Denise Folcik, 50, started dieting for the first time after the birth of her fourth child. Then nearing age 30, she struggled for months to lose about 20 pounds of "baby weight" until she got the idea of making herself throw up after meals, she says.
For the next 15 years, she purged food, over-exercised or starved herself. Friends praised her slim figure without knowing she felt weak, cold, tired and emotionally numb from making herself sick up to 20 times a day, says Ms. Folcik, who lives near Milwaukee, Wis. "People thought my life was perfect."
Then one day, as she was driving her daughter to the mall, Ms. Folcik blacked out at the steering wheel. Both were unharmed, Ms. Folcik says, but she realized her extreme dieting was putting her family at risk.
"I was on the path of probably dying."
Ms. Folcik chronicled her eating disorder in a 2010 book called In ED's Path. During four years of treatment in hospital and outpatient programs, she discovered that many women her age are going to dangerous lengths to be slim.
"In this society, thin is beautiful, thin is successful, thin is intelligent," she points out.
Women in their 30s, 40s and beyond face increasing pressure to look slender and youthful despite years of childbearing, hormonal changes at menopause and the demands of careers, parenting and caring for aging relatives, says Margo Maine, a clinical psychologist in West Hartford, Conn., and co-author of The Body Myth: Adult Women and the Pressure to Be Perfect.
"There is an epidemic of disordered eating and body image despair," says Dr. Maine, who is giving a talk on midlife eating disorders on Tuesday at a conference organized by the National Eating Disorder Information Centre in Toronto.
Some researchers call it the " Desperate Housewives effect," referring to the cultural influence of the hit TV series, in which improbably thin women in their 40s prance around in short shorts.
The exact rate of serious eating disorders in the 30-and-older set is unknown, Dr. Maine says, adding that clinical cases of bulimia (purging) and anorexia nervosa (self-starvation) remain more common in girls aged 13 to 15 and 17 to 19.
Nevertheless, a growing number of middle-aged patients are seeking treatment for binge eating and other disorders, according to NEDIC in Toronto and the National Eating Disorders Association in Seattle, Wash.
Specialists in the field say they've noticed an increase within the past five years. At Homewood Health Centre in Guelph, Ont., about 20 per cent of in-patients in the eating disorders program are 40 and up, says program co-ordinator April Gates.
While it's common knowledge that metabolism slows with age, it is no longer socially acceptable to give in to "middle-aged spread," Dr. Maine says. Women in particular fear losing power and status as they reach menopause because in today's competitive consumer culture, "women really are put out to pasture as they age."
Esther Kane, a clinical counsellor who specializes in eating disorders, says half of the clients she treats in her office in Courtenay, B.C., are middle-aged women. The majority have a history of disturbed eating that resurged after a crisis in midlife, she says, adding that the number-one trigger is when a husband leaves for a younger woman. "I see it every day."
Midlife transitions such as divorce, job loss, an empty nest and menopause challenge a woman's sense of identity and feeling of being in command of her life, Ms. Kane explains. "The only control she thinks she has is her body and the foods she puts into it."
Like adolescents with eating disorders, older patients suffer from low self-worth and anxiety. But they also deal with a crushing sense of shame and failure for being self-destructive around food for so many years, Ms. Kane says. "A lot of them are quite suicidal."
Eating disorders have the highest mortality rate of any psychiatric illness, notes Ed Tyson, a physician in Austin, Tex., and spokesperson for NEDA. Whereas medical cause of death is more common in younger patients, in older age groups, "suicide takes precedence."
Burdened with adult responsibilities, older women tend not to seek treatment until their health fails or they notice disordered eating in their children, Dr. Maine says, adding that she's seen women who have lost all their teeth because of deadly dieting.
For patients with the willingness and means to get help, several eating disorder clinics in the United States have begun to offer programs geared for adults 30 and up, including the Renfrew Center, which has treatment facilities in various cities.
In Canada, most treatment programs are for all ages. But depending on the individual, being in a mixed group may be an advantage for a patient in midlife, notes Merryl Bear, executive director of NEDIC in Toronto. Being perceived as older and wiser may provide a sense of self-worth, she says.
Dr. Maine says she helps women recognize the price they have paid for their chaotic eating, and let go of the fantasy of looking as youthful as some older celebrities - 48-year-old Demi Moore, for example. With time, she says, patients begin to value how their bodies have served them and "shift from seeing their body as an ornament to seeing it as an instrument."
Ms. Folcik, now six years in recovery, says she's learned new ways to cope with events that used to trigger a binge. Instead of heading to the fridge, she plays with her dog Mugsi or uses writing as an outlet .
During treatment, she gained insight into how her troubled marriage and alcoholism in her family contributed to her low self-image. Although her weight today is a little higher than it used to be, Ms. Folcik says that inside, she feels lighter than ever.
"I've gotten rid of so much emotional baggage."