Expert: Major life changes could trigger midlife eating disorders

The Renfrew Center, which has eating disorder clinics across the country, including in North Carolina, added a midlife treatment track after seeing a 42 percent spike in patients over 30 in the past decade.

At Carolina House, an eating disorder clinic in Raleigh, about 50 percent of its patients are older than 30, according to organizers. The eating disorders program at the University of North Carolina at Chapel Hill reports a similar trend. 

“What we’re seeing a lot in midlife is we’re seeing major changes, like divorce in midlife or infidelity of a spouse. Or menopause is another major trigger for eating disorders in older women,” said Dr. Cynthia Bulik, founding director of the UNC Center of Excellence for Eating Disorders.

When UNC’s eating disorder unit opened in 2003, Bulik says, she thought it would mostly help adolescents. Now, more than half the patients are over age 30. The shifting demographic prompted her to write the book: "Midlife Eating Disorders,” which focuses on genetic factors.

“I often say genes load the gun and environment pulls the trigger,” Bulik said. "So what we see is there are environmental triggers that are facing midlife individuals and seem to be pulling the trigger for the underlying predisposition to an eating disorder."

For Molly Carrier, turning 30 was a turning point in her health. After having her second baby, the Raleigh mother struggled to juggle two young children and her demanding job as a paramedic. She coped by dieting.

“It’s kind of like a lot of women, where you gain a little bit of weight with the first pregnancy and you gain a little more with the second pregnancy. (It’s) kind of hard to take it off because you’re busy,” Carrier said. “I found having control over my weight and my eating made me feel like I had control over my life.”

That so-called control quickly spiraled out of control, and Carrier says she soon became “like a robot.”

“I found I could not eat a certain amount of calories a day and I couldn’t go to bed at night unless I exercised for an hour and a half,” she said. “I missed out on a lot of things my kids were doing, because I had to exercise. I became so malnourished, I couldn’t think straight, and there are whole blocks of things I can’t remember.”

After a few years, a friend confronted Carrier about her shrinking size.

“I said, ‘No, of course I don’t have a problem. I’m fine. I’m very healthy. I’m very fit. Everything’s great. Look how wonderful my life is,’ and she said, ‘OK, I dare you to go out and have a meal with me and then go home and not exercise,’” Carrier recalled. “And I thought, ‘No problem. This will be a snap.’ (But I) couldn’t do it. I was sobbing on the floor because I wanted to do those things that helped me feel in control.”

Carrier decided to talk with a doctor, who confirmed that she had an eating disorder – anorexia nervosa. Experts say anorexia has the highest mortality rate of any psychiatric disorder.

“It took a long time for me to accept that was actually what was going on,” Carrier said. “My thought was, ‘Well, I’m not 13 years old and trying to look like a fashion model. This is not an eating disorder. This is a way of life. This is healthy.”

In 1998, Carrier sought help at the Renfrew Center and spent the next decade in and out of treatment at the center’s Charlotte and Philadelphia locations.

"Treatment isn't going to be a quick fix. Treatment does take time," said Paula Edwards-Gayfield, site director at the Renfrew Center of Charlotte. "Not only in treatment are you addressing these stressors, you're also learning how to nurture yourself. You're also identifying what's normal (and) balanced meals, so you're working with a nutritionist. You're working with a psychiatrist. You're working with a therapist."

Now 48 years old, Carrier is still in recovery. “I did then, and still now, have a lot of body distortion,” she said. “I feel extremely large … I’m hoping someday I will look in the mirror and see what other people see, but I’m working on it.”

Carrier credits her family, doctor, nutritionist and therapist for being her support network. Experts say finding that support is critical to any recovery.

“A lot of parents and spouses will say to us that, ‘At first, I thought they were just being healthy. They were eating healthier foods, cutting out junk foods.’ All of a sudden, it was like a switch turned off, and there is a line when it goes from healthful to being obsessional,” Bulik said.

10) Persistent view of yourself as fat that worsens despite weight loss