Despite the stereotype that eating disorders only occur in women, about one in three people struggling with an eating disorder is male, and subclinical eating disordered behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among men as they are among women.
In the United States alone, eating disorders will affect 10 million males at some point in their lives. But due in large part to cultural bias, they are much less likely to seek treatment for their eating disorder. The good news is that once a man finds help, they show similar responses to treatment as women. Several factors lead to men and boys being under- and undiagnosed for an eating disorder. Men can face a double stigma, for having a disorder characterized as feminine or gay and for seeking psychological help. Additionally, assessment tests with language geared to women and girls have led to misconceptions about the nature of disordered eating in men.
Treatment is not one-size-fits-all. For any person, biological and cultural factors should be taken into consideration in order to provide an effective treatment environment.
Studies suggest that risk of mortality for males with eating disorders is higher than it is for females - early intervention is critical.
A gender-sensitive approach with recognition of different needs and dynamics for males is critical in effective treatment. Men and boys in treatment can feel out of place when predominantly surrounded by women, and an all-male treatment environment is recommended—when possible.
Men and boys with anorexia nervosa usually exhibit low levels of testosterone and vitamin D, and they have a high risk of osteopenia and osteoporosis. Testosterone supplementation is often recommended.
Learn more about treatment >
Infographic: Eating Disorders in Men & Boys
Get the facts on eating disorders in men and boys with our infographic!
Learn More >
MEN AND BODY IMAGE
There are numerous studies on male body image, and results vary widely. Many men have misconceived notions about their weight and physique, particularly the importance of muscularity. Findings include:
Most males would like to be lean and muscular, which typically represents the “ideal” male body type. Exposure to unattainable images in the media leads to male body dissatisfaction.
The sexual objectification of men and internalization of media images predicts drive for muscularity.
The desire for increased musculature is not uncommon, and it crosses age groups. 25% of normal weight males perceive themselves to be underweight and 90% of teenage boys exercised with the goal of bulking up.
Muscle dysmorphia, a subtype of body dysmorphic disorder, is an emerging condition that primarily affects male bodybuilders. Such individuals obsess about being adequately muscular. Compulsions include spending many hours in the gym, squandering excessive amounts of money on supplements, abnormal eating patterns, or use of steroids.
Learn more about body image >
Types of Eating Disorders
Individuals are diagnosed as anorexic (according to the DSM-IV-TR) if they refuse to maintain the appropriate body weight (according to age and height), and have an intense fear of gaining any more weight - even though they are already underweight (Keel & Klump, 2003). Concisely, if patient "X" is significantly underweight, yet does not want to do anything to correct this then patient "X" is anorexic.
Bulimia nervosa, as defined by the DSM-IV-TR, is just as terrifying as anorexia nervosa. The criteria is as follows: Recurrent episodes of binge-eating--consuming an amount of food which is much larger than most would eat during a similar period of time--at least once a week for three months. A lack of control over binge eating. Recurrent and inappropriate behavior aimed at compensating for the weight gain, self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. The subject�s self-evaluation is based on and influenced mainly by body shape and weight. (Keel & Klump, 2003) In short, a diagnosis of bulimia nervosa is if subject "X" eats more then he or she should, and then inappropriately extinguishes the weight because the subject is not the weight he or she fantasizes to be.
These two disorders, anorexia nervosa and bulimia nervosa, are alarming. Do they have particular risk factors? Can culture, socioculture or genetics cause them? What is their prevalence? These are questions which this paper addresses.
Causes of Eating Disorders
To determine if an eating disorder is culture bound data must be collected and sorted from various cultures along a timeline of many years. Are Eating Disorders Culture-Bound Syndromes? Implications for Conceptualizing Their Etiology, by Pamela Keel and Kelly Klump did just that. They attained statistics from an assortment of cultures and along a timeline of sixty years. The experiment was done for anorexia nervosa and duplicated for bulimia nervosa. The results were surprising. Anorexia nervosa does not seem to be a culture-bound syndrome. Bulimia nervosa on the other hand does seem to be culture-bound. There has been a significant increase in bulimia nervosa during the later half of the twentieth century. One striking fact is that every non-western nation that had evidence of bulimia nervosa also had evidence of western influence. The authors do not take this to be a coincidence (Keel & Klump, 2003).
