Eating Disorder in Males

The stereotypical anorexic, bulimic, and binge eater is female. The stereotype is misleading. Boys and men get eating disorders too.

What eating disorders do men and boys get?

Just like girls and women, boys and men get anorexia nervosa and bulimia nervosa. Many males describe themselves as compulsive eaters, and some may have binge eating disorder. There is no evidence to suggest that eating disorders in males are atypical or somehow different from the eating disorders experienced by females.

Are the risk factors for males any different than the ones for females?

Risk factors for males include the following

• They were fat or overweight as children.
• They have been dieting. Dieting is one of the most powerful eating disorder triggers for both males and females, and one study indicates that up to seventy percent of high schools diet at one time or another to improve their appearance. (Theodore Weltzin, MD; Rogers Memorial Hospital)
• They participate in a sport that demands thinness. Runners and jockeys are at higher risk than football players and weight lifters. Wrestlers who try to shed pounds quickly before a match so they can compete in a lower weight category seem to be at special risk. Body builders are at risk if they deplete body fat and fluid reserves to achieve high definition.
• They have a job or profession that demands thinness. Male models, actors, and entertainers seem to be at higher risk than the general population.
• Some, but by no means all, males with eating disorders are members of the gay community where men are judged on their physical attractiveness in much the same way as women are judged in the heterosexual community.
• Living in a culture fixated on diets and physical appearance is also a risk factor. Male underwear models and men participating in reality show make-overs lead other males to compare themselves with these so-called Ideal body types. Weight loss and workout programs, as well as cosmetic surgery procedures, whose goal is chiseled muscularity can lead to the same sort of body dissatisfaction that afflicts women who read fashion magazines and watch movies and TV shows featuring "perfect" people.

In May 2004, researchers at the University of Central Florida released a study saying men who watched TV commercials with muscular actors felt unhappy about their own physiques. This "culture of muscularity" can be linked to eating disorders and steroid abuse, the researchers said.

Much has been made of the effect the Barbie doll has on the body image of a young girl. Now we have the Wolverine action figure marketed to boys. If he were life size, his biceps would be 32 inches around. Advertisers are marketing to males the same way they have pitched goods to females, with apparently many of the same related problems.

Compare and contrast males and females with eating disorders

• Males often begin an eating disorder at older ages than females do, and they more often have a history of obesity or overweight.
• Heterosexual males are not exposed to the same intense cultural pressures to be thin that women and girls endure. A casual review of popular magazines and TV shows reveals that women are encouraged to diet and be thin so they can feel good about themselves, be successful at school and at work, and attract friends and romantic partners. Men, on the other hand, are exhorted to be strong and powerful, to build their bodies and make them large so they can compete successfully, amass power and wealth, and defend and protect their frail, skinny female companions.
• It's interesting to note that when women are asked what they would do with one magic wish, they almost always want to lose weight. Men asked the same question want money, power, sex, and the accessories of a rich and successful lifestyle. They often think their bodies are fine the way they are. If they do have body concerns, they often want to bulk up and become larger and more muscular, not tiny like women do. Males usually equate thinness with weakness and frailty, things they desperately want to avoid.

Treatment of males with eating disorders

Because eating disorders have been described as female problems, males are often exceedingly reluctant to admit they are in trouble and need help. In addition, most eating disorder treatment programs and eating disorder support groups have been designed for females and are populated exclusively by females. Males report feeling uncomfortable and out of place in discussions of lost menstrual periods, women's socio-cultural issues, female-oriented advertising, and similar topics.

Nevertheless, like females, males usually need professional help to recover. The research is clear that males who complete treatment given by competent professionals have good outcomes. Being male has no adverse affect on recovery once the person commits to an effective, well-run program.

The wisest first step is two evaluations: one by a physician to identify any physical problems that are contributing to, or resulting from, the eating disorder; and a second by a mental health therapist to identify psychological issues underlying food behaviors.

