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Men account for approximately 20% of people with Anorexia Nervosa (AN) and 30% of people with Bulimia Nervosa (BN). The clinical features of eating disorders (EDs) in men and women have many similarities but also some interesting and important differences. Men with eating disorders face persistent stigmatization because of the stereotype that EDs are “female” conditions. Most structured risk assessment tools for AN/BN likely reinforce gender stereotypes by better reflecting female symptoms. Moreover, gender similarities and differences in EDs have received scant investigation. Clearly, this form of disordered eating can put men in danger of experiencing a wide range of negative outcomes. Due to this lack of knowledge, these patients usually go undiagnosed and undertreated for ten or more years. These clinical differences are evident in the processes related to treatment initiation, retention, completion, and outcomes. Therefore, we discussed how the manifestation and progression of male eating disorders can be influenced by social context, including family and work relationships, interactions with social institutions. Treatment recommendations are discussed in the context of gender-based physiological differences, behavioral differences, comorbidities, and men-specific conditions.
Department of Psychiatry, University of Missouri Kansas City, USA
California Southern University, USA
*Address all correspondence to: val.bellmanmd@gmail.com
1. Introduction
Eating disorders (EDs) are complicated conditions that are multifactorial and affect individuals of any age or gender [1]. Historically, the stereotype of individuals with EDs has been affluent, middle-class, Caucasian female adolescents; however, the incidence of EDs in males is increasing, yet there is a disproportionate representation of males in ED research and clinical guidelines [2]. These illnesses are associated with personal, familial, and societal costs, with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) being classified as two common EDs in the male population [3].
Roughly 10 million males in the United States will experience an ED throughout their lifetime. In a study that included 36,000 adults in the U.S., the ED lifetime incidence in men was approximately 1.2%. In Canada, males account for up to 20% of ED cases, while males account for 20–25% of ED cases in the UK. These numbers may be even greater, as men may experience feelings of shame surrounding their ED because of the stigma associated with the condition. Traditionally, EDs are thought only to be present in females. Therefore, having an ED as a male may feel emasculating, preventing many men from seeking treatment and support for their illness [1].
The frequency of these different EDs in males varies across studies. For example, the literature demonstrates that females are three times likelier to have BED, while other research indicates that males make up to 40 percent of all BED cases. Regardless, BED is much more prevalent in males than AN or BN. Additionally, male EDs sometimes present with what is known as muscle dysmorphia, which refers to the societal ideal that men should be highly muscular with low body fat. Men seeking this appearance may engage in strict disordered eating, which can eventually lead to an ED [1].
AN is typically associated with having an emaciated and thin figure, specifically in females. Men, however, usually prefer a more muscular and lean appearance over appearing thin. Likewise, only 4.9 percent of high school boys overvalue body weight compared to 24.3 percent of girls of the same age. However, AN can still occur in men, and AN screening and definitions do not always consider how AN presentation may differ in men [3].
For example, the Diagnostic and Statistical Manual of Mental Disorders (DSM) historically excluded males from an AN diagnosis, and until 2013, amenorrhea was a diagnostic criterion [2]. Endocrine dysfunction is another female-specific criterion that has since been removed [3]. On the other hand, BN has a lifetime prevalence of up to 1.6 percent in males. Among all BN cases, males account for roughly one-third of all cases [3]. BN most commonly presents in males as excessive exercise, as opposed to laxative use or vomiting, which is more frequently seen in females [2].
Research has demonstrated that the symptoms of EDs among males are as severe as females; hence, it is important for clinicians to implement more screening and education efforts among males who have EDs. In a study assessing the 5.5-year outcome of AN in male versus female adolescent inpatients, it was found that both genders follow a similar course: Both have a similar age at admission, age at ED onset, and duration of illness [4]. Another study showed that the onset of AN in men occurs between the ages of 14–18 years, while bulimia occurs at the late stage of adulthood. Unfortunately, most screening strategies focus on thinness-oriented behaviors and caloric restriction and do not consider male-specific eating patterns and differences in body image and self-perception. Men’s average scores on the ED screening scales are always lower than women’s—even though they receive the same standardized tests and adequate attention during the evaluation process [5, 6].
The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) contains diagnostic criteria for mental health disorders [1]. The criteria for AN and BN are summarized in Table 1.
Anorexia Nervosa
Bulimia Nervosa
1.
Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
Recurrent episodes of binge eating:
Eating in a discrete period (e.g., within any two-hour period), an amount of food that is definitely larger than most people eat during a similar period and under similar circumstances.
A sense of lack of control overeating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
2.
Intense fear of gaining weight or becoming fat, even though underweight.
Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
3.
Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on selfevaluation, or denial of the seriousness of the current low body weight.
The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
4.
Two subtypes: 1. Restricting type 2. Binge eating/purging type
Self-evaluation is unduly influenced by body shape and weight.
5.
Even if all the DSM-5 TR criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes individuals who meet the criteria for anorexia but who are not underweight, despite significant weight loss. Individuals with atypical AN may experience many physiological complications associated with AN.