Cashel, Cunningham, Cokley, and Muhammad, in Sociocultural Attitudes and Symptoms of Bulimia: Evaluating the SATAQ with Diverse College Groups, tested the affect of sociocultural attitudes on eating disorders. The method was to question an array of students from a Midwestern University in the United States. The participants consisted of both men and women. The procedure consisted of having the subjects fill out a structured questionnaire, the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ). After the questionnaire was finished a correlation between Caucasian women, all men, African American women, Hispanic American women, Caucasian sororities and Caucasian non-sororities to body dissatisfaction, drive for thinness, and bulimia was calculated.. SATAQ Internalization was significantly correlated with EDI-2 (a self-report measure developed to assess a variety of symptoms reflective of eating disorders), Body Dissatisfaction and Drive for Thinness. SATAQ Awareness scores were extensively correlated with the Body Dissatisfaction and Drive for Thinness scales for the Caucasian American and Hispanic American female groups. The SATAQ Awareness scores for African American women and men were not considerably related to scores from the EDI-2. The extent of the correlations with eating disorders was the strongest for Caucasian and Hispanic American women (Cashel, Cunningham, Cokley, & Muhammad, 2003). To get to the point, this study proves that there is an affect of sociocultural attitudes on eating disorders.
A third possible cause for eating disorders is substance abuse by the parents. Von Ranson, McGue, and Lacono (2003) tested 674 females and their parents. Daughters underwent assessment of eating disorders while their parents underwent assessment of substance abuse. The results of this study show no correlation between parents with past substance abuse problems and their daughters� eating disorders.
Another possible cause for eating disorders is heredity. If a mother has an eating disorder does it mean her child will as well? Von Ranson et al. (2003) tested this possibility. The findings were chilling. The results show a high correlation between mothers that have eating disorders and daughters that have eating disorders. This strengthens the theory that eating disorders can be passed down from generation to generation.
Genetic relationships could be a cause of eating disorders. The most accurate way to study this hypothesis is by examining monozygotic and dizygotic twins. Monozygotic twins have identical genes, while dizygotic twins do not. The higher the correlation between monozygotic twins points to greater genetic causes and less environmental causes. A study by Klump, K., McGue, M. & Lacono, W titled: Genetic Relationships between Personality and Eating Attitudes and Behaviors was undertaken. The study showed an extremely high correlation between genetic influence and eating disorders for the monozygotic twins and a low correlation for the dizygotic twins. Data can be viewed in Chart G in Appendix I. This strengthens the idea that there is a significant genetic influence in eating disorders.
As presumed, there are many things that can cause an eating disorder. Sociocultural attitudes, heredity, and genetics are much stronger influences then substance abuse and culture causes. This is not enough. Factors such as parent-child bonds, economic status, and intelligence must be studied. Unfortunately they have not. In light of this, we seem to know very little about what actually causes eating disorders.
Prevalence of Eating Disorders
Table 1 shows the point prevalence (1 year) of adolescent males and females. Table A-2 shows the lifetime prevalence of the same adolescents (Andrews, Hops, Roberts, Seeley & Lewinsohn, 1993).
The data in tables A-1 & A-2 was collected by interviewing 10,200 adolescents (under the age of 18) and their parents that lived in a population of 200,000. They were interviewed two times by clinical psychologists or certified social workers. The second interview was about one year (13.3 month mean) after the first. The results of the experiment are divided into anorexia nervosa and bulimia nervosa and further broken down by gender.
Focusing on the point prevalence (Table A-1), neither the adolescent males nor females were diagnosed with anorexia. With regards to bulimia nervosa, a significant number of females in interview one were diagnosed (Andrews, Hops, Roberts, Seeley & Lewinsohn, 1993). During the second interview, just one year later, the amount of females with bulimia nervosa rose.
The results of the lifetime prevalence show that during the one-year gap between the interviews the number of adolescent females diagnosed with anorexia nervosa almost doubled. The adolescent males show no signs of anorexia nervosa. Bulimia nervosa, just as anorexia nervosa, nearly doubles for the female subjects. For males, a small portion were diagnosed with bulimia nervosa; and had a small rise in one year (Andrews, Hops, Roberts, Seeley & Lewinsohn, 1993).
Assessing these results shows the researcher that adolescents are at risk of developing an eating disorder. Females are obviously more at risk (Table A-1 & A-2), but males cannot be omitted. This also shows that adolescents were diagnosed with bulimia nervosa two times more then with anorexia nervosa.
Table B-1 shows the lifetime prevalence of adults with anorexia nervosa (Zhang, & Snowden, 1999). The full chart can be viewed in Appendix I Chart J. The results come from a study of 18,151 American adults (18 years and older). They are broken down into four groups of white, black, Hispanic, and Asian. The results show that white Americans are more vulnerable to be diagnosed with anorexia nervosa then minority groups.
Table C-1 shows the lifetime prevalence of adults with bulimia nervosa divided by sexual orientation. (Siever, 1994) 250 adults participated in the study. The full chart can be viewed in Appendix I Chart K. The results of these findings show that homosexuals, both male and female are at a higher risk of being diagnosed with bulimia nervosa.