When the two evaluations are complete, treatment recommendations can be made that address the individual's specific circumstances. For a description of the various parts of a comprehensive recovery program, see our section on treatment.

It is important to remember that eating disorders in males, as well as in females, can be treated, and people of both genders do recover. Almost always, however, professional help is required. If you are concerned about yourself or your child, find a physician and mental health therapist who will be sympathetic to the male perspective. The sooner treatment is begun, the sooner the person can turn the problem around and begin building a happy, satisfying life. The longer symptoms are ignored or denied, the harder that work will be when it is finally undertaken.

Anorexia Nervosa in Males

Anorexia nervosa is a severe, life-threatening disorder in which the individual refuses to maintain a minimally normal body weight, is intensely afraid of gaining weight, and exhibits a significant distortion in the perception of the shape or size of his body, as well as dissatisfaction with his body shape and size.

Behavioral Characteristics:

• Excessive dieting, fasting, restricted diet
• Food rituals
• Preoccupation with body building, weight lifting, or muscle toning
• Compulsive exercise
• Difficulty eating with others, lying about eating
• Frequently weighing self
• Preoccupation with food
• Focus on certain body parts; e.g., buttocks, thighs, stomach
• Disgust with body size or shape
• Distortion of body size; i.e., feels fat even though others tell him he is already very thin

Emotional and Mental Characteristics:

• Intense fear of becoming fat or gaining weight
• Depression
• Social isolation
• Strong need to be in control
• Rigid, inflexible thinking, "all or nothing"
• Decreased interest in sex or fears around sex
• Possible conflict over gender identity or sexual orientation
• Low sense of self worth -- uses weight as a measure of worth
• Difficulty expressing feelings
• Perfectionistic -- strives to be the neatest, thinnest, smartest, etc.
• Difficulty thinking clearly or concentrating
• Irritability, denial -- believes others are overreacting to his low weight or caloric restriction
• Insomnia

Physical Characteristics:

• Low body weight (15% or more below what is expected for age, height, activity level)
• Lack of energy, fatigue
• Muscular weakness
• Decreased balance, unsteady gait
• Lowered body temperature, blood pressure, pulse rate
• Tingling in hands and feet
• Thinning hair or hair loss
• Lanugo (downy growth of body hair)
• Heart arrhythmia
• Lowered testosterone levels

Bulimia Nervosa in Males

Bulimia nervosa is a severe, life-threatening disorder characterized by recurrent episodes of binge eating followed by self-induced vomiting or other purging methods (e.g. laxatives, diuretics, excessive exercise, fasting) in an attempt to avoid weight gain.

Behavioral Characteristics:

• Recurrent episodes of binge eating: eating an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
• A sense of lack of control over eating during binge episodes
• Recurrent purging or compensatory behavior to prevent weight gain: secretive self-induced vomiting, misuse of laxatives, diuretics, or fasting, compulsive exercise (possibly including excessive running, body building, or weight lifting)
• Hoarding of food, hiding food and eating in secret
• Frequently weighing self
• Preoccupation with food
• Focus on certain body parts; e.g., buttocks, thighs, stomach
• Disgust with body size or shape
• Distortion of body size; i.e., feels fat even though he may be thin

Emotional and Mental Characteristics:

• Intense fear of becoming fat or gaining weight
• Performance and appearance oriented
• Works hard to please others
• Depression
• Social isolation
• Possible conflict over gender identity or sexual orientation
• Strong need to be in control Difficulty expressing feelings
• Feelings of worthlessness -- uses weight, appearance, and achievement as measures of worth
• Rigid, inflexible "all or nothing" thinking

Physical Characteristics:

• Weight fluctuations
• Loss of dental enamel due to self-induced vomiting
• Edema (fluid retention or bloating)
• Constipation
• Swollen salivary glands
• Cardiac arrhythmia due to electrolyte imbalances
• Esophageal tears, gastric rupture
• Lack of energy, fatigue

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