Bulimia Nervosa In Middle-Aged Women – It’s More Common Than You Think

Bulimia nervosa is an eating disorder that involves regular episodes of binging and purging behavior. Binging refers to eating large amounts of food in a very short period of time. After binging, a person with bulimia nervosa will purge or use laxatives or vomiting to prevent weight gain.

Approximately 2.8 percent of adults in the United States will develop bulimia during their lifetime. Most people assume only teens or young adults develop bulimia nervosa. However, this assumption is misguided. Recent research reveals eating disorders, such as bulimia nervosa and anorexia nervosa, are much more common among middle-aged women than previously thought. Contrary to popular belief, middle age is a critical time for the development of eating disorders in women. Unfortunately, eating disorders in older women are often overlooked by medical providers and others because there is a stereotype they only occur in younger adults or teens. Bulimia nervosa and anorexia nervosa treatment are essential for preventing the potentially fatal complications that can occur due to these eating disorders.

A 2012 study published in the International Journal of Eating Disorders found that middle-aged women binge, purge and engage in extreme dieting and exercise behavior about as often as adolescents do. The author of the study, Dr. Cynthia M. Bulik, states the incidence of eating disorders in this age group are as common as they are in the younger age groups. Approximately 13 percent of women over the age of 50 exhibited eating disorder symptoms in the study. To put that in perspective, around 12 percent of women develop breast cancer.

Some of the women in the study were diagnosed with eating disorders for the first time in their lives mid-life. Other study participants had eating disorder symptoms since adolescence. Many reported this was the first time they had spoken about these symptoms.

Bulimia nervosa and other eating disorders are often overlooked by doctors, especially in older women. Because of stereotypes about eating disorders, many clinicians do not recognize the symptoms of these deadly diseases in middle-aged women or they may believe the symptoms are related to other issues.

The Health Risks of Bulimia Nervosa

Eating disorders are devastating to young girls and women and they are just as difficult for older women. In fact, eating disorders may be harder on women when they occur later in life. Bulimia nervosa is a chronic illness. The longer a person lives with an eating disorder such as bulimia nervosa, the more severe the health consequences can be.

Some of the health complications of bulimia include:

  • Severe tooth decay and gum diseaseDental problems are common among women who have bulimia nervosa. Gastric acid from vomit eats away at the tooth enamel, which leads to dental cavities and other problems. People with bulimia often have sensitive teeth and gums.
  • Irritable bowel syndrome: Bulimia nervosa can permanently damage the intestines and stomach causing irritable bowel syndrome and other digestive issues.
  • Electrolyte imbalances: People with bulimia nervosa often have electrolyte imbalances. Electrolytes, such as potassium and sodium, are essential for proper organ functioning. Vomiting and laxative use causes dehydration and upsets electrolyte balances in the body.
  • Esophagus damage: Esophagus damage is a common complication of forceful vomiting. The vomiting causes tears in the lining of your esophagus, which can lead to life-threatening, severe bleeding. People with bulimia nervosa are also at a higher risk for esophageal
  • Acid reflux disease: Frequent bouts of self-induced vomiting can lead to acid reflux disease. The buildup of acid can cause a chronic cough, sore throat and hoarseness in people with bulimia nervosa.
  • Hormonal problems: Hormonal and reproductive issues, such as irregular and missed periods, are common among women who have bulimia nervosa.
  • Reproductive problems: Women who have bulimia may be at an increased risk of having miscarriages.
  • Respiratory problems: Repeated instances of vomiting can result in aspiration of regurgitated food and respiratory distress.
  • Heart damage: Bulimia nervosa can cause a variety of complications to the heart, such as abnormal heart rhythm, heart palpitations and heart failure. These problems can lead to sudden cardiac death.
  • Kidney damage: Electrolyte imbalances in bulimia nervosa can lead to permanent kidney damage.
  • Colon problemsThose who abuse laxatives may develop serious problems with their colon or intestines.
  • Mental health problems: Bulimia nervosa is linked to a variety of other mental health disorders, including depression and anxiety.

The Causes Of Bulimia Nervosa

There is no consensus as to a single cause of bulimia nervosa, especially in older women. The disease is likely due to a combination of factors, both genetic and environmental. Here are some factors that may lead to the development of bulimia nervosa in middle-aged women.


Researchers believe hormonal changes that occur during menopause may trigger bulimia nervosa and other eating disorders. Previous research has shown estrogen plays a significant role in turning on the genes that cause eating disorders in adolescents. Scientists believe the same process may occur in middle-aged women as estrogen fluctuations take place.

