Women in Mid-Life Have Higher Prevalence of Eating Disorders Than Expected

A United Kingdom study in 5320 women reported that 3% had an active eating disorder in mid-life. This figure was higher than anticipated, since eating disorders are typically associated with adolescence or early adulthood, according to BMC Medicine.

This 2-phase study marked the first time researchers have investigated eating disorder occurrence in women aged 40 to 50 years, targeting common predictors for full and subthreshold eating disorders. The researchers also sought to identify childhood, parenting, and personality risk factors, including child happiness, parental divorce or separation, life events, parental bonding, and early sexual abuse. It was also the first study to investigate childhood risk factors for purging disorder, a newly described eating disorder.

The study used data from an ongoing longitudinal, community-based sample of women in mid-life — the Avon Longitudinal Study of Parents and Children (ALSPAC) — who had enrolled 20 years earlier. Women were asked to complete a questionnaire, recording each eating disorder they had experienced in their lives. Women who reported symptoms of eating disorders and an equal number of women who reported never having symptoms of an eating disorder underwent standardized diagnostic interviews.

Researchers learned that nearly 15.3% of women reported having an eating disorder during their lives, with 3.6% reporting an eating disorder within the past 12 months. Additionally, less than 30% of women who had eating disorders said they had received treatment.

Parental separation or divorce in childhood was associated with increased odds for bulimia nervosa, binge-eating disorder, and atypical anorexia nervosa. Child sexual abuse was associated with all  binge-purge eating disorders. Sexual abuse perpetrated by a non-stranger occurred more often among women with anorexia nervosa binge-purge disorders but was equally as prevalent in sexual abuse by a stranger for bulimia nervosa and binge-eating disorder.

A woman’s risk of experiencing anorexia nervosa or bulimia nervosa increased by 4% to 10% per unit score of reports of childhood unhappiness. An external locus of control was positively associated with binge-eating disorders (a 19% increase in odds per 1-point score increase), but high maternal warmth was found to be protective for bulimia nervosa (20% decreased odds). Childhood life events and interpersonal sensitivity were associated with all eating disorders.

“These findings highlight, for the first time, that [eating disorders] are not confined to earlier decades of life and that both chronic and new-onset disorders are apparent in this stage of life,” Nadia Micali, MD, PhD, MSc, lead author from the department of psychiatry at the Icahn School of Medicine at Mount Sinai in New York and University College of London in England, said.

“This study also has implications for service provision, which at present is not specifically geared towards women in mid-life, and in identification of women who might be misdiagnosed given the lack of awareness among healthcare professionals of eating disorder presentations,” Dr Micali said.

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Micali N, Martini MG, Thomas JJ, Eddy KT, et al. Lifetime and 12-month prevalence of eating disorders amongst women in mid-life: a population-based study of diagnoses and risk factors [published online January 17, 2017]. BMC Med. doi: 10.1186/s12916-016-0766-4