The day Mary* booked to go on a group golfing holiday, she was excited. But in the weeks leading up to the trip, she became anxious and preoccupied. She knew she would have to eat more than usual to be inconspicuous, even if there were self-serve buffet options and she could push salad around on a plate. She wouldn’t be able to weigh herself. She wouldn’t be able to eat only her “safe” foods. “I was thinking: how can I get a feasible excuse so I can get out of it?” When the group arrived at the hotel, she slipped out to reception to ask whether there was a weighing scale for luggage. Her relief at locating one, where she could weigh herself surreptitiously, was enormous. So was her shame.“Here’s a 61-year-old woman going on a holiday, and the main thing for me is a weighing scale,” she says. “I’m confident. If you were to see me, you’d say, ‘God this girl has it all’. But I’m one of the most lonely people ever. I live with a controlling voice in my head. It’s unrelenting.”Mary is a bright, lively woman – a former nurse, a devoted mother of two, married for decades. She also has anorexia nervosa. We’re sitting in the cafeteria area of St Patrick’s hospital in Dublin, where she attends weekly compassion-focused group therapy specific to eating disorders, led by a psychologist. Last year she became an inpatient in the hospital for six weeks after she decided, in consultation with her family, that her best chance at recovery was as an inpatient, rather than staying as an outpatient, which she had been for two to three months. She believes she developed an eating disorder at about 21, when she first started denying herself food and began pounding the country roads around her house to burn off as many calories as she could, and quieten the noise in her head. People knew but they mostly didn’t say anything, with a few exceptions. One time, seven years ago, a consultant tapped her shoulder at work where she was nursing and asked her bluntly if she had an eating disorder. Another time, a friend asked her if she would die by suicide because of her struggle with anorexia. For 10 years, she speed-walked up to 20 miles a day, rising in secret two hours earlier than everyone else while it was still dark outside. She lied constantly, saying she had eaten when she hadn’t. She was so hungry that often it was hard to think properly. She had no peace of mind. She couldn’t stop moving, even to read a book or watch TV, because her brain would tug at her, telling her she wasn’t burning enough calories. “I never sat,” she says, but she was exhausted.Mary knows she is not what people imagine when they think of an anorexia patient because of her age: 61. “It doesn’t feel appropriate,” she says. “Age is a big barrier for treatment. There’s a lack of understanding. They think, ‘Oh, she’s vain’. I tried to get help. I was 10 years trying.” When she confided in doctors at regular intervals at the clinic she was attending for anxiety, she says they didn’t listen properly. “The staff were on rotation and they just brushed it off.”‘Life is different when you’re in your 50s and 60s. There can be lots of risk factors that accumulate at this time of life’— Harriet Parsons, BodywhysMore than 500 people in Ireland were diagnosed with an eating disorder in 2024, an increase of more than 100 cases from 2023. That same year, one in four calls taken by Bodywhys, the voluntary organisation supporting people affected by eating disorders, concerned people over the age of 36, according to their 2024 annual report. But the stories told in the media about eating disorders largely reflect young people’s experiences. Anorexia in middle age and beyond is less documented and less visible, with fewer support structures in place. There are just three public inpatient eating disorder beds for adults who are acutely unwell, in St Vincent’s hospital in Dublin. Yet eating disorders are often recurrent by nature. As a person ages, experiences such as the menopause or grief stemming from bereavement can be trigger points for an eating disorder, perhaps in abeyance, to strike again with more force. The prospect of retirement, bringing with it a change of routine, can be a factor. “Because I was coming up to retirement, I knew I would exercise more, if I had more time,” Mary says. “I knew I would be found dead somewhere.”Mary grew up in the countryside, one of a large family. Her late father, she says, was “probably an alcoholic”. “When he was drinking I was petrified, and when he was on the dry I was more petrified.” Her mother favoured her three sons over her daughters. “I had a love-hate relationship with her. I did anything I could for her, but I resented her. She didn’t stand up for us. She was callous.”She married young, and Mary’s husband knew about her restrictive eating habits, but at that time, Mary says, the eating disorder was “there, but quiet”. She had two