

Eating disorders are a type of illness characterized by a severe disturbance in eating behaviors and thoughts and emotions related to food and eating. People with eating disorders typically become preoccupied with food and their body weight. They also tend to experience distortions in body image.
Eating disorders affect people of all ages and social and cultural backgrounds. It is estimated that about 9% of Americans suffer from an eating disorder. Studies have shown that approximately 0.80% of adults will be affected by anorexia nervosa in their lifetime, 0.28% will be affected by bulimia nervosa, and 0.85% will be affected by binge eating disorder.
Although we see eating disorders in virtually every population, the types and presentation of eating disorders will vary. How an eating disorder presents in childhood is markedly different than how it may present in a geriatric client.
When we think of eating disorders, we often think first of teenage girls. Disordered eating is seen in younger children as well and the rate is increasing. While we don’t know exactly what causes an eating disorder, we do know that eating disorders are hereditary. If a first-degree relative has an eating disorder, the child is 7-12 times more likely to develop disordered eating than a child who does not. Children with chronic illnesses or mental health issues are also at increased risk.
Eating disorders seen in childhood include:
Pica – Persistent ingestion of non-food or non-nutritional substances.
Avoidant/Restrictive Food Intake Disorder – Lack of interest in food or a sensory aversion to certain foods. This avoidance or restriction may lead to significant weight loss.
Rumination Syndrome – Both voluntary or involuntary regurgitation and re-chewing of partially digested food that may be re-swallowed or spat out.
Anorexia Nervosa – In children, this disorder may manifest as a preoccupation with food and weight, restricting food, hoarding or hiding food. Younger children are less likely to use compensatory behaviors such as purging, laxative use, or exercising excessively.
Bulimia – Overeating followed by purging is less common among younger children. An eating disorder may not be immediately identifiable in children. Lack of growth is often an early sign that further assessment is warranted.
Eating disorders most often begin to emerge in the pre-teen or teen years. Teens, especially teen girls, are the group most often associated with eating disorders. Research has found that teen girls are more likely to develop a clinical eating disorder than boys. However, when comparing sub-clinical disordered behavior such as binge eating, laxative abuse, and fasting for weight loss, the behaviors are nearly as common among boys as they are among girls.
The most common types of eating disorders among teens are:
Anorexia Nervosa – A disorder characterized by significant weight loss and difficulty maintaining a body weight appropriate for height and age resulting from restriction of food or use of compensatory behaviors such as excessive exercise, purging, or laxative abuse.
Bulimia Nervosa – A potentially life-threatening eating disorder characterized by cycles of bingeing and purging to compensate for the effects of excessive or binge eating.
Binge-Eating Disorder (BED) – A severe, life-threatening eating disorder characterized by recurrent episodes of eating large amounts of food (quickly and to the point of discomfort. BED is the most common eating disorder in the United States.
Teens are at the greatest risk due to the pressures that they face as they mature. Some contributing factors include:
Early signs to be aware of include skipping meals, making excuses for not eating or eating in secret, preoccupation with food or weight, regularly going to the bathroom right after eating, or persistent worry or complaining about being “fat.”
Most eating disorders have their roots in adolescence but there is increasing evidence to suggest that eating disorders can develop in adulthood.
A study of Canadian women found that women ages 45 to 64 were more likely to binge eat, experience guilt about eating, and be preoccupied with food compared with younger women.
Another study conducted by a large eating disorders program found that 13% of women over 50 exhibited symptoms of an eating disorder.
Treatment centers are seeing this phenomenon as well as they are treating more and more adult patients, both men and women. While it is unclear as to exactly why these disorders emerge in adulthood, there is some evidence to suggest that social and physical changes that occur in adulthood and mid-life may play a role.
Older individuals can present with the same types of eating disorders as teens and younger adults. However, it has been noted that the symptoms of older women may not meet the strict standards set forth by the DSM-V. It is also important to rule out medical issues that may mimic an eating disorder or result in marked weight loss.
An eating disorder can develop at any age but in the elderly population, it can be easily overlooked. Fearing that they have a “teenager’s” issue, they may be embarrassed to be forthcoming with information.
They may not realize the extent of their symptoms and risks. There may be medical issues masking the eating issues and their presentation may not fit the standard profile of a client with an eating disorder.
Whether it is a newly-emerged eating disorder or one that went undiagnosed, an eating disorder in an older adult carries a significant risk for co-morbidity and mortality. A thorough mental health assessment is critical and must include a medical assessment to rule out or identify any co-occurring medical or other issues that could impact treatment.
The greatest concern for elderly adults with eating disorders is the toll it can take on the systems of the body. The most commonly diagnosed eating disorders in the elderly, anorexia and bulimia, place a tremendous strain on the body and can result in cardiac issues, electrolyte imbalances, GI distress, or dental problems.
This is of particular concern for the bulimic elderly client. The force of repeated purging can have significant detrimental effects on the cardiac and GI systems. Due to the medical fragility that comes with advanced age, the management of any eating disorder in this population should be multidisciplinary and include both medical and psychiatric care.
Eating disorders are among the most complicated conditions to treat. Successful treatment begins with a thorough assessment. Understanding the nuances among different groups and knowing what to look for means a more accurate assessment and ultimately better client-centered care.
Sources: