We Aren't Talking About Eating Disorders in Men Enough

Eating disorders are twice as common in women as in men. However, women may also be more likely to be diagnosed with eating disorders in part because the disorders themselves are so heavily associated with women.

Overall, male eating disorders are more likely to go undiagnosed. The NIMH in 2008 estimated the number of men with eating disorders to be about one million, but that number is likely higher, according to a 2012 study. A 2018 study noted that disordered eating behaviors are increasing among men more than among women.

Approximately 25% of all diagnosed cases of anorexia nervosa and bulimia nervosa are in men. However, the National Institute of Mental Health (NIMH) reports anorexia is three times more common in women and bulimia five times more common.

Although studies report binge-eating behaviors may be more common among men, binge-eating disorder, as defined by the DSM-5-TR, is statistically more common in women.

Common differences between male and female disordered eating

One difference in the presentation of disordered eating in men versus women is often the emphasis on gaining muscle. The idealized male body tends to be an “action figure” body type with a small waist and a larger chest and biceps.

This is an eating disorder pathology particular to men that lead some men to use anabolic steroids or other nonprescription drugs. Men are more likely to feel that they are too small or too thin. Women, in contrast, predominantly report a preoccupation with thinness and are more likely to starve or purge.

Men, for this reason, are more likely to overeat than women and more likely to report constantly examining their bodies. Women, in contrast, are more likely to report avoiding looking at themselves.

LGBTQ+ men are more vulnerable to eating disorders than cisgender men. Transgender men, in particular, are about five times more likely to develop disordered eating behaviors than cisgender men. They are also more likely to report body dissatisfaction.

Men are more likely to mask their eating disorder symptoms than women, along with depression and anxiety that may coexist with those symptoms. When men do not report their symptoms, they do not receive accurate diagnoses or any diagnoses at all.

Another problem with underreported symptoms is that it contributes to the lack of research on eating disorders in men. Because 99% of research focuses on the presentation of eating disorders in women, doctors and therapists may miss the signs of eating disorders in men.

For example, the current criteria for diagnosing an eating disorder centers on failure to gain weight; many men with eating disorders say they want a larger body or to gain weight.

Binge-eating disorder is the most common eating disorder in the U.S. and the most common among men, with a prevalence of 0.8%. Signs and symptoms of binge-eating disorder in men may include:

• a sense of loss of control over eating
• eating alone or in secret
• shame about eating or what you consume
• frequent dieting, perhaps without losing weight.
• substance misuse
• high cholesterol
• hyperlipidemia

Bulimia nervosa has a prevalence of 0.1% in men. Signs and symptoms of bulimia nervosa in men may include:

• excessive exercise
• laxative use that may cause intestinal distress
• binge eating
• eroded tooth enamel
• chronic sore throat
• dehydration
• electrolyte imbalance (In one study, 25% of adolescent boys with eating disorders had low potassium, 5% low calcium, and 10% low phosphorus.)

Anorexia nervosa has a prevalence of 0.3% in men. Signs and symptoms of anorexia nervosa in men may include:

• body dissatisfaction and body dysmorphia, particularly muscle dysphoria
• fear of gaining weight
• infatuation with a muscular body ideal
• low bone mineral density
• vital sign instability
• suicidal ideation (Dying by suicide is the second most common cause of death among people diagnosed with anorexia nervosa, after complications of starvation.)

Some of the most common risk factors for a an eating disorder in men include:

• Use of anabolic steroids.
• Substance misuse: particularly of stimulants, which may be used to control weight.
• Family history of eating disorders: There may be a genetic link to eating disorders. Social and cultural factors in families can also play a role; for example, a strong focus on food or dieting or appearance.
• A history of anxiety, mood, or impulse control disorders: These disorders tend to be comorbid with eating disorders, and are particularly linked to bulimia nervosa and binge-eating disorder, the latter of which is the most common eating disorder in men.
• Frequent use of social media.
• Being a member of a sexual or gender minority: One study shows that members of sexual or gender minorities – being gay, bisexual, or transgender, for example – are between two and four times more likely to develop an eating disorder than cisgender men. Another study showed that gay adolescent boys were more than six times more likely to fast, vomit, or take diet pills than heterosexual boys. Up to a third of gay or bisexual young adult men reported binge-eating.

There are several treatment options for men experiencing eating disorders. Speaking with a mental health professional is a great first step for determining the best treatment plan for you.

Group therapy

Group therapy with other men may mitigate the risk of being vulnerable about difficulties with food, body image, and weight. It can create a safe space where the stigma of eating disorders as something that are “women’s diseases” may be lessened.

Group therapy can help men discuss potential shame they have around their eating disorder. When therapy centers on these feelings of depression and shame, instead of just on the behaviors around food and eating, intervention may be more successful, according to one study.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) can be useful in treating eating disorders in men because this type of therapy helps change negative thinking patterns. CBT can help clients retrain their brains and learn how to manage triggers that set off certain types of harmful behavior, such as binging, purging, or starving.

Family therapy

For adolescent boys with eating disorders, engaging caretakers in treatment through family therapy and having them oversee what their child eats and regulate how often and when he exercises, can be very helpful. Caretakers are trained by therapists to patrol behavior instead of weight gain or loss.

Because control over what is eaten and the amount of exercise is often a key component of eating disorder behavior, removing that responsibility from the person with the disorder and placing it in the hands of caretakers can be an effective intervention.

Eating disorders in men are underreported and underresearched and, subsequently, are often underdiagnosed. The presentation of eating disorders in men is often different than in women, and doctors may miss the cues.

Men are more likely to be focused on weight gain and building muscle than on losing weight or appearing thin. In LGBTQ+ men, body dysmorphia is more common than among straight men and can result in the development of an eating disorder.

Men are also more likely to mask symptoms of eating disorders and to feel ashamed by them, making them harder to diagnose and treat.

Acknowledging that men are also subject to concern over food, diet, weight, and body image, and that in some men, that concern may manifest in an eating disorder, is the first step in raising the curtain that too often hides the reality of male eating disorders.