How Are Eating Disorders Manifested Differently In Males Than Females

Eating Disorders In Sport

Men who participate in sport are at higher risk of disordered eating and/or eating disorders. Disordered eating can occur in any athlete, in any sport, at any time, crossing boundaries of gender, age, body size, culture, socioeconomic background, athletic calibre and ability .

Research shows that people who engage in aesthetic, gravitational and weight-class sports such asweight-lifting, boxing, horse racing, rowing, gymnastics, swimming, figure skating and danceare at higher risk of disordered eating and/or an eating disorder .

Athletes with eating disorders may partake in unhealthy and potentially dangerous activities such as restrictive dieting, extreme exercise regimes and/or anabolic steroid abuse.

Find out more about eating disorders in sport

What Are The Implications For Psychiatric Practice A Treatment Approach That Emphasizes Normalized Nutrition And Eating Behaviors And That Includes Cognitive

Body image

Not surprisingly, evidence indicates that men are as concerned about body image as women.19 However, unlike women whose preferred body image is thin, mens preferred body image is muscular. Factors that contribute to an abnormal desired, or idealized, body and body image distortion in males include the media, cultural changes leading to unrealistic expectation of body image and muscularity, and body building.20-22

In developing the Swansea Muscularity Attitudes Questionnaire, a study was designed to investigate mens concerns about muscularity. The results suggest that men engage in activities that increase their muscularity because they perceive muscularity will enhance their feelings of masculinity and confidence while improving their attractiveness.

In an experimental study, a computerized body image assessment was used in 27 men with an eating disorder , 21 men who were athletic, and 21 nonathletic age-matched controls.23 The test allowed participants to morph a computer image using 10 levels of muscularity and body fat to depict 4 body types: the participants own body, his ideal body, the body of an average man in his age-group, and the body image women would prefer. While there were few differences on the muscularity indices, there were significant differences in the body fat indices, wherein the men with anorexia nervosa and bulimia nervosa perceived themselves as almost twice as fat as they actually were.

Excessive exercise

Evaluation and treatment

What Are The Warning Signs Of An Eating Disorder In Men

Eating disorders and disordered eating behaviours in boys and men may present differently than in girls and women, particularly with muscularity-oriented disordered eating . For men, body dissatisfaction is more commonly manifested as the pursuit of a muscular, lean physique rather than a lower body weight . While eating disorders in females often starts in adolescent years, men tend to develop eating disorders at an older age. The average age of onset in men is 1726 compared to 1518 in women .

Some of the warning signs of an eating disorder in men include:

• Excessive or compulsive exercise patterns (e.g. Exercising when injured/unwell, exhibiting distress if unable to exercise.
• Preoccupation with fitness and/or muscle toning, body shape, weight and appearance.
• Constant or repetitive dieting
• Restrictive eating behaviour .
• Behaviours focussed around food preparation and planning .
• Bingeing and/or purging.

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Risk Factors For Male Eds

Body dissatisfaction

Discrepancies between mens present body image and their ideal body image is defined as body dissatisfaction . Four studies indicated that there is a positive correlation between BD and development of an ED, especially in males who aspire to achieve a mesomorphic body type . Dakanalis et al. suggested that approximately 50% of the general male population was dissatisfied with their body, making BD one of the most robust risk factors for disordered eating and ED development. A study by Burnette et al. reported that men, in particular, with higher BD and weight suppression, were more likely to engage in loss of control eating and subsequent purging behaviors.

Muscle dysmorphia

Sociocultural influences

Sociocultural influences can negatively influence MD, BD, and subsequently EDs, by portraying a socially prescribed level of body perfectionism . The media and popular culture constantly showcase lean and muscular body image ideals that may evoke feelings of shame in men who fail to embody those aesthetics . This encouragement of BD and MD challenges men across their life span. First, adolescent boys may experience pressures to achieve the perfect body. These pressures are exacerbated as men age, and struggle to maintain this body image while balancing new work responsibilities and life commitments .

Other psychiatric/psychological predispositions

Identity & Eating Disorders

Eating disorders have historically been associated with straight, young, white females, but in reality, they affect people from all demographics and are not caused by any single factor. They arise from a combination of long-standing behavioral, biological, emotional, psychological, interpersonal, and social factors.

Misconceptions about who eating disorders affect have real consequences, leading to fewer diagnoses, treatment options, and pathways to help for those who dont fit the stereotype. Understanding that eating disorders dont discriminate is critical to making sure everyone has access to help and support. When it comes to identity and eating disorders, ones experience should be understood within the broader cultural context of oppression.

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Prevalence Of Eating Disorders In Adolescents

• Based on diagnostic interview data from National Comorbidity Survey Adolescent Supplement , Figure 3 shows the lifetime prevalence of eating disorders among U.S. adolescents aged 13 to 18 years.2
• The lifetime prevalence of eating disorders was 2.7%.
• Eating disorders were more than twice as prevalent among females than males .
• Prevalence increased modestly with age.
• In the NCS-A, eating disorders included anorexia nervosa, bulimia nervosa, and binge eating disorder.

