Tom Wooldridge, PsyD, addresses misinformation regarding eating disorders in men.
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Dr. Wooldridge is chair of psychology and assistant professor at Golden Gate University, San Francisco.
Are men immune to eating disorders? Absolutely not!
Yet it’s not only the general public that thinks of eating disorders as a “female problem.” Unfortunately, this bias afflicts health care professionals, too. We are plagued by misinformation. For example, it is often stated that 10% of individuals with eating disorders are male. As it turns out, this often-repeated statistic is highly problematic. When it was published 25 years ago, it represented the number of men and boys in treatment-not in the general population (Andersen, A. Males and Eating Disorders. New York, Brunner/Mazel, 1990). Somehow, though, the statistic has persisted in our minds.
In fact, the best available data indicate that males account for 25% of individuals with anorexia nervosa and bulimia nervosa and 36% with binge-eating disorder (Biol Psychiatry 2007; 61:348-58). Given that these numbers are significantly higher, why aren’t more men in treatment today?
Oftentimes, men do not seek treatment because they are reluctant to ask for help; but beyond that, they are consistently stigmatized by the idea that they might have an adolescent girl’s problem. Men and boys are less educated about eating disorders, so they might not even consider that their behavior (eg, extreme weight loss, purging, binge eating, compulsive exercise, etc.) is on the eating disordered spectrum. They might actually suffer from a diagnosable eating disorder and think that it is normal behavior!
In one study, male patients with anorexia nervosa emphasized the lack of gender-appropriate information and resources for men as an impediment to seeking treatment (BMJ Open 2014; 4:e004342). Additionally, assessment tests underscore males because they have been written for females (Eat Disord 2012; 20:416-26).
Male eating disorders and related issues are multi-cultural and exist across age groups, but there are certain specific populations that are particularly at high risk. People who identify as lesbian, gay, bisexual, transgender, or questioning are at higher risk of developing an eating disorder (Int J Eat Disord 2012; 45:792-9). Although globally more heterosexual males have eating disorders, there are a higher percentage of gay males (15%) who are diagnosed (Int J Eat Disord 2007; 40:218-26).
Certain athletes are at higher risk for eating disorders. For example, wrestlers, boxers, jockeys, gymnasts, and long-distance runners often lose weight by purging, fasting, and excessively exercising. In the related demographic of bodybuilders, muscle development can become a destructive obsession, leading to a diagnosis of muscle dysmorphia. While keeping these groups in mind can aid in the process of differential diagnosis, remember that eating disorders happen to males in all demographic groups.
The best way to combat this misinformation and failures during the process of differential diagnosis is by becoming educated about eating disorders in men and boys. This includes recognizing efforts to advocate for these populations, such as the National Association for Males with Eating Disorders (NAMED) and-most importantly-remembering that men are not immune to eating disorders!
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