healthy pregnancies and a hands-on career as a nurse. But when her mother became sick and died 11 years ago, leaving her sons her entire estate in her will bar some jewellery to be divided among her daughters, Mary fell apart. “I couldn’t cope,” she says. “I lost it. It wasn’t the money. I just couldn’t understand how a mother could do that.” ‘She eats late in the evening, as soon as we’re gone to bed. In the utility room, rarely in front of us’— Sandra*Her eating disorder roared back into life. “I had the insight about it,” she says. “But I couldn’t stop.”Harriet Parsons, a psychotherapist and chief executive of Bodywhys, says the dangers of an eating disorder regaining power as people age are significant. “Your body is changing. Your role as a person in society is changing. Life is different when you’re in your 50s and 60s. There can be lots of risk factors that accumulate at this time of life, where people turn to their body as a way of coping.”When a person has an eating disorder for a long time, particularly anorexia, it can be “incredibly difficult to shift their mindset”, she says. “For everybody around them, on the one hand there can be a kind of getting used to it, and on the other, it can be so difficult. People oscillate between feeling frustrated and angry and hopeless.” There can be a core reason for an eating disorder to begin, she says, an “objective trauma”, which a person cannot walk away from unscathed. “You can think of trauma like this big hole or gap that shatters everything. How people recover is by trying to knit together the pieces again, using words to describe the experience.”Sandra*, a retired business owner in her 80s, lives in Dublin with her husband and daughter Edith*. As a teenager, Edith, who is now in her 40s, was bubbly and outgoing. She loved sports, she was always on skates and she had lots of friends. Her parents worked in creative industries and the family enjoyed artistic pursuits. When Edith was 14, she left home one Friday evening to go and get chips nearby. She was a victim that night of what her mother calls “a trauma”. In the years afterwards, she started secretly self-harming and restricting her food intake, “seeming normal on the surface, but far from it underneath”. Her mother found out when Tallaght Hospital rang her out of the blue one day, after Edith had self-harmed in college and was rushed to the emergency department. “It all tumbled out.”‘She was punishing her body because deep down she had a wound she couldn’t cope with’— Laura BeattieEdith now lives a solitary life at home with her parents. “Mostly her daytime is sleeping and her night-time is living,” Sandra says. “She eats late in the evening, as soon as we’re gone to bed. In the utility room, rarely in front of us. She doesn’t go out: she’s been out three times in the last year. Her friends don’t call her any more, she’s very isolated. The only place we go to is dental appointments.”The dental appointments are a result of the restrictions in her diet, which affected her teeth. “Acidity destroyed her teeth,” Sandra says. “And the dentures they made, there’s a marginal mistake, they didn’t work.” There are times when her daughter expresses a desire to recover, but the challenge can feel insurmountable. “Suicidality drops into the scenario very frequently.” Sometimes they have screaming matches, particularly when her daughter feels anxious or overwhelmed. Sandra doesn’t know what’s going to happen when she and her husband cannot care for Edith any more. When she goes to support groups, she meets “terrified” parents in their 40s with unwell children and realises these parents are the same age as her daughter. She thinks a lot about how hidden the disorder is among Edith’s cohort. “I think there are far more people who are living with anorexia than show up in the statistics. They’ve given up trying to get help. They just live with it.”As a woman in her 80s, her sister keeps telling her: “This is the wrong way around. You need care.” Through attending support programmes offered by Bodywhys and reading the online blogs of authors including Julia Trehane and Tabitha Farrar, recovery coaches who specialise in eating disorder advice, Sandra has come to an understanding that perhaps she cannot help her daughter recover from anorexia – she can only assist her to live as well as possible with it, maintaining trust and hope between them. “Meet them where they’re at,” she says. “Be curious, not furious. If you manage to keep the thought that today I will try to recover – just that one seed – nurture that. Ask them: ‘Did you manage to eat anything last night? Well done. Fantastic.’”