And Eating Disorder
Eating Disorders Not Just a Girl Problem
Although fewer men than women suffer from eating disorders, a new study indicates that the number of men with anorexia or bulimia is much higher than previously believed. Despite this, men, whose treatment needs are the same as those of women, do not seek help and, therefore, do not get adequate treatment.
"[Eating disorders] have been seen largely as an issue affecting women, and because of that, I think men have been far less likely to identify themselves as affected by it or to seek out treatment -- much in the same way as men with breast cancer tend to show up in breast cancer clinics much, much later," says the study's author, D. Blake Woodside, MD.
Because there are few large studies of men with anorexia and bulimia, Woodside, who is with the department of psychiatry at the University of Toronto, evaluated and compared 62 men and 212 women with eating disorders with a group of almost 3,800 men with no eating disorders.
Although more than twice as many women as men had eating disorders, there were more men affected than would be expected, suggesting that the occurrence of eating disorders may be higher among men than the current National Association of Anorexia Nervosa and Associated Disorders estimates. According to the group, men are thought to make up about 1 million of the 8 million Americans with eating disorders.
In terms of symptoms and unhappiness with their lives, there was little difference between men and women with eating disorders. Both sexes suffered similar rates of anxiety, depression, phobias, panic disorder, and dependence on alcohol. Both groups also were much more unhappy with how things were going in their lives than men with no eating disorders.
Woodside says his study supports the assumption that anorexia and bulimia are virtually identical diseases in men and women.
A number of reports in the medical literature suggest that gay men account for a significant percentage of male anorexia. Woodside's study did not look at this issue, but he says it should be studied further to rule out whether gay men may simply be more likely to seek treatment for anorexia, though not necessarily more likely to suffer from the disorder than heterosexual men.
"Perhaps it may have a bit of a 'snowball effect,' because men may feel if they come forward they will be thought of as homosexual, even if they are not," Woodside says.
Another expert who treats eating disorders says society has a tendency to glamorize eating disorders while at the same time making fun of the people who have them.
"The media and society believe it's all about these beautiful models trying to lose weight, when that's really not what eating disorders are about," says Mae Sokol, MD. "They're less about food and eating and much more about people's sense of self-esteem and identity and who they are."
Sokol says anorexia may be less noticeable in men than women because men can still have muscle mass even though they are thin.
"In fact, it's more dangerous for men to develop anorexia nervosa than for females ... because when males get down to the lowest weight ranges, they've lost more muscle and tissue, whereas [fat] is something you can lose for a period of time without repercussions," says Sokol, a child and adolescent psychologist at Menninger, a psychiatric hospital in Topeka, Kan.
Despite the media's focus on anorexia, bulimia, and other eating disorders, Sokol says that men are still brought up to believe it's not something that's supposed to happen to them.
"The public thinks of it as a 'girl disease,' and these guys don't want to have to come out and say, 'I have a girl disease.' Plus, to have to come to a [treatment facility] where most of the patients are women -- they don't feel good about that at all," she says.
Woodside agrees that feeling uncomfortable may be a big part of why men are less likely to go for help for an eating disorder.
"I think, for a lot of them, it's definitely a case of 'Do I fit in here?' when men come in [to a treatment center]," he says.
In an editorial accompanying Woodside's study, Arnold Anderson, MD, writes that men seeking treatment "are often excluded from programs by gender alone or are treated indistinguishably from teenage girls."
Anderson, of the department of psychiatry at University of Iowa Hospitals and Clinic in Iowa City, says more research comparing men and women with eating disorders is welcomed because it will help identify factors that may lead to different treatment approaches.
The study appears in the April issue of the American Journal of Psychiatry.
Not just a woman's disease
Misconceptions of male eating disorders keep men from getting the help they need.
Walking up and down the aisle of the local supermarket, Richard Dickinson selected his groceries carefully, but he didn't shop for items to stock in his pantry or refrigerator. Instead, his list consisted of a few bags of cookies, a pumpkin pie, a gallon of chocolate ice cream, a jar of peanut butter, chocolate syrup, and a bag of potato chips. When Dickinson returned home, he sat down in front of the television, made sure no one else was around and began eating. He didn't stop until the cookies, the ice cream, the potato chips and the pie were gone. He then walked to the bathroom, knelt in front of the toilet and purged.
