While many in the mental health field who work with eating disorders are acutely aware that men do in fact suffer from eating disorders, there remains a high degree of stigma and a lack of awareness surrounding this topic in both the general public and among professionals. This was readily apparent as I began to research this article; a search of a popular research database yielded 1,961 results for “eating disorders” and “men”, while a search of “eating disorders” and “women” came up with nearly 10,000. This trend is unfortunately reflected socially, as many still believe that eating disorders are a gender specific problem. While the lifetime prevalence rates of eating disorders in males and females seems to hover at a 1:10 ratio, there is growing and significant evidence that this skew is a result of clinical under-detection and a lack of accurate self-reporting among men with eating disorders, rather than actual prevalence rates.
Recent studies have shown that the likelihood of a male having eating disorder symptoms is far more common than previously thought, and seem to be increasing (Gadalla, 2009). According to nationaleatingdisorders.org, 4-10% of college aged men showed positive screens for eating disorder symptoms. It has also been demonstrated that male body image concerns have dramatically increased over the past three decades, with 15-43% of men being dissatisfied with their body; this is a highly comparable rate to women. When comparing binge eating disorder specifically, the ratio between men and women who meet those criteria is around 1:2, with some studies showing an equal distribution. Even with growing evidence that men suffer from eating disorders much more commonly than previously thought, there is still a significant lack of awareness societally.
What factors into the perception that eating disorders are a gender specific problem and what are the costs of this? As stated above, the perception that males with eating disorders are rare is partly due to a lack of accurate diagnosis and/or inaccurate reporting from those who are experiencing the behaviors. In order to objectively assess the extent of eating disorder behaviors in an individual, clinicians and treatment centers often utilize one of many assessments for this purpose. Unfortunately, studies have shown that males typically score lower on eating disorder assessments than their female counterparts, even when the actual symptoms and behaviors are highly similar. The authors (Darcy, Doyle, Lock, et al., 2012) suggest that the questions used on these assessments reflect symptoms that are atypical for males. This does not mean, however, that their symptoms are any less severe. This makes it likely that even when men do seek help for their eating disorder behaviors, they may have difficulty getting that help because professionals are viewing their symptoms as not as severe as they actually are. Raevuon, Keski-Rahkonen, and Hoek (2014) confirm that there are sex-specific differences in the presentation of eating disorders that have not adequately been described in our diagnostic and assessment procedures, leading to clinical under diagnosis and a lack of treatment services.
Males are also typically less likely to seek help for any form of mental illness or distress. It has been suggested that this is due to cultural and social factors, including the gender norm that men should “man up” and not talk about their problems. Additionally, there is still a mental health stigma in our society that makes people, regardless of gender, hesitant to seek help. For men with eating disorders, these factors create significant barriers to seeking help. Men with eating disorders often experience a “double stigma”, of not only having a mental illness but having what is considered by many to be a “female only” mental illness. According to Raisanen and Hunt (2014), men who have sought treatment reported that health professionals were slow to recognize their behaviors as symptoms of an eating disorder, and that there was a significant lack of resources for men seeking help. To add to this, many treatment centers that focus on eating disorders do not allow men to participate in their programs (Inner Door Center does in fact treat men in our PHP and outpatient eating disorder programs). Keep in mind that eating disorders have the highest mortality rate of any mental illness, and a lack of treatment for any reason has the possibility of resulting in serious health consequences or death.
Raevuon et al., (2014) have identified important differences in risk factors and in the clinical presentation of men with eating disorders. There are significantly higher rates of eating disorders among the LGBTQ population, as well as among males who have been diagnosed with depression or PTSD. Litwick, Mitchell, and Sloan, et al. (2014) report that 45% of male veterans have experience one or more current symptoms of bulimia nervosa or binge eating disorder. Men with eating disorders can experience bodily concerns related to both weight and muscularity, and it is important to distinguish between them. An intense focus on athletic achievement and excessive exercise is also common. Many men report feeling an intense pressure to look a certain (often unrealistic, unobtainable, and potentially unhealthy) way, largely derived from the impact of mass media.
Inner Door Center is a JCAHO accredited eating disorder treatment center that offers multiple levels of care to fit your specific needs. If you, a loved one, or someone you know are suffering from an eating disorder, or any other mental health concern, please contact Inner Door Center at (248) 336-2868.
Written by Jeff White, LLPC