Gender differences in eating disorders may keep men from being properly diagnosed and treated. What may look extremely athletic may actually be tearing a man apart.
A recent review of multiple studies on male eating disorders highlighted gender differences in symptoms, underlying causes and appropriate treatment plans.
Changes in diet affecting testosterone levels, substance abuse problems and excessive exercise and strength training were all factors in the gender differences between eating disorders for men versus women.
"Seek professional help for any eating disorder symptoms."
Raymond Lemberg, PhD, eating disorder specialist at Prescott House, an extended care treatment facility for men in Prescott, AZ, worked with fellow therapists at Prescott House for this investigation.
For the study, researchers reviewed multiple studies on eating disorders to identify differences in anorexia nervosa and bulimia nervosa in men compared to women. To start, researchers noted that overall bulimia nervosa was found to be more common than anorexia nervosa in men.
Anorexia nervosa is an eating disorder defined by a drive to lose weight regardless of health consequences. People with anorexia often see themselves as overweight, even if they are underweight. Over-dieting and over-exercising are the most common weight-loss techniques used by anorexic people.
Bulimia nervosa is an eating disorder defined by a loss-of-control binge eating episode followed by an extreme measure to purge the body of the excess food. The most common purging techniques are inducing vomiting and/or abusing laxatives. Over-exercise after a food binge was found to be more common in men than in women.
Dr. Lemberg's team broke the gender differences in eating disorders down into seven categories. Each category highlights the ways in which past experiences, society and mental health states can influence eating disorders specifically in men.
Prior to developing an eating disorder, most women perceived themselves as fat, while in actuality they were within a normal weight range. Men, on the other hand, were more likely to report having been overweight or obese during childhood and/or adolescence. Many men also reported exercising in order to prevent the kind of medical illnesses they had seen in their fathers.
Frequently, eating disorders in men were linked to athletic goals or sport-specific expectations, especially in men with an injury who did not want to gain weight during recovery.
Sexual Abuse & Other Trauma
Based on previous research, authors estimated 30 percent of eating disorder patients were sexually abused. Authors suggested men might be underrepresented in this category, as males may be less likely to report sexual abuse than females.
Authors pointed to a distorted body image as the result of abuse or trauma that can contribute to developing an eating disorder. Authors recommended that treatments should include addressing the aspect of distorted body image that may be at the root of the eating disorder.
Male eating disorders may also result from bullying, which can drive men to manipulate their bodies to stop the aggression.
Gender & Sexual Orientation
Researchers reported eating disorder symptoms were 10 times higher in gay and bisexual men than in heterosexual men.
The over-dieting and/or over-exercising involved with anorexia nervosa can alter hormone levels causing a drop in testosterone in men. When men have issues with their sexuality, the drop in testosterone can cause an “asexual” state. A return to normal eating can reverse the asexual state and bring sex drive back to normal.
Testosterone suppression may be a subconscious desire fueling the eating disorder. Authors recommended awareness of any psychological issues with gender orientation or sexual orientation when treating anorexia nervosa.
Depression & Shame
Researchers referenced a study that found men and society may see depression and shame as “feminine,” thereby inhibiting men from reporting depression and shame as part of the eating disorder.
Authors said, "Underreporting of eating disorder symptoms (similar to what was mentioned previously about sexual abuse) is a major inhibitor to diagnosis, treatment, and accurate research for advancement in this area."
Exercise & Body Image
Men can develop a niche of anorexia called "anorexia athleticism" by over-exercising or excessive dieting. These behaviors can become obsessive and interfere with work, social activities or keeping up with day-to-day responsibilities.
Muscle dysmorphia, or reverse anorexia nervosa, can happen when a person sees certain parts of his or her body as unacceptable. Authors said, “[A]n individual is over-concerned, or obsessed, with certain parts of their bodies, in which they misperceive as being irregular or extremely unattractive.”
Abuse of steroids and growth hormones was also found in men with muscle dysmorphia, excessive exercising and eating disorders.
Drug & Alcohol Abuse
Researchers found that around 57 percent of males with binge eating disorder also had a substance abuse disorder, compared to only 28 percent of females.
Of men with bulimia, approximately 24 percent had alcohol abuse or dependence. The abuse of stimulants is also common for weight management.
Authors recommended that treatment programs for substance abuse include an evaluation to determine if an eating disorder is involved as well. If so, treatment of the substance abuse disorder alone may not solve the problem long-term.
Researchers cited a study which found that, over the last 25 years, male models have lost roughly 12 pounds of fat, while gaining around 27 pounds of muscle.
Unrealistic body images in the media began in the 1960s and have consistently become more and more unrealistic over the years.
Authors recommended treating men with eating disorders in all-male treatment groups, as eating disorders are based on body image and treating them requires an empathetic setting to encourage honesty and vulnerability.
Authors found men to have less of a drive for thinness than women. Men in the studies were just as likely to want to lose weight as they were to want to gain lean muscle mass. Authors recommended different approaches to assessing and treating men versus women with eating disorders since the underlying motives behind the disorders could be different as well as perceptions of body image.
This study was published in September in Eating Disorders: The Journal of Treatment & Prevention.
No financial information was given. No conflicts of interest were reported.