“Because of stigma and stereotypes, males often have a harder time being diagnosed and receiving treatment for an eating disorder,” – Lauren Smolar, director of programs at the National Eating Disorders Association (NEDA)
Eating disorders (EDs) are gender-neutral, although they have been routinely stereotyped as a women’s issue. This characterization has created a social stigma around males seeking psychological help for eating disorders.
Despite this bias, around one-tenth of all EDs occur in men[1], and sub-clinical eating disordered behaviors (including fasting, purging, and binge eating) are nearly as common among men as among women.
A principal issue of male EDs is the stigma surrounding the illness. While NEDA states that eating disorders will affect 10 million males in the United States at some point in their lives, the stereotype that eating disorders are illnesses that only affect women leads to feelings of shame and isolation among men and can be a barrier to treatment.[2]
Studies have found that men with EDs can be neglected by their peers, friends, and health professionals as the feminized cultural perceptions of eating disorders predisposes others to overlook symptoms. The stereotyping of eating disorders as a “women’s illness’ also results in men disregarding their symptoms until the behaviors are entrenched. [3]
The delay in recognizing symptoms has serious consequences, as we know that the early prevention and treatment of eating disorders is crucial for preventing long-term issues and death.[4] Eating disorders have the highest mortality rate of all mental health conditions, and from 1999-2009, hospitalizations involving eating disorders for male patients increased by 53%.[5]
Jeffrey Mechanick, MD, an endocrinologist at Mount Sinai Hospital in New York City, states that, “men with eating disorders do often get very sick because in general, they are not seeking out medical care or being identified as having a problem until much later in the natural history of the disease process, compared to women. … We are probably missing a lot of these patients.” [6]
There are several factors at play that lead to men with EDs receiving inadequate attention:[7]
- The historical omission of men from eating disorder research
- Lack of recognition of symptoms by males, their peers, and their family members
- Bias in professional diagnosis
- Cultural and social stigma associated with males seeking psychiatric help
- Female-only treatment centers
- Feminine branding of treatment centers, resources, eating disorder charities, etc.
- Eating disorders presenting with different symptoms in males than in females
- Inadequate attention to male eating disorder behaviors in most eating disorder assessment measures
- Gender biased diagnostic criteria that make it harder for males to be diagnosed
Eating Disorders – An Overview
Disorders tend to develop during adolescence, when teenagers’ bodies are changing and they are becoming more aware of cultural expectations. Engaging in unhealthy behaviors to modify weight and appearance can escalate and form a mental illness that is exceptionally challenging to break free from.
EDs tend to be addressed through a classification of symptoms, and the three most commonly diagnosed eating disorders are Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder.
A recent NEDA study found that men represent the following percentage of those affected among individuals with EDs:[8]
- Anorexia Nervosa – 25%
- Binge Eating Disorder – 36%
- Bulimia Nervosa – 25%
Due to the stigma surrounding male sufferers of EDs, the percentage affected who have not sought clinical help is likely to be far higher.
Various studies suggest that men with eating disorders have a higher mortality risk[9] as, along with the neglect towards initial symptoms, men with eating disorders often suffer from comorbid conditions such as anxiety, depression, excessive exercise, and substance use disorders. The most common eating disorders among men include:
Bulimia Nervosa
Bulimia nervosa is characterized by symptoms of binge eating and compensatory behavior, with over-evaluation of weight and shape. Bulimics tend to have a distorted body image alongside an obsessive desire to lose weight, which often co-occurs with symptoms of anxiety and depression.[10]
People with bulimia will go through cycles of extreme food restriction followed by episodes of binge eating and purging. They may also use laxatives, diuretics, and exercise to lose weight.
Anorexia Nervosa
Anorexia nervosa is characterized by fear of gaining weight, low body weight, and excessive food restriction or exercise to achieve thinness. Early warning signs can include sudden weight loss, refusal to eat, lying about what they have eaten, and an obsession with body shape and weight, along with purging or laxative use.