In contrast of these prevalence findings you can conclude that anyone is at risk for becoming diagnosed with an eating disorder. In all cases women are at more risk then men. However, men should not be overlooked as victims, as they usually are. The "Eating Disorder Information Board" says that one out of six people with an eating disorder is a man (http://www.eatingdisorderinfo.org/men_eating_disorders.htm). Therefore, eating disorders should be taken very seriously by men, women, and parents of adolescents.Conclusion Do you know someone that has ever had an eating disorder? You answer is more then likely yes. This paper has proved that no sets of people are immune, and that there is a wide variety of ways to contract this disease. There are many causes of eating disorders � genetics, and sociocultural factors are the most relevant. Anyone is at risk for being diagnosed with an eating disorder, however adult women face the highest risk. In contrast, be aware. Learn if you are at high risk for catching this disease. Study the symptoms. If you are experiencing any of them, seek professional help. "Knowing is not enough; we must apply. Willing is not enough we must do" (Johann Wolfgang von Goethe).
Andrews, J., Hops, H., Lewinsohn, P., Roberts, R., & Seeley J. (1993). Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology, 102, 133-144.
Carson, R. C., Butcher, J. N., & Mineka, S. (2002). Fundamentals of abnormal psychology and modern life. Boston: Allyn and Bacon.
Cashel, M., Cokley, K., Cunningham, D., & Muhammad, G. (2003). Sociocultural attitudes and symptoms of bulimia: Evaluating the SATAQ with diverse college groups. Journal of Counseling Psychology, 50, 287-296.
Dev, P., Elredge, K., Eppstein, D., Taylor, B., Wilfley, D., & Winzelberg, A. (2000). Reducing risk factors for eating disorders: Comparison of an internet- and a classroom-delivered psychoeducational program. Journal of Consulting and Clinical Psychology, 68, 650-657.
Dohm, F., Pike, K. M., Striegel-Moore, R. H., & Wilfley, D. E. (1998). Bias in binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 383-388.
Field, A., Heathernton, T., Keel, P., Mahamedi, G., & Striepe, M. (2001). A 10-year longitudinal study of body weight, dieting, and eating disorder symptoms. Journal of Abnormal Psychology, 106, 117-125.
Fitzgerald, L., & Harned, M. (2003). Understanding a link between sexual harassment and eating disorder symptoms: A mediational analysis. Journal of Consulting and Clinical Psychology, 70, 1170-1181.
Halmi, K. A., et al. (1991). Comorbidity of psychiatric diagnoses in anorexia nervosa. Archives of General Psychiatry, 48, 712-718.
Kaye, W.H., Weltzin, T., & Hsu, L. K. G. (1993). Relationship between anorexia nervosa and obsessive compulsive behaviors. Psychiatric Annals, 23, 365-373.
Keel, P., Kelly, L., Klump, L., & Pamela K. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychological Bulletin, 129, 747-769.
Klump, K., Lacono, W., & McGue, M. (2002). Genetic relationships between personality and eating attitudes and behaviors. Journal of Abnormal Psychology, 111, 380-389.
Lacono, W., McGue, M., & Von Ranson, K. (2003). Disordered eating and substance use in an epidemiological sample: II. Associations within families. Psychology of Addictive Behaviors, 17, 193-202.
Michel, D. (2002). Psychological assessment as a therapeutic intervention in patients hospitalized with eating disorders. Professional Psychology: Research and Practice, 33, 470-477.
Siever, M. (1994). Sexual orientation and gender as factors in socioculturally acquired vulnerability to body dissatisfaction and eating disorders. Journal of Consulting and Clinical Psychology, 62, 252-260.
Skodol, A. E., et al. (1993). Comorbidity of DSM-III-R eating disorders and personality disorders. International Journal of Eating Disorders, 14, 403-416.
Snowden, L., & Zhang, A. (1999). Ethnic characteristics of mental disorders in five U. S. communities. Cultural Diversity and Ethnic Minority Psychology, 5, 134-146.
Stice, E., Presnell, K., & Bearman, S. K. (2003). Relation of early menarche to depression, eating disorders, substance abuse, and comorbid psychopathology among adolescent girls. Developmental Psychology, 37, 608-619.
Stice, E., & Whitenton, K. (2001). Risk factors for body dissatisfaction in adolescent girls: A longitudinal investigation. Developmental Psychology, 38, 669-678.
Subich, L., & Tylka, T. (1998). A preliminary investigation of the eating disorder continuum with men. Journal of Counseling Psychology, 49, 273-279.
Von Ranson, K. M., Iacono, W. G., & McGue, M. (2003). Disordered eating and substance use in an epidemiological sample: I. Associations within individuals. International Journal of Eating Disorders, 31, 389-404.
Wilson, T. (1998). Stepped care treatment for eating disorders. Journal of Consulting and Clinical Psychology, 68, 564-572.