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Eating Disorders in Males
Prof. Rich Halverson
Psychology 41: Psychology of Health & Illness
December 3, 2001
Rachel Stein
Eating disorders have traditionally been a “woman’s problem.” It has not been
until recently that we have recognized the fact that males are suffering from
these deadly disorders as well. It has been generally agreed upon that anywhere
from five to 15 percent of all reported cases of eating disorders are
attributed to men. This paper will examine its incidence in males and the
physical and psychological aspects associated with having an eating disorder.
First lets look at the history of eating disorders. The very first case of an
eating disorder diagnosed was actually a male. In 1689, Dr. Richard Morton
described a case of “nervous consumption” in a 16-year-old male and he was
prescribed restraint from horseback riding and his studies. (Carlat, Camargo,
& Herzog, 1997) In the 1700s the full plump female figure was considered to
be the most beautiful because it showed a sign of wealth. It was not until the
1920s that smaller female figures seemed to be in vogue. The Barbie doll came
out in the 1940s which put an absolutely unrealistic measuring stick up to
little girls. It was during this time that women began to dress more
“provocatively” in flapper dresses. The 1960s saw an upsurgance of anorexia
when Twiggy, the gaunt British actress became popular. And recently our society
has seen an increase in the incidence of eating disorders, especially in men.
Now lets define anorexia nervosa and bulimia. According to the DSM-IV the
diagnostic criteria for anorexia nervosa are “body image distortion,
amenorrhea, and intense fear of gaining weight, resulting in body weight that
is at least 15% below that expected for age and height.” (Hausenblas &
Carron, 1999) The definition for bulimia is less clear. Bulimia includes
“self-evaluation that is unduly influenced by body shape or weight and
recurrent episodes of uncontrollable binge eating…followed by inappropriate
compensatory behavior undertaken to prevent weight gain.” (Hausenblas &
Carrron, 1999) This compensatory behavior may include use of laxatives,
diuretics, self-induced vomiting, strict dieting, fasting or inordinate
exercising. Unlike anorexics, bulimics are usually at or above their body
weight.
These diseases may result in biological problems including amenorrhea for
females, gonadotropin secretion in males, electrolyte imbalances,
gastrointestinal disorders, endocrine problems, and may result in death. “A
full 8-18% of anorexic patients die as a result of the affliction.” (Zerbe,
1992) Psychologically these individuals usually have problems with depression,
anxiety, and obsessive/compulsive disorders. (Crosscope-Happel, Hutchins, &
Hayes, 2000)
Studies have shown that over one million males are affected with anorexia
nervosa yearly. (Crosscope-Happel, Hutchins, & Hayes, 2000) Some have
suggested that these numbers are on the rise as the media continues to assert a
more and more unattainable goal of beauty on the public.
The majority of the population suffering from eating disorders is female, so
lets look at the general prototype of a patient. She is generally a teenager,
from a middle to upper class background and white. She generally excels at
schoolwork and extra-curricular activities, and is often times labeled a
perfectionist. How does this differ from a male with eating disorders? Not all
that much actually, he also does well in school although sports tend to be
overemphasized.
The family tends to play an important role in the development of eating
disorders. Males tend to have very strict, domineering fathers who encouraged
development in sports. It has also been recognized that many men with eating
disorders may not have had a father figure around at all. (Zerbe, 1992) Their
mothers have been described as overprotective and controlling. (Romero, 1994)
Adolescent boys with eating disorders relate that parents or siblings are
usually on diets as well and there tends to be an emphasis on food and dieting
in the house.
Boys with eating disorders have stated that their father has often pressured
them into excelling in sports and there are often very high expectations in
this arena. (Romero, 1994) As a result of this obligation to succeed the boy
may have low self-esteem and feelings of inadequacy. He needs to control his
life in some way, and he sees an opportunity in controlling his bodies. By
taking their previously obsessive behavior in academics and sports and
expanding that obsession into eating as well.