Anorexia nervosa is a dangerous disease with potentially fatal health complications and affects all body systems, including malnutrition, cardiac arrest, brain damage, infertility, and osteoporosis.[11] Anorexia nervosa is an extremely serious condition and has the highest mortality rate of all psychiatric disorders, not just EDs.
Anxiety disorders, depression, substance use disorders, schizophrenia, and personality disorders have been reported to be over-represented in male patients with Anorexia Nervosa versus their female counterparts.[12]
Binge Eating Disorder
Binge Eating Disorder tends to be associated with eating large quantities of food in one sitting. This is a difficult disorder to characterize as the definition of binging will look different to different people. However, all sufferers will have strong food-related cravings, eat compulsively and often quickly, eat in secret, and frequently eat more than they need. There are associated risks of diabetes and other metabolic dysfunction. More men than women are diagnosed with Binge Eating Disorder.[13]
Orthorexia Nervosa
Orthorexia Nervosa is characterized by an obsession with healthy food, where individuals are more concerned with the quality of the food than the quantity. This extreme concern for food can lead to a disorder with potentially fatal consequences associated with malnutrition, affective instability, and social isolation caused by dietary restriction.[14]
A 2020 study connected orthorexia with dysfunctional exercise among male students. Findings revealed positive relationships between high levels of orthorexia symptoms and eating pathology, exercise dependence, thin and athletic internalization, and behavioral dimensions of drive for muscularity.[15]
Muscle Dysphoria
Muscle Dysmorphia is a form of body dysmorphia, which is a type of obsessive-compulsive disorder.[16] The core symptom of muscle dysmorphia is a drive to build muscle. It is characterized by a distorted body image, compulsive over-exercising, restricted diet, disordered eating behaviors, and the use of protein supplements and performance-enhancing drugs or steroids.
Studies have found that the most common presentation of EDs in men is muscularity-oriented disordered eating, which combines behaviors associated with orthorexia and muscle dysmorphia.[17]
EDs are on the rise among male athletes, and studies show that athletes who participate in sports where leanness offers a competitive advantage may be at greater risk of eating disorders.[18]
Conclusion
A gender-sensitive approach is needed to reduce the stigma associated with male eating disorders. As a result of the media, sexual objectification, and cultural trends, men are now developing greater body image anxieties that lead to unhealthy, disordered patterns of behavior and catastrophic physical and mental effects when they attempt to achieve an impossible to obtain physique.
With 25% of normal-weight males perceiving themselves to be underweight and 90% of teenage boys stating a desire to “bulk up,” there is growing concern over the proliferation of male disordered eating.
Correcting the false impressions of eating disorders being a “women’s illness” is vital to removing the stigma surrounding gender and eating disorders. By de-stigmatizing eating disorders and creating awareness around new cultural norms, we can ensure that everyone achieves equal access to diagnosis and treatment.
If you are concerned about any issues discussed in this blog, please contact Heather R. Hayes & Associates – call 800-335-0316 or email info@heatherhayes.com today.
[1] Parra-Fernández, María-Laura et al. “Prevalence Of Orthorexia Nervosa In University Students And Its Relationship With Psychopathological Aspects Of Eating Behaviour Disorders”. BMC Psychiatry, vol 18, no. 1, 2018. Springer Science And Business Media LLC, doi:10.1186/s12888-018-1943-0. Accessed 25 Mar 2021.
[2] Sangha, Simrin et al. “Eating Disorders In Males: How Primary Care Providers Can Improve Recognition, Diagnosis, And Treatment”. American Journal Of Men’s Health, vol 13, no. 3, 2019, p. 155798831985742. SAGE Publications, doi:10.1177/1557988319857424. Accessed 25 Mar 2021.
[3] Räisänen, Ulla, and Kate Hunt. The Role Of Gendered Constructions Of Eating Disorders In Delayed Help-Seeking In Men: A Qualitative Interview Study: Table 1. 2021.
