Genetic factors can play a role in the development of eating disorders, according to psychologist Cynthia Bulik, director of the University of North Carolina Eating Disorders Program. “But we also know that in many cases it is the environment that serves as a trigger for the underlying genetic predisposition,” she says. “Genes load the gun; environment pulls the trigger.
“In the past, the triggers—extreme dieting, pressures to be thin—were most likely to come in adolescence,” Bulik says. “Now we see women and men of all ages engaging in high-risk behaviors [such as extreme dieting] that can serve as the trigger to an underlying predisposition.”
People are particularly vulnerable during times of stress. “A lot of the adults who have eating disorders had them in adolescence, and they were unsuccessfully treated or incompletely treated,” Ratner says, “so it’s almost as if the eating disorder lies dormant until a life transition or a stressful event triggers it again 20 or 30 years later.”
Margo Maine, a psychologist in West Hartford, Conn., says eating disorders often occur during developmental transitions, which used to mean the teen years. “Now we are seeing them again during or after pregnancy and as women hit other life transitions such as divorce, menopause or having an empty nest,” says Maine, co-author of The Body Myth: Adult Women and the Pressure to Be Perfect (Wiley, 2005). “Whenever there’s a lot of change happening externally in your life, that can shake up how you feel about yourself internally.”
Adult women often struggle with body dissatisfaction. In a 2009 study, researchers at the University of North Carolina at Chapel Hill surveyed more than 4,000 women ages 25 to 45 and found that 75 percent of them had unhealthy thoughts about their body weight and shape that interfered with their happiness. Many also engaged in unhealthy eating behaviors: 31 percent of those with no previous history of anorexia or binge eating reported having occasionally purged to control their weight.
“Because there’s so much emphasis on youth, thinness and looks in our culture, for many women, the body is the way they express the stresses and pressures they feel,” Maine says. This can lead some to severely limit their food intake, weigh themselves excessively, obsess about calories, abuse laxatives and exercise to extremes—all in an effort to preserve their youthful figures, prevent middle-aged spread or forestall other aspects of aging.
“For a woman who’s getting older, having a thinner or younger looking body may seem like the answer because it returns you to the appearance of a younger, simpler time in your life when you felt more in control,” Maine says.
One aspect of eating disorders “that’s not true of any other psychiatric disorder is people ‘float’—they might be anorexic in their teen years and become bulimic later on when they’re concerned about their fertility. Then they might struggle with binge eating after they stop purging,” says Ann Jacob Smith, a psychotherapist specializing in weight management and eating disorders in Chevy Chase. “Some people vacillate between the disorders depending on their stage of life.”
Many of these people can be found skipping meals, cutting way down on fats or carbs, avoiding social situations involving food and cruising from one exercise class or cardio machine to the next to burn as many calories as possible. “One of the reasons it’s so hard for women to acknowledge they have a problem is because they’re surrounded by women who are doing the same things,” Maine says.
In 1997, Dr. Steven Bratman, co-author of Health Food Junkies (Broadway, 2001), coined the term “orthorexia” to describe one aspect of this disordered behavior—an unhealthy obsession with eating healthy food. It’s increasingly common in the Bethesda region.
“We live in a very well-educated area where everybody’s trying to eat healthfully,” says dietitian Ann Gerber, owner of Wellness On The Run, a Bethesda-based weight management and wellness practice. “With orthorexia, people are treating their body like a temple. It can be a lifestyle or a coping mechanism. It’s empowering, and it gives a sense of control and makes people feel good. But healthy eating habits can be taken too far and can become obsessive.”
Orthorexia can lead to nutrient deficiencies, Gerber says, and can negatively affect a person’s relationships. Some experts also fear that severely limited “healthy” diets may serve as a bridge to anorexia or other serious eating disorders.
