Despite the growing awareness about eating disorders in diverse populations several stubborn myths persist. EDs do not just affect women and girls. In fact, in some age groups the rates of disordered eating and atypical EDs are actually higher in groups of men. Men with EDs, disordered eating and body image distress remain largely invisible and this invisibility reinforces largely unintended biases about men with EDs amongst researchers, clinicians, payors and even the families of the men who struggle with these issues.
The myths about men and EDS persist in part because, as myths often do, they include some element of truth. Men do appear to be somewhat insulated from some of the most intense drivers of body shame and dissatisfaction and may face somewhat less pressure to equate their self-worth with their own appearance and body image. But the rates of EDs in men and boys continue to skyrocket and we now know for certain that ED and disordered eating have an enormous impact on their well-being. One reason for the increased rates is that more and more people are now better informed about male ED and with that awareness we are seeing more sensitive detection, assessment, and treatment referrals. But there is still a gap between our sensitivity to these issues in females compared to that sensitivity regarding men, boys, and people who are gender non-binary.
Why might EDs in men and boys elude detection? While the majority of the signs and symptoms of an ED are similar across genders there are some important gender differences in the clinical features of the ED. Men are generally less focused on attaining thinness and it is more common for them to describe their concerns about being “soft” or lacking sufficient muscular definition. While some men and boys display all the typical signs and symptoms of EDs, many others have a variety of symptoms that do not fit neatly into our conventional diagnostic and assessment categories. In fact, many of our clinical assessment tools and protocols have not been adapted to address some of these less conventional features so they may actually further complicate efforts to be sure men and boys are referred for treatment early in their ED course.
When boys and men do find their way into treatment they may face another set of barriers that may limit therapeutic engagement. At the residential and PHP level male patients are often the only non-female in the “room.” It can take considerable extra effort to help men feel comfortable and “seen” in a program. Individual clinicians can also make small but meaningful adjustments to their own treatment techniques to help men engage. One simple but very powerful step is to simply and directly ask about how being a male with an ED fits into their sense of maleness and masculinity. This simple question can often open up a rich line of discussion about core beliefs, concerns about masculine gender roles, shame, denial, and concerns about being inadequate or defective. Clinicians working with men may find it helpful to ask specific questions about how an ED affects their patient’s sense of masculinity. Men with ED who are seeking treatment should try to express any concerns they have about the nature of the type of treatment they are being offered. They may find it helpful to directly ask their clinicians about their experience in working with men and about the clinician’s familiarity with the differences between men and women with ED. Opening up this sort of discussion early on in treatment can help improve early engagement in treatment. It will also help to make the issues of men with ED less shameful, stigmatizing and invisible.
Douglas W. Bunnell, PhD, FAED, CEDS-S is a clinical psychologist in Fairfield, Connecticut. He has specialized in the treatment of people with eating disorders for the past 30 years. Dr. Bunnell is a past board chair of the NEDA and recipient of their Lifetime Achievement Award. Dr. Bunnell has helped to design, develop and manage PHP and residential programs for several national eating disorder programs. He is a Fellow of the Academy for Eating Disorders and Certified Eating Disorder Supervisor for IAEDP. Dr. Bunnell has co-authored numerous chapters and journal articles on the treatment of eating disorders and the training of clinicians. He is particularly focused on the integration of evidence-based treatment into higher levels of eating disorder treatment programming. More recently, Dr. Bunnell has been working on clinical protocols for addressing eating disorders and co-morbid psychiatric issues such as PTSD.