Back to Basics: Men And Eating Disorders

     This month’s article was written by Gary Snapper, LPC, LLP, an active SMEDA Board member.  He is a licensed Professional Counselor and a Limited License Psychologist who founded Cognitive Behavior Solutions in Kalamazoo. He specializes in the treatment of eating disorders, anxiety disorders, and personality disorders.

 Back to Basics:  Men and Eating Disorders

     Most people associate eating disorders with women; women with anorexia, women who binge and purge their food, women who binge eat. Many are surprised to learn that men are also susceptible to eating disorders.  Examples of men struggling with disordered eating have appeared in medical records over the centuries. The earliest recorded example of a man with anorexia is a commonly considered case from 1689. The English physician Richard Morton described the case of a male adolescent who began fasting at 16 years of age.   Dr. Morton described the trigger for the fasting as “studying too hard,” along with “the passions of his mind.”  Dr. Morton told the adolescent to abandon his studies, move to the country, take up riding and drink plenty of milk.  This change in lifestyle led to the young man recovering, “his health in great measure.” If only all treatments of anorexia could be accomplished so directly.

     Today, males are estimated to represent up to 25% of cases of anorexia, with only 5% of these seeking treatment.  As with females, stigma contributes to treatment avoidance in males with ED.  One study concluded that being labeled gay or feminine can act as a stigma in male eating disorders, preventing some males from seeking treatment.  Another source of stigma is the pervasive female focus in the literature, support services, research, and treatment options.  One survey concluded that over 99% of books published on eating disorders assume a female bias in pronoun, as well as in the topic focus. Males who start to search resources for ED treatment are likely to observe these biases, and may be reluctant to continue their exploration.

     Comparative analyses between male and female eating disorders are needed, including manifestations, treatment options, outcomes and stigma.  Initial studies suggest a number of gender-specific trends in eating disorders.  For example, mortality of eating disorders may be higher in men.   Another trend is that males with ED tend to have a higher incidence of overexercising than do females. A study comparing results between 108 men and women receiving residential treatment for eating disorders, identified that men scored lower (less intense) on questions regarding body dissatisfaction, bulimic behavior and drive for thinness. This supports the hypothesis that assessment tools may be more effective if created to be gender specific. Similarly, further research might help steer the development of gender- aware treatment protocols to enhance effectiveness of therapy options. 

     Unfortunately, as with treatment of eating disorders in women, men with eating disorders have limited options for evidence-based treatment.  For adolescent males and females with Anorexia, there is a research-supported treatment option termed Family Based Therapy (or the Maudsley approach).  This therapy approach includes three phases of treatment.  Phase I is focused on refeeding at home, with parents encouraging the teen to eat more food per meal with the goal of weight restoration. Phase II focuses on client empowerment, giving more control back to the teen and decreasing parental supervision over time. Phase III focuses on establishing a healthy adolescent identity (increased autonomy, developing healthy boundaries toward and from parents, and fostering increasing independence over time). Studies suggest that weight restoration occurs in 70-90% of both male and female participants, with 5-year weight retention.

     For adults of both genders, research continues to support the use of Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), and Interpersonal Psychotherapy (IPT) as treatments of choice for Bulimia Nervosa, Binge Eating Disorder, and Anorexia Nervosa (mildly effective).  Unfortunately, as with all eating disorders, even the most effective treatments are not as effective for individuals with more intense symptoms of each type of eating disorder. Underfunding for research of treatments for eating disorders is yet another challenge to overcome.

     In summary, despite centuries-old records of males with eating disorders, research on males with eating disorders is and has always been limited.  The available research suggests that although current evidence-based treatments may be equally effective for both genders, males’ symptoms manifest differently and are less likely to be diagnosed than those of their female counterparts.  Males also avoid seeking treatment for different reasons than do females.   Attention to these differences and a more inclusive support environment are needed to help males get the treatments currently available that might benefit them.

References:

1)      Stanford, S.C. Volume 20, 2012 - Issue 5: Males and Eating Disorders. A Clinical Comparison of Men and Women on the Eating Disorder Inventory-3 (EDI-3) and the Eating Disorder Assessment for Men (EDAM). The Journal of Treatment and Prevention.

2)      Striegel RH, Bedrosian R, Wang C, Schwartz S: Why men should be included in research on binge eating: results from a comparison of psychosocial impairment in men and women. Int J Eat Disord. 2012, 45 (2): 233-240. 10.1002/eat.20962.

3)      Striegel-Moore RH, Leslie D, Petrill SA, Garvin V, Rosenheck RA: One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims. Int J Eat Disord. 2000, 27 (4): 381-389.

4)      Zhang, Chengyuan. Journal of Eating Disorders 2104 2:138. What Can We Learn From the History of Male Anorexia Nervosa?