Eating Disorders in Adults: The Ones Nobody Talks About

“I thought I was too old for this.”

A woman of forty-seven, two children, a job, a house, everything apparently in order. That day she spoke about her relationship to food out loud for the first time in her life – not to her partner, not to her doctor, but to a stranger in an office. It had been going on since she was nineteen. Twenty-eight years in which nobody had asked anything, because the question seemed out of place. In our minds, eating disorders have the face of a teenage girl. Nobody looks for what they do not expect to see.

This piece is about adults. About people who have been in it far too long, and about those in whom it only started at an age when, by all our assumptions, it should no longer be able to.

The picture we carry in our heads

Say “eating disorder” and nearly everyone produces the same image: a young girl, probably at secondary school, probably anorexia. That image is not invented – adolescence really is the period when these disorders most often begin. The problem is that we stop at that image, as though the whole thing resolved itself at twenty.

The data do not support that. When large population studies actually asked adults, it turned out that eating disorders in adulthood are far from rare, and that the most common form of all is binge eating disorder – something that does not feature in our mental picture at all. A large proportion of people also fall into the group of “other specified” disorders, which does not mean they are milder, but that they do not fit the narrow descriptions written with adolescents in mind.

In short: someone who does not look the way we expected, and is not the age we expected, falls through the net, because the net was not woven for them.

What triggers a first onset in adulthood

When the disorder appears for the first time later in life, there is almost always a period behind it in which the ground shifted under someone’s feet. A divorce. The death of a parent. Children leaving home. Losing a job at fifty. An illness after which the body is no longer what it was. The menopause, which many women experience as a loss of control over something that had until then been taken for granted.

The pattern is the same as in adolescents; only the triggers differ. When life becomes unmanageable, attention shifts to the one thing that can still be managed. Food is to hand, it is measurable, and it gives an immediate sense that something at least is going to plan.

Often what appears first are physical symptoms that send a person round the surgeries – digestive trouble, fatigue, dizziness, disturbed sleep. The results are usually fine for a while, and that creates a distress of its own. I have written about what it is like when the body speaks and the tests stay silent in the piece on psychosomatics.

Why adults do not tell anyone

With an adolescent there is at least a chance that someone notices. An adult lives alone with themselves and has far better tools for concealment – their own kitchen, their own timetable, their own reasons that sound entirely plausible.

But the main reason is not practical, it is shame. In an adult, the shame is not about food. It is about age. An eating disorder is regarded as a teenage thing, so an adult experiences it as evidence that they are not as grown up as they ought to be. A woman of fifty who tells me this apologises first. The opening sentence is almost always something like: “I know how stupid this sounds.”

Systematic reviews of barriers to help-seeking in eating disorders bear this out. Among the most common barriers are not money or waiting lists but shame, the belief that the problem is not serious enough, and the fear of not being believed. I have written about how shame works in the piece on how shame speaks about you rather than about what you did.

Why healthcare does not ask either

This is not a reproach to any individual doctor. It is a consequence of how expectations are shaped. Questions about food are usually put to an adult patient in an entirely different context – as part of a conversation about physical health, not as a question about mental distress. The answer “I watch what I eat” is therefore generally received as good news, and the conversation moves on.

On top of that, many adults with the disorder function. They go to work, they look after a family, they are reliable. Eating disorders in adults often do not fall apart outwardly; they fall apart inwardly, and nobody looks inward unless you ask them to.

If you are thinking about the routes to help in our system, I have described them in the piece on referrals and waiting lists.

What is different in treatment

The first difference is time. When someone has lived with a pattern for decades, it is no longer merely a symptom – it is part of how they organise the day, how they calm themselves, how they punish themselves and how they give themselves a sense of order. Removing it is like taking out a load-bearing wall. So with long courses we work more slowly and first build what will take over the space.

The second difference is that an adult generally has nobody to take eating over for them, and should not have. With an adolescent, responsibility rests temporarily with the parents. With an adult it stays with them, which is harder but also more durable.

