Eating Disorders

Could I Have an Eating Disorder?

Sparked by hormonal or life changes, eating disorders in older women carry serious health consequences, such as bone loss and heart problems. They also often go unrecognized.

By Johanna Kandel Updated on May 8, 2025
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Some women at midlife adopt extreme measures to stay thin, perhaps because the hormonal changes of menopause have caused them to gain weight, or maybe a divorce has pushed them back into the dating scene. Whatever the reason, eating disorders in midlife and older women are not uncommon, yet they are under-recognized.

In research examining eating disorder symptoms among women aged 45 to 61, body dissatisfaction was cited as a key risk factor.1 I have seen this firsthand. In 2024, more than 21% of calls to the National Alliance for Eating Disorders, a support and advocacy organization I founded in 2000, were from individuals (primarily women) age 40 and older.

Eating disorders are serious, brain-based mental illnesses with a strong genetic link.2 They have the second-highest mortality rate among all psychiatric disorders.3 Yet many middle-aged and older women may not even recognize that they’re struggling with eating disorders due to misconceptions about these conditions and who they affect.

[Self-Test: Do I Have an Eating Disorder?]

An adult might have an eating disorder if they:

  • experience extreme weight loss or dramatic weight fluctuations
  • refuse to eat certain foods or skip meals
  • exercise excessively
  • show signs of purging

Calorie restriction, or bingeing and purging, can have a particularly adverse effect on an older body, possibly leading to poor health outcomes. When eating disorders go untreated, they can lead to bone loss, heart problems, and, in people who force themselves to vomit, lung conditions. And research shows that 11% of women with ADHD, compared to 1% of women without it, have a history of bulimia nervosa, a common eating disorder that involves gorging followed by vomiting or laxative use.
Other eating disorders common in older adults include:

  • anorexia nervosa (extreme food restriction)
  • binge eating (consuming large amounts of food beyond the point of feeling full)

Eating Disorder Triggers

For some women, the battle with eating disorders began in childhood. For others, body image struggles may be triggered by later-in-life events. These include:

  • Perimenopause and menopause. The transition to menopause is now recognized as a high-risk time for eating disorders to develop or redevelop, in part because women are seeking ways to “control” their changing bodies amid significant estrogen shifts.4
  • Aging and unrealistic ideals. The anxiety and stress of aging in a society that values youthfulness provides fertile ground for increased symptoms of disordered eating and dysfunctional attitudes, beliefs, and behaviors around food and physical appearance.
  • Transitions. Divorce, an empty nest, widowhood, and other life events may lead to or reactivate disordered eating.

[Watch: “Eating Disorders Comorbid with ADHD — ARFID, Anorexia, and Others”]

“Too Old” for an Eating Disorder

Eating disorders are considered diseases of the young, and, consequently, they often go unrecognized in older women. Many clinicians believe their mature patients are “too old” to have such conditions.

If you suspect that you or a loved one may have an eating disorder, talk with a doctor trained in this area. The National Alliance for Eating Disorders offers guidance, resources, and referrals for treatment and care. It provides free, therapist-led virtual support groups for women at midlife and older to connect with others who are experiencing or recovering from eating disorders.

Do I Have an Eating Disorder: Next Steps

Johanna Kandel is the founder and CEO of the National Alliance for Eating Disorders and the author of Life Beyond Your Eating Disorder: Reclaim Yourself, Regain Your Health, Recover for Good. (#CommissionsEarned)

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1Kilpela, L.S., Hooper, S.C., Straud, C.L., Marshall, V.B., Verzijl, C.L., Stewart, T.M., Loera, T.T., Becker, C.B. (2023) The longitudinal associations of body dissatisfaction with health and wellness behaviors in midlife and older women. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph20247143

2Berrettini W. (2004). The genetics of eating disorders. Psychiatry (Edgmont), Nov;1(3):18–25. PMID: 21191522; PMCID: PMC3010958

3van Hoeken, D., & Hoek, H. W. (2020). Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. Current opinion in psychiatry. https://doi.org/10.1097/YCO.0000000000000641

4Khalil, J., Boutros, S., Kheir, N., Kassem, M., Salameh, P. et al. (2022). Eating disorders and their relationship with menopausal phases among a sample of middle-aged Lebanese women. BMC Women’s Health. https://doi.org/10.1186/s12905-022-01738-6