[4] Stanford, Stevie Chariese, and Raymond Lemberg. “Measuring Eating Disorders In Men: Development Of The Eating Disorder Assessment For Men (EDAM)”. Eating Disorders, vol 20, no. 5, 2012, pp. 427-436. Informa UK Limited, doi:10.1080/10640266.2012.715522. Accessed 25 Mar 2021.
[5] “Eating Disorders In Men & Boys”. National Eating Disorders Association, 2021, https://www.nationaleatingdisorders.org/learn/general-information/research-on-males.
[6] (COVID-19), Coronavirus et al. “Men’s Eating Disorders Often Not Recognized”. Webmd, 2021, https://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/news/20190906/mens-eating-disorders-often-not-recognized.
[7] “What To Know About Male Eating Disorders”. Verywell Mind, 2021, https://www.verywellmind.com/male-eating-disorders-4140606.
[8] “Eating Disorders In Men & Boys”. National Eating Disorders Association, 2021, https://www.nationaleatingdisorders.org/learn/general-information/research-on-males.
[9] Quadflieg, Norbert et al. “Mortality In Males Treated For An Eating Disorder—A Large Prospective Study”. International Journal Of Eating Disorders, vol 52, no. 12, 2019, pp. 1365-1369. Wiley, doi:10.1002/eat.23135. Accessed 25 Mar 2021.
[10] Levinson, Cheri A. et al. “The Core Symptoms Of Bulimia Nervosa, Anxiety, And Depression: A Network Analysis.”. Journal Of Abnormal Psychology, vol 126, no. 3, 2017, pp. 340-354. American Psychological Association (APA), doi:10.1037/abn0000254. Accessed 25 Mar 2021.
[11] Gibson, Dennis et al. “Medical Complications Of Anorexia Nervosa And Bulimia Nervosa”. Psychiatric Clinics Of North America, vol 42, no. 2, 2019, pp. 263-274. Elsevier BV, doi:10.1016/j.psc.2019.01.009. Accessed 25 Mar 2021.
[12] Kask, J. et al. “Anorexia Nervosa In Males: Excess Mortality And Psychiatric Co-Morbidity In 609 Swedish In-Patients”. Psychological Medicine, vol 47, no. 8, 2017, pp. 1489-1499. Cambridge University Press (CUP), doi:10.1017/s0033291717000034. Accessed 25 Mar 2021.
[13] “Eating Disorders In Men”. Psychology Today, 2021, https://www.psychologytoday.com/gb/blog/living-eating-disorders/202103/eating-disorders-in-men.
[14] Parra-Fernández, María-Laura et al. “Prevalence Of Orthorexia Nervosa In University Students And Its Relationship With Psychopathological Aspects Of Eating Behaviour Disorders”. BMC Psychiatry, vol 18, no. 1, 2018. Springer Science And Business Media LLC, doi:10.1186/s12888-018-1943-0. Accessed 25 Mar 2021.
[15] White, Mika et al. “Body Image And Body Change Behaviors Associated With Orthorexia Symptoms In Males”. Body Image, vol 34, 2020, pp. 46-50. Elsevier BV, doi:10.1016/j.bodyim.2020.05.003. Accessed 25 Mar 2021.
[16] Murray, Stuart B. et al. “Muscle Dysmorphia And The DSM-V Conundrum: Where Does It Belong? A Review Paper”. International Journal Of Eating Disorders, vol 43, no. 6, 2010, pp. 483-491. Wiley, doi:10.1002/eat.20828. Accessed 25 Mar 2021.
[17] Murray, Stuart B. et al. “Muscle Dysmorphia And The DSM-V Conundrum: Where Does It Belong? A Review Paper”. International Journal Of Eating Disorders, vol 43, no. 6, 2010, pp. 483-491. Wiley, doi:10.1002/eat.20828. Accessed 25 Mar 2021.
[18] “Eating Disorders Among Male Athletes”. Current Sports Medicine Reports, vol 7, no. 6, 2008, pp. 332-337. Ovid Technologies (Wolters Kluwer Health), doi:10.1249/jsr.0b013e31818f03c5. Accessed 25 Mar 2021.
