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Eating Disorders in Men are Underdiagnosed and Undertreated

I

t’s a common misconception that only teen girls and young women struggle with eating disorders, like anorexia nervosa and bulimia nervosa. People of all genders, including boys and men, are affected by eating disorders and require individualized, gender-sensitive treatment. In fact, a recent study estimated that about 10 million men and boys in the United States will experience an eating disorder at some point in their life. (1)

Unfortunately, eating disorders often go under-diagnosed and under-treated in boys and men, due to reasons such as stigma, shame, treatment provider bias, and difference in eating disorder symptom presentation. Untreated eating disorders can lead to potentially dangerous consequences.

Reasons Men Don’t Receive Treatment for Eating Disorders

Men and boys encounter countless barriers to eating disorder diagnosis and care, including: (1,2,3)

  • Stigma associated with what’s falsely considered to be a “female problem”
  • Lack of awareness about eating disorders and their impact on men
  • Female-centric diagnostic criteria, including irregular menstruation
  • Eating disorder symptoms presenting differently in men than women
  • Biased insurance providers refusing to cover eating disorder care for men
  • Cultural pressures for men to repress their emotions
  • Traditional gender roles pressuring them to be independent and self-reliant
  • Studies omitting boys and men from eating disorder research
  • Profound feelings of shame and weakness associated with admitting they need help

These barriers often prevent men from receiving eating disorder diagnoses and referrals to treatment. And, if they do wind up receiving eating disorder treatment, their condition may be more severe, since they have often been struggling for much longer than their female counterparts. (2)

How Eating Disorders May Present Differently in Men

Many of the classic eating disorder symptoms in women, such as desire for thinness and weight loss, are not present in men, which may lead to underdiagnosis. (4) 

Rather, men with eating disorders are often in pursuit of the “ideal male body” they see in movies, TV shows, magazines like Men’s Health, and beyond. The image of a perfect male body is often associated with muscularity and low body fat, depicting six pack abs and high definition. As such, men with eating disorders do not typically have a desire for thinness and are much more likely to want to gain weight, particularly muscle. In this obsessive pursuit for muscularity and weight gain, men with eating disorders may turn to steroids and growth hormones to achieve their desired results. Steroid use tends to be reinforcing at first, causing rapid gains in muscle mass with few side effects. However, long-term steroid use can cause significant medical and psychological issues, such as depression, suicidal thoughts, high cholesterol, and prostate enlargement. (4)

Additionally, research shows that men are less likely than women to engage in compensatory behaviors, like laxative abuse or vomiting. Rather, their compensatory behaviors tend to involve excessive exercise  to control body shape and weight. (4) 

Men also report that anger often triggers their bingeing episodes, in which they eat a large amount of food in a short period of time. Conversely, women often report that they binge in an effort to control or repress their anger. (4)

These are just some of the more pertinent differences between eating disorders symptoms in men and women, but there are many. These differences may mean that men are not only under-diagnosed but also stigmatized or invalidated if they don’t have dangerously low body weight or more “classic” eating disorder symptoms. 

Risk Factors for Eating Disorders in Men

Just as eating disorders may present differently in men, men may also have a unique set of risk factors that increase their likelihood of an eating disorder. Risk factors for men may include: (1)

  • Muscle dysmorphia: A subtype of body dysmorphic disorder, muscle dysmorphia is characterized by an extreme preoccupation about not being muscular enough. This is often seen in men, who have internalized the belief that the ideal male body is muscular with low body fat. In an attempt to achieve this body type, men may engage in disordered eating behaviors, such as compulsive exercise.
  • Body dissatisfaction: While women with eating disorders experience high levels of body dissatisfaction too, men often experience it for different reasons. They may feel that they aren’t muscular enough, while women are often preoccupied with thinness. Research indicates that many men who develop an eating disorder aim to achieve a mesomorphic body type, one with a high muscle-to-fat ratio. 
  • Pop culture and media messaging: Pop culture and the media are largely responsible for presenting muscular and lean body image ideals that may cause men who can’t achieve these body types to feel immense shame and body dissatisfaction.
  • Participation in elite athletics: Many male athletes may feel pressure to gain or lose weight or to become more muscular to improve athletic performance. This pressure could result in disordered eating behaviors, such as severe caloric restriction and compulsive exercise.
  • Other psychiatric conditions: Anxiety, obsessive-compulsive disorder (OCD), depression, and other mood disorders may increase the chance of developing an eating disorder, in both men and women. Moreover, men with eating disorders are about twice as likely to have a substance addiction as well. These substances are commonly stimulants, like cocaine and amphetamines, that reduce appetite.

