MALES AND EATING

DISORDERS
William Harryman

DO MEN SUFFER FROM EATING DISORDERS?
 GENDER CONSIDERATIONS
 Eating disorders have been
consistently found to be more
common among women than men.
 Only 5% to 10% of patients are men.
Other studies suggest anorexia
nervosa among males may be as little
as 0.02% per year and the prevalence
of current bulimia nervosa in men is
between 0.1% and 0.5% (Hoek &
van Hoeken, 2003).
 Differences attributed to cultural
factors; however, biologic and
psychodynamic factors may also play
a role.

Former model: Jeremy Gillitzer, 88 lbs  Defining symptom (amenorrhea) not

relevant in men.

UNDERSTANDING EATING DISORDERS:
SIMONA GIORDANO (2005)
 Males represent around 8 per cent
of the anorexic sufferers, 15 per
cent of the bulimic sufferers, and
20 per cent of binge-eating
disorder sufferers.
 Manfred Fichter and Heidelinde Krenn, ‘Eating
Disorders in Males’, in Janet Treasure, Ulrich
Schmidt, and Eric van Furth (eds.), Handbook of
Eating Disorders (2nd ed., Chichester: Wiley, 2003),
pp. 369–83.
 The age of onset of anorexia in
males is reported as ranging
between 15.5 and 17.2, whereas
bulimia normally manifests later.
 Faccio, Il disturbo alimentare, 30, 32; Mara Selvini
Palazzoli, S. Cirillo, M. Selvini, and A. M.
Sorrentino, Ragazze anoressiche e bulimiche: La
terapia familiare (Milan: Cortina 1998), ch. 2
 According to other studies, the age
of onset for eating disorders in
males is 18–26, as compared to
15–18 for females.
 Fichter and Krenn, Eating Disorders in Males, 369–
83.

MANOREXIA?
 As of 2008, in England, the number of men
being treated for anorexia has gone up by
67 per cent in the past five years.
 137 men suffering the most severe cases of
anorexia saw specialists in the past year –
up from 82 during 2001/02 – this is only
the tip of the iceberg
 ~ British Department of Health
 The increase is being blamed partly on the
rising popularity of lifestyle magazines for
men featuring pictures of trim sportsmen
such as David Beckham.

MORE ACCURATE NUMBERS
 Twenty years ago it was thought that for every 10-15 women with anorexia
or bulimia, there was one man.
 Today researchers find that for every four females with anorexia, there is
one male
 and for every 8-11 females with bulimia, there is one male. (American
Journal of Psychiatry 2001; 158: 570-574)
 Binge eating disorder seems to occur almost equally in males and females,
although males are not as likely to feel guilty or anxious after a binge as
women are.
 Clinics and counselors see many more females than males, but that may be
because males are reluctant to confess having what has become known as a
"woman's problem."
 Also, health professionals do not expect to see eating disorders in males and
may therefore underdiagnose them.

RISK FACTORS FOR MEN
 They were overweight as children.
 They have been dieting. Dieting is one of the most powerful eating
disorder triggers for both males and females - up to 70% of high
schoolers diet to improve appearance
 Living in a culture fixated on diets and physical appearance
 Members of the gay community who are judged on their physical
attractiveness, lean and muscular as ideals
 They participate in a sport/job demanding thinness:
… Runners & jockeys at higher risk than football players & weight lifters.

… Wrestlers who try to compete in a lower weight category

… Body builders depleting fat & fluid for high definition

… Male models, actors and entertainers

Stats on last two slides from United Health Care fact sheet.

EATING DISORDERS IN MALES:
A REPORT ON 135 PATIENTS (1997)
 One hundred thirty-five males with eating disorders were identified:
… 62 (46%) were bulimic

… 30 (22%) were anorexic

… 43 (32%) met criteria for an eating disorder not otherwise specified

 There were marked differences in sexual orientation by diagnostic group :

… 42% of the male bulimic patients were identified as either homosexual or bisexual

… 58% of the anorexic patients were identified as asexual

 Comorbid psychiatric disorders were common:

… Major depressive disorder (54% of all patients)

… Substance abuse (37%)

… Personality disorder (26%)

 Many patients had a family history of affective disorder (29%) or

alcoholism (37%)
~ Carlat, Camargo, Jr., & Herzog. (1997). Eating Disorders in Males: A Report on 135 Patients. Am
J Psychiatry 154:8, August 1997 .

BIGOREXIA = MUSCLE DYSMORPHIA
 Bigorexia, reverse anorexia, The
Adonis Complex (Pope, Phillips, &
Olivardia, 2000), and now, Muslce
Dysmorphia (MDM), a form of
Body Dysmorphic Disorder
 Men become obsessed with muscle
size and appearance
 From The Adonis Complex:
… 17% said that they would give up
three years of their life to achieve
their weight goal

