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January 27, 2016

Unique Challenges for the Clinician Treating a Middle-Aged Eating Disorder Patient

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Contributor: Dawn Theodore, MA, MFT, CEDS, Director of Day Treatment Services for Monte Nido and Affiliates

When I treat clients with eating disorders, I always talk to the person about the “fork in the road”, which is the choice they have as to whether to choose their life in that moment or their eating disorder. Every decision that is made moves them closer to one destination or the other.

The Fork in the Road

As I sat across from a woman in her 50’s who has been struggling with her eating disorder for 40 years, I have to wonder why she has chosen her eating disorder and not life. After all, she is working and functioning in life, but she continues to struggle with her eating disorder and is sitting in treatment yet again after many failed attempts.

I had a lot of empathy and compassion for this woman who had developed her eating disorder at age fifteen about the same age that I had developed anorexia nervosa. We were approximately the same age and yet we had chosen a different fork in the road.

In the past, eating disorders would be seen at developmental transitions such as middle school to high school, high school to college, college to life and before and after pregnancies. Now there are additional transitions that are leading to an increase in eating disorders in individuals 40 and above.

Many clients being seen for eating disorders in the 40 and older range could have had an eating disorder for many years, but it was never recognized or treated. The person was functional in their life and able to keep their eating disorder a secret for many years.

A client may also have had recovery from their eating disorder at an earlier time in their life and a life event has triggered a relapse.

The Pressures of Aging

Some of the possibilities as to why the 40 and older population is developing their eating disorder now can have to do with transitions associated with the age. At this age, the person may be beginning to recognize the societal pressure to look younger as the aging process begins. Their children are developing in to beautiful adults as they begin to see the signs of aging.

man-1005333_640x426Children are leaving the home and the empty nesters are being asked to reevaluate their lives after raising a family. This is a time when the couple has to look at their marriage, relationship and divorce is a distinct possibility as they rediscover life without their children.

There may also be financial concerns as they have children in college and they are preparing for retirement. Women may be forced back in to the work force after years of being removed if they were a stay at home mom. Seeking treatment may be costly and they feel shame to take money from college funds and/or retirement.

The sandwich generation is stressed by the pressures of raising their own family while caring for ailing parents. The loss of parents is another developmental transition which can cause someone to begin looking at their own mortality and aging fears.

As young girls transition from childhood to adolescence, they receive attention for their new body. Women who are going through menopause are also going through a transition with their body, but this time they are not receiving the positive reinforcement they had as an adolescent. In fact, it is a time when they may really be dissatisfied with their body.

Treating this Population

When treating this population, it is important to look at the current stressors in their lives. Being able to identify what has gotten them to treatment and actually be able to talk about it without shame and guilt.

cheerful women in yoga classIf they have had an eating disorder in the past and have relapsed or if they have secretly had an eating disorder for a long time, they may feel hopeless and as though they will have their eating disorder forever.

Teaching the client how to be authentic and congruent may be healing as they take off the mask they have presented to the world. This may be the first time that they actually have the time to focus on themselves and their well being.

What they were presenting to the world and how they actually have felt were not the same. The person will need to identify their feelings and learn how to communicate their feelings to their support system.

The support system for this population may include their children, husband, friends, and siblings. Helping the client identify what she or he needs from their support system and how they can be supportive. The more educated the families are about the clients eating disorder, the less this client will be able to act out in their eating disorder.

Communicating Concerns

Helping the family to be able to communicate their concerns can be difficult. The children may have to be honest about how their parent’s eating disorder has impacted them.

Depressed woman talking with her therapistThe roles may be reversed and the child may be the one setting limits with their parent. Teaching families to be loving, empathetic and communicating without judgment is key through the process. Also being able to speak their truth without being attached to the results.

The belief system of the eating disorder will need to be challenged. If the client has had their eating disorder for a long time, the belief system will be rigid and it will take a lot of support from the therapist, dietician, family and friends to begin to shift the distorted cognitions.

As I sat across from my client, I was aware of how her eating disorder had pushed the support system away with it’s relentless demands on her. She had no relationships in her life and she was returning to an apartment she shared with her cat. As she made the transition out of treatment and back to her life, I held the hope for her journey in to recovery, but also knew it was her choice and she had the tools to choose life.

Community Discussion – Share your thoughts here!

How do you think eating disorder been impacted by age? How has age impacted recovery?


Dawn Theodore Image -122x143 - 1-27-16About the author: Dawn Theodore, MA, MFT, CEDS, is a specialist in the treatment of eating disorders. Dawn has a private practice in Calabasas and Brentwood, CA, and she is Director of Day Treatment Services for Monte Nido and Affiliates. She was the owner “Carousel” a transitional living home for women with eating disorders and chemical dependency, with her colleague, Terry Eagan, MD.

Dawn worked for seven years at Monte Nido Residential Treatment Center in Malibu, CA with women suffering from anorexia, bulimia and exercise addiction. She has worked as a primary therapist as well as a facilitator of the weekly multi-family group, cognitive behavioral, dance therapy and creativity groups. She worked for 6 years as an Eating Disorder Consultant for Visions Adolescent Treatment Center in Malibu, where she worked with adolescents who suffer from drug addiction, alcoholism in addition to having an eating disorder. Dawn was the Clinical Director of the Eating Disorder Center of California in Brentwood (Los Angeles) for 5 years.


The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on January 27, 2016
Published on EatingDisorderHope.com

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