Consequences of Untreated Eating Disorders

Many men may go their entire lives without receiving proper eating disorder treatment. Others may begin treatment after several years of severe and endangering symptoms. Many men have reported not receiving a diagnosis or care because of a misconception that their behaviors are not disordered or that they may indicate a different psychiatric disorder, such as depression. (1)

However, untreated eating disorders can be life-threatening. Eating disorders are the second most deadly mental health condition, with the first being opioid addiction (5) An untreated eating disorder can put men at risk for severe mental and physical health complications, such as: (3,5)

  • Stroke
  • Severe constipation and dehydration
  • Osteoporosis
  • Tooth damage
  • Organ failure
  • Brain damage
  • Low blood pressure
  • Gastrointestinal issues
  • Heart failure
  • Arrhythmia (irregular heartbeat)
  • Erectile dysfunction
  • Anxiety
  • Depression
  • Suicidal ideation

Additionally, men who take anabolic steroids to increase muscularity may experience many harmful side effects, such as: (6)

  • Heart attacks and strokes
  • Peliosis hepatitis
  • Liver cancer
  • Jaundice
  • Decreased sperm production
  • Enlarged breasts
  • Shrunken testicles
  • Testicular cancer
  • Male-pattern baldness
  • Tendon injuries
  • Depression
  • Mania

Treatment for Men with Eating Disorders

Regardless of who the patient is, treatment should always be individualized and tailored to meet each person’s needs. Treatment should also be informed by the biological, psychological, and socio-cultural factors that may have contributed to the development of an eating disorder.

Given that many treatment centers may have mostly female patients, men may feel more comfortable in an all-male environment where fellow patients are more likely to understand their unique challenges, such as pressures to gain more muscle. A men-only treatment facility may also encourage disclosure and vulnerability amongst male patients. (1)

Eating disorder treatment providers should understand how eating disorders present differently in men than women and may have different causal factors. One focus of care may include redefining masculinity and challenging antiquated beliefs about masculinity. Other focal points may include media and pop culture pressures, excessive exercise, and the interaction between shame and depression. (4) Studies of treatment experiences in men with eating disorders have shown that male patients appreciated their providers challenging gender stereotypes, empowering them for change, and validating all the different forms of masculinity. (3)

Lastly, these treatment approaches should always be combined with evidence-based treatment modalities that have proven successful in female patients, such as cognitive-behavioral therapy (CBT), interpersonal psychotherapy, group counseling, and family therapy.

Posted 
Mar 24, 2022
 in 
Text Link
 category

Resources

  1. Sangha, S., Oliffe, J. L., Kelly, M. T., & McCuaig, F. (2019). Eating Disorders in Males: How Primary Care Providers Can Improve Recognition, Diagnosis, and Treatment. American Journal of Men's Health, 13(3), 1557988319857424. https://doi.org/10.1177/1557988319857424
  2. Collier R. (2013). Treatment Challenges for Men with Eating Disorders. CMAJ : Canadian Medical Association journal = Journal de L'Association Medicale Canadienne, 185(3), E137–E138. https://doi.org/10.1503/cmaj109-4363
  3. Thapliyal, P, and Hay, P.J. (2014). Treatment Experiences of Males with an Eating Disorder: a Systematic Review of Qualitative Studies. Translational Developmental Psychiatry 2(1). https://doi.org/10.3402/tdp.v2.25552
  4. Strother, E., Lemberg, R., Stanford, S. C., & Turberville, D. (2012). Eating Disorders in Men: Underdiagnosed, Undertreated, and Misunderstood. Eating Disorders, 20(5), 346–355. https://doi.org/10.1080/10640266.2012.715512
  5. Cleveland Clinic. (2020). Eating Disorders.
  6. National Institute on Drug Abuse. (2018). What are the Side Effects of Anabolic sSeroid Misuse?

