Men with Eating Disorders - Men and Eating Disorders

Written by Carolyn Costin, MA, M.Ed., MFCC

Sexual Attitudes, Behaviors, and Endocrine Dysfuncion

• 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 eating disorder 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.

Andersen and other researchers, such as George Hsu, agree that the most important factor may be that there is less reinforcement for slimness and dieting for males than for females. Dieting and weight preoccupation are precursors for eating disorders and these behaviors are more prevalent in females. Andersen points out that by a ratio of 10.5 to 1, articles and advertisements concerning weight loss are more frequent in the ten most popular women's versus men's magazines.

It is more than interesting that the 10.5 to 1 ratio parallels that of women to men with eating disorders. Furthermore, in subgroups of males where there is a great emphasis on weight loss - for example, wrestlers, jockeys, or football players (such as in the above-mentioned case of Super Bowl defensive end Dennis Brown), there is an increased incidence of eating disorders. In fact, whenever weight loss is required for a particular group of individuals, male or female, such as in ballerinas, models, and gymnasts, there is a greater likelihood that those individuals will develop eating disorders. From this it can be speculated that as our society increasingly places pressure on men to lose weight, we will see an increase in males with eating disorders.

In fact, it is already happening. Men's bodies are more frequently the targets of advertising campaigns, leanness for men is increasingly being emphasized, and the number of male dieters and males reporting eating disorders continues to rise.

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, stop 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.