‘I have recovered a good bit, but I still have a long way to go’— Mary*Sometimes, though, she despairs. “In the end, have I done the right thing? Have I just kept her in a life of misery?”What constitutes recovery for a person with anorexia is a question Harriet Parsons of Bodywhys often encounters in her work as a psychotherapist. [ How eating disorders are changing: ‘I’m not the stereotype. I’m a man, I’m plus-sized’Opens in new window ]“When we talk about recovery with a teenager, we might be talking about them moving on and getting out of it. When we talk about recovery for somebody who has had an eating disorder for the majority of their adult life, we might be talking about something different,” she says. “We might be talking about them trying to improve the quality of their life. They might find what brings them joy. They might get a job or leave a job or do something that makes them feel happy. They might not be eating what they need to be eating, but they might be living. You’re balancing all the time. I think there would now be a recognition that it might not be helpful to focus on full recovery all the time.”In the past, some of the therapeutic practices for anorexia were rooted in an ignorance about what the illness, a psychiatric disorder with physical symptoms, constituted. Even today the system makes it hard for people with the condition to be helped. Doctors are on rotation, patient confidentiality restricts access for carers to information, and support helplines are not useful if the patient – as is often the case – refuses to engage. “Helplines are too impersonal. What people don’t realise is it takes every ounce of your energy to say you have an eating disorder, you need someone to grab you at that particular time,” says Mary. For an older patient and their families, it’s easy to feel invisible. Laura Beattie, a nurse from Roscommon, got in touch with The Irish Times Magazine after an Instagram call-out and she did it for a specific reason: she never sees her story in the media. On how anorexia is viewed by the general public, she is clear: “It’s a stereotype of a teenage girl,” she says. She believes support organisations can give up on people once they age past a certain point. “Anybody, male or female, in any age bracket, can suffer from an eating disorder,” she says. Laura Beattie with her mother When Laura was 28 in 2011, her mother, who had anorexia, died at the age of 58, lacking the resilience to survive after a bad bout of pneumonia. “I lived with her illness all my life,” she says. She wishes more had been done for her mother. “It was just, ‘We’ll give you a tube in your nose and give you loads of calories’. It wasn’t hours of therapy. It was a physical solution to what they perceived as a physical problem.”Laura’s mother was a former teacher near Ballina in Co Mayo, with artistic sensibilities. “She wanted to study art, but my granny was adamant she was going to be a teacher. It wasn’t really what she wanted to do.” Her mum’s father had died when she was very young, and she married a divorcee, Laura’s dad, at a time in Ireland when society would have made them both subject to moral judgment.It’s impossible to tell why someone develops anorexia, but perfectionism and desire for control may form part of a personality type more likely to be at risk, says Parsons. “It might be that you’re driven, a high achiever, you may have a tendency towards being anxious or perfectionist. Added to that is internal things like not feeling good in yourself, it might be low self-esteem or self-worth.”Laura knows her mother had low self-esteem. She saw it every day.“The way she spoke about herself was heartbreaking. She would say, ‘I’m no good. You don’t deserve a mother like me.’ She was always apologising. She never showed any compassion for herself. She would have tried to take her own life a few times because she felt so hopeless.“She was punishing her body because deep down she had a wound she couldn’t cope with.”The effect of her mother’s anorexia was profound in the household. Laura’s father was consumed with keeping his wife alive, tube-feeding her via a nasogastric tube nightly for three or four years at the end. As a teenager, Laura, an only child, looked on “from the sideline”, seized by waves of anger and remorse. Seeking therapy after the birth of her first child in 2016, she says, “I felt so guilty for feeling angry that she didn’t do what she should have done as a mother, nurturing and loving and protecting.” When Laura was doing her Leaving Certificate, her mother attempted suicide. Her father then had a heart attack and was rushed to intensive care. With both parents critically ill, her friends’ parents were the ones who ferried Laura to school and home. Nobody in a medical setting offered Laura counselling, beyond handing her a book on emotional intelligence to read when she was aged 10. Laura Beattie as a baby with her mother Laura had postnatal depression after the birth of her first daughter and realised she needed to unpick the trauma of her childhood, to piece the puzzle of her old shattered life together. “Becoming a mother made me really reflect on my own mother,” she says. “And what she didn’t do.