Although males tend to over exercise instead of using other means of purging
they do participate in dieting as well. There are three major differences
between males and females when it comes to dieting. The first is the reason for
dieting, woman tend to diet because they feel fat whereas men start to diet
because they had previously been overweight. The second difference is that more
often than women, men diet to maintain certain goals in relation to an athletic
activity, for example to avoid injury rather than to loose weight. And the last
difference is that more men diet to avoid potential medical problems.
(Crosscope-Happel, Hutchins, & Hayes, 2000) It is through dieting that men
can feel more in control of their lives and more masculine and successful.
Dieting tends to be a trigger for men and women and is often a risk factor for
the development of eating disorders. Other risk factors for men include:
1. They were overweight children.
2. They participate in a sport that demands thinness. (e.g. runners and
wrestlers)
3. They have a profession that places an emphasis on portraying a body image.
(e.g. male models, actors and entertainers)
4. Some, but by no means all, males with eating disorders are members of the
homosexual community where men are judged on their physical attractiveness in
much the same way as women are judged in the heterosexual community. (ANRED,
1998)
Some studies suggest that as a result of being overweight children men with
eating disorders are more likely to have experienced ridicule from other
children.
Unfortunately, much more serious problems exist for men with eating disorders.
There is a high positive correlation between childhood abuse and the
development of eating disorders for males. Studies have found that anywhere
from 35-65% of patients with eating disorders have histories of sexual abuse.
(Phillpot & Sheppard, 1998) Zerbe states that multiple personality disorder
and participation in satanic cults is not uncommon in the more difficult to
treat cases. Borderline, obsessive-compulsive, dependent, passive-aggressive,
and avoidant personalities are also over represented in this population.
(Crosscope-Happel, Hutchins, & Hayes, 2000)
The media is to blame for a great deal of the development of eating disorders
in men and women. They portray and unrealistic ideal of thin emaciated women
who will be protected by big, muscular, powerful men. A study was done by
DiDomenico and Anderson, they looked at magazines and found that those
magazines which targeted women had a greater number of articles and
advertisements for dieting and weight reduction while those targeted at men had
more concerning shaping the body and bulking up.
In fact, a study done by Nemeroff, Stein, Diehl, and Smilack found that males
may be receiving more media messages regarding dieting, the ideal of
muscularity, and plastic surgery options. (Shiltz, 2000) The American Society
of Plastic and Reconstructive Surgeons, Inc. found that the rate of aesthetic
surgery being performed on men today is at 13%. (Phillpot & Sheppard, 1998)
Athletes have also been found to be more at risk for eating disorders. Three
subcatagories of athletes have been identified as being observed for high risk
of the development of eating disorders. The first is for those who participate
in sports where weight classifications apply such as wrestlers and rowers. The
second is sports in which weight or small body size is important for
performance success and example of these athletes include distance runners and
cyclists. And the final subcatagory is for those who compete in sports in which
subjective evaluation and aesthetic ideals coexist, like figure skaters,
gymnasts, and divers. (Hausenblas & Carron, 1999)
It has also been suggested that “athletes’ vulnerability to eating disorders
might be increased because several psychological characteristics (e.g.,
perfectionism, compulsiveness, self-motivation, high achievement expectations)
thought to be advantageous for athletic performance are the same
characteristics commonly found in individuals with eating disorders.”
(Hausenblas & Carron, 1999) This would all seem to point to the suggestion
that athletes are at especially high risk for eating disorders, but this is not
necessarily the case. The current research seems inconclusive.
Athletes also have a great deal of pressure put on them by coaches, teammates,
judges and fans to succeed as well. It would seem logical that if one possesses
the personality characteristics stated above he would be more susceptible to
eating disorders. There has been another interesting finding in regards to the
characteristics of men with eating disorders.