Figure 3

Minority Mental Health Month

July is Minority Mental Health Month, and we at Seeds of Hope make a point to reflect on the truth that all people can be affected by eating disorders regardless of ethnicity, gender, sexual preference or age. Keeping this in mind can help in identifying the signs of different types of eating disorders in yourself, or in a loved one by remembering that eating disorder dont discriminate.

No matter your background, experience or story, Seeds of Hope is here to help. If you or someone you know is looking for a consultation or is ready to enroll in eating disorder treatment, contact Seeds of Hope today at .

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What Explains The Surprising Rise In Eating Disorders Among Men

Eating disorders have long been associated with women and the societal pressures of body image. While its true that eating disorders are more prevalent in women, and particularly young women, men arent immune. Around 10 percent of all anorexia nervosa and bulimia nervosa cases can be attributed to men: a small yet significant statistic. Yet eating disorders in men have long been ignored, even within the medical community.

Thankfully, that may be changing as mental health disorders are increasingly destigmatized and more and more men affected by eating disorders come forward. The changing dynamics have allowed healthcare practitioners to better understand eating disorders, including the ways in which eating disorders affect men. One question that continues to be studied: What explains the rise in eating disorder diagnoses in men and boys, and what can be done to address it.

Other Specified Feeding And Eating Disorder

This diagnostic category includes eating disorders or disturbances of eating behavior that cause distress and impair family, social or work function but do not fit the other categories listed here. In some cases, this is because the frequency of the behavior dose not meet the diagnostic threshold or the weight criteria for the diagnosis of anorexia nervosa are not met.

An example of other specified feeding and eating disorder is “atypical anorexia nervosa”. This category includes individuals who may have lost a lot of weight and whose behaviors and degree of fear of fatness is consistent with anorexia nervosa, but who are not yet considered underweight based on their BMI because their baseline weight was above average.

Since speed of weight loss is related to medical complications, individuals who lose a lot of weight rapidly by engaging in extreme weight control behaviors can be at high risk of medical complications, even if they appear normal or above average weight.

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Statistical Methods And Measurement Caveats

This webpage presents data from the following sources.

National Comorbidity Survey Replication

Diagnostic Assessment and Population:

• The NCS-R is a nationally representative, face-to-face, household survey conducted between February 2001 and April 2003 with a response rate of 70.9%. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview , a fully structured lay-administered diagnostic interview that generates both International Classification of Diseases, 10th Revision, and DSM-IV diagnoses. The DSM-IV criteria were used here. Participants for the main interview totaled 9,282 English-speaking, non-institutionalized, civilian respondents. Eating disorders were assessed in a subsample of 2,980 respondents. The Sheehan Disability Scales assessed disability in work role performance, household maintenance, social life, and intimate relationships on 010 scales. The NCS-R was led by Harvard University.

Survey Non-response:

• In 2001-2002, non-response was 29.1% of primary respondents and 19.6% of secondary respondents. Reasons for non-response to interviewing include: refusal to participate respondent was reluctant- too busy but did not refuse circumstantial, such as intellectual developmental disability or overseas work assignment and household units that were never contacted .
• For more information, see PMID: 15297905 and the NIMH NCS-R study page.

Survey Non-response:

Gendered Accounts Of Eating Disorders For Men

The burgeoning field of masculinity studies has begun to address the consequences of the ways through which men construct themselves as men and members of a larger culture. Others have explored how men construct and maintain gender roles. Intersectional understandings of how men develop bodily aesthetics, gender norms, and gender roles have found racial differences in how men perceive beauty in women , the relationship between class and gender , the social power behind where masculine ideals come from Chen . Davids and Green found that bisexual men had higher rates of eating disorder symptomology than heterosexual men but did not examine the causes for the disorders or how gender or sexual orientation affect their recovery .

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Signs Of Eating Disorders In Boys

Of course not all boys who express dissatisfaction with their bodies will develop an eating disorder.

Heres what to look for if youre trying to determine whether a boys habits are within the normal range of eating behavior or have crossed into something that needs attention:

• Excessive focus on and time spent exercising
• Rigidity around eating rituals
• Eating large of amounts of food
• Going to the bathroom in the middle of meals or right after
• Refusing to eat certain food groups
• Having unusual behaviors around food
• Obsessively reading nutrition information or counting calories
• Constantly weighing himself or looking in the mirror
• Avoiding or withdrawing from social gatherings involving food

Are Eating Disorders In Males A Rarity

While the notion that EDs did not occur in males prevailed for close to a century, clinical data during the late 1970’s and 1980’s began to illustrate a limited number of male ED presentations in specialist ED clinics across several countries , forcing researchers to reconsider this premise. During the 1990’s, more systematic research sought to examine the prevalence and

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Weight At Presentation And Premorbid Weight History

No significant gender differences with regard to weight in SDS, BMI or BMI SDS at presentation were found. These results are in line with some of the previous research . With regards to premorbid weight history we found, in line with Sharp and colleagues , Fernández-Aranda and colleagues and Gueguen et al. , that males had a higher prepuberty BMI, BMI SDS and weight measured in kilograms, as well as a higher top weight measured in kilograms and SDS but not as measured in BMI or BMI SDS. However, as many as one in every five males had a history of a premorbid BMI SDS greater than 2 both at prepuberty and at top weight, highlighting the need for clinicians to thoroughly investigate the previous weight history as our study indicates that males may present with a more drastic weight loss despite having a similar BMI SDS at presentation.

