Recent findings suggest that the perception of eating disorders as a female problem may be preventing boys and men from seeking help.
About one in eight people with anorexia nervosa is male. This equates to one in 2,000 men, compared with one in 250 women.
Anorexia is one of the four recognized types of eating disorders, with the others being bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified (EDNOS). It has the highest mortality rate of all adolescent psychiatric conditions.
Rates among men are rising, but there is often poor recognition of the signs and symptoms of eating disorders in men, said Dr. Ulla Raisanen of Oxford University, U.K., and her team. As such, true rates may be higher than the official estimates. Some studies suggest that men with anorexia are more likely to engage in obsessive exercise and have more severe psychiatric problems as a result of the condition.
The team interviewed 39 young people aged 16 to 25 with an eating disorder. Of the interviewees, 10 were men. The male respondents had all been slow to realize that they had the potential signs and symptoms of an eating disorder. Crucially, behaviors such as going days without eating, purging, obsessive calorie-counting, exercise, and weighing became entrenched during this time.
Some cited the perception that eating disorders are a women’s problem as one of the main reasons why it took them so long to realize. One said he thought eating disorders only affected “fragile teenage girls”, and another said he thought these disorders were “something girls got”.
The eating disorder often went unrecognized by friends, family, and teachers, and was often only diagnosed at a crisis point such as being admitted to hospital for self-harming.
The study is published in the journal BMJ Open. The authors write, “Our findings suggest that men may experience particular problems in recognizing that they may have an eating disorder as a result of the continuing cultural construction of eating disorders as uniquely or predominantly a female problem.”
The team also reports that men’s experiences of the health care system were mixed. “They said they often had to wait a long time for specialist referral and had sometimes been misdiagnosed, or, as in one case, told by the doctor ‘to man up.’ They complained of insufficient information about eating disorders targeted specifically at men,” they write.
One participant was given information and advice, but still felt that “I don’t think there’s any real information out there particular for men or any even awareness that it exists.”
The men expressed a strong desire for balanced, gender-tailored information. They felt that gender-blind information reflected wider societal constructions of anorexia as predominantly or only affecting women.
A lack of understanding and training among health professionals may also contribute to delays in diagnosing and treating anorexia among men, in part because men with anorexia might account for symptoms regarding weight and dieting behaviors differently from female sufferers. For example, “unusual behaviors could be misinterpreted as personal choices,” they explain.
But they point out that the study is limited to young people, so does not contribute to an understanding of older people with eating disorders.
“Men with eating disorders are under-diagnosed, under-treated, and under-researched. In order to improve the outlook for men with eating disorders, early detection is imperative,” they state.
Early diagnosis and intervention for anorexia has been shown to prevent the development of long-term, potentially life-threatening, psychiatric issues. Treatment can include psychological and drug interventions as well as dietary advice, but early diagnosis and intervention is important for long-term outcomes.
Another recent study indicated that treatment outcomes in all eating disorders are better for men than women, when remission was measured by a return to healthy weight and relapsing.
“In order to improve prognosis for men with eating disorders, early detection is imperative,” the team writes.
“Primary care clinicians have a key role in recognizing early symptoms. Until information resources are made more appropriate for men with eating disorders, health care providers need to be particularly sensitive to men’s needs in relation to an illness so strongly associated with women.
“Raising awareness of eating disorders more widely in society is also crucial to help men (and women) to recognize and seek help before their symptoms and behaviors become intractable.
“It is important to decouple the experience and self-management of eating disorders from feminized cultural imagery, resources, and clinical practice if we wish to prevent men from dismissing signs and symptoms themselves, and prevent health and other professionals (e.g. teachers) from overlooking signs and symptoms in boys and young men that they may readily recognize as indicative of eating disorders in young women.”
Raisanen, U., & Hunt, K. The role of gendered constructions of eating disorders in delayed help-seeking men: a qualitative interview study. BMJ Open, 9 April 2014 doi: 10.1136/bmjopen-2013-004342