What percentage of men struggle with bulimia nervosa?
Studies have found that bulimia nervosa affects 0.1% to 1.6% of men in the United States, which translates to well over a million men living with this eating disorder alone.1
Among all patients struggling with the disorder, roughly 10% are cisgender men, according to one widely-cited analysis—though some reports have put that number as high as 25%.2
And certain groups of men have also been found to be particularly high risk for developing BN. Within the gay men population, up to 14% of men reportedly struggle with bulimia nervosa.3 And male athletes—especially those in college—also present a heightened risk, with one study finding men making up one of every three college athletes screened for disordered eating behavior.4
How do bulimia nervosa symptoms present in men?
Several factors make it difficult to accurately determine the prevalence of male eating disorders, including how many men struggle with bulimia nervosa. And one of them is due to the different ways the disorder tends to present in cisgender men compared to cisgender women.
Binging and purging behaviors
Both men and women experience cycles of binge eating and purging (self-induced vomiting) when struggling with bulimia nervosa. Still, they may express these disordered eating behaviors differently and for different reasons. Some studies found that these cycles for men—and, particularly, athletes—fall more along the lines of certain muscle-building routines, which call for periods of "bulking" and "cutting" weight.5
In these cases, binging episodes are considered either part of a "bulking" phase (body weight gain) or a dietary cheat meal, and they are treated as more socially acceptable in men, even when they result in a loss of control over how much food is eaten.1 Similarly, purging episodes may be tied less to the guilt caused by binge eating and more to the concept of "cutting" weight after bulking.1
And while these routines may be started intentionally, they can develop into a form of bulimia nervosa through the creation of undue stress or the triggering of several other factors.
Regardless of the driver, however, men generally tend to use alternate compensation methods—such as excessive exercise or fasting—to compensate for binge eating, as opposed to more stereotypical BN behaviors, such as self-induced vomiting or laxative abuse.2
Dietary concerns and fixations
A fixation on food is also common among people struggling with BN, though men may focus on different aspects and outcomes of their diet.
While women who struggle with bulimia nervosa tend to fixate on food to lose or manipulate weight, men tend to be more preoccupied with foods or diets that help them bulk up. This could mean focusing on specific foods or certain diet routines to optimize workouts or muscle building.
Both groups are similar in that they will experience these thoughts frequently and obsessively, to the point where they become disruptive to everyday life.
Body image concerns and issues
Unfortunately, poor body image and low self-esteem are very common among people struggling with an eating disorder, including bulimia nervosa. But one of the primary reasons bulimia nervosa is often expressed differently in cisgender men and cisgender women is the different cultural expectations placed on their bodies.
While women are taught through a number of social and cultural cues that thinness is the ideal, men are shown that a lean and muscular build is their preferred body type. In fact, one study found male models having consistently smaller waists, larger biceps and chests, and less body fat and more muscle over the last several decades.6
The number of boys and men trying to keep up with that ideal has also grown, with up to 60% of American boys in one recent study saying they've intentionally manipulated their diet to gain muscle.1
Up to 60% of American boys manipulate their diet to gain muscle.
The trend mirrors another growing concern among cisgender men called muscle dysmorphia. With onset primarily in cisgender men during later adolescence, the condition causes a distorted image of how muscular someone is. As a result, these patients tend to feel they are skinnier, "punier," or "flabbier" than they appear.
Though research on the concept is still relatively new, muscle dysmorphia has been linked to unhelpful thought and behavioral patterns that can lead to eating disorders, including bulimia nervosa.1
Challenges with diagnosing bulimia nervosa in men
Aside from the different ways bulimia nervosa manifests in cisgender men, some complications may make it challenging to correctly diagnose boys and men with the condition.
Much of what is currently known about bulimia nervosa is based on studies conducted exclusively on cisgender women patients. In fact, a number of hallmark signs and symptoms of these eating disorder behaviors are also based on this research, including some—such as amenorrhea or the disruption of a menstrual cycle—that have no equivalent in cisgender men's bodies.
The lack of research on how the disorder impacts men may make it more difficult for doctors to see or understand the signs and symptoms of bulimia nervosa in men or for men to even see or understand these symptoms within themselves.
As with most other eating disorders and mental health concerns, cases may be underreported due to the social stigma around the topic. For cisgender men struggling with bulimia nervosa, it may be even more challenging to speak up or seek treatment, thanks to the compounding misconception that the condition only impacts women.
While understanding how bulimia nervosa develops and manifests in cisgender men and boys is limited, research is even more limited regarding the experiences of transgender individuals experiencing BN, including transgender women, transgender men, and non-binary people.
When to get help
Bulimia nervosa remains a dangerous and potentially even deadly disorder, whether or not it's officially diagnosed, in men, women, or non-binary people. Thankfully, treatment for bulimia nervosa can provide a path to healing, and many people do recover.7
If you exhibit signs and symptoms of bulimia nervosa or any type of disordered eating, please reach out for support as soon as possible. Remember that when it comes to gender, eating disorders do not discriminate.
The more quickly these behaviors can be addressed, the better the chances of overall recovery. But it's important also to remember that it's never too late to start down the path toward healing.