specified, says Dr. Edward Camella, Remuda's director of research and education. Such patients often rely on idiosyncratic dieting and compulsive exercise to control their weight. "It used to be that they were terrified of fat grams, but now they're terrified of carbs," says Camella.

An eating disorder can wreak havoc on the body at any age, but at midlife the damage can be swift: stress fractures from prolonged exercise, early osteoporosis from poor nutrition and heart arrhythmia brought on by being too thin and exercising to exhaustion.

As with other addictions, the first step to recovery is acknowledging the problem. Smith remembers being "very resistant" when she arrived at Renfrew's residential center. "I sat around crying and thinking, 'I'm not like these other people,'" she recalls, "but they wouldn't release me without a game plan, so I said what they wanted to hear for the first few days. After a while, I realized how much I needed help." Even then she was skeptical that she could beat a problem that went back to her teen years. She attributes her progress to psychotherapy, an organized routine and the group environment. "Prior to this, I had never talked to anyone about my problem or been around other people with the same problem, so I always felt very alone and isolated."