Eating disorders in men: Why they're underdiagnosed and undertreated

Why male eating disorders are undertreated

There are several reasons why eating disorders in men and boys may go under-treated.

Since body image concerns are so often associated with girls and women, there's a perceived stigma around men experiencing these feelings, which may lead many to write off what they're going through, ignore or hide their struggles, or tell themselves eating disorders are a “female problem.”² Cultural influence and the concept of traditional gender roles may also play a part in some men repressing their emotions or feeling uncomfortable to speak up or seek out treatment.^2,3

But it's not all on the side of the individual experiencing the eating disorder. Medical studies on these conditions have long focused almost exclusively on females, which can lead to one-sided or exclusionary findings.³ In fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM) long used female-centric criteria for diagnosing eating disorders, including irregular menstrual cycles.

While many core symptoms are similar, eating disorders do, in fact, present differently in men and boys than in women and girls.^1,2,3 Because of this, medical providers may be unaware of how eating disorders impact or present in men and males and fail to either look for or see the signs and symptoms.¹

How eating disorders in men present differently

The way eating disorders have long been understood in the medical community is almost exclusively from a female perspective. But what are often considered "classic" eating disorder symptoms, such as a desire for thinness and weight loss, are not as strongly presented in men.⁴

Cisgender men and women often draw ideas of the "ideal" male or female body from different cultural sources, and each group is usually presented with different body images. Rather than the long and lean image presented to women, the image of a "perfect" male body is often associated with muscularity and low body fat, six pack abs, and bulging biceps.

As such, men may showcase different eating disorder behaviors, including attempts to even gain weight or build muscle. The use of steroids and growth hormones is much more common in men with eating disorders.⁴ Unfortunately, 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 overall, but are more likely to favor specific compensatory behaviors, including self-induced vomiting and over-exercising.^3,4 And men impacted by binge eating-related disorders may also be triggered by different emotions than women with these conditions.⁴

Risk factors for men with eating disorders

Just as eating disorders may present differently in men, men may also have a unique set of risk factors that increase their likelihood of developing an eating disorder.

A combination of genetic, psychological, and environmental factors often plays a role in any eating disorder. But the specific risk factors for men include:¹

• Muscle dysmorphia
• Body dissatisfaction
• Pop culture and media messaging
• Participation in elite athletics
• Other psychiatric conditions

Consequences of untreated male eating disorders

One of the dangers related to under-treated and under-diagnosed disorders is the tendency for those disorders to be worse by the time someone does seek out treatment if that ever happens.

Many men have reported not receiving eating disorder diagnoses or treatment because of the misconception that their behaviors are not disordered or that they stem from 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 only opioid use disorders and addiction claiming more lives annually.¹

Barring that worst-case scenario, an untreated eating disorder can put men at risk for severe mental and physical health complications, such as:^3,5

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

• Heart attacks and strokes
• Hepatitis from sharing/dirty needles
• Prostate cancer
• Kidney and liver disease
• Jaundice
• Decreased sperm production
• Enlarged breasts
• Shrunken testicles
• Male-pattern baldness
• Tendon injuries
• Depression
• Mania, paranoia, and psychosis

Treatment for eating disorders in men

Regardless of who the patient is, eating disorder treatment should always be individualized and tailored to meet each person’s needs, addressing any biological, psychological, and socio-cultural factors that may have contributed to the development of their particular condition.

Male-only treatment centers

Many disordered eating treatment programs focus mostly around female patients and their particular sets of needs, so boys and men struggling with these disorders may feel more comfortable in an all-male environment. These types of centers for male eating disorders are more likely to address the unique challenges facing boys and men, such as pressures to gain more muscle or debunking the myth that body image dissatisfaction is a "female problem."

A men-only treatment facility may also help men find a community of others going through similar challenges and encourage disclosure and vulnerability amongst male patients, which can be important tools on the path toward healing.¹

How treating males differs to treating females

From the perspective of a treatment provider, it should be understood how eating disorders present differently in men than in women and may have different causal factors. In a treatment setting, providers can focus on challenging antiquated beliefs around the idea of "masculinity," including those commonly presented in media and pop culture, as well as addressing issues related to excessive exercise, and the interaction between shame and depression.⁴

In fact, 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

Finding help for men with eating disorders

Struggling with an eating disorder is never easy, but seeking out appropriate care can feel especially difficult for men and boys who may be culturally conditioned to believe these issues are "female problems." But if you or a loved one are struggling with an eating disorder, it's essential to seek out help.

Your primary care physician or therapist are great places to start. These experts may be able to help you secure a diagnosis or point you in the direction of your next best steps.