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men & ED



-An estimated 10 to 15% of people with anorexia or bulimia are male. Carlat, D.J. Camargo. Review of Bulimia in Males. American Journal of Psychiatry, 154, 1997

-Men constitute 40% of those exhibiting Binge Eating Disorder. American Psychiatric Association. Diagnostic & Statistical Manual of Mental Disorders Fourth Ed. (DSM-IV). Washington DC, 1994.

-In looking at male sexuality and eating disorders, higher percentage of gay (15%) than heterosexual males (5%) had diagnoses of ED (Feldman, 2007), but when these percentages are applied to population figures, the majority of males with ED are heterosexual.

-The most widely-quoted study estimates that males have a lifetime prevalence of .3% for anorexia nervosa (AN), .5% for bulimia nervosa (BN) and 2% for binge eating disorder (BED). These figures correspond to males representing 25% of individuals with AN and BN and 36% of those with BED. They are based on DSM-IV criteria (Hudson, 2007).

-In the United States, 10 million men will suffer from a clinically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder, or EDNOS. [EDNOS is now recognized as OSFED, other specified feeding or eating disorder, per the DSM-5] (Wade, Keski-Rahkonen, & Hudson, 2011).

-In a study of 1,383 adolescents, the prevalence of any DSM-5 ED in males was reported to be 1.2% at 14 years, 2.6% at 17 years, and 2.9% at 20 years. (Allen, 2013).

-Men with eating disorders often suffer from other conditions such as depression, excessive exercise, substance disorders, and anxiety. (Weltzin, 2014).

-In a study of 1,383 adolescents, the prevalence of any DSM-5 ED in males was reported to be 1.2% at 14 years, 2.6% at 17 years, and 2.9% at 20 years. (Allen, 2013).


Eating disorders are gender neutral, but they have been routinely characterized as “women’s problems.” The stereotypical person with anorexia nervosa is a rich, white, adolescent girl; which is far from reality, because ED effects all genders, ages, races and socioeconomic classes.  Yes, men get eating dirorders too.


Several factors lead to males being undiagnosed for ED.  Men can face a double stigma, for having a disorder characterized as feminine and for seeking psychological help. Additionally, assessment tests with language geared to females have led to misconceptions about the nature of male ED.


Correcting false impressions that characterize ED & BD as female disorders is necessary to removing stigmas about gender and ED. By de-stigmatizing ED, everyone will get better access to diagnosis and treatment.





Culturally, men are celebrated for what they can achieve and conquer, while women are valued for their appearance. But things are changing and we live in a highly visual culture with a complex and intrusive media that places importance on appearance for all genders and all ages. The message is clear. Being attractive is equivalent to being good. Failure to master the appearance leads to stigmatisation both of appearance and of character.


Men do worry about their appearance but:


 - They desire a fit healthy ideal with a v-shaped back rather than a skinny frame. For men there is a social penalty for being underweight.

 - They do not want to look slimmer than other males (as women strive to be thinner than other women).

 - They tend not to view themselves as fat unless they are fatter than most males around them (while women of all weights tend to feel fat as default).

 - They are concerned with their stomach, hair and genital size (while women are sensitive about their hips and thighs).

 - Media images which are iconic for males are strong and muscled, or lean and sporty while for women they are pathologically thin with surgically enhanced breasts.

 - Men do not aspire to standardisation of sizes like the female “size zero” and are thus less exposed to comparison based on absolutes. Women tend to pick their “ideal shape” as much smaller than they are at any weight. With regard to ideal shape, men in studies reliably select the ideal shape that is bigger (more powerful) than they are.

 - So it would seem that although males and females share a culture in which there are strong pressures to attain an appearance which is aesthetically acceptable and appropriate, there are still some differences in gendered receptivity to these pressures. However, males can and do get eating disorders too.





 * Being bullied or criticised for being overweight/underweight

 * Being bullied for being gay or being perceived as gay

 * Comments from an athletic coach

 * Being in a sport which requires extreme weight control

 * Illness and loss at home

 * A relationship breakdown

 * Not coping with pressures, such as exams

 * A career change

 * Unbearable pressure at work





The Media


The media, as already described, emphasises physical fitness and bodybuilding for males. A survey of the 10 magazines most commonly read by young people revealed that men’s magazines contained more than 10 times fewer advertisements and articles promoting weight loss as women’s’ magazines, (Andersen and DiDomenica 1992). These investigators argue that the 10-fold difference in this gender-related reinforcement of dieting behaviour is more relevant than any biological parameter to the difference in eating disorder prevalence in males and females. But this ratio of health to weight loss exposure has changed radically since then.

