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Eating Disorders
Why We Don't Know Enough About Eating Disorders in Adults
Despite severe health consequences, there is too little research.
Posted February 5, 2022 Reviewed by Tyler Woods
Key points
- Eating disorders in adults are serious illnesses.
- Adults are often denied treatment because of their age.
- The aging process brings new risk factors for eating disorder development.
- More research is needed to understand eating disorders in adults.
I recently attended an Instagram Live session hosted by BEAT (the U.K.’s leading eating disorders charity) with guest Gerome Breen, the Scientific Lead at the Eating Disorders Gene Initiative. The chat was an informal, lovely introduction to the genetics of eating disorders.
What wasn’t wonderful were the comments from adults with eating disorders in the live feed, which included frustration about being denied treatment, as well as feeling embarrassed about their eating disorders and feelings that they didn’t deserve treatment for them.
While statistics show that most eating disorders develop in adolescence or early adulthood, older adults (over 30) develop eating disorders, too. Eating disorders in adults are no less severe or debilitating. Some surprising statistics:
- In the US, most anorexia-related deaths occur in adults over 80 years old.11
- The percentage of men who die from anorexia nervosa is more than double the reported prevalence rate of 10 percent.11
Yet, adults with eating disorders don’t typically receive the access to treatment (or respect) that they need and deserve. The stigma of being an adult with an eating disorder can discourage many from seeking help. This is exemplified in Apple TV's dramedy, Physical, where the adult female protagonist nervously assures her friends that she gave up that "kid stuff" (bulimia) years ago, all the while hiding her binge-purge cycles.
The scientific community, unfortunately, overlooks adults with eating disorders, too. Consequently, the neuroscience of eating disorders in adults hasn’t really been explored.
Developing an Eating Disorder as an Adult
Eating disorders in adulthood are often a continuation of a previous eating disorder, a relapse, or a more severe version of previous struggles with food, exercise, and body image.
Because eating disorders have genetic and biological risk factors, it’s less likely that an older adult will randomly develop an eating disorder without earlier warning signs (e.g., body image concerns, anxiety, depression). Nonetheless, there are exceptions.
One is sleep-related eating disorders, which can develop at any age.6 While we know that these illnesses often manifest from sleepwalking, sleep-related periodic limb movement syndromes, or sleeping pill abuse, the exact neurological factors that contribute to them aren't clear. Some possibilities are dopaminergic7 or serotonergic dysfunctions.8 Much more research is needed, though, to understand what causes sleep-related eating disorders.
Additionally, aging brings risk factors that can increase an individual’s vulnerability for developing an eating disorder. For instance, the sharpness of sensory experiences (e.g., taste, smell, vision) diminishes with age.12 This can result in reduced food intake for older adults, which could contribute to eating disorder development in those who are most susceptible.
Adult Eating Disorders in Women
As women age, they encounter new risk factors for eating disorders. These vary, as women now have a range of lifestyles to pursue (e.g., career, family, world traveler). Maine et al. (2015) acknowledge this beautifully, interweaving the biological (weight gain, hormone changes, aging) with the social (marriage, divorce, family, finances, career, self-exploration).9
Nonetheless, women still, unfortunately, carry most of the familial (pregnancy, childcare, babysitting, elderly care) and household (cleaning, cooking) burdens. Consequently, they often overlook their own health, which can make them more vulnerable (via stress, depression, anxiety) to eating disorders.
Risk factors specific to aging also exist. Like puberty, transitioning into menopause brings new biological susceptibilities for eating disorders, including hormonal changes.2
In a study of women matched for demographic, menopausal status, and weight history, it was discovered that perimenopausal women had a significantly higher prevalence of eating disorders, self-ratings of “feeling fat,” and higher body shape dissatisfaction compared to premenopausal women.1 This, again, highlights the biological and environmental intersections that can increase eating disorder susceptibility across the lifespan.
Adult Eating Disorders in Men
Information about eating disorders in adult men is scarce, at best. This could be because eating disorders in men are often disguised as sport activity.3 Another reason could be stigmatization about men with eating disorders.
