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Bulletin of the Menninger Clinic. 56, 167-188. Eating Disorders in MalesProf. Rich HalversonPsychology 41: Psychology of Health & IllnessDecember 3, 2001Rachel SteinEating disorders have traditionally been a womans 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 eatingfollowed 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 womens disease. One reason for the high rate of asexuality among men with eating disorders may be the overprotective role of the anorectics 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.
