Atypical anorexia in men

What is atypical anorexia nervosa?

Previously listed under the umbrella term "other specified feeding or eating disorder" (OSFED), atypical anorexia nervosa (AAN) is one of the newest conditions to be recognized in its own right in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the listing of all officially identified mental health conditions.¹

The issue involves all the same diagnostic criteria as anorexia nervosa (AN), except for low body weight.³ In other words, those with AAN still experience an intense fear of gaining weight, work to actively prevent weight gain, and harbor a disturbed or distorted body image. However, they remain at a "normal" or "above normal" weight per BMI classifications, even after experiencing "significant weight loss" related to the condition.³

Despite some in the medical world taking issue with this vague definition, AAN has been studied as it stands, with research indicating that the condition may be more common than anorexia nervosa itself.¹ Some research even suggests those with AAN may experience even greater distress around body image than those with anorexia nervosa.¹

Still, many studies concede that the condition has not been widely studied, meaning it's possible that even more people struggle with atypical anorexia nervosa than current estimates indicate.¹ And, due to additional common medical blindspots around men and eating disorders, it's possible that a large number of these people are male.^2,8

How does atypical anorexia affect men?

With limited research behind the issue, it's difficult to make broad statements about atypical anorexia in men. However, some studies suggest that athletes and racial/ethnic, sexual, and gender minorities may be at an increased risk of developing the disorder.⁵

It's likely that, as with typical anorexia nervosa, AAN may also present differently in men than in women.⁴ In men, distorted body image tends to center around muscularity and building a lean, muscular body, as opposed to achieving thinness, as is generally the focus in women.⁴

Similarly, men and boys with atypical anorexia may focus on building muscle mass through excessive exercise, weightlifting, and supplement use instead of or alongside restricting their food intake.⁶ The food restriction may take the form of eating lots of protein while cutting out fat and carbs. This may also co-occur with muscle dysmorphia or the irrational belief that their muscles aren't big enough, leading to a fixation on working out or building muscle.⁷

Treatment barriers men with atypical anorexia face

Men with any kind of eating disorder encounter some common barriers to treatment, including diagnostic criteria and scientific research that has long focused on a very narrow population: dangerously underweight women.¹

This long history may have led to issues with screening and assessment of eating disorders in boys and men.⁴ Some in the scientific community have called for other measures of disordered thoughts and behaviors, such as muscularity-oriented eating tests (MOETs), to be used when evaluating patients, particularly boys or men, for eating disorders.⁹

Current eating disorder treatment guidelines are similarly skewed toward the experiences of girls and women.⁸ This can present further issues or interruptions to treatment, even when or if a male is successfully diagnosed with atypical anorexia nervosa or other eating disorders.⁸

All told, this unfortunate combination of factors can lead to men and boys with atypical anorexia nervosa and other eating disorders going undiagnosed for longer, which can lead to an increased risk of medical complications. (6)

How to better support men with atypical anorexia

Men with atypical anorexia nervosa may be at a particularly high risk of experiencing serious eating disorder symptoms without receiving appropriate care. But there are ways to work on correcting this dangerous issue.

Including better, more inclusive ways to screen for eating disorders, particularly tests like the MOET, which account for presentations more common in males, can help researchers better identify these conditions in all populations.⁹

Reworking treatment programs to consider the symptoms, needs, and other issues particular to men with atypical anorexia and other eating disorders can also be helpful. Conducting further research on atypical anorexia in men can help bring to light more information, which can be used in continuing to refine these processes as well as educating healthcare workers to understand the condition better.

Treating atypical anorexia nervosa in men

Further research is the first step toward developing better and more specific treatment methods for men with AAN and other eating disorders. But short of that, there are other ways for men to find appropriate help.

Most eating disorders require an individualized, multidisciplinary approach to treatment, including a combination of therapies, nutrition education, and medical support. These may include psychological therapy, alternative therapies, family and group therapy, nutrition counseling, and medical monitoring to ensure their physical health is stable. 

Creating a safe, supportive, stigma-free environment to share feelings and challenges is another crucial aspect of supporting men with atypical anorexia or anyone who is struggling with any eating disorder.

Working closely with experts who specialize in eating disorders and strive to provide compassionate, inclusive, individualized care to all can make all the difference on the road to recovery. Contact the Within treatment team today to learn more about our personalized treatment programs.

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