Understanding bulimia in men

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While the majority of people with bulimia nervosa (BN) are women, men and people of other genders also deal with this eating disorder. 

The features, elements of treatment, and path of recovery of bulimia in men are remarkably similar to that of women. However, some fundamental differences can pose barriers to diagnosis and treatment for men suffering from bulimia and other eating disorders. (1)

Lack of research and assumptions about how eating disorders affect different genders has resulted in eating disorders in men being misunderstood, under-diagnosed, and undertreated. 

Keep reading to learn more about how bulimia affects men, the important differences, and the best forms of treatment for the eating disorder.

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In this article

What is bulimia?

Bulimia is a potentially life-threatening eating disorder that is characterized by episodes of binge eating, followed by purging or compensation in an attempt to counteract the binge. (2) Purging can take several forms including excessive exercise, forced vomiting, extreme calorie restriction, and the use of laxatives or diuretics.

Individuals with bulimia often have a poor body image. They may be self-critical and overly focused on their weight and body shape. Bulimia can be hard to diagnose as many people with the condition are not at a weight that would cause alarm or medical concern. (2)

How does bulimia affect men?

Although there is often an omission of men and nonbinary people from studies on eating disorders (less than 1% of eating disorder research focuses specifically on men, (3) what research exists suggests that 0.5% of men will experience bulimia at some point in their lives. (2)

This number could be much higher as there is often gender bias towards women in diagnostic criteria, and due to cultural bias, men are much less likely to seek help for their disordered eating behaviors. (3,4)

Signs and symptoms of bulimia in men

The signs and symptoms of bulimia are typically similar in men to those in women with the condition, with the exception of favored purging behaviors. Excessive exercise and fasting are the most common purging behaviors in men, whereas in women it tends to be self-induced vomiting and laxative use. (5)

Other bulimia signs and symptoms in men may include: (6)

  • Recurring episodes of eating abnormally large amounts of food in a single sitting
  • Feeling a loss of control during binging
  • Hiding or hoarding food
  • Preoccupation with body shape and weight
  • Fear of gaining weight
  • Using dietary supplements excessively for weight loss

The short-term effects of bulimia are often rather subtle, such as electrolyte imbalances, fatigue, and dental issues, but if there is no intervention, bulimia can lead to much more serious consequences. 

If the binge and purge cycle carries on for the long term, men may suffer a loss of bone density and muscle mass, low blood pressure, heart damage, reduced immune function, and esophageal tearing if they’re regularly self-inducing vomiting.

Men with eating disorders, like bulimia, often suffer from comorbid conditions, including: (5,7)

  • Anxiety
  • Exercise addiction
  • Depression
  • Substance disorders
  • Muscle dysmorphia
  • Psychotic disorders such as schizophrenia

Bulimia differences in men

There are some major differences in how men and women experience bulimia. Men with eating disorders, including bulimia, tend to be older, have greater rates of other psychiatric issues, and engage in more self-harm and suicidal ideation than women. (3)

Furthermore, men tend to have a longer duration of illness with bulimia than women, as cultural stigma means they are much less likely to seek treatment. Waiting so long to seek treatment may mean that men are more likely to be sicker and more entrenched in their bulimia.

These aren’t the only differences between men and women when it comes to bulimia, there are also discrepancies when it comes to the reasons for their disordered eating behaviors, their compensatory behaviors, and more. (1)

Potential drives of bulimia

While the binge-purge cycle in women is often driven by a drive for thinness and deep body satisfaction, in men, there are other reasons why they engage in disordered behaviors. In addition to wanting to be thinner, men are more likely to be driven by a want to appear stronger, or more muscular, to fit into the idealized masculine appearance.

Whatever the drive for excessive exercise, the consequences are usually the same. Taking in inadequate energy to fuel workouts can trigger binge eating. Men may also have rigid rules around types of food eaten, including over focusing on protein consumption, which can result in physical and mental restriction that also plays a role in triggering binges. 

This loss of control over eating causes distress, leading back to excessive exercise, and so the cycle continues.

Exercise behaviors

Both men and women may engage in excessive exercise with the goal of losing weight. Men may also exercise excessively with the goal of gaining muscle, which can contribute to their disorders being misunderstood and misdiagnosed because this is seen as a culturally normalized behavior. 

Body image

In some men with bulimia, their extreme drive towards pursuing muscularity is impacted by muscle dysmorphia, which is a cognitive distortion leading them to believe their muscles are too small, no matter their actual size. 

This can lead to obsession with diet, overuse of stimulants like caffeine, and use of performance-enhancing drugs, such as anabolic steroids. (1)

Treatment for bulimia in men

Studies suggest that the risk of mortality for men with eating disorders is higher than it is for women, (4) and therefore, early intervention for bulimia in men is key.

Treatment for bulimia is not one-size-fits-all. For anyone seeking treatment for eating disorders, biological, environmental, and cultural factors should be taken into account to provide a personalized care plan.

A gender-sensitive approach, which takes into account the unique challenges and needs of men with eating disorders, is key in effective bulimia treatment. For example, treatment programs usually feature marketing and rehabilitation centers tailored towards women. (3)

This can mean that men may feel out of place in bulimia treatment programs when predominantly surrounded by women. (4) This could result in men not engaging in treatment, so an all-men treatment for bulimia is recommended whenever it’s possible. (4)

When men have been included in research studies on bulimia, they appear to respond well to the same treatment that women do, particularly cognitive behavioral therapy, interpersonal therapy, and family-based therapy.

Final words

There exists a stigma associated with men seeking help for eating disorders like bulimia. But struggling with an eating disorder is nothing to be ashamed of no matter your gender. The consequences of delaying treatment for bulimia are just as serious in men as they are in women.

If you or a loved one of yours 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 is possible.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Men with bulimia: Similar, and so different. Eating Disorder Hope. (2014, November 4). Retrieved May 9, 2022, from https://www.eatingdisorderhope.com/information/bulimia/men-with-bulimia-similar-and-so-different 
  2. Gabbey, A. E. (2022, February 16). Bulimia nervosa: Signs, causes, and treatment. Healthline. Retrieved May 9, 2022, from https://www.healthline.com/health/bulimia-nervosa 
  3. Lauren Muhlheim, P. D. (2020, November 13). What to know about male eating disorders. Verywell Mind. Retrieved May 9, 2022, from https://www.verywellmind.com/male-eating-disorders-4140606 
  4. Eating disorders in men & boys. National Eating Disorders Association. (2018, February 26). Retrieved May 9, 2022, from https://www.nationaleatingdisorders.org/learn/general-information/research-on-males 
  5. Clopton, J. (2019, September 5). Men's eating disorders often not recognized. WebMD. Retrieved May 9, 2022, from https://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/news/20190906/mens-eating-disorders-often-not-recognized 
  6. Men & Eating Disorders. National Eating Disorders Association. (2018, February 26). Retrieved May 9, 2022, from https://www.nationaleatingdisorders.org/men-eating-disorders

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