Eating Disorders in Males

Key points

Introduction and historical context

Eating disorders (EDs) are pernicious psychiatric illnesses associated with significant psychiatric and medical morbidity and mortality, and at significant personal, familial, and societal costs.¹ Historically, EDs are among the most gendered of psychiatric illnesses, and it was not until nearly a century after anorexia nervosa (AN) was first clinically described² that the notion of male ED presentation was broached in the extant literature.³ Particularly as amenorrhea, historically a hallmark

Epidemiology and prevalence rates

It is likely that prevalence rates for male ED cited in much of the recent history of research is a gross underestimate. Emerging evidence in community settings now indicates that rates of ED in males are increasing at a faster rate than for females, and with no degree of difference in clinical severity of symptoms across the sexes.6, 7 Some population-based data suggest that there are no sex differences in the age of presentation of EDs,⁸ including for early-onset (<14 years old) cases.⁹

Similarities and differences in presentation of eating disorders across the sexes

Along with the paucity of empirical research devoted solely to male populations, many full-scale clinical trials continue to exclude male patients on the premise of their assumed atypicality.¹⁴ Although many symptoms of ED among males may indeed be qualitatively different than for females, gold standard assessments for EDs demonstrate a lack of sensitivity in detecting and qualifying ED symptoms in males.15, 16 Many EDs in males may be undetected, or at least indexed with symptoms that appear

The muscular ideal

As briefly mentioned earlier, the male body ideal typically features a dual focus on a drive for both muscularity and leanness (ie, low body fat).²³ This distinct male ideal offers unique consequences for patterns in ED behaviors and attitudes. For instance, males may be motivated to pursue rigid eating or exercise routines, as well as the use of appearance-enhancing or performance-enhancing drugs (eg, anabolic steroids) to achieve a muscular body idea. Males also endorse a drive for thinness

Risk associated with sexual orientation

Over several decades, evidence has accumulated in support of an association between sexual orientation and ED symptoms in adults, particularly in men,43, 44, 45, 46, 47 and in adolescent males.48, 49, 50 In examination of trends over time in eating pathology among adolescent sexual minority subgroups, although notably improved compared with sexual minority females, males continue to report higher prevalence of purging, using diet pills, and fasting to lose weight compared with their

Clinical impact of a female-centric framework of assessment and treatment

Moving both within and beyond a long history whereby men are consistently marginalized in screening, treatment, and research of EDs, there are several areas that receive the greatest impact from the traditionally held female-centric ED framework. One of these domains is treatment seeking, or what some have referred to as “help seeking.”⁷ Lack of insight, denial, shame, and secrecy are all factors that have an impact on willingness to seek treatment of EDs across the sexes. However, this

Future directions

Although there is increasing momentum within the field to focus specifically on the screening, assessment, and study of ED presentation among adolescent males, considerable efforts are required to attenuate to the knowledge base within the field, established for EDs among female peers. Toward that end, some specific domains are highlighted whereby targeted research would be optimized. Perhaps the most important of these domains is in the area of improving the tools with which male ED symptom

Summary

Estimates of prevalence for EDs among youth and adolescent males are likely considerably underestimated. Perpetuation of the perception that EDs are largely a female phenomenon over nearly 5 decades has led to the consistent exclusion of young men from research efforts, and subsequent paucity of understanding and accuracy in classification and assessment. Although increased appreciation of eating and body image concerns among males has been demonstrated, methods of identification, assessment,