Men with Eating Disorders

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For binge eating disorder, both males and females binge eat and feel distress and out of control over their eating. However, the problem of identification continues. Males with eating disorders have been so rarely acknowledged or encountered that the diagnostic possibility of anorexia nervosa, bulimia nervosa, or binge eating disorder is overlooked when males present with symptoms that would lead to a correct diagnosis if presented by a female.

Diagnostic criteria aside, the problem of identifying males with eating disorders is heightened by the fact that admitting to an eating disorder is difficult for anyone, but even more difficult for males due to the perceived notion that only females suffer from these illnesses. In fact, males with eating disorders commonly report fears of being suspected of homosexuality for having what is considered a "female problem."

GENDER IDENTITY AND SEXUALITY

As far as the sexuality issue goes, males with all variations of sexual orientations develop eating disorders, but studies have indicated a possible increase in gender identity conflict and sexual orientation issues among many males who do develop eating disorders. Dieting, thinness, and obsession about appearance tend to be predominantly feminine preoccupations, so it is not surprising that male eating disorder patients often present with gender identity and orientation issues including homosexuality and bisexuality. Tom Shiltz has also compiled the following statistics on sexuality, gender identity, and eating disorders, reprinted here with his permission.

GENDER DYSPHORIA AND HOMOSEXUALITY

• Fichter and Daser found that male anorexics saw themselves and were seen by others as more feminine than other men, both in attitudes and behavior. In general, the patients appeared to identify more closely with their mothers than their fathers.

• Homosexuals are overrepresented in many samples of eating disordered men. While the proportion of male homosexuals in the general population cross-culturally is estimated to be 3 to 5 percent, samples of eating disordered men are commonly twice as high or higher.

• Several authors have noted that homosexual content preceded the onset of the eating disorder in up to 50 percent of male patients.

• Conflict over gender identity or over sexual orientation may precipitate the development of an eating disorder in many males. It may be that by reducing their sexual drive through starvation, patients can temporarily resolve their sexual conflicts.

• HealthyPlace.com Audio Body Dysmorphic Disorder Britney would spend hours every night obsessing over her face, wondering what she could do to change it and make it "acceptable". "I'd become suicidal over my appearance, feeling that I was so disgusting, hideously ugly, that I didn't deserve to live. I thought that those around me shouldn't have to suffer by being with me." She shares her life with BDD and our psychiatrist, Dr. Spratley, discusses what the treatment for Body Dsymorphic Disorder entails. Listen with Real Player.

  Body image concerns may be important predictors of eating disorders in males. Wertheim and colleagues found that a desire to be thinner was a more important predictor of weight loss behaviors than psychological or family variables for both male and female adolescents.

• Kearney-Cooke and Steichen-Asch found that the preferred body shape for contemporary men without eating disorders was the V-shaped body, whereas the eating disordered group strove for the "lean, toned, thin" shape. The authors found that most of the men with eating disorders reported negative reactions from their peers. They reported being the last ones chosen for athletic teams and often cited being teased about their bodies as the times when they felt most ashamed of their bodies.

SEXUAL ATTITUDES, BEHAVIORS, AND ENDOCRINE DYSFUNCTION

• Burns and Crisp found that male anorexics in their study admitted "obvious relief" at the diminution of their sexual drive during the acute phase of their disease.

• A study by Andersen and Mickalide suggests that a disproportionate number of male anorexics may have persisting or preexisting problems in testosterone production.

One problem with eating disorder and gender studies is that what are often considered feminine traits, such as a drive for thinness, body image disturbance, and self-sacrifice, are the hallmarks of eating disorders in both males and females. Therefore, using these traits to determine the degree of femininity in anyone with an eating disorder, male or female, is misleading. Furthermore, many studies involve self-reporting and/or populations in treatment settings, both of which may provide unreliable results. Since many individuals find it difficult to admit they have an eating disorder, and since the admission of homosexuality is also a difficult matter, the actual incidence of homosexuality among males with eating disorders in the general population is an unclear and undetermined issue.