The third difference is the most painful: an adult with this difficulty is often also a parent. That brings into the room the question almost everyone asks sooner or later – have I passed this on.

When you are also a parent

The answer I give sits somewhere between comfort and truth. Yes, children learn their relationship to body and food largely at home, and more from what they see than from what they hear. No, this is not destiny, and transmission is not automatic.

What is most interesting is that many parents with this history try so hard that they make the opposite mistake – food is never mentioned at home, every comment is forbidden, every table is made careful. A child does not read silence as freedom but as tension. They read that there is something here that must not be spoken about.

What works better is a third thing: calm ordinariness. A shared table, without appraisal, without praise and without warnings. And working on yourself so that your child’s plate does not set off your own distress – because children sense that, even if you say nothing.

What it does to a relationship

With adults there is almost always someone else in the picture who has lived alongside this for a decade or two and does not know what to do with it. The partners I meet come in two versions. Some are worn out from years of trying to help and running into a wall each time. Others did not know at all – they found out recently and are now somewhere between hurt and anger that something so large ran past them for so long.

I tell both the same thing. First, the concealment was not a lie aimed at them. Shame hides from the people you care about most, not from strangers. Second, monitoring by a partner does not work. With an adult there is no version in which somebody else takes responsibility for their eating – that makes sense with an adolescent, but with an adult it turns the partner into a guard and the relationship into a stage.

What does work is more modest and more demanding: stay in the relationship, do not take on the task. Say once, clearly, that you see it and that you are worried, then offer what you can actually give – company, a lift to the first appointment, patience that lasts longer than a month. And look after yourself at the same time, because in a long course the person merely watching burns out too.

Often the biggest change in these relationships is simply that the subject appears on the table. Not solved, just spoken. Many couples come precisely because of that, not because of food – because for a decade they have been talking around something that was in the room the whole time.

Where this article does not apply

Now against myself. Not every change in a person’s relationship to food in midlife is an eating disorder, and it would be harmful if anyone loaded that onto themselves after reading this.

In adulthood appetite changes for many reasons that have nothing to do with the mind. Thyroid disease, medication, pain, digestive trouble, periods of exhaustion, hormonal change. Reduced appetite during deep sorrow is a normal part of grief, not a disorder. There are also people who changed their habits in midlife and simply find it suits them – without rigidity, without guilt, without narrowing their lives.

More importantly still: if the relationship to food changed quickly and with no comprehensible reason, the first port of call is not a therapist but a doctor. Physical causes are ruled out first, not last. The same holds when the body is already affected – fainting, heart rhythm disturbances, rapid deterioration. Therapy does not work on an unstable body.

And the reverse is true as well: a diagnosis, if one comes, is not a label for a person. I have written about what a diagnosis says and does not say in the piece a diagnosis is a map, not a name.

The first step if you recognise yourself

The hardest part is usually saying the first sentence, and that sentence does not have to be a good one. You do not have to begin with the history, you do not need tidy words, and you do not need to know whether it is “bad enough”. The measure of whether something is worth speaking about is not severity but how much room it takes from you.

If you are wondering what a first session looks like and what actually happens in it, I have described that in the piece on preparing for a first appointment. And if you have decades behind you in which you told yourself you were too old for this – that is the most widespread and least true thought in this whole territory.

What to remember

Eating disorders do not end with adolescence. In adults there are two routes: a long course that began in youth and was never treated, and a first onset in adulthood, almost always triggered by loss or upheaval.

Adults do not speak about it mainly because of shame that is attached not to food but to age, and because of the belief that the problem is not serious enough. Healthcare rarely asks, because it is looking for a different picture – young, visible, dramatic. Adults with the disorder usually keep functioning until they fall apart on the inside.

In treatment, the key point with adults is that the pattern is not only a symptom but a load-bearing part of daily life, and so it has to be replaced rather than merely removed. If you are also a parent: transmission is not automatic, and silence helps less than calm ordinariness at a shared table.

And when the body changes quickly or is at risk, a doctor comes before everything else, including this article.