Nonetheless, we do know that muscularity concerns aren’t the single risk factor for eating disorders in adult men. Rather, a study found that, in addition to muscularity, men aged 19 to 84 show a range of body image (e.g., weight and shape) and behavior (e.g., excessive exercise and dietary restrictions) symptoms.4 This illustrates that eating disorders in adult men are complex. Consequently, more research is needed to understand the biological (and environmental) factors contributing to these variations in adult men.
Unfortunately, few, if any, studies specifically explore the brain’s role in eating disorders in an adult male sample. Consequently, we can only speculate using relevant research as a guide.
We know that men who have experienced disordered eating in adolescence or young adulthood can develop gonadal changes, which can result in sustained, reduced testosterone later in life.5 Because testosterone has shown to be a protective factor for eating disorders, this reduced testosterone production could increase susceptibility for eating disorder development in adulthood; it could also contribute to an eating disorder relapse or the continuation of a previous one from adolescence.2
Similarly, because certain neurological, blood, gastrointestinal, and/or liver changes can result from early life disordered eating, we can’t rule these out as potential risk factors for adult eating disorder development.5 For example, gastrointestinal disorders can contribute to eating disorder-like symptoms (e.g., food avoidance), which include changes in eating habits. This, coupled with the added distress, pain, and poor gut health that these illnesses bring could develop into an actual eating disorder for individuals susceptible to eating disorder development.10
Another possible risk factor for adult eating disorder development is growth retardation, which is a consequence of early life disordered eating.5 It’s possible that being less developed than others could contribute to body dissatisfaction across the lifespan, potentially contributing to eating disorder development in adult men.
Conclusions
Researchers, unfortunately, haven’t extensively explored the neurological (and related) underpinnings of eating disorders in adults. Consequently, this post can only highlight preliminary findings and speculations about possible risk factors for eating disorder development in these populations.
Given the destructive nature of these illnesses, however, it becomes imperative to understand and treat adults with eating disorders. While most eating disorders develop early in life, these illnesses become more deadly the longer they persist in aging bodies. Consequently, eating disorders in adulthood have an added urgency and must be taken seriously.
References
1) Mangweth-Matzek, B., et al. (2013). The menopausal transition – A possible window of vulnerability for eating pathology. International Journal of Eating Disorders, 46, 609-616.
2) Culbert, K., Sisk, C., & Klump, K. (2021). A narrative review of sex differences in eating disorders: Is there a biological basis? Clinical Therapeutics, 43, 95-111.
3) Mangweth-Matzek, B. (2017). Epidemiology and treatment of eating disorders in men and women of middle and older age. Current Opinions in Psychiatry, 30, 446-451.
4) Hughes, E., et al. (2016). Measures of eating disorder symptoms, drive for muscularity, and muscle dysmorphia: Norms and typologies of Australian men. Australian Journal of Psychology, 68, 270-280.
5) Nagata, J., et al. (2021). Eating Disorders in Boys and Men.
6) Schenck, C., et al. (1991). Sleep-related eating disorders: Polysomnographic correlates of a heterogeneous syndrome distinct from daytime eating disorders. Sleep, 14, 419-431.
7) Vetrugno, R., et al. (2006). Nocturnal eating: Sleep-related eating disorder or night eating syndrome? A videopolysomnographic study. Sleep, 29, 949-954.
8) Miyaoka, T., et al. (2003). Successful treatment of nocturnal eating/drinking syndrome with selective serotonin reuptake inhibitors. International Clinical Psychopharmacology, 18, 175-177.
9) Maine, M., et al. (2015). Eating disorders in adult women: Biopsychosocial, developmental, and clinical considerations. Advances in Eating Disorders: Theory, Research and Practice, 3, 133-143.
10) Bern, E., & O’Brien, R. (2013). Is it an eating disorder, gastrointestinal disorder, or both? Current Opinion in Pediatrics, 25, 463-470.
11) Hewitt, P., et al. (2001). Death from anorexia nervosa: Age span and sex differences. Aging & Mental Health, 5, 41-46.
12) Mathieu, M., et al. (2019). Sensory profile of adults with reduced food intake and the potential roles of nutrition and physical activity interventions. Advances in Nutrition, 10, 1120-1125.
