Despite the growing awareness of eating disorders as serious mental health concerns, misconceptions and stereotypes continue to abound. Eating disorders are often considered to be a girls’ or women’s issue, popularly conflated with the desire to be thin. Although girls and women are more likely to struggle with an eating disorder in their lifetime, reported rates of eating disorders among boys and men are increasing. Reported rates of lifetime prevalence of eating disorders in men range from about 0.4% (anorexia nervosa) to 1.1% (binge-eating disorder).[1] Bear in mind that these rates are diagnosed cases based on clinical criteria, meaning that boys and men who have not sought medical or paramedical attention, and boys and men with eating disorder symptoms that do not meet the full criteria for diagnosis are not included in these numbers. When we take into account “subclinical” levels of disordered eating, about 8% of men struggle with patterns of binge-eating or extreme dietary restriction.[2] What becomes even more concerning are the signs that boys are beginning to struggle with their relationship with food and their bodies more frequently and earlier on in life. In fact, up to 25% of boys between the ages of 10 and 14 report dieting to lose weight.[3] That’s one in four boys, even before adolescence, which surely shakes up the notion that dieting and disordered eating are girls’ issues.
What exactly are eating disorders?
It can be helpful to think about eating and weight-related behaviours along a spectrum, with ‘healthy’ or ‘normal’ behaviours on one end, and clinically diagnosed eating disorders on the other end. Some people (probably more accurately, many people) have challenging relationships with food and their bodies, and often show signs or symptoms of disordered eating, but may not struggle in all the specific ways that comprise a clinically diagnosable eating disorder. Examples of these signs or symptoms of disordered eating include:
- Feeling significant anxiety or guilt about food, eating, or exercise.
- Feeling emotions like disgust or shame about eating behaviours and/or oneself.
- Restricting or avoiding food leading to significantly low body weight.
- Intense fear of gaining weight.
- Eating large amounts of food in one sitting, and feeling out of control or unable to stop eating, even when feeling uncomfortably full.
- Vomiting, using laxatives, fasting, or turning to excessive exercise to “make up for” food eaten/to prevent weight gain.
Understanding why people struggle with disordered eating or develop eating disorders is a difficult task. Although it’s generally thought that media influences and appearance ideals contribute to eating disorder development, in reality, eating disorders are much more complex and run deeper than a desire to be thin or look a certain way. Disordered eating patterns, whether restricting or avoiding food, exercising excessively, or binge-eating, often signal underlying struggles with beliefs about self (e.g., feeling ‘not good enough’) and function as ways of dealing with anxiety and difficult emotions like sadness, shame, or fear.
Are there differences in the types of eating disorders that men and women struggle with?
The short answer is no, men can be diagnosed with the exact same eating disorders that women can be diagnosed with, although the ways boys and men are socialized can influence the ways that disordered eating shows up. For example, for men, being muscular is often valued at a (Western) societal level over being thin or small. Also, social dynamics and acceptable behaviour can shape how disordered eating shows up in boys’ and men’s lives. An illustration of this is the way in which eating large amounts of food in one sitting tends to be more ‘normal’ or acceptable for boys or men, in comparison to girls or women. Because of these social norms and expectations, signs of disordered eating among boys and men can be missed or even reinforced by peers, family, coaches, etc. Imagine the 16-year-old boy who spends a couple hours a day at the gym and goes through bouts of fasting and binge-eating to make a specific weight class for his next wrestling match. In these sorts of situations, it can be easy for disordered eating signs to go unnoticed because they may seem ‘normal’ within that particular social sphere.
What should you do if this information resonates with yourself or someone you know?
If you’re reading this and can see some of your own struggles reflected, or are reminded of someone that you know, you might be wondering about how to find help and healing. As a starting point, remember that eating disorders often signal underlying struggles with beliefs about self and function as a means of dealing with difficult emotions. Teaching boys and men the importance of emotional awareness and healthy ways of dealing with difficult emotions are essential for combatting eating disorders and other types of mental health concerns. Moreover, having open conversations about the importance of taking care of one’s body-self, and emphasizing function of the body over appearance, are key in building an environment for healthy, attuned ways of relating to food and our bodies. Lastly, because of the stereotype that eating disorders are a girls’ or women’s issue, boys and men can end up facing an added barrier to getting the help that they need to prevent and heal from eating disorders. Such misconceptions can contribute to a lack of awareness, secrecy, and even shame surrounding boys’ and men’s struggles with disordered eating. Understanding, relational connection, and empathy are antidotes to shame and central to the process of healing from eating disorders.
References
[1] Allen, K.L., Byrne, S.M., Oddy, W.H., Crosby, R.D., (2013). DSM-IV-TR and DSM-5 eating disorders in adolescents: prevalence, stability, and psychosocial corre- lates in a population-based sample of male and female adolescents. J. Abnorm. Psychol. 122, 720–732.
Hudson, J.I., Hiripi, E., Pope, H.G., Kessler, R.C., 2007. The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biol. Psychiatry 61, 348–358.
Preti, A., de Girolamo, G., Vilagut, G., Alonso, J., de Graaf, R., Bruffaerts, R., De- myttenaere, K., Pinto-Meza, A., Haro, J.M., Morosini, P., Investigators, E.-W., 2009. The epidemiology of eating disorders in six European countries: Results of the ESEMeD-WMH project. J. Psychiatr. Res. 43, 1125–1132.
Raevuori, A., Keski-Rahkonen, A., Hoek, H.W., 2014. A review of eating disorders in males. Curr. Opin. Psychiatry 27 (6), 426–430.
[2] Woodside, D.B., Garfinkel, P.E., Lin, E., Goering, P., Kaplan, A.S., Goldbloom, D.S., Kennedy, S.H., 2001. Comparisons of men with full or partial eating disorders, men without eating disorders, and women with eating disorders in the com- munity. Am. J. Psychiatry 158, 570–574.
[3] Bernier, C. D., Kozyrskyj, A., Benoit, C., Becker, A. B. & Machessault, G. (2010). Body image and dieting attitudes among preadolescents. Canadian Journal of Dietetic Practice and Research, 71, 34-40
McVey, G.L., Tweed, S., & Blackmore, E. (2005). Correlates of dieting and muscle gaining behaviors in 10-14-year-old males and females. Preventive Medicine, 40, 1-9
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