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Eating Disorders in Men are Underdiagnosed and Undertreated

I

t’s a common misconception that only teen girls and young women struggle with eating disorders, like anorexia nervosa and bulimia nervosa. People of all genders, including boys and men, are affected by eating disorders and require individualized, gender-sensitive treatment. In fact, a recent study estimated that about 10 million men and boys in the United States will experience an eating disorder at some point in their life. (1)

Unfortunately, eating disorders often go under-diagnosed and under-treated in boys and men, due to reasons such as stigma, shame, treatment provider bias, and difference in eating disorder symptom presentation. Untreated eating disorders can lead to potentially dangerous consequences.

Reasons Men Don’t Receive Treatment for Eating Disorders

Men and boys encounter countless barriers to eating disorder diagnosis and care, including: (1,2,3)

  • Stigma associated with what’s falsely considered to be a “female problem”
  • Lack of awareness about eating disorders and their impact on men
  • Female-centric diagnostic criteria, including irregular menstruation
  • Eating disorder symptoms presenting differently in men than women
  • Biased insurance providers refusing to cover eating disorder care for men
  • Cultural pressures for men to repress their emotions
  • Traditional gender roles pressuring them to be independent and self-reliant
  • Studies omitting boys and men from eating disorder research
  • Profound feelings of shame and weakness associated with admitting they need help

These barriers often prevent men from receiving eating disorder diagnoses and referrals to treatment. And, if they do wind up receiving eating disorder treatment, their condition may be more severe, since they have often been struggling for much longer than their female counterparts. (2)

How Eating Disorders May Present Differently in Men

Many of the classic eating disorder symptoms in women, such as desire for thinness and weight loss, are not present in men, which may lead to underdiagnosis. (4) 

Rather, men with eating disorders are often in pursuit of the “ideal male body” they see in movies, TV shows, magazines like Men’s Health, and beyond. The image of a perfect male body is often associated with muscularity and low body fat, depicting six pack abs and high definition. As such, men with eating disorders do not typically have a desire for thinness and are much more likely to want to gain weight, particularly muscle. In this obsessive pursuit for muscularity and weight gain, men with eating disorders may turn to steroids and growth hormones to achieve their desired results. Steroid use tends to be reinforcing at first, causing rapid gains in muscle mass with few side effects. However, long-term steroid use can cause significant medical and psychological issues, such as depression, suicidal thoughts, high cholesterol, and prostate enlargement. (4)

Additionally, research shows that men are less likely than women to engage in compensatory behaviors, like laxative abuse or vomiting. Rather, their compensatory behaviors tend to involve excessive exercise  to control body shape and weight. (4) 

Men also report that anger often triggers their bingeing episodes, in which they eat a large amount of food in a short period of time. Conversely, women often report that they binge in an effort to control or repress their anger. (4)

These are just some of the more pertinent differences between eating disorders symptoms in men and women, but there are many. These differences may mean that men are not only under-diagnosed but also stigmatized or invalidated if they don’t have dangerously low body weight or more “classic” eating disorder symptoms. 

Risk Factors for Eating Disorders in Men

Just as eating disorders may present differently in men, men may also have a unique set of risk factors that increase their likelihood of an eating disorder. Risk factors for men may include: (1)

  • Muscle dysmorphia: A subtype of body dysmorphic disorder, muscle dysmorphia is characterized by an extreme preoccupation about not being muscular enough. This is often seen in men, who have internalized the belief that the ideal male body is muscular with low body fat. In an attempt to achieve this body type, men may engage in disordered eating behaviors, such as compulsive exercise.
  • Body dissatisfaction: While women with eating disorders experience high levels of body dissatisfaction too, men often experience it for different reasons. They may feel that they aren’t muscular enough, while women are often preoccupied with thinness. Research indicates that many men who develop an eating disorder aim to achieve a mesomorphic body type, one with a high muscle-to-fat ratio. 
  • Pop culture and media messaging: Pop culture and the media are largely responsible for presenting muscular and lean body image ideals that may cause men who can’t achieve these body types to feel immense shame and body dissatisfaction.
  • Participation in elite athletics: Many male athletes may feel pressure to gain or lose weight or to become more muscular to improve athletic performance. This pressure could result in disordered eating behaviors, such as severe caloric restriction and compulsive exercise.
  • Other psychiatric conditions: Anxiety, obsessive-compulsive disorder (OCD), depression, and other mood disorders may increase the chance of developing an eating disorder, in both men and women. Moreover, men with eating disorders are about twice as likely to have a substance addiction as well. These substances are commonly stimulants, like cocaine and amphetamines, that reduce appetite.

