Sex differences in psychosocial impairment associated with eating-disordered behavior: What if there aren't any?

Highlights

• We examined psychosocial impairment associated with ED behaviors.

• Participants were a community sample of women and men.

• Impairment associated with bingeing, purging & overvaluation did not differ by sex.

• Considering ED behavior as primarily a problem of women may no longer be tenable.

• ED prevention and early intervention programs may need to be reconceptualized.

Abstract

Objective

We sought to test the hypothesis that eating-disordered behavior (EDB) is associated with comparable levels of impairment in psychosocial functioning in men and women.

Method

Postal questionnaires that assessed EDB (binge eating, purging, extreme dietary restriction, excessive exercise and weight/shape overvaluation) and psychosocial impairment (general psychological distress, life satisfaction and social support) were completed by a general population sample of men (n = 957) and women (n = 1899).

Results

Binge eating, purging and overvaluation were associated with comparable levels of psychosocial impairment for both men and women and this was the case for each of the three measures of psychosocial functioning employed. Extreme dietary restriction was associated with greater psychosocial impairment in women than in men, whereas excessive exercise was not associated with psychosocial impairment in either women or men.

Conclusions

There appear to be few differences between men and women in terms of psychosocial impairment associated with EDB. It may no longer be appropriate to base the development of eating disorder prevention programs on the premise that EDB is primarily a problem of women. Health professionals may be more likely to see more men with EDB in their practices in the future.

Introduction

Findings from recent population-based studies suggest that the prevalence of eating-disordered behavior (EDB), namely, binge eating, extreme weight-control behaviors, and key cognitive features, such as the overvaluation of body weight/shape, may be increasing in men (Hay et al., 2008, Mond et al., 2014). Thus, cross-sectional surveys of some 3000 men and women aged 15 years or more (mean in 1995 = 43.4 years, SD = 19.2; mean in 2005 = 45.1 years, SD = 24.5) conducted in Australia in 1995 and 2005 found that the prevalence of each of the three behaviors assessed – binge eating, purging and extreme dietary restriction – more than doubled in both men and women during this (10-year) period (Hay et al., 2008). Some behaviors, such as binge eating, may now be as common, or nearly as common, in men as in women (Striegel, Bedrosian, Wang, & Schwartz, 2012). Others, such as extreme dietary restriction, likely remain more common in women but may be increasing more rapidly in men (Hay et al., 2008).

Recent research evidence also suggests that men, like women, experience significant distress and disability associated with EDB (Mond et al., 2014, Striegel et al., 2012). Findings that EDB may be associated with comparable levels of psychosocial impairment in men as in women, when taken with evidence for increases in the prevalence of EDB in men, may have public policy implications. For example, there may be a need to give greater attention to the occurrence of EDB in males when developing preventive interventions (Mond et al., 2014). This would be an important shift in the field in that eating disorder prevention programs have, thus far, been developed on the premise that EDB is primarily a problem of women (Stice et al., 2013, Wilfley et al., 2013). There may also be implications for clinical practice, such as demand for treatment, given that impairment in psychosocial functioning is strongly predictive of help-seeking behavior among individuals with eating disorders and individuals with mental health problems more generally (Mond et al., 2009). For these reasons, it has been suggested that greater priority may need to be given to the inclusion of males in studies of the prevalence and correlates of EDB (Mond et al., 2014, Striegel et al., 2012).

To our knowledge, only three recent studies have examined impairment in psychosocial functioning associated with EDB in population-based samples of men and women. Mond and Hay (2007), in an Australian sample of men and women (n = 3047) aged 15 years or more (mean = 49.6 years, SD = 18.7), found that participants who reported regular extreme dietary restriction, binge eating or purging, experienced greater impairment in role functioning than individuals who did not report these behaviors and that this was the case for both men and women. Further, women and men who reported regular EDB and weight/shape overvaluation experienced greater impairment that those who reported EDB alone, although impairment was more closely linked to the presence of overvaluation in women. Mitchison and colleagues (Mitchison, Mond, Slewa-Younan, & Hay, 2013), also in an Australian sample of men and women (n = 3034) aged 15 years or more (mean = 45.7 years, SD = 18.9) found that extreme dietary restriction, binge eating, purging and overvaluation, were associated with comparable levels of impairment in quality of life in women and men, with the exception that impairment in mental health associated with overvaluation was greater in women. Striegel et al. (2012) found, in a very large sample of USA employees (n = 46,351) aged 18 to 64 years (mean = 42.16–44.25 years, SD = 10.15–11.28), that participants who reported binge eating experienced significantly greater distress and disability than those who did not. Further, on a range of different measures, impairment associated with binge eating did not differ by sex. No other behaviors were assessed in this study. In all of these studies, men constituted a substantial minority – in excess of one third – of participants reporting EDB.

Findings from these studies suggest that impairment in psychosocial functioning associated with EDB may be similar in men and women, although further research, employing a more comprehensive assessment of EDB, is needed. The goal of the current study was to conduct research of this kind. Specifically, we sought to examine sex differences in psychosocial impairment associated with a broad range of EDB in a large, general population sample of men and women. In view of the paucity of existing evidence, hypotheses were tentatively made, first, that the occurrence of EDB would be associated with significant impairment in psychosocial functioning in both men and women; and second, that EDB would be associated with comparable levels of impairment in men and women, with the possible exception of greater impairment associated with weight/shape overvaluation in women.