Societal Pressures

Societal pressures may contribute in part to the development of eating disorders in older women. At times, America’s youth-oriented culture embraces the idea that aging is bad. American society may put a high value on youth, which can undermine an older women’s self-esteem and lead to body dissatisfaction. A simple internet search reveals article after article depicting methods to hide or avoid the signs of aging.

Many middle-aged women feel intense pressure to conform to a youthful appearance. Signs of aging must be “fixed” or eliminated. Older women may engage in extreme exercise or other maladaptive behaviors to lose weight. At the extreme end, these behaviors may trigger eating disorders in women who are vulnerable due to a genetic risk or change in estrogen levels. For some, societal pressures to look young, genetic factors and fluctuating hormone levels can combine to create a risk of eating disorders.

Signs Of Bulimia Nervosa

The signs of bulimia nervosa can often begin so subtly it is difficult to recognize what is happening. It may start with an emotional crisis, such as a death or divorce or a child who has left home. Concerns about body weight or image may be another subtle sign. Other signs and symptoms of bulimia nervosa include:

  • Binge eating: Eating large amounts of food within a very short period of time. The amount of food consumed is typically far greater than what most people would eat during the same time period.
  • Purging: Purging, or using self-induced vomiting, laxatives, diuretics or excessive exercise to compensate for binge-eating and avoid weight gain is one of the signs of bulimia nervosa.
  • Feeling a lack of control over eating: A person who has bulimia may feel they cannot stop eating or control their behavior during binges.
  • Skipping meals or eating alone: The person may avoid eating around others. They may disappear to the bathroom right after mealtimes.
  • Gastrointestinal issues: Stomach cramps and bloating are common bulimia nervosa side effects.
  • Muscle weakness: Electrolyte imbalances can lead to muscle weakness and other problems. Muscle weakness is also one of the symptoms of anorexia nervosa.
  • Fluctuations in body weight: A person with bulimia may have a normal body weight. They may also have extreme fluctuations in body weight in a short period of time.
  • Dental problemsCavities and tooth sensitivity are common bulimia nervosa side effects.

Treatment for Eating Disorders in Older Women

A growing awareness of eating disorders in middle-aged women has led to more treatment options. Bulimia nervosa and anorexia nervosa treatment options include residential treatment, day treatment, supervised living and outpatient therapy.

  • Residential treatment: Residential anorexia nervosa treatment consists of 24-hour medical care and supervision. The person lives at the treatment center while undergoing treatment. The length of treatment varies depending on the treatment plan.
  • Outpatient therapy/Day treatment: These programs are ideal for clients stepping down from a residential level of care or those who need support in addition to weekly individual therapeutic appointments. There are both day and evening treatment programs available.
  • Supervised living: This level of care takes place in a recovery-focused environment and can be combined with residential, partial hospitalization or day treatment. The client receives supervised support during the evening and off hours from therapy.

Treatment is generally tailored to the individual and may include a variety of interventions, such as:

  • Medical management: Residential treatment for eating disorders may include 24-hour on-site medical care and monitoring by qualified health providers. Psychiatric care and medication management are also Medical treatment may include bone scans, laboratory tests, and other medical screenings. These tests help identify any health complications of bulimia nervosa.
  • Exposure therapy: Exposure therapy helps the person adjust to previously difficult situations, such as outings involving food or social
  • Movement therapy: Quality treatment should include movement therapy. The exact types of movement are based on the individual’s’ preferences and medical professionals’ recommendations and may include dance, yoga and nature walks.
  • Meal planning: A customized meal plan will help the person meet both therapeutic and nutritional needs.
  • Individual psychotherapy: Psychotherapy helps the person identify maladaptive thought patterns that may trigger eating disorder behaviors. It also helps the person identify more adaptive ways of coping with stress and triggers.
  • Nutritional therapyNutritional therapy helps the person develop a more mindful relationship with food and develop an increased awareness of hunger cues.  It also helps them achieve nutritional stability.
  • Cooking groups and meal planning: This treatment helps the person learn to cook nutritionally-balanced meals for themselves.
  • Continuing care: Discharge planning and continuing care provide long-term support for a person who is in the process of becoming fully-recovered from an eating disorder. It helps them find support and avoid relapse.

If you or someone you know exhibits signs of bulimia nervosa or another eating disorder, it is important to reach out to a binge eating treatment center for help right away. Bulimia nervosa has serious health complications. Bulimia nervosa recovery is possible. There are a variety of treatment options available for eating disorders for women of all ages. Treatment can reduce the chance of bulimia nervosa side effects.


With 20 years of behavioral health business development experience, Carrie combines world-class marketing, media, public relations, outreach and business development with a deep understanding of client care and treatment. Her contributions to the world of behavioral health business development – and particularly eating disorder treatment – go beyond simple marketing; she has actively developed leaders for her organizations and for the industry at large.