Midlife Anorexia: Why Older Women Are Developing Eating Disorders
While eating disorders have often been stereotyped as affecting mostly skinny, white, affluent teenage girls and young adults, there’s now a consensus among mental health professionals that they affect individuals of all sexes, racial/ethnic and socio-economic backgrounds, body weights, and ages.
Life transitions and stressors common in midlife and beyond—such as caring for aging parents, divorce, children leaving the home, and menopause—are exacerbating anorexia symptoms in women.
In fact, eating disorders in midlife and eating disorders in older women are on the rise. Though research is still very new, epidemiological research from 2023 shows approximately 2 percent to 7.7 percent of older women meet the requirements for an eating disorder diagnosis such as anorexia, bulimia, or binge-eating disorder.
In particular, anorexia nervosa—characterized by having an intense fear about gaining weight and severely restricting food consumption causing unhealthy weight loss—is rearing its head again or for the first time in women at midlife.
Anorexia is officially categorized into two subtypes: the restricting type and the binge eating and purging type:
Older women with anorexia usually have had symptoms since adolescence that were either overlooked or poorly treated. Now the life transitions and stressors common in midlife and beyond—such as caring for aging parents, divorce, children leaving the home, and menopause—are exacerbating anorexic symptoms in women.
Identifying and treating anorexia at any age is critically important as it has one of the highest mortality rates of any psychiatric illness. Indeed, patients with anorexia nervosa have a 521 percent increased chance of dying compared to someone from the general population, according to 2025 research findings.
Here’s what you need to know about anorexia symptoms in older women, its unique challenges, and the most comprehensive course of treatment.
WHAT IS ANOREXIA?
Anorexia nervosa is a treatable eating disorder in which an individual severely limits their food intake leading to a less-than-minimal healthy body weight. They additionally have a strong fear of gaining weight or becoming fat, or they exhibit persistent behavior that interferes with weight gain.
Often, their self-worth is tied to their body shape or weight. They may be unhappy with their body shape and weight. O they persistently fail to understand the gravity of their low weight.
But not all individuals with anorexia are “thin.” Sometimes an individual with a history of living in a larger body can become preoccupied with losing weight and may lose a substantial amount of weight but still remain in a range considered healthy.
This is an example of what’s called atypical anorexia nervosa. Surprisingly, this lesser-known atypical anorexia is three to four times more common than anorexia, according to research in the Journal of Abnormal Psychology.
Anorexia is officially categorized into two subtypes: the restricting type and the binge eating and purging type:
The lifetime prevalence of anorexia nervosa might be up to as much as 4 percent in females and 0.3 percent in males, according to a 2021 study. Although onset is most common in adolescence and young adulthood, it can develop earlier. And now, research shows that anorexia and eating disorders are an issue for women at midlife and beyond.
Related: What Is Atypical Anorexia?
| SIGNS AND SYMPTOMS OF ANOREXIA NERVOSA | |
|---|---|
| 1Distorted body image | |
| 2Severely restricted eating | |
| 3Low body weight | |
| 4Obsessive worry about weight gain | |
| 5Amenorrhea (skipped menstrual periods) | |
| 6Excessive physical activity | |
| 7Denial of hunger | |
| 8Peculiar, obsessive, or ritualized eating behaviors | |
| 9Depression and/or anxiety | |
| 10Preoccupation with food, calories, exercising | |
| 11Rules about dieting, body shape and weight | |
| 12Irritability around mealtimes | |
| 13Slowed thinking and decreased ability to concentrate | |
| 14Denial of the problem or the seriousness of the problem | |
| 15Frequent weighing | |
| 16Measuring body parts | |
| 17Often checking oneself in the mirror for “excess fat” | |
| 18Difficulty eating in public | |
| 19Strong need to control one’s environment | |
| 20Binge eating followed by purging behaviors | |
| 21Substance abuse | |
HEALTH CONSEQUENCES OF UNTREATED ANOREXIA
Health issues resulting from self-starvation can be deadly. When anorexia persists, it wreaks considerable damage on the brain and body as they do not get an adequate supply of the nutrients necessary for healthy functioning.
This can lead to a number of serious health problems, including:
- Osteoporosis
- Constipation
- Low blood pressure
- Anemia
- Fatigue
- Menstrual irregularities
- Infertility
- Electrolyte imbalances
- Heart problems
One recent study found that approximately 5 percent of patients with anorexia died within four years of the diagnosis. Most deaths related to anorexia stem from heart conditions and suicide.
Related: Do You Know the Deadliest Mental Health Disorder?
