A stereotypical person with an eating disorder is a woman – and there is some truth behind that stereotype, as many women do struggle with issues involving body image and nutrition.
For example, in a survey of American women ages 25-45, highlighted by Psych Central, 65 percent had at least one behavioral issue involving food intake, and about 10 percent has symptoms consistent with an eating disorder.
Clearly, many women in this country struggle with issues involving body shape and size, but eating disorders can impact men, too. In fact, the National Eating Disorders Association (NEDA) suggests that about 10 million men struggle with some type of eating disorder at some point in life. And that number could be obscuring many men who have eating disorders, according to Ralph Carson, MD.
“Males are not really researched, simply because it’s hard to get subjects to observe,” he says. “There is a very real stigma with eating disorders. Men think it’s ‘for girls’ or that it’s gay.”
When men do not enter treatment programs, they do not give researchers the chance to understand their stories, their risks, and their successes. So leaning on published statistics does not always tell the whole story of men with eating disorders. “The data can be weak or just old,” Dr. Carson says.
Since eating disorders are not typically associated with being male, and since there are not many published articles about how these disorders impact men, those males who do have eating disorders could be struggling in silence.
Their behaviors may be explained away or hidden altogether, and they may not even recognize that their thoughts and behaviors are indicative of an eating disorder.
It is a difficult issue, but thankfully, there is a growing awareness that men can deal with eating disorder issues. That means there are many new and innovative programs that could help men to recover from the issues impacting their health and happiness.
Any man could develop an eating disorder. These issues do not discriminate based on factors like age, race, or sexual preference. However, prior research suggests that eating disorders are more common among men who identify as gay. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), about 14 percent of men who identify as gay have bulimia, and over 20 percent have symptoms consistent with anorexia.
That high prevalence could be due, in part, to cultural pressures within this community of men. NEDA reports that men who identify as gay tend to weigh significantly less than men who identify as heterosexual, and they tend to idealize an underweight body type. These are men with a drive for thinness, and they might be willing to do almost anything to achieve that body shape, even if it involves an eating disorder.
This has been, for years, a standard explanation for eating disorders in men. But Dr. Carson says that research is shifting that belief.
“It’s clear that LGBTQ people are overrepresented in eating disorder literature in males, and that might be because that’s who comes to seek treatment. They ask for help, so it appears that there are more of them with eating disorders,” he says.
“But there is a movement to call this the ‘male myth of eating disorders,'” he says. “Eating disorders are not only a gay man’s issue. The same doesn’t apply for lesbian women, so why should it be true in men? And if it’s a stigma that keeps men out of treatment, it is something that should be discussed.”
Dr. Carson stresses that men who do not identify as gay can still develop eating disorders. After all, the cultural expectation of beauty for heterosexual men involves a body that is both thin and muscular. A V-shape, packed with muscles in the shoulders and tapering down to slim legs, may not be achievable for all men, unless they resort to unhealthy habits in order to push their bodies into this particular shape.
There is a link between victimization with sexual harassment and male eating disorders, Dr. Carson says. People who are targeted due to the way they look can become interested in changing that outer appearance, so they will not become victims another time. Bullying due to appearance has also been linked to the development of eating disorders in some men.
Men who participate in sports like wrestling, swimming, and gymnastics can also be vulnerable to the development of an eating disorder, Dr. Carson says, because these athletes might use diet and relentless exercise in order to change their bodies in ways that are consistent with the sport. Those changes could be disastrous for the health of the body as a whole.The way a man feels about his body will help to influence what sort of eating disorder is in play.
Of those eating disorders, BED is the most common among men. About 2 percent of men have BED, according to NEDA, and about 40 percent of all people who have BED are men. There are some eating disorders that seem to impact men more often than women.
“Body dysmorphia, which isn’t really recognized as an eating disorder, impacts a high amount of males,” Dr. Carson says. “It is, in some ways, the antithesis of anorexia. A male with this disorder wants to gain weight, not lose it. And it can morph into an Adonis complex or bigorexia.”
A man with body dysmorphia is still, at his core, concerned with the way his body looks, and he is likely to use diet and exercise, along with surgical corrections and medications, to change his body in order to meet that cultural expectation of shape. That’s what makes body dysmorphia fall into a continuum of eating disorders.
“For so long, eating disorders have been considered a female condition, so males shy away from it,” Dr. Carson says. “They aren’t females, so they think it can’t happen to them, or they don’t want to be given a female label or a female disease.”
That stigma could be devastating to a man, and it could impact his recovery. According to ANAD, men are less likely to search for treatment options for eating disorders, simply because they think only women develop these diseases. If they recognize their symptoms at all, they may attribute them to some other illness or issue, so they may not ask for specific eating disorder therapy. Should these men know that they do have eating disorders, they may assume that there are no treatment programs that could help, as they may assume that men are not welcome in eating disorder programs since most are made for women.
