Historically

 Eating disorders have long been perceived to occur primarily in women; however, the first description of eating disorders in the English language included descriptions of men (Morton, 1694). Men with eating problems have thereafter consistently appeared within historical descriptions including the diaries of Lord Byron and Franz Kafka suggesting that they both suffered from an issue resembling anorexia nervosa.  Men are now reported by the NHS to represent 25% of cases of eating disorders.  Alarmingly it was reported that boys as young as 13 years old were being admitted to hospital for eating disorders in the 12 months to October 2013.

Causes

The stigma of being a man with an eating difficulty continues, and we persist in attempting to fit men with eating disorders into a theoretical and clinical framework which is in fact largely focused on the physical, psychological, and emotional development of women.  Research and theories suggest that there are various causes behind developing an eating problem in men:

  • Genetics

One of the most compelling sources of evidence for the heritability of eating disorders was a study published in 2011. The authors found that eating disorders have a substantial hereditary basis, particularly in twins.  Another study in 2005 suggested that personality plays a big role and is frequently associated with different types of eating trouble.  Anorexia for example, is more common in individuals with high constraint and low novelty seeking, whereas bulimia is more common in individuals with a tendency towards high impulsivity, high sensation seeking, and high novelty seeking (all of which are typical of more open and creative individuals).  Much of the research into genetics seems to suggest that personality increases a person’s predisposition to suffer from eating disorders but whether they actually do depend on how this vulnerability interacts with environmental factors.

  • Environment

At any age, an eating problem seems to stem from feelings that your life is out of control. Compulsive food management, whether it’s extreme dieting, purging, or binging, gives you an emotional “fix” that can put you back in control – but only until the next crisis comes crashing in on you. Many experts are now pointing to a collection of environmental stress factors that commonly occur as powerful catalysts for the onset, or re-emergence – of eating disorders in later-life.  These can include but are not limited to:

  • Family or other relationship problems such as rejection in close personal relationships
  • Difficult or turbulent childhood for example, being abandoned or losing a parent
  • History of physical or sexual abuse from significant people or carers in our lives
  • Professions/activities that encourage a focus on weight, such as gymnastics, running, modelling etc.
  • Peer pressure or cultural ideals which also focus on weight as a measure of success
  • Being bullied because of weight or appearance in general which possibly leads to a reliance on comfort eating
  • Stressful transitions or life changes such as going to University
  • Financial difficulties which create strain and may also trigger comfort eating
  • Culture

The growth of male orientated media in the press and on the internet, which is devoted to health and fitness, brings attention back to male embodiment and how it is experienced. It forces us to ask questions about how this visual media impacts on the body image of male participants and how this affects their mental health and behaviour. Feldman and Meyer’s (2007) research focused on a higher prevalence of eating disorders in gay or bisexual men, but, more recent research (note 3 below), suggests that preoccupation with male body image and body dissatisfaction, is widespread in younger men regardless of sexual orientation who are being increasingly confronted with the same impossible body image ideals that already challenge women and gay men.

  • Biochemistry

Individuals with eating disorders may have abnormal levels of certain chemicals that regulate and control processes such as appetite, mood, sleep and stress. Similar imbalances are known to cause psychiatric disorders, such as depression.  Both people with bulimia and anorexia have higher levels of the stress hormone cortisol, while individuals with anorexia have also been found to have too little serotonin. This, along with too much cortisol, keeps them in a constant state of stress/anxiety. Research has linked both disorders to anxiety, indeed, these eating behaviours seem to help their victims cope with anxiety – but only at first. Any comfort the behaviour brings is short-lived. And then the cycle of feeling badly about themselves and trying to ‘fix it’ through improper eating habits, can repeat itself.

  • Psychology

Various psychological factors can contribute to eating disorders and eating issues.  These can be more prevalent in individuals who already struggle with clinical depression, anxiety disorders and/or obsessive-compulsive disorder. This may be because the individual is already significantly preoccupied either with something about themselves; their lives, or the environment around them, and so ‘lean on’ a coping mechanism which brings short term relief and evokes a feeling of coping better with the world. Other factors include:

  • Low self-esteem.
  • Feelings of lack of control in life.
  • Feelings of inadequacy.
  • Depression, anger, or anxiety.
  • Major life events (i.e. loss of a family member)
  • Accumulation of stress without adequate strategies to cope.
  • Stress and fear of the responsibilities associated with jobs, parenting etc.

Very few eating disorder diagnoses are solitary diagnoses in themselves, and the majority are accompanied by 2-4 additional, separate, psychiatric diagnoses (note 4 below)

Treatment

The broad principles for treatment of eating disorders are relatively similar in men and women.  Patients with weight loss require safe, effective nutritional rehabilitation. This is to ensure that they rectify their behaviour encouraging them to re-learn normal eating habits, which is essential so that patients do not simply go back to their old habits once they are released from hospital. Psychological treatment often involves cognitive-behavioural principles as these appear to be useful for treating this.  Antidepressants are of variable value in treating eating issues it would seem, however, there are no published studies that we can find, on whether they are particularly useful for men.

Conclusion

It is important to point out that even though comparatively little research has been carried out on eating disorders specifically in men, and most research and health studies remains focused almost exclusively on women (see note 5 below), it does seem apparent that many of the above risk factors causing eating disorders are just as applicable to men.  In particular, eating problems can be a symptom in themselves; indicative either as a coping mechanism, or an expression of, underlying emotional stress. This is just as applicable to men as much as it is women.  Culturally, men are celebrated for what they can achieve and conquer, while women are often 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.  Failure to master one’s appearance seems to lead to stigmatisation both of appearance and of character.

Although eating disorders remain predominantly female illnesses, these issues are sufficiently common so that even if only 5% of sufferers are men, hundreds of thousands of men are affected, making it an important health problem for men. This is compounded by a tendency for eating issues in men to go unrecognised or undiagnosed, due to the possible reluctance among men to seek treatment for these stereotypically female conditions. More work needs to be done to identify treatment approaches which are especially helpful to men, as well as prevention strategies which will help males as well as females, maintain a balanced relationship with food.

Men with eating disorders may not always recognise their symptoms and therefore it can take a long time for them to seek the help they need. It is common for someone affected by an eating problem to deny it and they may refuse to acknowledge anything is wrong if someone tries to confront them about it.  If you have or think you may have an eating disorder, it’s important that you consider speaking to someone about it.  If you would like to find out more information on who to talk to, click here or go to the Beat website.

By Georgina Yates

Notes:

  • Morton: Or, a treatise of consumptions. London: Smith & Walford.
  • Matthew B. Feldman PhD, Ilan H. Meyer PhD (2007): Childhood abuse and eating disorders in gay and bisexual men
  • Morgan JF & Arcelus J (2009) Body image in gay and straight men: a qualitative study. European Eating Disorders Review 17 (6) 435–443.
  • Margolis R, Specer W & DePaulo R (1994) Psychiatric comorbidity in eating disorder patients. Eating Disorders 2 (3) 231–236.
  • Golden N, Katzman DK, Kreipe RE, Stevens SL, Sawyer SM, Rees J, Nicholls D & Rome ES (2003) Eating disorders in adolescents: position paper of the Society for Adolescent Medicine: medical indications for hospitalization in an adolescent with an eating disorder. Journal of Adolescent Health 33 (6) 496–503.