In a UK study of 5,320 women, 3% were found to have an active eating disorder in mid-life, a figure higher than expected as eating disorders are primarily associated with adolescence or early adulthood (University of Bristol, 2017). The research, using data from the University of Bristol’s Avon Longitudinal Study of Parents and Children cohort, is published in the open access journal BMC Medicine.

This is the first time the prevalence of eating disorders has been investigated in a population sample of women in their forties and fifties and the researchers were surprised to find that eating disorders affected a significant amount of women aged between forty and fifty. Around 15.3% of participants in the study reported having an eating disorder at some point in their life and 3.6% reported an eating disorder in the past twelve months. Less than 30% of women who had eating disorders said they had sought help or received treatment.

Dr Nadia Micali, lead author from the Department of Psychiatry at Icahn School of Medicine at Mount Sinai in New York and University College London, said “Our study shows that eating disorders are not just confined to earlier decades of life, and that both chronic and new onset disorders are apparent in mid-life. Many of the women who took part in this study told us this was the first time they had ever spoken about their eating difficulties, so we need to understand why many women did not seek help. It may be that there are some barriers women perceive in healthcare access or a lack of awareness among healthcare professionals.”

The researchers also assessed factors that may be associated with the onset of an eating disorder including childhood happiness, parental divorce or separation, life events, relationship with parents, and sexual abuse.

Nadia Micali explained “The early risk factors we assessed were associated with different eating disorders. Anorexia, bulimia, binge eating and purging disorder were all associated with childhood unhappiness, and parental separation or divorce during childhood seemed to increase the risk of bulimia, binge eating disorder and atypical anorexia. We also found that death of a carer could increase the likelihood of purging disorder and that sexual abuse during childhood, or a fear of social rejection, was associated with all eating disorders.”

Women selected for the study were asked to complete a questionnaire where each eating disorder they had experienced in their life was recorded. Women who reported having ever had any symptoms of eating disorders, and an equal number of women who reported never having symptoms, were interviewed using standardised diagnostic interviews. Women who reported experiencing any eating disorder were asked if they had ever sought and/or received treatment for these.

In the study a woman’s risk of suffering from anorexia nervosa or bulimia nervosa, two of the most common eating disorders in the UK, was increased by 4-10% per unit score of “unhappiness” if they reported being unhappy during childhood. Higher interpersonal sensitivity, the ability to accurately assess others’ feelings, was associated with an increased risk of binge eating by 19% per unit score of “sensitivity”. A good mother–daughter relationship was associated with a 20% reduced chance of developing bulimia.

The study was observational and longitudinal, so it can increase the understanding of possible links between early risk factors and eating disorders, but it cannot show cause and effect.

The data in this study covers the last forty years and might reflect the past rather than the current lack of clinical awareness of eating disorders in the UK. The sample may also be limited as the cohort was made up of women who were pregnant at a specific point in time and from a defined region of the UK. Further studies are needed to better characterise eating disorders in mid-life and determine the different impact of the various risk factors that lead to mid-life eating disorders compared to those that occur earlier in life.