“Having a parent with a psychiatric illness, you develop a wound as a child that doesn’t really heal. It affects your own self-worth. It’s like, am I not worth being here for?“It’s an empty space. You’re so vulnerable to [questions like]: why am I not enough for them to want to be better? You always carry a little bit of that feeling, but it’s managing it. And feeling like, I am good enough, but I have to work very hard at reminding myself that I am.”[ ‘Just eat’ is the worst advice for someone with an eating disorderOpens in new window ]Getting past the past isn’t easy. Shame, helplessness and regret crop up regularly when in conversation with Mary, the former nurse. Mary also feels lucky that she managed to get help at a time when more support is becoming available. In 2016 there were five eating-disorder specialists within the whole of the Health Service Executive (HSE). Now there are approximately 110 dedicated eating-disorder clinicians from the national clinical programme working in different teams around the country. Twenty new specialist eating-disorder beds are to be opened around the country, under new plans being developed by the HSE. Help for Mary came in a slow, staggered way, in the decade after her daughter, then aged 14, was suspected by Mary of having an eating disorder and referred to the HSE’s Child and Adolescent Mental Health Service (Camhs). “I was always mindful of her and I felt so embarrassed because I thought, I’m such a poor role model. It really hurt.”“Camhs rang me and said, ‘Right, will you bring her over?’ We brought her over and it completely changed her life. Really what helped was the talking therapy. She saw a psychologist. It was a whole-team approach, over about two years. I can confidently say that she has recovered from anorexia. She came out the other side a strong, independent young lady. She learnt skills there that I would be jealous of.”While they were with Camhs, Mary was asked whether she would like professional advice to help her support her child. Referred to a clinic, a consultant diagnosed Mary with anxiety and prescribed medication. After her daughter was successfully treated, Mary’s body started to give up on her.[ Eating disorders in later life: Some of my peers have had teenage weight levels for decadesOpens in new window ]“I was booked in for surgery for a prolapsed colon, which was probably because of the eating disorder. I was petrified, not because of the surgery but because I was told I couldn’t exercise.” She “banked” her exercise, upping it, and further restricting her food intake. Her doctors, she says, didn’t register her distress. “I was honest. I said ‘My mood isn’t so great, I’m controlling my eating, I’m over-exercising.’ They’d say, ‘Services are backed up. Go on Bodywhys’.” There was one person who changed things: a doctor in the clinic who really listened. “He was the first person who saw me.”The doctor told Mary, “We have to get help for you. Would you become an inpatient?” Deeply unwilling to do this, but afraid of what might happen if she didn’t, she took the plunge and celebrated her 60th birthday as an inpatient in St Patrick’s hospital in Dublin. She confided in her new GP that she was doing so. Her GP said, “I’m so proud of you. You’re getting help. So many people don’t.”Words like that made a big difference to Mary. She believes that coming to St Patrick’s hospital saved her life. “I was desperate for help,” she says. “I was just barely holding it together.” Her children think so too. Her daughter told her: “I’m so glad you got help, Mammy, because I always imagined you’d be found dead on the road having had a heart attack.”[ Eating disorders: ‘I wouldn’t speak to my worst enemy the way I talked to myself’Opens in new window ]Mary knows she’s not cured – “I have recovered a good bit, but I still have a long way to go” – but she has been given tools to bring herself forward. On the ward as an inpatient, she heard simple observations that hit hard, such as that from a nurse who urged her on, telling her, “I’ve never met a person that regretted recovery”. Before, she couldn’t see beyond burning calories. Now, through compassion-focused therapy, she is remapping her horizons. She does yoga, she is more patient and she can allow her body to rest. “Treatment helps you to get to know yourself, the nice bits, and be kind to yourself,” she says. “Self-compassion is so important.” Mary wants to tell other people with the condition and their families there is a way out. “You can change and there’s a better life. I genuinely feel I’ve a brighter, happier future ahead.” *Names have been changedIf you have been affected by the issues raised in this article you can seek help from Bodywhys, the Eating Disorders Association of Ireland, at 01 2107906 or bodywhys.ie