Attractive is Good: There is also a shift in cultural norms which are now portraying a slim lean and highly toned body as the aesthetic male ideal. Is this leading to a new male quest of striving to achieve these aesthetic ideals, not only for expected health benefits, but also for what the ideals symbolise – control, self discipline, competence and sexual desirability? We now associate overwhelmingly positive “masculine” personality traits to slim, toned males just in the same way as we talk approvingly of women who achieve the slim ideal; perceiving these icons of physical perfection as more altruistic and noble, with high moral values.




Athletes who participate in sports that emphasise leanness, or that match participants by weight (boxing, wrestling, rowing) and competitive body builders, are at risk for engaging in severe dieting and fluid restriction. In small studies in which dietary restraint and attitudes towards eating were surveyed, high performance male athletes, including distance runners, have shown disordered eating, poor attitudes toward body image and dieting behaviours that are comparable to those of females with eating disorders.
Although we are not sure about the link between athletic pursuits and the development of eating disorders in males, some researchers believe that male athletes may be especially vulnerable to developing full-fledged eating disorders.
Jockeys however are thought to be a particularly vulnerable group and many indulge in very serious weight control practices. An article about weight control practices in jockeys is on the NCFED website.


Sexual Orientation


There is a direct connection between homosexuality and eating disorder in males but not in females. This does not mean that all males with eating disorders are gay. Only 20% of males with eating disorder are thought to be gay. However the expectation that a male will be regarded by a health professional as gay stops many men from getting the help they need.

The homosexual male subculture places greater emphasis on body appearance and shape, and this focus on physical appearance might heighten males’ vulnerability to body dissatisfaction and disordered eating.  Don’t jump to conclusions . Bear in mind that every individual is different. Yes, there is a higher incidence of bulimia and other eating disorders in homosexual males than in heterosexual males. But again, most males with eating disorders are not gay.




Males with eating disorders show disorder-specific personality characteristics exactly the same as in females. There are high levels of perfectionism, harm avoidant character styles and relationship difficulties. Anorexic males, like females, have problems with flexibility, obsessional features – which may be a consequence of emaciation – a high drive for simplicity and maturity fears. They are likely to have underlying anxiety and obsessive compulsive characteristics. Bulimic males, like females, tend to be novelty seekers, impulsive with a possible history of past or current substance abuse.


Obsessive Working Out


The term “Adonis Complex” has been coined to describe the situation of men who develop body image disturbance and whose apparent motivation is to achieve the cultural “ideal shape for males.” To become, in other words, the 21 st century Adonis, loved and desired by all. However, the obsessive behaviours and abuse of chemicals, hormones and steroids in pursuance of this goal may cripple both physical and emotional health. The disorder goes largely unrecognised and untreated.


Body Dysmorphia is, like anorexia, a perceptual disturbance of the body which is, in this case, considered too thin, too puny and too flabby. The consequence of this perceptual disturbance is the adoption of harmful weight and shape control practices. These usually involve a change of diet which is also harmful, such as purging if the man eats fat. Thus the condition may morph from a body dysmorphic disorder into an eating disorder.  Men with BD are similar to men with anorexia. They are likely to compare themselves constantly and critically to men with more muscle in the same way as the male anorexic compares himself to males who are leaner. They are perfectionist, obsessive, anxious and usually have low self esteem.  Practices which attempt to “compensate” for the perceptual disturbance of being too puny include muscle building sport, performed beyond the point which is good for health and wellbeing. The sufferer is likely to seek supplements which boost muscle size and seek illegal anabolic steroids or other hormones which will help them to lose fat and bulk up muscle.  Muscle dysmorphics will become obsessed about the quality of food and its powers to make them “fat”. They may cut out major food groups such as fat and overdose on protein. Dietary chaos and nutritional deficiencies often lead to reactive binge eating and it is not unusual for sufferers to purge so that they will not gain fat.





Being aware about eating disorders and acting on the warning signs and symptoms can have a marked influence on the severity and duration of the illness. Seeking help at the first warning signs is very important in this respect. However, the very nature of an eating disorder means that the sufferer will try and ensure any warning signs are concealed.

There are physical, psychological and behavioural warning signs that can signal the onset or the presence of an eating disorder in a male or a female but there are some warning signs that are more likely to occur in males:


 - Preoccupation with body building, weight lifting or muscle toning

 - Weight lifting when injured

 - Lowered testosterone

 - Anxiety/stress over missing workouts

 - Muscular weakness

 - Decreased interest in sex, or fears around sex

 - Possible conflict over gender identity or sexual orientation

 - Using anabolic steroids




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