… 11% said they would give up five

years of their life

MDM IN THE NEW CENTURY
 In the 1970s, about 15% of men said
they were dissatisfied with their body.
 In the 1980s that doubled to about
34%.
 In the 1990s it went up to close to
50%,
 If you survey men now it’s probably
over 50%.
 The Adonis Complex looks at men
who are endangering their lives in
pursuit of the perfect body
 They will work out five hrs a day
lifting weights, take steroids, engage
in unhealthy eating habits in order to
gain more muscle
DIAGNOSIS AND PREVALENCE
 Muscle dysmorphia is a type of body
dysmorphic disorder: DSM-IV-TR
 The mean age of onset is 19.4 years (SD = 3.6)
- Three main components (Olivardia, 2001):
 (a) a preoccupation with the idea that the body
is not muscular or lean enough
 (b) a clinically significant impairment in life
activities (always at the gym, food), continued
harmful behaviors (steroids) due to
preoccupation with insufficient musculature,
and
 (c) the preoccupation is focused on having
insufficient musculature or being too small and
not on other aspects of appearance (Olivardia,
2001).
 (Olivardia, 2001; Olivardia et al., 2000; Pope
et al., 1997).
 THE DRIVE FOR MUSCULARITY SCALE
The scores were normed on an adolescent population (M = 37.78, SD = 12.20).In studies of convergent validity, an ANOVA found
that higher DMS scores were related to subjects' attempts to gain weight. The frequency of weight training was positively but
weakly related to DMS scores (r = .24). In terms of discriminant validity, the DMS had no significant correlation with the drive for
thinness construct of the Eating Attitudes Test (r = -.05) and had a slightly negative correlation with the Body Dissatisfaction Scale
(r = -.15).

1: Always 2: Very Often 3: Often 4: Sometimes 5: Rarely 6: Never

1. I wish that I were more muscular. 1   2 3 4 5   6

2. I lift weights to build up muscle. 1    2     3     4     5    6
3. I use protein or energy supplements. 1    2    3    4    5    6
4. I drink weight gain or protein shakes. 1     2    3    4    5    6
5. I try to consume as many calories as I can in a day. 1      2    3     4     5     6
6. I feel guilty if I miss a weight training session. 1     2   3   4    5    6
7. I think I would feel more confident if I had more muscle mass. 1    2    3   4   5    6
8. Other people think I work out with weights too often. 1    2   3    4   5   6
9. I think that I would look better if I gained 10 pounds in bulk. 1     2   3     4      5 6            
10. I think about taking anabolic steroids. 1 2   3    4    5     6
11. I think that I would feel stronger if I gained a little more muscle mass. 1     2      3     4     5     6
12. I think that my weight training interferes with other aspects of my life. 1     2     3    4     5   6
13. I think that my arms are not muscular enough. 1     2     3    4    5     6
14. I think that my chest is not muscular enough. 1     2     3    4    5     6
15. I think that my legs are not muscular enough. 1     2     3   4    5     6
Source: McCreary, D.R., & Sasse, D.K. (2000). An exploration of the drive for muscularity in adolescent boys and girls.
Journal of American College Health, 48, 297-304.
 TREATMENT
 Treating Eating Disorders
 The basic principles for treating
women with eating disorders also
apply to men
 (1) Work toward weight restoration (2)
Disrupt maladaptive behaviors (3)
Treat comorbidity (4) challenge
thoughts related to weight and shape
(5) Teach ways to adapt to
sociocultural and gender roles
(Andersen, 2002)
 CBT and DBT most common
approaches
 Multidisciplinary care in collaboration
w/ dietician and psychiatrist most
successful
 12-step approach in combination with
integrated approach also works
 Treating Muscle Dysmorphia
 Medications: Prozac, Paxil, and other
antidepressants are useful due to
comorbidity w/ depression and anxiety
 Hudson & Pope (1990) suggested that
MD, OCD, bulimia, anorexia, and
some anxiety disorders may share a
common physiological abnormality
 Thus MD might be a member of this
"family" of affective spectrum
disorders
 Drive for Muscularity Scale (DMS), a
15-item, self-report questionnaire, is
useful
 Psycho-education (steroids, nutrition,
rest); Social History; CBT; cognitive
distortions
 REFERENCES
 Carlat, Camargo, Jr., & Herzog. (1997). Eating Disorders in Males: A Report on 135 Patients.
Am J Psychiatry 154:8, August 1997 .
 Leone, J.E., Sedory, E.J. & Gray, K.A.. (2005). Recognition and Treatment of Muscle
Dysmorphia and Related Body Image Disorders. Journal of Athletic Training; Oct-Dec 2005;
40, 4; ProQuest Psychology Journals, pg. 352.
 Manfred Fichter and Heidelinde Krenn, ‘Eating Disorders in Males’, in Janet Treasure,
Ulrich Schmidt, and Eric van Furth (eds.), Handbook of Eating Disorders (2nd ed.,
Chichester: Wiley, 2003), pp. 369–83.
 McCreary, D.R., & Sasse, D.K. (2000). An exploration of the drive for muscularity in
adolescent boys and girls. Journal of American College Health, 48, 297-304.
 Morgan, J.F. (2008). The Invisible Man: A self-help guide for men with eating disorders,
compulsive exercise, and bigorexia. New York: Routledge.
 Olivardia, P. (2001). Mirror, Mirror on the Wall, Who’s the Largest of Them All? The
Features and Phenomenology of Muscle Dysmorphia. Harvard Rev Psychiatry; 9:254–59.
 Olivardia, R, Pope Jr., H.G., Borowiecki III, J.J & Cohane, G.H. (2004). Biceps and Body
Image: The Relationship Between Muscularity and Self-Esteem, Depression, and Eating
Disorder Symptoms. Psychology of Men & Masculinity; Vol. 5, No. 2, 112–120.
 Pope, Phillips, & Olivardia, (2000) The Adonis Complex. New York: Free Press.
 WEB RESOURCES
 Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED) http
://www.anred.com/
 Empowered Parents: http://www.empoweredparents.com
 National Eating Disorders Association : http://
www.NationalEatingDisorders.org
 National Eating Disorders Screening Program (NEDSP): http://
www.mentalhealthscreening.org/eat.htm
 National Association of Anorexia Nervosa and Associated Disorders
(ANAD): http://www.anad.org
 Muscle Dysmorphia; Eating Disoder Recovery Center; http://
www.addictions.net/default.aspx?id=33