There is a common misconception that eating disorders occur only in women and young girls. Contrary to this popular opinion, approximately one in three people struggling with an eating disorder is male. Additionally, eating disordered behaviors such as binge eating, purging, laxative abuse, and fasting for weight loss are nearly as common among men and teenage boys as they are with women in the same age groups. In the United States alone, eating disorders will impact approximately 10 million men and boys at some point in their lives. Unfortunately, eating disorders often manifest themselves differently in boys than in girls, so they are harder to detect for both parents and healthcare providers.
Reasons for Misdiagnosed Male Eating Disorders
Far too often, the eating disorders of men and boys go undiagnosed or underdiagnosed due to the view’s society has on eating disorders and what it means to be a “man.” There are social biases and societal stigma faced by men and boys who suffer from eating disorders or disordered eating behavior. As a result, men and boys are much less likely to seek treatment for their disease even when they know they need help. Several factors can lead men and boys to avoid medical intervention.
1 – Men face a double stigma
First, they face the stigma associated with having an eating disorder. All too often, eating disorders are characterized as feminine, a “girl thing” or as “gay.” This stigma alone is enough to keep most men and boys from reaching out for help when they need it. Second, they face the stigma of seeking psychological help. Men who see a psychologist are often seen as weak or made to feel less than manly. As a result, no matter how much support may be needed, the fear of and desire to avoid stereotypes about not being perceived as an alpha male will outweigh the need for help.
2 – Assessment tests are geared towards females
Many of the assessment tests designed to identify eating disorders contain language geared towards women and girls. This has led to misconceptions among men and boys about the nature of eating disorders and what it means to be a male with a potential eating disorder. Unfortunately, similar to the tests, most eating disorder programs are centered on girls who can make boys feel uncomfortable and out of place. Currently, there are a few male-centered programs, and those numbers are growing. Hopefully, as awareness of this concern grows and the stigma is reduced, more programs will be developed.
3 – The “why” is different
Even if a diagnosis is sought and received, the family and social circles of which the male is a member often do not understand why the boy or man is seen as or diagnosed as having “a problem.” Girls with eating disorders are generally obsessed with being thin.
They want to resemble the cover model on the magazine or the movie star they saw on screen. They want to have that dancers’ body. Similar motives drive boys with anorexia, but the manifestation is different. Boys are often more focused on achieving a muscular physique. As a result, they will have all the psychological features of anorexia, except they are pushing everything in the opposite direction. To achieve what they see as an “ideal” physique, boys may work out excessively or use steroids or over the counter supplements to minimize body fat while increasing muscle mass and definition.
An obsession with “clean eating” or cutting out carbs while increasing protein or strict adherence to highly restrictive fad diets is also another common feature. The desire to be muscular and physically attractive is not always seen as a negative, and therefore sometimes the problem goes on for some time before there is awareness that something may be wrong. Additionally, simply because a boy has the desire for a muscular build does not mean he has an eating disorder. There is a fine line that must be walked between healthy exercise and eating habits and disordered exercise and eating habits.
Men and Their Body Image
There are many studies out there regarding men and body image. The results of these studies vary widely. Also, there is a wide variation in how men and boys are raised. Far too often, boys are raised with a be strong, do not cry, do not complain, do not be a sissy attitude. They are raised to be a man’s man, and if, for some reason, that is not the case, they are often made to feel inadequate. Most males would like to be lean and muscular as that represents the “ideal” male physique. For some, constant exposure to unattainable images such as movie stars and bodybuilders leads to dissatisfaction with the body and possible ends with disordered eating. Unlike girls, who often become alarmingly skinny and visibly unhealthy, eating disorders in boys are harder to spot because nothing looks “wrong” from the outside. Male eating disorders are easier to hide under what is considered acceptable, normal male behavior.
Causes of Male Eating Disorders
The underlying causes of eating disorders for boys and girls are thought to be very similar. These include a combination of genetic predisposition, environmental impacts, and societal messages that promote or reward the attainment of the “ideal” body. For men and boys, this could include muscular physiques, the proverbial “six-pack abs,” and an overall athletic build. Athletes who compete in specific sports that require particular weight goals or emphasize appearance could be at higher risk than their peers. These sports include but are not limited to gymnastics, wrestling, rowing, bodybuilding, running, and dancing.
Eating disorders affect people of all sexual orientations. Statistically, more “straight” men have eating disorders, but men who identify as part of a sexual minority seem to be at higher risk of developing an eating disorder.
Similar to women, negative body image can trigger disordered eating among men. It has been shown men will reach to images of highly chiseled men in the same way women will react to skinny and shapely models.