CAUSES OF ANOREXIA
Anorexia nervosa develops from a complex interplay of factors including the following:
Genetic Factors: Women with a first-degree relative with anorexia are 11 times more likely to develop the disorder, research has found. An individual can have a genetic predisposition too, with certain genes related to mood, anxiety, and appetite playing a role.
Poor Body Image: Having a distorted and unrealistic perception of one’s body, often in combination with low self-esteem, can lead to a strong desire to control one’s body and lose weight to an unhealthy level.
Perfectionism and Control: People with anorexia often exhibit an intense need for control and perfection. This can manifest in obsessive, restrictive eating as way to achieve control over one’s body.
Co-occurring Mental Health Conditions: Comorbid mental health disorders such as anxiety and depression, and obsessive-compulsive disorder (OCD), and substance use disorder (SUD) are prevalent among anorexic individuals, contributing to the disorder’s development and oftentimes worsening it too.
Trauma: Individuals who have experienced abuse (physical, sexual, or emotional) or other traumatic events may develop anorexia as a coping mechanism.
Social Influences: Family, social media, and peer pressure valuing and idealizing a thin body ideal and linking it to success, beauty, and happiness can factor into the development of eating disorders, including anorexia, research shows. It can influence a vulnerable person to reject their body and feel pressure to diet or overexercise.
Profession or Activities Where Body Image/Shape Is Important: Athletic sports, dance, acting, or modeling that require a specific body type can increase pressure to achieve a certain level of thinness or fitness, contributing to anorexia.
Brain Dysfunction: When certain areas of the brain are under or overperforming, it can increase anxiety and obsessive-compulsive behavior leading to anorexia.
ANOREXIA IN WOMEN OVER 40
Anorexia nervosa, along with binge eating disorder and bulimia nervosa, make up the three most common eating disorders in women over 40. And disordered eating in midlife is increasing.
The Renfrew Center, the first residential treatment facility in the U.S. for eating disorders, recently reported a 42 percent increase of women over 35 seeking treatment over the last decade.
Maintaining mental health and aging is particular tough for women in the context of a changing body. Indeed, poor body image in older woman is surprisingly prevalent, according to some research.
A published survey study found that 71.2 percent of the sampled women over 50 were trying to lose weight. Of course, this is a major risk factor for the development of anorexia and other eating disorders. Indeed, a study in the International Journal of Eating Disorders estimates that 13 percent of U.S. women over 50 have eating disorder symptoms
Interestingly, experts are finding that many older adults with eating disorders have struggled with the problem since youth, while others experienced some recovery earlier in life but are finding themselves in a relapse situation.
In some cases, there’s undiagnosed anorexia in adults where they have had issues with food and body image for years but the condition had never incapacitated them until now.
One reason women at midlife may be struggling with anorexia again is that eating disorder treatment was still very nascent in the 1970s, ’80s, and early ’90s. It is believed these women didn’t get the comprehensive treatment that is available today, so the condition persisted.
Of course, there are those who begin to develop rituals related to body appearance, food intake, and exercise for the first time. Experts say that these cases of late-onset anorexia are not as common as recurrences of or previously undiagnosed anorexia.
There’s no doubt that facing the stressors of aging in a youth-obsessed culture factors in—but there are many others as well.
Press Play to Learn More About Overcoming Eating Disorders
In this video, Dr. Julie Brush, Naturopathic Doctor at Amen Clinics Los Angeles and eating disorder and addiction specialist, shares with Tana Amen the best approaches to healing from eating disorders, and what can someone do right now if they’re suffering.
Click below to tune in.
RISK FACTORS FOR EATING DISORDERS LATER IN LIFE
Eating disorders at midlife have their own unique triggers that have to do with challenges at later stages of life. Some key risk factors for anorexia and other eating disorders in midlife include:
- Pregnancy and childbirth
- Divorce
- Menopause – The end of the reproductive cycle and the hormonal shifts characteristic of this major change in a woman’s life can cause body dissatisfaction and a desire for control, which may lead to restricted eating and weight loss. Indeed, women who report severe menopausal symptoms show more eating disorder pathology compared with those with low symptoms, research
- Signs of aging and the anxiety that aging can create have been found to increase the risk of body dissatisfaction and disordered eating
- Grief and loss such as death of a loved one or becoming widowed
- Illness of a loved one
- Experiencing illness personally
- Retirement
- Becoming an empty nester
- Becoming a grandparent
- Caring for aging parents
- Moving
CHALLENGES FOR OLDER WOMEN WITH EATING DISORDERS
Experiencing anorexia later in life is different contextually than it is for teens and young women. As a result, there are unique obstacles and challenges for older women with eating disorders, including the following:
- Shame and embarrassment about having a “teen’s” problem
- An awareness of what they have lost due to their eating disorder
- They may have more stubborn and entrenched eating disorder if they have had it for many years as it may be part of their identity
- Adult responsibilities may provide obstacles to treatment (having children or aging parents to care for)
- Increased anxiety about health and appearance due to the natural aging process
- More complex stressors and losses that go hand in hand with adult development
- Fear of facing the long-term impacts of disordered eating on older bodies—including osteoporosis, heart disease and dental problems—amongst other related health issues
- Being the only mature adult at treatment centers that treat teens and young women. Even though medical experts are increasingly recognizing eating disorders in later life, most treatment is still geared toward much younger women. A 60-year-old could share a room or do therapy with someone 20 or 30 years her junior.
