Male Eating Disorders

Contrary to popular belief, eating disorders affect people of all genders, not only females: males are diagnosed with eating disorders at all ages.

For a long time, there has been very limited research on eating disorders in males, for reasons such as:

• Bias by professionals;
• Gender-biased diagnostic criteria;
• Stigma associated with males seeking help for a “female” illness;
• No recognition of symptoms by males and their families;
• Omission of males from eating disorders research;
• The difference in eating disorder symptoms in males and females;
• Inadequate attention to male eating disorder behaviors in the majority of assessments;
• “Feminine” branding of eating disorder treatment centers;
• Exclusion of males in eating disorder treatment centers.

A brief history of male eating disorders

In 1689 physician Richard Morton described “nervous consumption” in a male patient. In 1874, Ernest Charles Lasegue and Sir William Gull reported cases of males affected by anorexia nervosa.

However, for a long time, males with eating disorders have been dismissed or forgotten.

Before the latest update of the DSM-5, the loss of a menstrual period (amenorrhea) was a criterion required to be diagnosed with anorexia, effectively making it impossible for people without a uterus to qualify for this disease. Several assessment criteria, such as “I think my thighs are too large”, are designed to diagnose eating disorders in females, and are not effective in the assessment of a male patient.

All this started to change once anorexia nervosa in males began to be studied in 1972, and as males recently became included in treatment studies. This allowed for the creation of improved diagnostic criteria and treatments.

More recently, male-specific assessment tools such as the Eating Disorder Assessment for Males have been created to allow for the appropriate diagnosis of males.

Still, less than 1% of all eating disorder research targets males.

Some estimates

It is estimated that males have a lifetime prevalence of:

• 3% for anorexia nervosa;
• 5% for bulimia nervosa;
• 0% for binge eating disorder.

According to older statistics, 10% of people with eating disorders are male. However, this estimate doesn’t account for stigma, reluctance, and the gaps in research on the subject when it comes to males, so most experts believe it to be higher.

Estimates from the National Association for Males with Eating Disorders reported that 25 to 40% of all people with eating disorders are male.

Other estimates also indicate that about 40% of people with binge eating disorder are male.

One study of children in a pediatric gastroenterology network showed that 67% of ARFID (Avoidant Restrictive Food Intake Disorder) diagnoses were males.

Symptoms

Eating disorders present very differently in males and females. Comparatively, males are generally found to:

• Be older;
• Have previously been overweight;
• Present greater rates of such as anxiety, depression, and substance use;
• Engage in more suicidal behaviors at a higher rate;
• Be less likely to purge;
• Be more likely to exercise as a compensation behavior;
• Be less likely to pursue treatment.

According to some researchers, in a departure from the thinness traditionally seen in female anorexia, eating disorders are more likely to present in men as muscularity-oriented disordered eating, or muscle dysmorphia.

Muscle dysmorphia is a type of obsessive-compulsive disorder characterized by a desire for a bigger, more muscular body, and fear of not meeting the standards of the “ideal” male body.

Symptomatic behaviors include:

• Compulsive exercise;
• Protein supplementation and dietary restriction;
• “Cheat meals” to increase muscle;
• Taking supplements, performance-enhancing drugs or steroids;
• Distinct, alternating phases (to encourage muscle, and reduce body fat).

These behaviors cause serious medical risks, but because they are often perceived as healthy practices, they often go unnoticed.

According to one study, body dysmorphia may be present in 53% of competitive bodybuilders.

The sexual orientation myth

Many believe that the majority of males affected by eating disorders are queer.

A 2007 study showing a higher percentage of gay males with anorexia nervosa has contributed to this belief.  In truth, eating disorders are more prevalent in heterosexual males.

There is a very limited connection between sexual orientation and the incidence of eating disorders, according to a study.

A connection has been observed between the way the eating disorder manifests, and the patient’s gender identification: people identifying as male are more likely to seek out muscularity, while those identifying as female are more likely to seek out thinness.

Treatment

At the moment, no treatment specifically addresses eating disorders in males. Male patients, in fact, tend to respond well to the same treatments prescribed to females.

Cognitive behavioral therapy seems to be especially effective in adults, and family-based treatment (FBT) can be successful with adolescents – including those with muscle dysmorphia.

Exercise is often a patient’s initial symptom, and the last to remit. Most treatments on males focus on that and protein intake.

It is also important to address the stigma associated with what is erroneously perceived as a “female” illness. Reaching out to organizations like the National Association for Males With Eating Disorders is recommended when seeking help or a diagnosis.