Eating disorders in males

This is a research summary of the following source: Gorrell, S and Murray, S B (2019) Eating Disorders in Males. Child Adolescent Psychiatric Clinics of North America 28(4): 641–651. 

Historically, the association of eating disorders with females has led to the marginalisation of males in the screening, treatment and research of eating disorders. Recent research in psychiatry has begun to indicate the prevalence of eating disorders among males, although these figures may still be a gross underestimate. In America, males comprise approximately one in four presentations of bulimia nervosa and anorexia nervosa (Hudson et al, 2007). In the United Kingdom, eating disorders in preadolescent males comprise one in three cases (Nicholls et al., 2011). 

Figures associated with the prevalence of eating disorders among males may be skewed partly by the fact that screening and assessment of eating disorders often focuses on symptoms that may not directly apply to males. Screening and assessment tend to centre around the thin ideal more typical in women. However, the ideal body type typically presented among males is associated with muscularity (Lavender et al., 2017). Figures may also be skewed by the fact that males may be less willing to seek treatment for eating disorders, owing in part to the perceived stigma associated with disclosure of mental health issues (Mitchison and Bond, 2015; Griffiths et al., 2014) and the cultural stereotypes that continue to perpetuate the perception that eating disorders are typically a female disorder. Furthermore, evidence on the age of onset of eating disorders among males is conflicting. It is therefore important that teachers develop a better understanding of how eating disorders can present in boys and girls, so they can seek appropriate support when needed.

Bulking and cutting are associated with muscularity-oriented disordered eating, which describes a cycle of muscle building (where protein is typically consumed) and extreme dietary restriction to decrease body fat and improve muscular definition (Griffiths et al., 2013). Muscle dysmorphia, which causes men to believe that they are skinny and small, despite being large and muscular, is a type of body image distortion that was initially identified in a study of male body builders (Pope et al., 1993). Muscle dysmorphia has been associated with the use of anabolic steroids in men (Pope et al., 2012). Sexual minority males may be at particular risk of eating disorders. In the United Kingdom, one study found that homosexual and bisexual boys at age 14 reported significantly greater body dissatisfaction than their heterosexual male peers (Calzo et al., 2018). Although these differences may be due to self-reporting, this study forms part of a much larger body of evidence accumulated over several decades which suggests that sexual minority status may be a contributing risk factor for eating disorders among young males.

Given these differences between males and females, screening and assessment tools need to be specifically developed and tested among males. Further research is also needed that focuses on the age of onset of eating disorders among males. More diverse male samples must be included in this research, to understand how risk interests with cultural and ethnic identification. Furthermore, treatment of eating disorders in males that directly address muscularity-oriented body image concerns should be developed and tested. Given the risk among sexual minority males, this treatment must also address a broad spectrum of gender and sexual presentations. 

Key takeaway points

• Eating disorders occur among a significant minority of youth and adolescent males. 
• Eating disorder risk factors are specific to males, particularly related to body image concerns.
• It is important that teachers are aware of how eating disorders may present differently in boys compared to girls.