Men with Eating Disorders

Not For Females Only

It is generally assumed that the problem of eating disorders is a female issue because, after all, appearance, weight, and dieting are predominately female preoccupations. Magazine articles, television shows, movies, books, and even treatment literature dealing with eating disorders focus almost exclusively on females.

Binge eating is seen somewhat differently than the classic eating disorders anorexia and bulimia. Males have always been included in the literature and in treatment programs for compulsive overeating. Compulsive overeating, however, has only recently been recognized as its own eating disorder—binge eating disorder—and it still is not accepted as an official diagnosis. Because anorexia and bulimia are official diagnoses, the term eating disorder usually refers to one of these two disorders.

Males do develop anorexia and bulimia, and, rather than being a new phenomenon, this was observed over three hundred years ago. Among the first well-documented accounts of anorexia nervosa, reported in the 1600s by Dr. Richard Morton and in the 1800s by the British physician William Gull, are cases of males suffering from the disorder. Since these early times, eating disorders in males have been overlooked, understudied, and underreported. Worse still, eating disordered males seeking treatment are turned down when requesting admission to most of the programs in the country because these programs treat females only.

The number of females suffering from eating disorders far exceeds that of males, but in the last few years reported cases of males with anorexia nervosa and bulimia nervosa have been steadily increasing. Media and professional attention have followed suit. A 1995 article in the Los Angeles Times on this subject entitled "Silence and Guilt" stated that roughly one million males in the United States suffer from eating disorders.

A 1996 article in the San Jose Mercury News shocked readers by reporting that Dennis Brown, a twenty-seven-year-old Super Bowl defensive end, revealed that he used laxatives, diuretics, and self-induced vomiting to control his weight and even underwent surgery to repair bleeding ulcers made worse by his years of bingeing and purging. "It's always been the weight thing," said Brown. "They used to get on me for being too big." In the article, Brown reported that after making such statements in an NFL-sponsored interview session, he was pulled aside and reprimanded by coaches and team officials for ". . . embarrassing the organization."

The following research summaries, provided by Tom Shiltz, M.S., C.A.D.C., from Rogers Memorial Hospital's Eating Disorder Center in Oconomowoc, Wisconsin, are included here to provide insight into the various biological, psychological, and social factors influencing male eating disorders.

• Approximately 10 percent of eating disordered individuals coming to the attention of mental health professionals are male. There is a broad consensus, however, that eating disorders in males are clinically similar to, if not indistinguishable from, eating disorders in females.

• Kearney-Cooke and Steichen-Asch found that men with eating disorders tend to have dependent, avoidant, and passive-aggressive personality styles and to have experienced negative reactions to their bodies from their peers while growing up. They tend to be closer to their mothers than to their fathers. The authors concluded that "in our culture, muscular build, overt physical aggression, competence at athletics, competitiveness, and independence generally are regarded as desirable for boys, whereas dependency, passivity, inhibition of physical aggression, smallness, and neatness are seen as more appropriate for females. Boys who later develop eating disorders do not conform to the cultural expectations for masculinity; they tend to be more dependent, passive, and non-athletic, traits which may lead to feelings of isolation and disparagement of body."

• A national survey of 11,467 high school students and 60,861 adults revealed the following gender differences:

  • Among the adults, 38 percent of the women and 24 percent of the men were trying to lose weight.

  • Among high-school students, 44 percent of the females and 15 percent of the males were attempting to lose weight.

• HealthyPlace.com Articles/Conference Transcripts Help For Parents Of Children With Eating Disorders Positive Body Image

  Based on a questionnaire administered to 226 college students (98 males and 128 females) concerning weight, body shape, dieting, and exercise history, the authors found that 26 percent of the men and 48 percent of the women described themselves as overweight. Women dieted to lose weight whereas men usually exercised.

• A sample of 1,373 high-school students revealed that girls (63 percent) were four times more likely than boys (16 per-cent) to be attempting to reduce weight through exercise and caloric intake reduction. Boys were three times more likely than girls to be trying to gain weight (28 percent versus 9 per-cent). The cultural ideal for body shape for women versus men continues to favor slender women and athletic, V-shaped, muscular men.

• In general, men appear to be more comfortable with their weight and perceive less pressure to be thin than women. A national survey indicated that only 41 percent of men are dissatisfied with their weight as compared with 55 percent of women; moreover, 77 percent of underweight men liked their appearance as opposed to 83 percent of underweight women. Males were more likely than females to claim that if they were fit and exercised regularly, they felt good about their bodies. Women were more concerned with aspects of their appearance, particularly weight.

• DiDomenico and Andersen found that magazines targeted primarily to women included a greater number of articles and advertisements aimed at weight reduction (e.g., diet, calories) and those targeted at men contained more shape articles and advertisements (e.g., fitness, weight lifting, body building, or muscle toning). The magazines most read by females ages eighteen to twenty-four had ten times more diet content than those most popular among men in the same age group.

• Gymnasts, runners, body builders, rowers, wrestlers, jockeys, dancers, and swimmers are vulnerable to eating disorders because their professions necessitate weight restriction. It is important to note, however, that functional weight loss for athletic success differs from an eating disorder when the central psychopathology is absent.

• Nemeroff, Stein, Diehl, and Smilack suggest that males may be receiving increasing media messages regarding dieting, ideal of muscularity, and plastic surgery options (such as pectoral and calf implants).

The increase in articles and media reports on males with eating disorders is reminiscent of the early years when eating disorders in females first began to get public attention. One wonders if this is our early warning of how frequently the problem with males really occurs.

The studies indicating that somewhere between 5 and 15 percent of eating disorder cases are males are problematic and unreliable. Identifying males with eating disorders has been difficult for several reasons, including how these disorders are defined. Consider that until DSM-IV, the diagnostic criteria for anorexia nervosa included amenorrhea, and since originally bulimia nervosa was not a separate illness but rather absorbed into the diagnosis of anorexia nervosa, a gender bias existed for both of these disorders such that patients and clinicians held the belief that males do not develop eating disorders.

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Walter Vandereycken reported that in a 1979 study, 40 percent of internists and 25 percent of psychiatrists surveyed believed that anorexia nervosa only occurs in females, and that in a 1983 survey 25 percent of psychiatrists and psychologists considered femaleness fundamental to anorexia nervosa. Being overweight and overeating are culturally more acceptable and less noticed in males; therefore, binge eating disorder also tends to go underrecognized.

As it now stands, the three essential requirements for the diagnosis of anorexia nervosa—substantial self-induced weight loss, a morbid fear of becoming fat, and an abnormality of reproductive hormone functioning—can be applied to males as well as females. (Testosterone levels in males decrease as a result of this disorder, and in 10 to 20 percent of cases, males remain with features of testicular abnormality.) The essential diagnostic features for bulimia nervosa—compulsive binge eating, a fear of fatness, and compensatory behaviors used to avoid weight gain—can also be equally applied to males and females.

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By Carolyn Costin, MA, M.Ed., MFCC - Medical Reference from "The Eating Disorders Sourcebook"

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