Consequences of Untreated Eating Disorders

Many men may go their entire lives without receiving proper eating disorder treatment. Others may begin treatment after several years of severe and endangering symptoms. Many men have reported not receiving a diagnosis or care because of a misconception that their behaviors are not disordered or that they may indicate a different psychiatric disorder, such as depression. (1)

However, untreated eating disorders can be life-threatening. Eating disorders are the second most deadly mental health condition, with the first being opioid addiction (5) An untreated eating disorder can put men at risk for severe mental and physical health complications, such as: (3,5)

  • Stroke
  • Severe constipation and dehydration
  • Osteoporosis
  • Tooth damage
  • Organ failure
  • Brain damage
  • Low blood pressure
  • Gastrointestinal issues
  • Heart failure
  • Arrhythmia (irregular heartbeat)
  • Erectile dysfunction
  • Anxiety
  • Depression
  • Suicidal ideation

Additionally, men who take anabolic steroids to increase muscularity may experience many harmful side effects, such as: (6)

  • Heart attacks and strokes
  • Peliosis hepatitis
  • Liver cancer
  • Jaundice
  • Decreased sperm production
  • Enlarged breasts
  • Shrunken testicles
  • Testicular cancer
  • Male-pattern baldness
  • Tendon injuries
  • Depression
  • Mania

Treatment for Men with Eating Disorders

Regardless of who the patient is, treatment should always be individualized and tailored to meet each person’s needs. Treatment should also be informed by the biological, psychological, and socio-cultural factors that may have contributed to the development of an eating disorder.

Given that many treatment centers may have mostly female patients, men may feel more comfortable in an all-male environment where fellow patients are more likely to understand their unique challenges, such as pressures to gain more muscle. A men-only treatment facility may also encourage disclosure and vulnerability amongst male patients. (1)

Eating disorder treatment providers should understand how eating disorders present differently in men than women and may have different causal factors. One focus of care may include redefining masculinity and challenging antiquated beliefs about masculinity. Other focal points may include media and pop culture pressures, excessive exercise, and the interaction between shame and depression. (4) Studies of treatment experiences in men with eating disorders have shown that male patients appreciated their providers challenging gender stereotypes, empowering them for change, and validating all the different forms of masculinity. (3)

Lastly, these treatment approaches should always be combined with evidence-based treatment modalities that have proven successful in female patients, such as cognitive-behavioral therapy (CBT), interpersonal psychotherapy, group counseling, and family therapy.

Posted 
Mar 24, 2022
 in 
Text Link
 category

Resources

  1. Sangha, S., Oliffe, J. L., Kelly, M. T., & McCuaig, F. (2019). Eating Disorders in Males: How Primary Care Providers Can Improve Recognition, Diagnosis, and Treatment. American Journal of Men's Health, 13(3), 1557988319857424. https://doi.org/10.1177/1557988319857424
  2. Collier R. (2013). Treatment Challenges for Men with Eating Disorders. CMAJ : Canadian Medical Association journal = Journal de L'Association Medicale Canadienne, 185(3), E137–E138. https://doi.org/10.1503/cmaj109-4363
  3. Thapliyal, P, and Hay, P.J. (2014). Treatment Experiences of Males with an Eating Disorder: a Systematic Review of Qualitative Studies. Translational Developmental Psychiatry 2(1). https://doi.org/10.3402/tdp.v2.25552
  4. Strother, E., Lemberg, R., Stanford, S. C., & Turberville, D. (2012). Eating Disorders in Men: Underdiagnosed, Undertreated, and Misunderstood. Eating Disorders, 20(5), 346–355. https://doi.org/10.1080/10640266.2012.715512
  5. Cleveland Clinic. (2020). Eating Disorders.
  6. National Institute on Drug Abuse. (2018). What are the Side Effects of Anabolic sSeroid Misuse?