Male Anorexia: One million victims, ashamed
Gear magazine, in their Jan/Feb 99 issue, took on a subject that few main stream men's magazines would touch. They report, "Until now, the national clamor over eating disorders and body image problems has concentrated exclusively on women, reinforced by the feminist assumption that the mania is "caused" by the tyranny of the media-fueled beauty cult. It is women, not men, who have been pegged as the 'victims' of this obsessive focus on looks and nothing fuels the victim image more satisfying than an emaciated, anorexic woman. But recent studies, though they have received little attention, have illuminated a startling and troubling fact: one in six cases of eating disorders are diagnosed in men." Dr Arnold E Andersen, MD a professor of psychiatry at the University of Iowa says that men with eating disorders have been "ignored, neglected and dismissed because of statistical infrequency, or legislated out of existence by theoretical dogma." (When have we heard that before? Cancer, domestic violence, rape, statutory rape, sexual harassment. Also,men out-die women in all 15 major causes of death while the press and research dollars and awareness campaigns virtually ignore the situation. That's really something to think about!)
The stigma attached to eating disorders, profound as it is among women, is almost insurmountable among men, who not only resist treatment, but are frequently refused treatment even when they do seek it. Those men who do get help often have a heavy burden of shame to unload. In fact, amenorrhea (the cessation of menstrual periods in females) was regarded for years as a central criterion of anorexia - men, by definition couldn't have it. Also, the stereotype of the effeminate homosexual male model also dominates, but 80 percent of men with eating disorders - whether bulimia or anorexia - are heterosexual. Anorexia and bulimia are characterized, in both men and women, by essentially the same traits: self-induced starvation, an excessive fear of becoming fat even when thin, and a tendency toward compulsive living patterns. Men don't necessarily think in terms of "fat" or "thin" as women do. They relate in terms of "strong" or "weak", where fat is associated with being weak, unmanly and disgusting. So, for many men, structured forms of exercise are carried to obsessive levels. Treatment needs differ between men and women - they have different preoccupations with body image, and will be returning to different body shapes. Even if men do decide to seek treatment, the medical establishment may not be prepared and many don't even know how to respond.
Thanks Gear for having the guts to provide the information. Now, let's
hope that those million plus men affected by anorexia are man enough to seek
Men now falling victim to eating disorders
By BethAnne Black, HealthScoutNews
Thomas Holbrook knows from experience that eating disorders don't discriminate between the sexes.
A Wisconsin psychiatrist who actually specializes in the treatment of eating disorders, Holbrook fell victim to anorexia nervosa when he stopped running in 1976 after suffering a knee injury and began obsessing about becoming fat.
So he adopted a strict diet of carrots and cabbage and began walking six hours a day.
"I was waking up at 2:30 or 3 in the morning and walking for hours on end. I was the champion of denial, and probably sicker than any of my patients," Holbrook remembers.
Holbrook is among the small but growing number of men who suffer from eating disorders, which can range from anorexia nervosa to bulimia nervosa to binge eating. Although there are no reliable statistics on the number of men with eating disorders, anecdotal evidence indicates the problem is increasing, according to experts.
"More and more men with eating disorders have sought help over the past few years," says Jill Pollack, a psychotherapist in private practice in New York City.
"We've seen lots of men step forward with these problems in the past year, perhaps because they're seeking resources and support," adds Judy Teffer, a spokeswoman for the National Association of Anorexia Nervosa and Associated Disorders.
She estimates that of the 8 million Americans with eating disorders, 1 million are now men.
But the mistaken belief that only women or teen-age girls are afflicted by eating disorders still prevails, experts say.
"Historically, women were the targets of the diet industry. But, only in the past few years have men been so aggressively marketed to with weight-loss and bulk-up products," says Leigh Cohn, who co-authored the book Making Weight: Men's Conflicts with Food, Weight, Shape and Appearance with Holbrook.
Says Pollack: "I've counseled wrestlers who feel pressured to 'make the weight' in order to be on their school's team. To my horror, their coaches will give them water pills, tell them to use the steam room, run more, or bulk up to a certain size."
Roadblocks to Recovery
Not surprisingly, men with eating disorders are less likely than women to seek treatment because they feel shame or embarrassment.
Compounding the problem is that doctors often don't spot the signs in men.
"I visited the emergency room countless times and no questions were ever asked about my appearance, despite the fact that my skin was orange from eating too many carrots," Holbrook says.
One telltale sign of a man with an eating disorder is an obsessive preoccupation with his body, weight and shape. This is often coupled with certain behaviors such as compulsive over-exercising or abusing products that help "bulk up," says Dr. Angela Guarda, the director of the eating-disorders program at Johns Hopkins University in Baltimore.