It was stated earlier that being a homosexual male may be a risk factor for
developing eating disorders. Surprisingly this finding has been statically
proven that homosexual males are over represented when it comes to eating
disorders. There have been estimates as high as 21% of the affected males being
homosexual. (Crosscope-Happel, Hutchins, & Hayes, 2000) In a study one with
135 male patients with both anorexia and bulimia, 27% were admittedly
homosexual or bisexual and 32% were asexual. (Carlat, Camargo, & Herzog,
1997) Some authors have noted that up to 50% of male patients experienced
homosexual conflict before the onset of their disorder. (Shiltz, 2000) These
are assumed to result for different reasons, which will be addressed in the latter
portion of this paper.
Misdiagnosis among males is extremely common. Presumably the obvious reason is
that doctors just simply are not looking for it. Usually men with eating
disorders will come in with complaints regarding gastrointestinal problems and
the physician may not look for other symptoms that comply with the diagnosis of
an eating disorder.
It is also difficult to diagnose because an eating disorder in a man may not be
as noticeable as that of a woman. “Instead of a low body weight, they seek well-defined
muscles, sleek abs and sculptured pecs.” (Goode, 2000) As a result of being
less visible men tend not to seek treatment voluntarily and often do not even
recognize the disorder themselves.
Although often misdiagnosed, once discovered the treatment for both men and
women generally follows the same format. There should be combination of
therapies, including nutritional, individual, group, and family sessions.
(Romero, 1994) The only issue that comes up is the fact that group therapies
mostly women and men tend to have trouble relating to discussions about lost
periods and our patriarchal society. (ANRED, 1998)
Men have been found to have a high incidence of the coexistence of other
addictive behavior besides the eating disorder. Addictions to alcohol, drugs,
gambling and sex have all been found in men with eating disorders. (Phillpot
& Sheppard, 1998) And they actually are much more proud of these addictions
because they are considered more manly.
Regardless of the treatment eating disorders are very difficult to treat in
general because when one wants to cure an addiction to anything else, the
obvious answer is abstention. But one cannot abstain from food, regardless of
the emotional and physical problems he is having he must continue to eat. It then
becomes an issue of where is the balance between healthy and too much, or too
little?
The final issue to be presented is that of the inordinate amount of homosexual
males with eating disorders. There have been a few explanations. The first is
concerned with the formation of a sexual identity. Anorexia, especially, is
associated with severe gender identity problems. And as stated earlier there
have been reports of significant homosexual conflict among males prior to the
development of the disorder. (Romero, 1994)
Another explanation for the high rates of homosexuality among men with eating
disorders is the heightened level of objectification among the gay community.
Within the gay community men, like women in a heterosexual community, share the
same role of having their bodies as a commodity. A study found that homosexual
men specifically attributed the onset of their disorder to a “pressure toward
thinness in the gay subculture.” (Carlat, Camargo, & Herzog, 1997)
Strangely this is not the case for homosexual women. The same study found that
there was a 24% of males with eating disorders were gay while only 2% of the
female population with eating disorders were lesbian. (Carlat, Camargo, &
Herzog, 1997)
A further explanation of greater rates of homosexuality among men with eating
disorders is that they plainly may be more willing to attribute the secondary
deviance label of bulimic or anorexic to themselves. So the incidence may not
be higher at all it is just that gay men are not as worried about the stigma of
having a “women’s disease.”
One reason for the high rate of asexuality among men with eating disorders may
be the overprotective role of the anorectic’s mother. As a result of
controlling parents, he may not be able to develop a sense of autonomy and
independence and thus is not equipped to cope with the maturational
requirements of adolescence. (Romero, 1994) Consequently, he is maintaining the
body type of a boy, who is not capable of becoming an self-ruling entity.
Males with eating disorders also exhibited a higher level of anxiety in
response to sexual issues than did women. A study found that up to 80% of males
stated that sex was a forbidden subject in their households growing up. And
some were even relieved when their sexual drive had diminished in the more
severe stages of their disorder.
There are many differences between men and women who have eating disorders.
Sexuality, onset, development and course are just a few. Yet the underlying
issue of control is common for both genders. Unfortunately, there is not
extensive research regarding males with eating disorders, and their numbers are
rising.