- Decline of cognitive functioning due to restrictive dieting and weight loss. Cognitive issues can be a key risk factor in helping to identify eating disorders in older adults.
BRAIN-BASED UNDERPINNINGS OF ANOREXIA
Gaining insight and knowledge about the brain-based causes of anorexia can make an important difference in successful treatment of the disorder, especially for women at midlife.
Brain SPECT imaging shows that people who suffer from all eating disorders—including anorexia—have abnormalities such as:
- Overactivity in the basal ganglia, where anxiety originates
- Overactivity in the anterior cingulate gyrus, which is associated with rumination
- Parietal lobe issues, which involve a sense of direction and sensory processing (a facet of body dysmorphia)
Support for anorexia treatment needs to be multidimensional and brain scans offer an effective way to find the origin of the eating disorder as well as co-occurring brain health issues such as depression, anxiety, and obsessive-compulsive disorder.
When a woman can actually see the brain dysfunction that plays a role in her eating disorder, it helps to dispel shame and increase willingness to take steps to get better.
TREATING MIDLIFE ANOREXIA
While a solution to anorexia at midlife might not be straightforward given the complicated array of issues associated with this disorder, help, and recovery are possible.
Anorexia treatment typically involves medically supervised weight gain and cognitive behavioral therapy. An in-patient program or hospital stay may be necessary, especially for issues such as severe malnutrition, continued refusal to eat, heart rhythm problems, electrolyte imbalances, dehydration, or more severe mental health issues.
At Amen Clinics, we take a comprehensive approach which combines brain SPECT imaging with a biological, psychological, social, and spiritual history, plus cognitive assessments. This helps our doctors understand the underlying cause of an individual’s symptoms so that a targeted and personalized treatment plan can be created.
To heal from anorexia, nutritional counseling and treatment for any underlying brain health or mental health issues are necessary, which may include lifestyle changes, supplements, and medication when necessary. Addressing environmental factors, such as chronic stress, negative thinking patterns, and troubled relationships are key as well.
Specifically for women at midlife facing recovery from anorexia, the contextual factors of a woman’s stage of life must be considered too. This means addressing menopausal symptoms and hormonal imbalances, and suggesting grief counseling, therapy, and seeking peer group support.
The great news is that recovery from anorexia is possible—at any age. Following a comprehensive treatment plan can help put people with this condition on the road to regaining a healthy body image and relationship with food, emotional well-being, and physical health.
Eating disorders and other mental health conditions can’t wait. At Amen Clinics, we provide personalized, science-backed treatment plans designed to target the root causes of your symptoms. Our 360-approach includes brain SPECT imaging, clinical evaluations, innovative therapeutic techniques, medications (when necessary), and holistic lifestyle recommendations to promote the health of your brain, body, and mind. Speak to a specialist today at 888-288-9834 or visit our contact page here.
Amen Clinics
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The Renfrew Center website
https://www.renfrewcenters.com/services/specialized-programming/midlife
Accessed July 11, 2025
Gagne DA, Von Holle A, Brownley KA, Runfola CD, Hofmeier S, Branch KE, Bulik CM. 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. Int J Eat Disord. 2012 Nov;45(7):832-44.
Hofmeier SM, Runfola CD, Sala M, Gagne DA, Brownley KA, Bulik CM. Body image, aging, and identity in women over 50: The Gender and Body Image (GABI) study. J Women Aging. 2017 Jan-Feb;29(1):3-14.
Mangweth-Matzek B, Kummer KK, Hoek HW. Update on the epidemiology and treatment of eating disorders among older people. Curr Opin Psychiatry. 2023 Nov 1;36(6):405-411.