It is not just teenage girls who suffer from eating disorders: in the UK, roughly 3.6% of women in their 40s and 50s could also be affected. A number of risk factors, such as the death of a parent or sexual abuse in childhood, may make it more likely for women of this age to report an eating disorder diagnosis.
Eating disorders are severe psychiatric issues associated with major health consequences and high levels of mortality. They are described in the Diagnostic and Statistical Manual for Mental Disorders 5th edition (DSM-5) and range from anorexia nervosa and bulimia to binge-eating disorder and purging disorder.
These disorders frequently appear in adolescence and are more common among young people – girls in particular. According to the charity Anorexia and Bulimia Care, anorexia most commonly develops around the age of 16 or 17, while bulimia mainly affects females aged between 16 and 40.
However, eating disorder cases can also be diagnosed well into adulthood and among young children. Research into eating disorders is thus expanding to take into account this complex reality, and to help doctors improve how they treat these conditions.
The latest study on the topic, published in BMC Medicine, is the first to look at the prevalence of eating disorders among women in their fourth or fifth decade of life. The scientists wanted to find out what proportion of women at this age had been diagnosed with an eating disorder in the last 12 months or at any other point in their lives. Looking back at the women's life experiences, they also analysed what risk factors made such a diagnosis more likely.
Affecting 3% of women
The researchers, led by Dr Nadia Micali from Icahn School of Medicine at Mount Sinai and University College London, collected data from women taking part in the Avon Longitudinal Study of Parents and Children. This extensive, population-based prospective study of UK women and their children investigates the effects of environment, genetic and other factors on health and development.
Some 5, 658 of these women filled in a questionnaire where they recorded if they had experienced symptoms of eating disorders sometime during their lifetime. The women were 47 years old, on average.
Some 524 women who had symptoms of a disorder and 518 who didn't were together selected to go through standardised diagnostic interviews to confirm a diagnosis. This allowed the scientists to estimate the prevalence of these conditions among these older women. Around 15.3% of participants were found to have had an eating disorder at some point in their lives, and 3.6% in the past 12 months. Among these, nearly half of them were diagnosed for the first time.
"Our study challenges the view that developing eating disorders is something that happens adolescents and young adults. Women in their 40s and 50s are also affected. However, it is difficult to say whether this is a new phenomenon or if it is because we had not studied this age group before", Micali told IBTimes UK.
Trauma in childhood
The scientists also conducted interviews to learn more about the women's childhoods and life experiences. In particular, they looked at whether factors such as childhood happiness, early sexual abuse, parental deaths or separation, interpersonal sensitivity (the ability to accurately assess other people's feelings) and IQ scores increased the risk of developing an eating disorder.
Although none of these factors is enough on its own to trigger the development of eating disorders, the scientists showed that parental separation or divorce in childhood was associated with increased odds for bulimia, binge-eating disorder and atypical anorexia.
Sexual abuse in childhood was associated with binge-eating behaviours, and the death of a parent with seven-fold increased odds for purging disorder. Women who rated their childhood as unhappy were more likely to report any of these four eating disorders: they had increased by 4-10% per unit score of 'unhappiness' of developing anorexia and bulimia if they reported being unhappy when young.
Higher interpersonal sensitivity was associated with an increased risk of binge eating by 19% per unit score of 'sensitivity'.
"All these factors are important because they are preventable or, at the very least, if we know about them we can offer support and therapy to people to try and help them before they go on to develop eating disorders", Micali said.
Despite the relatively high prevalence of these disorders at mid-life and the fact they are sometimes linked to important childhood traumas, very few women told the researchers that they had sought or received treatment. Improving access to care at all ages of life and researching in greater details the long-term impact of childhood traumas will be very important in years to come to reduce the incidence of eating disorders.