Men with Eating Disorders

continued

One final note is that, according to Andersen, eating disordered men differ from eating disordered women in a few ways that may be important for better understanding and treatment.

• They tend to have genuine histories of pre-illness obesity.

• They often report losing weight in order to avoid weight-related medical illnesses found in other family members.

• They are likely to be intensely athletic and to have begun dieting in order to attain greater sports achievement or from fear of gaining weight because of a sports injury. In this respect, they resemble individuals referred to as "obligatory runners." In fact, many eating disordered men may fit another proposed but not yet accepted diagnostic category, referred to as compulsive exercise, compulsive athleticism, or a term coined by Alayne Yates, activity disorder. This syndrome is similar to but separate from the eating disorders and is discussed in this book in chapter 3.

TREATMENT AND PROGNOSIS FOR MALES

Although more research needs to be done on the specific psychological and personality features of males with eating disorders, the basic principles for treatment currently promoted are similar to those for treating females and include: cessation of starvation, cessation of binge eating, weight normalization, interrupting binge and purge cycles, correcting body image disturbance, reducing dichotomous (black-and-white) thinking, and treating any coexisting mood disorders or personality disorders.

Short-term studies suggest that the prognosis for males in treatment is comparable to that for females, at least in the short term. Long-term studies are not available. However, empathetic, informed professionals are necessary, due to the fact that males with eating disorders feel misunderstood and out of place in a society that still doesn't understand these disorders. Even worse, males with eating disorders are often made to feel uncomfortable and otherwise rejected by females similarly afflicted. Although it may turn out to be true, it is often mistakenly assumed that males with eating disorders, most particularly anorexia nervosa, are more severely disturbed and have a poorer prognosis than females with such disorders.

There are good reasons why this may appear to be the case. First, since males often go undetected, only the most severe cases come into treatment and thus under scrutiny. Second, there seems to be a contingent of males with other serious psychological disorders, most notably obsessive-compulsive disorder, where food rituals, food phobias, food restriction, and food rejection are prominent features. These individuals end up in treatment mostly due to their underlying psychological illnesses, not for their eating behavior, and they tend to be complex, difficult-to-treat cases.

STRATEGIES FOR PREVENTION AND EARLY INTERVENTION OF MALE EATING DISORDERS

• Recognize that eating disorders do not discriminate on the basis of gender. Men can and do develop eating disorders.

• Learn about eating disorders and know the warning signs. Become aware of your community resources (e.g., treatment centers, self-help groups, etc.). Consider implementing an Eating Concerns Support Group in the school setting to provide interested young men with an opportunity to learn more about eating disorders and to receive support. Encourage young men to seek professional help if necessary.
   

  HealthyPlace.com Audio Athletes and Eating Disorders Eating issues among athletes (overexercising). What's the best way to approach a person you think has an eating disorder? Answered by expert at Columbia Health Services. Listen with Real Player.

• Athletic activities or professions that necessitate weight restriction (e.g., gymnastics, track, swimming, wrestling, rowing) put males at risk for developing eating disorders. Male wrestlers, for example, present with a higher rate of eating disorders than the general male population. Coaches need to be aware of and disallow any excessive weight control or body building measures employed by their young male athletes.

• Talk with young men about the ways in which cultural attitudes regarding ideal male body shape, masculinity, and sexuality are shaped by the media. Assist young men in expanding their idea of "masculinity" to include such characteristics as caring, nurturing, and cooperation. Encourage male involvement in traditional "nonmasculine" activities such as shopping, laundry, and cooking.

• Never emphasize body size or shape as an indication of a young man's worth or identity as a man. Value the person on the "inside" and help him to establish a sense of control in his life through self-knowledge and expression rather than trying to obtain control through dieting or other eating disorder behaviors.

• Confront others who tease men who do not meet traditional cultural expectations for masculinity. Confront anyone who tries to motivate or "toughen up" young men by verbally attacking their masculinity (e.g., "sissy" or "wimp"). Dem-onstrate respect for gay men and men who display personality traits or who are involved in professions that stretch the limits of traditional masculinity (e.g., men who dress colorfully, dancers, skaters, etc.).

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  Research has shown that a man who develops an eating disorder presents the following profile: he appears to lack a sense of autonomy, identity, and control over his life; he seems to exist as an extension of others and to do things because he must please others in order to survive emotionally; and he tends to identify with his mother rather than with his father, a pattern that leaves his masculine identity in question and establishes a repulsion of "fat" that he associates with femininity. With this in mind, the following suggestions for prevention can be made:

  • Listen carefully to a young man's thoughts and feelings, take his pain seriously, allow him to become who he is.

  • Validate his strivings for independence and encourage him to develop all aspects of his personality, not only those that family and/or culture find acceptable. Respect the person's need for space, privacy, and boundaries. Be careful about being overprotective. Allow him to exercise control and make his own decisions whenever possible, including control over what and how much he eats, how he looks, and how much he weighs.

  • Understand the crucial role of the father in the prevention of eating disorders and find ways to connect young men with healthy male role models.

Source: Used with permission of Tom Schlitz, M.S., C.A.D.C., of the Rogers Memorial Hospital Eating Disorder Center.

With more time and research devoted to analyzing and understanding the sociocultural, biochemical, and gender-related factors in the roots of the problems of males with eating disorders, optimal prevention and treatment protocols will be revealed.

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