What is bulimia?
Bulimia is a potentially life-threatening eating disorder, characterized by episodes of binge eating followed by compensatory purging behaviors, performed in an attempt to counteract the binge. These purging behaviors can take several forms, including excessive exercise, self-induced vomiting, extreme calorie restriction, and the use of laxatives or diuretics, among others.
Individuals with BN often struggle with a poor body image and may be self-critical and overly focused on their weight and body shape. And many people with this condition also struggle with comorbid—or, co-occurring—mood disorders, including depression, anxiety, and obsessive compulsive disorder (OCD).2
How many men have bulimia?
There is often an omission of men and nonbinary people from eating disorder research. What studies do exist have come up with mixed numbers on the subject.
One 2015 analysis attempted to crunch the many numbers around eating disorder diagnoses reported in the United Kingdom over the years. Among the population of eating disorder patients, it ultimately predicted anywhere from 10%-25% might be male, while drawing no formal conclusions.1
Another study on eating disorders among the general population found that 0.5% of men in the United States will experience BN at some point in their lives, along with 0.1-1.3% of males across all of North America, Europe, and Australia.3 And yet other numbers calculated the number of men with an eating disorder in the U.S. at 10 million.4
And certain groups of men have also been found to be at particularly high risk for developing eating disorders, including BN. Some studies have noted that gay men were seven times more likely to report binging behaviors and 12 times more likely to report purging behaviors, compared to heterosexual males.5 Gay and bisexual boys were also more likely to have reported fasting, vomiting, or taking laxatives or diet pills to control their weight within the last 30 days.5
Still, it’s possible the reality of those numbers is much higher, as there is often gender bias towards cisgender females in diagnostic criteria. Cultural bias may also make men less likely to seek help from a mental health professional for their disordered eating behaviors.4
Signs and symptoms of bulimia in men
The signs and symptoms of bulimia nervosa are typically similar in males and females, with both groups generally struggling with binge eating, self-induced vomiting, fasting, excessive exercising, and laxative abuse.
One study found that men report overeating at a much higher rate than women.
Few studies have been done to illuminate different ways the disorder may manifest in men and women, though one look into the subject found that men report overeating at a much higher rate than women, while exhibiting body checking and body avoidance behaviors at a much lower rate.6
Like women and people of other genders struggling with the condition, men with bulimia may also experience:7
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Bulimia differences in men
Bulimia nervosa and other eating disorders have long been culturally portrayed as “female issues.” And this long standing concept—false as it may be—may influence the ways these disorders manifest in or are perceived by men.
Body image concerns and issues
Unfortunately, poor body image and low self-esteem are very common among all people who struggle with eating disorders. 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.
In one study, up to 60% of boys said they've intentionally manipulated their diet for weight gain, specifically to gain muscle.
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.8
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 for weight gain, specifically to gain muscle.9
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 which can lead to eating disorders, including bulimia nervosa.9
Potential drivers of bulimia
Aside from striving to achieve an “ideal” body type, men may have other primary drivers behind their disordered eating behaviors.
As opposed to women, most of whom have a “normal” weight history before engaging in eating disorder behavior, more men experience BN symptoms after a history of being mildly to moderately obese.10
Other studies found that men report engaging in compensatory behaviors, including excessive exercising, as a way to avoid developing medical conditions they may have seen their fathers deal with, compared to women, who, in that study, reported engaging in these behaviors more to lose weight or achieve thinness. (10)
More men than women also reported the desire to lose weight in connection to an athletic pursuit, including achieving an elevated performance level, or becoming eligible to compete in a certain sport.10
Likelihood of seeking treatment
While it’s impossible to know how many people struggle with eating disorders, it’s possible to imagine certain factors that may influence someone’s desire to seek help for these conditions.
Overall, it’s been estimated that males are less likely to seek treatment for bulimia nervosa or other eating disorders, with the discrepancy often chalked up to a number of issues.11
Cultural bias around the concept of BN—specifically, the idea that it’s a “female” or “feminine” issue—is thought to be a primary barrier for males seeking treatment. Social stigma around the condition can make it even more difficult for cisgender men to speak up about their struggle, or feel safe, comfortable, or accepted in their experience.
But the issue also penetrates into the world of care and treatment itself, as far less research and information has been made available about the effects and presentation of these conditions in males.11 The lack of scientific evidence and references can make it difficult to spot BN and other eating disorders in men, or make it easier for them to go undiagnosed or misdiagnosed, even if they do seek out help.
Eating disorder treatment for bulimia in men
Treatment for bulimia is not one-size-fits-all. For anyone seeking treatment for eating disorders—whether they be male, female, transgender, or nonbinary—a mix of biological, environmental, and cultural factors should be taken into account to provide a personalized care plan.
Still, a gender-sensitive approach, which takes into account the unique challenges and needs of cisgender men with eating disorders, may prove a helpful tool in providing effective bulimia treatment. All-men rehab facilities, or support groups focused on issues predominantly experienced by males, can help create a sense of community for people who may otherwise feel alone and misunderstood.
Indeed, struggling with an eating disorder is nothing to be ashamed of, no matter your gender. And the consequences of delaying treatment for bulimia nervosa are just as serious for men as they are for women.
If you or a loved one is struggling with the binge-purge cycle of bulimia, early intervention, and the right treatment are so important. Although it won't happen overnight, with the right medical and psychological support, a full recovery from bulimia nervosa is possible.
