Molly Woolsey of St. Paul was 19 when her anorexia was diagnosed. She's struggled with it all her life.
Once she passed her 20s, Woolsey said, passersby assumed she had cancer or another terminal illness because she was so thin.
"It doesn't occur to them that someone my age could have an eating disorder," said Woolsey, now 45.
Anorexia, binge eating and bulimia are considered afflictions of teenage girls or women in their 20s. But increasingly, older women are admitting to eating disorder symptoms, which put them at higher risk for a wide range of health problems.
"Nine years ago, the mean age for anorexia nervosa was reported to be between 15 and 19 and the mean age for bulimia presentation was 23," said Cynthia Bulik, director of the University of North Carolina Eating Disorders Program. "Now, over half of the women presenting for treatment in our program are over the age of 30."
Bulik was the leader of a study published in the International Journal of Eating Disorders, which showed that more than 13 percent of women age 50 and older have reported eating disorder symptoms. Eight percent reported purging; nearly 4 percent binge eating. And 12 percent admitted to using unhealthful methods of dieting to lose weight, such as laxatives or diet pills.
Bulik said eating disorders in older women can primarily be traced to a culture that "doesn't allow us to look our age. Now that 70 is the new 50, women feel pressure to keep up their appearance."
Repeatedly engaging in bingeing weakens bodies young and old, but eating disorders exact greater punishments on women who may already be on the decline physically because of aging.
Older women with eating disorders are often at higher risk for osteoporosis, gastrointestinal ailments, heart and dental problems. "These disorders wreak such havoc on younger bodies, and older bodies are less resilient," Bulik said.
And while older women with eating disorders are more likely to seek treatment on their own, doctors are sometimes missing diagnoses because they aren't looking for it in middle-age patients, Bulik said. "I have had women tell me they got up the courage to go to their doctor and say, 'I think I have bulimia,' only to have him tell her, no, that's a young woman's disorder."
Woolsey said she's feeling the effects on her body more intensely than she did in her teens.
"I get tired so much more easily now," she said. "I just don't have the stamina. I'm also a compulsive exerciser, so I have to remind myself I'm not lazy -- I have a disorder."
The survey didn't collect data on whether it was the first time the women had developed symptoms, but Bulik said that based on clinical observation, she estimates that a majority had problems as teens or young adults that may or may not have been recognized at the time, got better and then relapsed later in life. About 20 percent have suffered chronically their entire lives, and 10 percent were developing their symptoms for the first time.
The study's results don't surprise Jillian Lampert, director of the Emily Program in St. Paul. In the past four years, 10 to 15 percent of the eating disorder treatment center's 8,300-plus clients have been between ages 50 and 87.
"We now know it is a common occurrence, and many are suffering in silence," Lampert said. "It is common that they have been dealing, alone, with an illness that is treatable for a significant amount of time because they're reluctant, at their age, to disclose struggles with food and body image."
Avoiding the truth
A 54-year-old Minneapolis nurse named Ann, who didn't want her last name used because she has kept her eating disorder a secret from her siblings, fits that description. More than 100 pounds overweight due to compulsive overeating, she recently received from the Emily Program a diagnosis of a common, catch-all type of eating disorder involving a combination of symptoms, like bingeing and occasionally purging.
"It's really a shame-based illness," she said. "I feel like as a nurse, I should know better, but it's not about sticking with a food plan, it's about the underlying issues and how we deal with them."
During a recent session with a counselor to discuss other issues, the counselor immediately suggested that Ann look into eating-disorder treatment.
"I didn't know there was help available," she said. "I felt such relief when I heard her say that."
Sometimes people are unaware that treatment resources exist, or that the problem they have even has a name, Lampert said. "Some worry that they will be 'too old' for treatment, or fear stigma if they disclose struggling with an eating disorder."
Woolsey said that another difference about being middle-aged with an eating disorder is that there is no parent pushing her to get treatment. She has to do it on her own.
"You tell yourself you shouldn't need anyone else's help anymore," she said. "But I've realized if I could do it on my own, I would have."
Some people have a genetic predisposition to eating disorders, Bulik said, "but it doesn't act alone. It's pals with environmental triggers."
When Woolsey was young, her emotional trigger was about fitting a magazine image. Now, it's her isolation and "being critical of myself," she said.
In older women, those triggers might be a major change such as empty nest or divorce, especially if a husband has left her for a younger woman.
"That often leads to intense feelings of physical inadequacy," Bulik said, adding that the beauty industry compounds the problem by encouraging women to be discontented with the way they look. "They are no longer allowed to look old or have their bodies expand the way 50-year-old bodies like to do. It's almost like it's your responsibility to buy these products or get this surgery so you won't appear to age."
Bulik was surprised by one trigger she hadn't seen coming -- financial uncertainty. "Worrying about whether they'll be able to retire, whether they'll have enough to live on for the rest of their lives, can cause major stress."
Passing it on
Lampert said the growing number of older women with eating disorders is doubly concerning because the anxieties that cause one generation to develop an eating disorder can be passed to the next.
Ann, who met with a nutritionist this month to start her treatment plan, said she thinks her two daughters have food issues related to her own.
"It was always an issue in our household," she said. "If you're thinking about food all the time, it takes a lot of time and energy away from normal living. Now that I'm getting help, I hope I can lead by example."
Kristin Tillotson • 612-673-7046