Again, it should be noted that it is difficult to compare differences in weight between studies since not all studies report the same measures . A universal reporting of weight would make comparison of results across studies simpler.

Age Culture And Ethnicity

Of the relatively few studies relating specifically to EDs in males to date, the majority have been conducted in Western settings, and have focussed on adolescents or young adults of Caucasian ethnicity. With specific respect to age, while a focus on young adult or adolescent samples may seem intuitive given that this is the most common period of onset , an important gap in the literature relates to the trajectory of disordered eating profiles in males

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Mens Eating Disorders Often Not Recognized

But even as he lost weight, she and her husband didnât realize the extent or true cause of the problem.

Like all the parents quoted in this story, she asked that her last name not be used to protect her sonâs privacy.

Ashley wasnât the only one who failed to identify what was happening. Her husband thought their son was having a growth spurt. A nutritionist called it âa phase.â The emergency room doctor she sought out when she didnât know where else to turn attributed his weight loss to being active and involved in sports. The ER doctor also said they needed to follow up with a pediatric oncologist to make sure Jordan didnât have cancer.

âHe basically told my son to add smoothies to his diet, and he jumped to cancer as a possibility,â Ashley says.

Ashley had to wait 3 weeks before a pediatric oncologist could see her son. But thankfully, he knew exactly what was going on. âHe pulled my husband and I aside and said, âYour son doesnât have cancer. He has an eating disorder.ââ

âI look back at pictures now and think, how did we miss it? But we were around him all the time, and we saw him eating. We didnât realize how much he was exercising though, and we just didnât notice the drastic change at first,â she says. âAn eating disorder didnât come to mind because itâs just not well-known in boys.â

Initial Contact With Healthcare Services And Information

Eight of the men had been formally diagnosed with an ED. The other two identified with prolonged ED behaviours over years but neither had yet chosen to seek diagnosis. The route to diagnosis could be complex and lengthy, even when men presented late in their illness and were in need of specialist psychiatric services. Men could face a lengthy waiting list, during which time their symptoms escalated further. Even when men had made the decision to seek help, commonly someone else, typically their mother, took them to the first appointment. Usually the first contact with formal services was with their GP, although participant 3 preferred to see a locum GP because obviously didn’t have a relationship with that doctor, so that made it a bit easier to talk about stuff and I think I was so desperate anyway I just wanted to tell somebody and participant 4 chose to see the school counsellor.

Participant 1 described his first GP contact as very helpful, acknowledging his GP’s willingness to offer support, but ultimately frustrating because:Her struggle was that they haven’t got the services to give to you. They want to but they just haven’t got them. Participant 1

Only after an admission to accidents and emergency department following a suicide attempt were participant 5s problems recognised and he was immediately referred to an ED clinic for intensive outpatient treatment.

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Biological Sex Gender Identity And Depression

Biological sex and gender identity are among these contributing factors. It’s long been thought that men and women experience and express depression in different ways, but that doesn’t mean the condition could be divided into two distinct forms. Its more akin to the way mental illness can manifest differently in children and teens than it does in adults.

On their own, biological sex and gender differences may not have a powerful impact. When combined with other factors, such as life stressors, sexism, toxic masculinity, trauma, and co-occurring mental health conditions like anxiety, substance use disorders, or eating disorders, these influences may make a person more prone to depression.

Understanding The Subtle Differences

Carly Snyder, MD is a reproductive and perinatal psychiatrist who combines traditional psychiatry with integrative medicine-based treatments.

• Impact on Depression Treatment

Depression is characterized by a core set of symptoms including low mood, lack of motivation, loss of pleasure in activities and hobbies, changes in appetite, sleep disturbances, feelings of guilt, and difficulty concentrating.

Most people with depression experience at least a few of these hallmark symptoms, though they may not have them all and they may have others. Research has suggested that individual factors combine to determine what someones experience of depression looks and feels like.

No two people with depression will have identical experiences, but understanding how each contributing factor affects a person’s risk and symptoms could lead to more effective treatment.

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Hiding In Plain Sight

Unlike with girls, who often become alarmingly skinny and visibly unhealthy, eating disorders in boys are harder to recognize because often nothing looks wrong on the outside. Eating disorders in boys are also easier to hide under the guise of what is considered acceptable, even laudable, male behavior.

Exercising, even excessively, is socially valued in men, says Dr. Bunnell, who adds that overeating is also more socially condoned in men than in women. A group of 17-year-old boys eating multiple Big Macs, for example, might be considered amusing or even cool, he says. In fact, these behaviors may be masking an eating disorder, but we dont notice the psychological suffering piece.