Just as men may not seek out treatment for themselves, their family members and friends may not offer the sort of guidance that could lead to an eating disorder treatment program. These family members and friends may not intervene, simply because they may not recognize the signs of eating disorders in men. Dr. Carson uses anorexia in males as an example of this phenomenon.
“Anorexia in males can be very different. They just don’t look as thin as women with anorexia do. Women look really thin because they use starvation. Men use excessive exercise, and when people see them, they just think these men are slim,” he says. “In reality, they are much too slender, but it can be easier to hide.”
Even clinicians may overlook signs of eating disorders in men. “In the past, the clinical reference books didn’t even mention men. Up until recently, the DSM defined anorexia with a lack of menstrual periods. Men were just invisible. A lot of that is changing now,” Dr. Carson says.Some men add to the issue by engaging in disordered eating habits that are considered culturally acceptable for men. For example, research from Oregon State University suggests that men tend to exercise much more frequently than their female counterparts. Men tend to get at least 30 minutes of exercise each day, while women get much less.
A man with anorexia could mask that issue by spending a great deal of time at the gym. He could run on the treadmill, hoping to burn calories, or he could spend hours doing fast weightlifting moves in order to burn away fat cells. His behavior is driven by his eating disorder and his relentless need to get smaller, thinner, and leaner. But his behavior might seem, to an outsider, like a behavior that is acceptable or even desirable for a man. If most men go to the gym, this man might fit right in. His behavior may not raise any red flags for the people who love him.
Similarly, men with BED might take in a huge amount of calories each and every day during a binge, but those episodes might be culturally acceptable behaviors for men. Some people believe that men, if given the opportunity, will sit down and eat everything they can find. This is a cultural expectation, and it makes binging at least familiar, if not accepted, behavior for all men.
Men with anorexia or bulimia might be influenced in the opposite direction, too. If it is assumed that lazy, unappealing men eat anything they can eat in great amounts, men with anorexia or bulimia who have very strict rules about what they can and cannot eat might be praised for that behavior. It might seem as though they are pushing back against a negative stereotype, and they might get recognition, not concern, for the food choices they make.
Men with body dysmorphic disorder may hide their behavior by suggesting that they are simply trying to change the way they look in one very small, very specific way. They may suggest that they will stop making changes once they have achieved that one tiny change, but for someone with body dysmorphic disorder, there are always new things to change.
There are red flags to watch for, Dr. Carson says, including pec or calf implants, and steroid abuse. These are strong body changes, and they could indicate that something new and unusual is happening; however, they could be issues men try to hide.
When behaviors are hidden or explained away, they can keep families from stepping in and providing appropriate help. That means families that do not recognize signs of an eating disorder might not hold an important conversation about eating disorders known as an intervention.
In an intervention, the family talks openly about the signs and symptoms of eating disorders seen in the man they love. The family discusses how these issues come about, and how they can be treated. The family then asks the man with the eating disorder to enroll in a treatment program and get the appropriate help for that disorder, as soon as possible. Sometimes, the family even escorts the man to care at the end of the conversation.
An intervention like this is easier to hold when the man agrees that there is an eating disorder present. Eating disorders in men can come with a great deal of denial. Men just may not realize that this is an issue, and they may not agree to get care at the end of an eating disorder intervention.
“Men don’t get treatment because they are scared to admit it, or because they are not aware that it exists,” Dr. Carson says. These men are not being stubborn or difficult. They simply do not understand what is happening right now or what should happen in the future.
The health issues associated with an eating disorder can, in time, prove fatal. The body needs the right amount of nourishment at the right time in order to perform at an elite level. People who eat too little or too much can put their very lives at risk.
But the consequences of an eating disorder do not stop with the physical realm. There are mental health consequences, too. Mental Health America reports that people with eating disorders can face co-occurring mental health conditions, including depression and anxiety. Those mental health concerns can make people feel even worse about their bodies, and that can lead to even more disordered eating behavior. Sometimes, men with eating disorders can develop drug and/or alcohol addictions as they attempt to medicate the distress the disordered eating can cause. Those addictions can make people feel yet worse, and that could make the urge to engage in disordered eating even stronger.
Relationships can also suffer, when a man has an eating disorder. It is hard to connect in an open and honest way with other people when a man is hiding the one thing that is most important to him. If he cannot talk about the way he feels about his body, or if he does not feel as though he can discuss the foods he either craves or ignores, even though these are thoughts that consume him, he may not feel as though he can have an authentic relationship. He may withdraw from his relationships altogether, or he may lash out at the few people who are trying to help him. As his isolation grows, his need to medicate with food may grow yet stronger.
Dr. Carson recommends looking for facilities that both accept male patients and that have a large number of male patients. A man should not be the only male in the program at that time.
He will need peers, and he will need a treatment team that is accustomed to assisting men with eating disorders.
“I will know that men are seeking help when treatment centers for men start opening up,” Dr. Carson says. Families may need to be selective, but there is help available.
Recovery for men with eating disorders is possible. It could start now. If you, or someone you love, are dealing with this issue, ask for help. It could change your life.