Updates on Men and Eating Disordersby Mark Warren, M.D.
Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.
Males are historically underrepresented throughout the eating disorder field- as patients, treatment professionals, by diagnosis and prevalence, in research studies and in stories of recovery. 30 years ago men with eating disorders were virtually invisible and options for treatment were mostly non-existent. Fortunately, we are at a tipping point in our understanding of males and eating disorders. While major gaps still exist in our understanding, we are continuously learning more about males with ED.
According to the National Comorbidity Study (Hudson, 2007), lifetime prevalence in ED in men is:
Anorexia Nervosa- 0.3%
Bulimia Nervosa- 0.5%
Binge Eating Disorder- 2%
In this study, over 50% of men also had co-morbidities.
In a study by Striegel-Moore, et al in 2009, over 26% of men in the community had ED symptomatology.
Men and women may have different presentations of their eating disorder. Men are more likely to purge less and exercise more. However, particularly in some newer studies, men have been shown to have significant purging behaviors than previously thought. Women compensate primarily to lose weight while men compensate more to decrease body fat. Men with an ED usually have less body dissatisfaction, less drive for thinness, a more likely history of being previously overweight, and less a history of feeling overweight when they are of average weight. Women tend to focus on dieting and thinness. Men are more likely to want to increase muscle mass, although this is not universal. Muscularity is a signature concern in males with ED. Muscularity is often the central feature in male ED, with the use of terms like "softness" rather than "fat", "lean" and "muscular" rather than "thin" and "sleek", and a preoccupation with shape rather than with thinness alone.
Treatment for men with an ED should acknowledge similar needs for refeeding and normalizing behaviors while also noting that men are likely to be less informed about ED in general, have less facility with therapy, may associate therapy and weakness, may fear dependence, may have to deal with shame issues from new power dynamics and may resist connection. Providers can help to overcome these potential obstacles.
For more information on men and eating disorders check out The National Eating Disorders Association Information and Resources for Men and Boys.
Contributions by Sarah Emerman