National Eating Disorders Association

Males Don't Present Like Females with Eating Disorders

Andrew Walen LCSW-C, LICSW, CEDS

True or false?: Males make up 1 in 10 of those with an eating disorder. Many say false, and think the number is even less. But it’s quite the opposite. Frustratingly, it’s the statistic most frequently quoted in the media. Why? Because this number represents the percentage of males seeking treatment. The reality is males make up at least 1 in 4 of those with anorexia and bulimia and maybe even as high as 40% (Hudson 2007), and almost half of those diagnosed with binge eating disorder based on the most recent research studies. But there’s more to this story. 

Relatively little is known about males with eating disorders, as historically they are almost universally excluded by epidemiological studies and treatment trials, according to Dr. Stuart Murray, co-director of The National Association for Males with Eating Disorders (NAMED). Males make up less than 1% of research to date (Murray et al, 2016). What studies have been done show the same level of distress and disability, proving there is a need for this research and treatment. 

The problem is males with eating disorders are less likely to be diagnosed and their symptoms are dismissed out of hand simply because of their gender. For 20 years I suffered from an eating disorder without even one therapist or psychiatrist asking me a single question about my relationship with food, body image and weight. This reflects the lack of awareness of the disorder among health professionals, as well as a misunderstanding of how males present differently than females.

Here is the key difference: body dissatisfaction in males is typically characterized by a drive for muscularity rather than a drive for thinness. This preoccupation with body weight and shape leads to disordered eating and exercise practices. Studies show more than 90% of adolescent boys report exercising predominantly to increase muscle mass or tone, 66% report changing their diet to increase muscle size or tone, and 15% are using substances like anabolic steroids for the same purpose (Field et al, 2014). 

Approximately 8% of young men describe being so driven by their desire for muscularity they will choose “dangerous” means to achieve their goals. In an effort to bulk up and “cut weight,” males report becoming hypervigilant about protein, dietary fat, and carbohydrate consumption. The use of these behaviors and anabolic steroids are now seen as commonly as, if not more commonly than, extreme weight control behaviors are seen in young women. And they come with the same level of psychological and physical distress. While males do present with stereotypical thinness-oriented presentation of anorexia and bulimia, and the prevalence may be increasing due to our thin-obsessed societal norms, the majority of males with body image disturbance struggle with concerns about muscularity. 

In my own experience, I was fixated on the number on the scale, but less so than on my deep desire to see a leaner, more muscular body. My fixation on running led to significant joint damage in my hips, and compulsive weight lifting led to two shoulder operations to repair damage I did to my rotator cuffs. My eating disorder drive appeared normal to my doctors and peers. Nobody questioned it. What they also missed was that my social anxiety was completely related to my perception of having a grotesque body and overvaluation of that body. Classic signs of an eating disorder, but dismissed out of hand. When my body could no longer handle the stress of exercise that I demanded of it, my disorder morphed into straight binge eating disorder. Again, the only comment from my providers was to go to Weight Watchers. Had they considered my history with restriction, compulsive exercise and binge eating, perhaps treatment would have come sooner. 

The core issue – regardless of being a male or female, or thinness-oriented or muscularity-oriented fixation – is an overvaluation of weight and shape. The resulting work is to find the origin of this fixation – be it trauma, psychopathology, neurology, biology, environment, culture or family of origin – and expertly treat the individual. We have to normalize the experience of being a male with an eating disorder, eliminate the stigma of seeking treatment, and get healthcare professionals the tools and education to be able to accurately diagnose the disorder and discuss it with their clients or patients. In time we’ll see that the statistic, 1 in 10 of those with eating disorders in treatment are male, starts to accurately reflect the reality of the disease. 

Andrew Walen is the founder and CEO of The Body Image Therapy Center and author of the book Man Up to Eating Disorders. Andrew will also be speaking at the 2016 NEDA Conference. Learn more by visiting