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According to the National Eating Disorders Association (NEDA), about 1 in 3 people struggling with an eating disorder is male. Plus, subclinical disordered eating behaviors, such as binge eating, purging, excessive exercise, and laxative use, are nearly as common in men as in women.1
However, the assumption among men, and even many healthcare providers, that eating disorders primarily affect women may lead to missed diagnoses.2 Furthermore, due to stigma and feelings of shame, men may deny their symptoms are a problem and, therefore, hesitate to seek treatment.
Eating disorders are considered among the most gendered mental health disorders, strongly associated with femininity.2 Therefore, males living with eating disorders and body image issues have a stigma to overcome and, as a result, are neglected in both diagnosis and treatment.
This social stigma can challenge a man’s masculine identity and create an internal conflict related to aligning with gender norms.3 Traditionally, male gender roles include being independent, resilient, and self-reliant. As a result, research has shown that self-judgment and the stigma of “needing help” correlated with an increased likelihood for men to postpone seeking medical or psychological care.4
Each and every one of us can be an advocate for a male loved one we believe to be struggling with an eating disorder or body image issues. Here are a few tips for helping a man you suspect may be suffering in private:
In the United States alone, eating disorders will affect 10 million males at some point in their lifetime, but they are far less likely than women to seek treatment. The positive news is that once men find the appropriate help, they show similar treatment outcomes to women.1. So how can we create more inclusive spaces for men with eating disorders to encourage more to seek the help they need?
While eating disorders can present differently in men, the language around their diagnosis is often narrowly focused on women. For example, in the DSM (Diagnostic and Statistical Manual of Mental Disorders), one of the diagnostic criteria for anorexia nervosa is loss of periods. However, most men don’t have periods to lose.
Furthermore, many terms have recently emerged on body image problems, specifically as they apply to men, such as the colloquial “bigorexia.” Also known as muscle dysmorphia, “bigorexia” is the preoccupation with being insufficiently muscular, which can lead to dangerous steroid use and excessive exercise. Yet, this is not technically an eating disorder.
Empirical evidence suggests that males are more likely to be diagnosed at specialized treatment centers.5 This often leads to the eating disorder having a greater hold over the individual and a longer duration of illness.
Establishing medical, psychiatric, and psychological guidelines that are more inclusive to the male experience of eating disorders, such as testosterone impairment, cardiovascular complications, bone density issues, and steroid use, can help reduce misdiagnoses due to how eating disorders present differently in men.
For example, men with bulimia are less likely than women to engage in “typical” compensatory behaviors, such as self-induced vomiting or laxative use, having more of an inclination to use excessive exercise to control weight and body shape.6 In this case, using assessment tools that emphasize binge habits, emotional triggers, and compensatory behaviors in males could improve accuracy reporting in men and lead to more appropriate interventions.
Men and boys can feel out of place in treatment when surrounded mostly by women. All male therapy groups can encourage vulnerability through empathy. When one man takes a risk and opens up about his issues with food or body image, other men may feel safer disclosing their own issues.
Until more attention and interest are focused on male eating disorder issues, men will continue to be misunderstood, underdiagnosed, and under-treated.
Promoting awareness of the issues surrounding male eating disorders is important in creating environments where men feel safe talking about their issues with food and self-image without worrying they will be judged.
Sometimes men don’t even recognize that their behaviors are a problem, as eating disorders have largely been viewed as a women’s issue. Plus, diet culture often celebrates symptoms such as excessive exercise, striving for a muscular figure, or obsession with healthy eating.
By speaking up about your own experiences with eating disorders and recovery, you can help promote an accepted culture that allows vulnerability in men. This may help create a world in which men will recognize disordered behaviors in themselves and open up about them more frequently.
Furthermore, there is an apparent marginalization of males in eating disorder research. People need to speak up about what research does exist on male eating disorders features a lack of representation within culture, ethnicity, pathophysiology, age, and more.
Not enough voices advocate for men living with disordered eating and poor self-image. So, it’s essential to keep the conversation going to combat the stigma, generalizations, and shame that men with eating disorders face.
Singer, an advocate at the forefront of raising awareness about eating disorders in men, describes himself as a “Professional advocate not by accident, but not on purpose.”
He lived with an undiagnosed eating disorder for 9 years and once was diagnosed with Other Specified Feeding or Eating Disorder (OSFED). He found the most challenging part of recovery was finding resources, communities, and support for men with eating disorders online—there was nothing. That’s when he realized “I could be what I needed for other people.”
“How did I become an advocate? I don’t know, but here we are,” comments Abhilash Patel, Co-Founder of Within Health, when asked about his journey into advocacy for male eating disorders. However, his message is clear, the more people that talk about male eating disorders, the more men will get the help they need.
Encouraging a culture that allows for male vulnerability must be a major goal. In our present culture, men are not supposed to be emotionally vulnerable, yet they encounter intense pressure to be more muscular to meet the current male body ideals.
Also, despite these intense pressures, according to our current culture, men aren’t supposed to be focused on their appearance, so why would they reveal weight or body image concerns?
When more of us start advocating for male eating disorders and more men advocate for themselves, the stigma surrounding these issues can change, and more men can get the help they need.
There is also a clear need for more research into male eating disorders so that better medical guidelines and treatment options specific to males can be developed.