Anorexia is getting older – and younger – and not just white and female. What's going on?

Think anorexia is a teen disease, or a habit taken up by spoiled, white rich girls? Think again.

White women in their teens and 20s still account for most anorexia cases in the U.S. But experts say women in their 40s and 50s, men, black and Hispanic women, and even little girls as young as 8 or 9 years old are showing up in doctors' offices with anorexia, bulimia, and other eating disorders.

These folks are hardly the typical profile dating from the 1980s, when movies like The Best Little Girl in the World portrayed the distorted body image and birdlike eating habits of well-off white teenagers and young women in their 20s. Research, too, focused primarily on this group of patients.

Now, experts wonder, what's going on? Are eating disorders on the rise in these populations -- or are we finally seeing what's been there all along?

It's a little of both, suggests Diane Mickley, MD, co-president of the National Eating Disorders Association (NEDA, www.nationaleatingdisorders.org) and the founder and director of the Wilkins Center for Eating Disorders in Greenwich, Conn.

"I've done intakes at our center for 25 years, and there's no question that our patients are getting older, and we have many more middle-aged patients," she says. "Now, this is an illness that starts in adolescence, which burgeoned in the 1970s and 1980s. The majority of patients get better, but some do not, and they get older."

Few of these cases indicate a truly new onset of the disease at age 35 or 45. "Instead, it's the resurgence of a disease that they may have had since adolescence. We do see the occasional patient with middle-aged onset of anorexia, but the increase in older patients coming for care is predominantly among those who've had it for a long time," says Mickley.

Nevertheless, many of these women are seeking care for the first time in their 30s, 40s, and 50s. Why now?

"For women in their 30s, it may be that they want to have children and it forces them to confront something that might be affecting their fertility," says Doug Bunnell, PhD, past president of NEDA and the clinical director of the Renfrew Center of Connecticut. (Headquartered in Philadelphia, the Renfrew Center operates treatment facilities for eating disorders in several states.)

"In the 40s and 50s, what might spur a re-emergence of the disease, and a decision to seek treatment, is often some sort of disruption: divorce, death, cancer or other illness scare, empty nest syndrome -- any sort of developmental transition," he adds.

Anorexia Is Getting Younger, Too

As the face of anorexia gets older, it's also getting younger.

"For a long time, kids have talked about weight and being fat or thin at a young age," says Bunnell. "But what we're seeing now is an earlier emergence of actual eating disorder behavior. The research hasn't caught up with what we're seeing clinically, but anecdotally, we're treating girls of 10, 9, and 8 years old with full-blown anorexia nervosa."

One heartbreaking challenge to diagnosing these girls: a key diagnostic criterion for anorexia is the loss of menstrual periods, but more and more of these girls are too young to have even had a first period yet.

Besides age, ethnicity is a telling factor in current cases of anorexia. "For Caucasian and Hispanic girls and women, the rates of anorexia are basically indistinguishable," says Bunnell. "On the other hand, there does seem to be some protective factor from anorexia if you're African-American."

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Reviewed: 03/2006