Santa Clara University

Males and Eating Disorders

Approximately 7-10 million women across the country suffer from eating disorders.   However, as many as a million men may also struggle with the diseases and the numbers are growing! Approximately 10% of eating disordered individuals coming to the attention of mental health professionals today are male.  There is a broad consensus, however, that eating disorders in males are clinically similar to, if not indistinguishable from, eating disorders in females.  Male gymnasts, runners, body builders, rowers, wrestlers, jockeys, dancers, and swimmers are particularly vulnerable to eating disorders because their sports necessitate weight restriction.  It is important to note, however, that weight loss in an attempt to improve athletic success differs from an eating disorder when the central psychopathology (i.e., depression, rituals, obsessions, compulsions, behaviors) is absent.

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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 they 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.

Anorexia Nervosa in Males: Anorexia is a life-threatening disorder that is characterized by self-starvation and excessive weight loss.  Symptoms include:

• Food rituals
• Compulsive exercise and/or preoccupation with body mass, muscles, etc.
• Preoccupation with food
• Refusal to maintain body weight at or above a minimally normal weight for age, height, body type, and activity level
• Intense fear of gaining weight or becoming fat, even though underweight
• Disturbance in the way in which one's body weight or shape is experienced
• Undue influence of body weight or shape on self-evaluation, or denial of the seriousness of current low body weight
• Lying about eating or difficulty eating around others
• Depression, isolation, loneliness
• Unrealistic and perfectionistic standards
• Difficulty expressing feelings
• Low self-esteem
• Need for control
• Possible sexual orientation and gender identity issues
• Decreased interest in sex, anxiety surrounding sexual activity
• Fatigue and muscle weakness
• Low blood pressure and body temperature
• Thinning hair or hair loss, lanugo
• Heart arrhythmia and electrolyte disturbances

Bulimia Nervosa is characterized by a highly secretive cycle of binge eating followed by purging. Bulimia includes eating large amounts of food (more than most people would eat in a meal) in a short period, then getting rid of the food and calories through vomiting, excessive exercise, or laxative abuse.   Symptoms include:

• Recurrent episodes of binge eating
• A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
• Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise
• Self-evaluation is unduly influenced by body shape and weight
• Preoccupation with food
• Hoarding, hiding, stealing food
• Fear of gaining weight or becoming fat
• Depression, isolation and loneliness
• Difficulty expressing feelings
• Possible sexual orientation and gender identity issues
• Low self-esteem
• "People-pleasers"
• Perfectionistic standards
• Fatigue
• Weight Fluctuations
• Edema
• Dental problems
• Electrolyte imbalances

Compulsive Overeating is characterized by periods of uncontrolled, impulsive or continuous eating beyond the point of feeling full. While there is no purging, there may be fasts or repetitive diet attempts. Often there are feelings of shame and self-hatred after a binge.  Symptoms include:

• Recurrent episodes of binge eating
• Hoarding, hiding, stealing food
• Eating rapidly and/or eating until uncomfortably full
• Consuming large amount of food when not hungry
• Body weight fluctuations
• Depression, anxiety, and loneliness
• Low self-esteem
• "People-pleasers"
• Perfectionistic
• Difficulty expressing feelings
• Negative attention received about their body while growing up
• Feelings of guilt and shame during and/or after a binge episode
• Binge eating used to numb feelings, relieve tension, deal with anger, depression and other emotional states
• Problems with heart and blood pressure and/or blood sugar problems
• Fatigue
• Joint problems

Other eating disorders may include some combination of signs and symptoms of anorexia, bulimia, and/or compulsive overeating. These behaviors may not meet the clinical criteria of an "eating disorder"; however, they can still be extremely dangerous physically and psychologically. All forms of eating disorders require professional help.

How many males have eating disorders?

The numbers seem to be increasing. Twenty years ago it was thought that for every 10-15 women with anorexia or bulimia, there was one man. Today researchers find that for every four females with anorexia, there is one male, and for every 8-11 females with bulimia, there is one male. (American Journal of Psychiatry 2001. 158-570).  Binge eating disorder seems to occur almost equally in males and females, although males are not as likely to feel guilty or anxious after a binge as women are sure to do.

Clinics and counselors see many more females than males, but that may be because males are reluctant to confess having what has become known as a "teenage girls' problem." Also, health professionals do not expect to see eating disorders in males and may therefore under-diagnose them.

Risk factors for males include the following

• They were overweight as children.  
• They have been dieting. Dieting is one of the most powerful eating disorder triggers for both males and females.  
• 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.  

Just like women, men are becoming more and more exposed to the “perfect” male body image portrayed in the media and feeling the pressure for the weight loss diets and pills, protein powders, exercise regimes all promising the hard body and “six-pack abs”. 

Treatment of males with eating disorders

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, 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.

Book Resources on Males and Eating Disorders:

• Andersen, R.E., et al. (1995). Weight loss, psychological and nutritional patterns in competitive male body builders. International Journal of Eating Disorders, 18, 49-57.
• Andersen, ROE. (1995). Eating Disorders in Males. In K. Brownell, K. & Fairburn, C.G., (Eds.), Eating Disorders and Obesity: A comprehensive Handbook. New York: Guilford Publications, Inc.
• Dept. of Health and Human Services (1987, 1995). Anorexia Nervosa and Bulimia.
• Eating Disorder Awareness and Prevention, EDAP (1998). www, edap.org, Males and Eating Disorders.
• Kearney-Cooke, A., & Steichen-Asch, P. (1990). Men, Body Image, and Eating Disorders. In A. Andersen (Ed.), Males with eating disorders (p. 47 New York: Brunner/Mazel.
• Schneider, J.A., & Agras, W.S. (1987). Bulimia in males: A matched comparison with females. International Journal of Eating Disorders, 6, 235-242.
• Shiltz, T. (1997). Eating Concerns Support Group Curriculum. Greenfield, WI: Community Recovery Press.
• Wertheim, E.H. et al. (1992). Psychosocial predictors of weight loss behaviors and binge eating in adolescent girls and boys. International Journal of Eating Disorders, 12, 151-160.
• Wolf, N. (1991). The beauty myth. New York: William Morrow.

Sources:

National Association for Anorexia and Bulimia Nervosa (ANAD)

National Eating Disorder Association