Eating Disorders in Men and Boys
Reviewed by Douglas Bunnell, Ph.D, FAED, CEDS
Despite the stereotype that eating disorders only occur in women, about one in three people struggling with an eating disorder is male, and subclinical disordered eating behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among men as they are among women.1
In the United States alone, eating disorders will affect 6.6 million males at some point in their lives.2 However, due in large part to cultural and gender bias, they are much less likely to be assessed or diagnosed for their eating disorder and even less likely to seek treatment.3 Assessment tests with language geared to women and girls have led to misconceptions about the nature of disordered eating in men. Two persistent myths about men with eating disorders, that these disorders only occur in women or gay men, delay men in recognizing their behaviors as possible symptoms of an eating disorder and deter many men from seeking help once they do recognize their eating concerns.4 The good news is that once men find help, they show similar responses to treatment as women.5
Men and Body Image
There are numerous studies on male body image, and results vary widely. Many men have misconceived notions about their weight and physique, particularly the importance of muscularity. Findings include:
- Most males would like to be lean and muscular, which typically represents the “ideal” male body type. Exposure to unattainable images in the media leads to male body dissatisfaction.6
- The exposure to and internalization of media images of an idealized male body predicts drive for muscularity.7 However, many other factors also influence male body image including peer/parent/partner influence, gender role expectations and body ideals within some specific gay communities.8
- The desire for increased musculature is not uncommon and it crosses age groups. For example, 27% of normal weight males perceive themselves to be underweight and in another study 22% of men engaged in muscularity-oriented disordered eating behavior including eating certain foods and taking supplements and androgenic anabolic steroids to gain weight or “bulk up.”9,10
- Muscle dysmorphia, a subtype of body dysmorphic disorder, which is defined as an excessive preoccupation with a perceived physical defect or slight physical difference to a point of causing significant impairment in one’s functioning, is an emerging condition that primarily affects male bodybuilders.11 Such individuals obsess about being adequately muscular. Compulsions include spending many hours in the gym, squandering excessive amounts of money on supplements, abnormal eating patterns, or use of steroids.12
Treatment Considerations
Treatment is not one-size-fits-all. For any person, biological and cultural factors should be taken into consideration in order to provide an effective treatment plan.
Studies suggest that the risk of mortality for males with eating disorders is 6 to 8 times higher than the rates for men and boys without an eating disorder.13 Furthermore, rates for eating disorders in males are increasing at a faster rate than for females – early intervention is critical.14
A gender-sensitive approach with recognition of different needs and dynamics for males is critical for delivering effective treatment. Men and boys in treatment can feel out of place in settings that predominantly treat, and are staffed, by women. Opportunities for men with eating disorders to access gender specialized programming can enhance treatment outcomes.15
Males with eating disorders do have several gender specific clinical features and medical symptoms. Men and boys with anorexia nervosa usually exhibit low levels of testosterone and vitamin D, and they have a high risk of osteopenia and osteoporosis. Testosterone supplementation is often recommended. Boys and men with eating disorders are also at high risk for the use of growth enhancing medications such as steroids. Medical and psychological treatment plans need to address these unique clinical features.16
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Sources
[1] Mitchison, D., Mond, J., Bussey, K., Griffiths, S., Trompeter, N., Lonergan, A., Pike, K. M., Murray, S. B., Hay, P. (2019). DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: Prevalence and clinical significance. Psychological Medicine, 50(6), 981-990. https://doi.org/10.1017/s0033291719000898
[2] Deloitte Access Economics. (2020). The Social and Economic Cost of Eating Disorders in the United States
of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and
the Academy for Eating Disorders. Available at:
https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/
[3] Bomben, R., Robertson, N., & Allan, S. (2022). Barriers to help-seeking for eating disorders in men: A mixed-methods systematic review. Psychology of Men & Masculinities, 23(2), 183–196. https://doi.org/10.1037/men0000382
[4] Räisänen, U.,& Hunt, K. (2014). The role of gendered constructions of eating disorders in delayed help-seeking in men: A qualitative interview study. BMJ Open, 4(4). https://doi.org/10.1136/bmjopen-2013-004342
[5] Trompeter, N., Bussey, K., & Mitchison, D. (2021). Epidemiology of eating disorders in boys and men. Eating Disorders in Boys and Men, 37–52. https://doi.org/10.1007/978-3-030-67127-3_4
[6] Murray, S. B., Griffiths, S., & Mond, J. M. (2016). Evolving eating disorder psychopathology: conceptualising muscularity-oriented disordered eating. The British journal of psychiatry: the journal of mental science, 208(5), 414–415. https://doi.org/10.1192/bjp.bp.115.168427
[7] Lennon, S. J., & Johnson, K. K. (2021a). Men and muscularity research: A Review. Fashion and Textiles, 8(1). https://doi.org/10.1186/s40691-021-00245-w
[8] Tylka, T.L. (2021). Models of Body Image for Boys and Men. In: Nagata, J.M., Brown, T.A., Murray, S.B., Lavender, J.M. (Eds.), Eating Disorders in Boys and Men (pp. 7-20). Springer. https://doi.org/10.1007/978-3-030-67127-3_2
[9] Lavender, J. M., Brown, T. A., & Murray, S. B. (2017). Men, Muscles, and Eating Disorders: an Overview of Traditional and Muscularity-Oriented Disordered Eating. Current psychiatry reports, 19(6), 32. https://doi.org/10.1007/s11920-017-0787-5
[10] Nagata, J. M., Murray, S. B., Bibbins-Domingo, K., Garber, A. K., Mitchison, D., & Griffiths, S. (2019). Predictors of muscularity-oriented disordered eating behaviors in U.S. young adults: A prospective cohort study. The International journal of eating disorders, 52(12), 1380–1388. https://doi.org/10.1002/eat.23094
[11] American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787
[12] Specter, S. E., & Wiss, D. A. (2014). Muscle dysmorphia: Where body image obsession, compulsive exercise, disordered eating, and substance abuse intersect in susceptible males. In T. D. Brewerton & A. B. Dennis (Eds.), Eating disorders, addictions and substance use disorders: Research, clinical and treatment perspectives (pp. 439–457). Springer-Verlag Publishing/Springer Nature. https://doi.org/10.1007/978-3-642-45378-6_20
[13] Quadflieg, N., Strobel, C., Naab, S., Voderholzer, U., & Fichter, M. M. (2019). Mortality in males treated for an eating disorder—a large prospective study. International Journal of Eating Disorders, 52(12), 1365–1369. https://doi.org/10.1002/eat.23135
[14] Gorrell, S.,& Murray, S. B. (2019). Eating disorders in males. Child and Adolescent Psychiatric Clinics of North America, 28(4), 641–651. https://doi.org/10.1016/j.chc.2019.05.012
[15] Bunnell, D.W. (2021). Psychotherapy with Men with Eating Disorders: The Influence of Gender Socialization and Masculine Gender Norms on Engagement and Treatment. In: Nagata, J.M., Brown, T.A., Murray, S.B., Lavender, J.M. (Eds.), Eating Disorders in Boys and Men (pp. 197-213). Springer. https://doi.org/10.1007/978-3-030-67127-3_14
[16] Ganson, K.T., Golden, N.H., & Nagata, J.M. (2021). Medical Management of Eating Disorders in Boys and Men: Current Clinical Guidance and Evidence Gaps. In: Nagata, J.M., Brown, T.A., Murray, S.B., & Lavender, J.M. (Eds.), Eating Disorders in Boys and Men (pp. 127-136). Springer. https://doi.org/10.1007/978-3-030-67127-3_10