Other symptoms include restricting the amounts or types of foods eaten (eating no fat or eating only vegetables, for example); "purging" eaten foods by vomiting or using laxatives or diuretics; relying on diet pills; and losing noticeable weight or fluctuating in size.
Although eating disorders describe an array of problematic behaviors, the three main types that afflict men — and women — are:
- Anorexia nervosa, which is often characterized by self-starvation and compulsive exercising.
- Bulimia nervosa, which involves recurring periods of binge eating and purging. Large amounts of food are consumed in a short amount of time, followed by self-induced vomiting, the abuse of laxatives or diuretics, and fasting.
- Binge-eating disorder involves out-of-control or compulsive overeating. Someone with this condition often fluctuates between periods of overeating and dieting.
Men who participate in competitive sports where body shape and size are important — gymnastics, ice skating, crew, dance and wrestling — are at increased risk for eating disorders.
Experts say other forces can lead to eating problems in men, including:
- Negative family patterns. Parents who stress fitness or athleticism to an unhealthy degree, or have unrealistic expectations for their children, can often contribute to eating problems.
- Media influence. Magazines and TV commercials increasingly sport photos of lean, muscular, athletic-looking men, increasing the pressure to be trim and fit.
- Traumatic events. Sexual, physical or emotional abuse can also set the stage for eating disorders.
The common thread is that the patient has experienced intense emotional pain and doesn't know how to cope with it in a healthy way. Controlling eating habits, weight or bodily functions often provides a false sense of control, Pollack says.
Fortunately, psychotherapy and support groups can help.
"A huge part of recovery is accepting that you have an eating disorder and talking about it," Holbrook says. "Getting therapy was the best thing that I've done for myself."
What To Do
The first step in dealing with an eating disorder is to speak with a psychotherapist or mental-health professional who specializes in the treatment of these disorders.
Experts also recommend contacting a nutritionist or registered dietitian to help develop healthful eating habits and menu planning.
Doctors and psychologists are failing to identify men suffering from eating disorders, research has found
The study, by the Eating Disorders Association (EDA), found that health professionals were only used to treating women with conditions such as anorexia and bulimia.
Now the EDA hopes to raise awareness of the fact that men too can suffer from the debilitating disorders.
Around one in 10 of the UK's 60,000 people reported as suffering from eating disorders are men.
But experts believe the figure could be far higher as men are less likely to admit to the condition than women.
They also believe that gay men are more likely to suffer from eating disorders because of an obsession with body image and physical perfection.
The EDA review of services for men with eating disorders aims to collect more up-to-date and accurate figures, and ask male sufferers about their experiences.
It will be completed by the end of the year and further research will then be commissioned into men and eating disorders.
The issue was highlighted in 1997 by the public admission of pop star and former Coronation Street actor Adam Rickitt that he battled with bulimia at school.
Not used to seeing men
A spokesman for the EDA said: "The usual route to an eating disorders unit is through a GP and then a psychologist.
"The problem is that at least 90% of the people seen with eating disorders are women.
"Doctors and psychologists are not used to seeing men and may not pick up on the warning signs that they are suffering from an eating disorder."
He added: "Men have different problems when it comes to eating disorders and the diagnosis can be more complicated.
"Instead of simply starving, they tend to over-exercise and cut down on the amount they eat.
"They may not look drawn and painfully thin like female sufferers, but instead appear muscular, but they are still suffering from the same eating disorder."
The spokesman said another problem was that classic signs of anorexia, such as missed periods, are obviously not going to be seen in men.
Men may also require different therapies and an alternative approach to treatment.
"We need to find out what men need from the provision of healthcare services and whether it is different from women," the spokesman said.
College men suffer from eating disorders, too
University of Utah student Jonathan Taylor was unsatisfied with his body. "I was a little guy," Taylor said. "I was the typical skinny, nerdy kid that people picked on. I hated it."
Males with eating disorders: Some questions and answers
What eating disorders do men and boys get? How many males have these disorders? Are the risk factors any different for males than they are for females?
According to new research, teenage boys who suffer from anorexia also suffer from growth delays caused by the disease.
Books on males and eating disorders
Males With Eating Disorders by Arnold E. Andersen
The best clinical book regarding males and eating disorders
My Life As A Male Anorexic by Michael Krasnow
Excellent: it takes all of the "glamour" out of eating disorders