Health Impacts of Eating Disorders
All eating disorders can result in serious health problems. While some health effects are limited to one gender or the other due to genetic make-up, many health problems transcend both genders. Bone density issues such as osteoporosis can result due to nutritional deficits. Men and boys will usually exhibit low levels of testosterone, and vitamin D. Other health problems include muscle damage, joint, and tendon damage from over-exercising. The use of steroids to hasten the process of “bulking up” can result in acne, testicular atrophy, decreased sperm count, high blood pressure, high cholesterol, abnormal liver function, constipation, and anger outburst (commonly known as “roid rage”). Both men and women with eating disorders are more likely to struggle with depression, anxiety disorders, substance abuse, and personality disorders. For boys, there is an increased risk of suicide from depression and other mental health impacts.
Statistically, men are more likely to die to an eating disorder than women. This is because it is easier for men to lose weight than it is for women. Men also lose body fat easier and tend to be diagnosed with an eating disorder much later if they are even diagnosed at all.
Characteristics of Eating Disorders to Look For
As noted above, eating disorders will often manifest differently for males than they will for females. It is also believed that eating disorders in males may develop earlier than eating disorders in females. It can be challenging to determine if a boy’s habits are with normal range or related to an eating disorder. However, here are some symptoms parents can watch for that may indicate a particular behavior has crossed the line into something concerning which needs additional attention:
- Excessive focus on and time spent exercising
- Rigidity around eating rituals
- Eating large amounts of food
- Going to the bathroom in the middle of meals or right after
- Refusing to eat certain food groups
- Having unusual behaviors around food (cutting food into small pieces, pushing food around the plate)
- Obsessively reading nutrition information or counting calories
- Constantly weighing himself or looking in the mirror
- Avoiding or withdrawing from social gatherings involving food
Treatment of Eating Disorders
Fortunately, once help is sought and begin, men and boys have shown similar responses to treatment as their female counterparts. Treatment is not what is suitable for one is suitable for everyone’s situation. For any patient, male or female, biological and cultural factors need to be taken into consideration to provide the most effective treatment protocol. Sadly, studies suggest that the risk of mortality among males with eating disorders is higher than it is for females. This is primarily due to the lack of early intervention and a lack of diagnoses, while the disorder is allowed to impact the life and health of the individual severely.
Critical to effective treatment is the understanding that males are going to react differently to treatment and the process of seeking treatment. Again, male patients with eating disorders often face societal stigma amongst their peers and close social circles, so they are not as likely to see help until it may be too late. A gender-sensitive approach that recognizes that needs are different for males will be critical in effective and successful treatment. When it comes to treatment processes, it is also essential to keep in mind that men and boys are not likely to feel comfortable in a treatment setting where a predominately female culture surrounds them. If at all possible, an all-male treatment setting is likely to be more successful, with residential settings being the most beneficial of all. Residential settings will open up access to not only psychologists and nutritionists but medical providers as well, which will be critical in treating some of the medical conditions associated with eating disorders.
Residential Treatment for Teen Eating Disorders
Regardless of gender, a team approach is usually the best method for treating teenage eating disorders. This will likely include various medical professionals, including a medical doctor, mental health professional, and nutritionist. Residential treatment is a highly recommended solution for teens as it provides an opportunity for full-supervision of the teen’s eating and related behaviors. Further, in a residential setting, the teen is removed from various triggers and situations that can create compulsive eating (or starvation-related) behaviors.
During residential treatment, the teen will receive care from a medical doctor to address any resulting medical afflictions. This may mean treatment for severe malnourishment, depression and suicidal thoughts, or treatment resistance. Nutritional counseling will help your teen to develop better eating habits. Moreover, therapy will help your teen to identify with the feelings that have caused the poor and dangerous eating habits. A residential setting can also help a teenage boy express their concerns about their eating disorder without the feelings of anxiety and stigma associated with being male and having a “female” associated disorder.
Therapy will often include multiple approaches, such as individual therapy, family therapy, and group therapy. Each of these approaches provides a different level of support for the teen and ensures that the teen has the proper level of support on the home front.
When the teen returns home from residential treatment, the parents need to maintain a positive environment that will allow the teen to thrive. Parents are encouraged to make mealtimes fun, to set a positive example as a role model with good eating habits, and to help promote self-esteem in the teen. Finally, parents who seek to understand their teen’s point of view but also do their research on eating disorders will be best equipped to create a positive and nurturing environment for their child.
Here at Hillcrest Adolescent Treatment Center, we understand how teens dealing with an eating disorder can suffer in their day to day lives. Because of our experience working with teenagers that are dealing with mental health issues and eating disorders, we believe that we are a fantastic place to send your teenager for help with developing coping mechanisms for their eating disorder – or any other form of mental health issue. Not sure how we can help? Why not contact us to learn how we may support or to set up a tour?