The disturbance does not occur exclusively during episodes of AN.
Table 1.
Diagnostic criteria for AN and BN.
The DSM-5 also includes severity specifiers (i.e., mild, moderate, severe, extreme) for AN and BN, which are determined by weight status (AN) and frequency of inappropriate compensatory behaviors (BN) [1]. Table 2 summarizes the severity specifiers for both EDs.
Level of severity
Anorexia Nervosa (BMI)
Bulimia Nervosa
Mild
>I7 kg/m2
An average of 1–3 episodes of inappropriate compensatory behaviors per week
Moderate
16–16.99 kg/m2
An average of 4–7 episodes of inappropriate compensatory behaviors per week
Severe
15–15.99 kg/m2
An average of 8–13 episodes of inappropriate compensatory behaviors per week
Extreme
<15 kg/m2
An average of 14 or more episodes of inappropriate compensatory behaviors per week
Table 2.
Severity specifiers for AN and BN.
The revisions in the DSM 5 addressed the clinical utility of a diagnostic criteria set for EDs, allowing more male patients to be properly diagnosed [7, 8].
Males are often unaware that their eating patterns and associated behaviors are characteristic of an ED [9]. They tend to develop a pattern of binging and purging behaviors, commonly described as coping mechanisms with daily stressors [10].
Many men report that they put off going to their PCP for as long as possible, even when they are experiencing life-threatening symptoms. They also tend to ignore mental health problems and seek help less often than women for mental health challenges [2]. The gender-specific characteristics of AN vs. BN are summarized in Table 3.
Anorexia Nervosa in men
Bulimia Nervosa in men
Dietary restrictions among males with AN are usually focused on leanness with a goal to improve muscle definition and body shape [11]
Lots of similar patterns with regards to medical complications but later age of onset (18–26 years) [18]
The pathological preoccupation with weightlifting and strict adherence to eating foods that lower weight, not feeling muscular enough (“bigorexia”) [12]
Men are more concerned about shape while female patients tend to be more focused on their weight [13]
Men prefer high protein and high fat content foods during binge-eating episodes [22]
Compulsive exercises and/or anxiety associated with missing a workout is often the last symptom to resolve, and the first sign of relapse [6]
Male patients tend to report eating large amounts of food and/or eating more often. Experiencing loss of control, distress, or somatic complaints due to binge eating tend to be underreported [23, 24]
Decreased interest in sex and low testosterone levels with associated behavioral changes [14]
Men tend to engage in non-purging compensatory behaviors [6]
The binge-purging subtype of AN is more common in men [15]
Overeating or binging on a cheat day or meal followed by a period of rigid dietary restriction [25]
Men may have a higher BMI among patients with AN [15]
Spitting of food as compensatory behavior in men with BN [26, 27]
Hospitalized boys with AN tend to be medically compromised (e.g., extremely low BMI and large orthostatic shifts in heart rate and blood pressure) [16]
Less concerned about their binge-eating behaviors and less preoccupied with weight control measures [28]
Adult males who are hospitalized for AN exhibit even more severe medical complications, with very high levels of osteopenia and osteoporosis [17]
Higher rates of psychiatric comorbidities (e.g., depression and anxiety) and substance use [18]
Frequently present like females but with higher rates of comorbid substance use and psychiatric disorders [18]
Possibly increased prevalence of homosexual or bisexual orientation [29, 30]
The duration of hospitalization for AN in males was shorter, and male patients had fewer suicide attempts (vs. female patients) [19]
Men who struggle with binge-eating disorder may develop bulimia if purging is used to cope with the fear of weight gain
Central role of the frontostriatal area as its decreased activation in BN contributes to the severity of illness [31]
Table 3.
Characteristics of AN and BN in men.
Both genders, male and female, with EDs were found to have a similar level of unhappiness with themselves. As EDs involve a major focus on weight, body shape, fat percentage, and distribution, they lead to dangerous behavioral adaptations. A lack of gender-appropriate information and resources for men with EDs as an additional stressor has been reported in the literature [32].
In another study that reported on the mortality of DSM-IV EDs among a large sample of males aged 16–61 and females aged 14–65, mortality rates for males were higher than in females, respectively, for AN and BN [33]. It was also found that compared to females, males with anorexia or bulimia showed shorter survival times. In the AN study, remission after 5.5 years was more frequent in males than in females [4]. Also, males with AN were found to have a shorter duration of ED and a shorter period of inpatient treatment [4].
4. Medical and psychiatric comorbidities in men with EDs
Men with ED suffer from many psychiatric disorders (including anxiety, depression, post-traumatic stress disorder (PTSD), and substance abuse) compared to the general population. Male EDs and related comorbidities are often underdiagnosed, undertreated, and misunderstood by many clinicians [34]. Moreover, men with AN and psychiatric comorbidity may exhibit a ninefold increase in mortality if left untreated [35].
Previous studies of men with ED have found that 56–95% of patients with an ED also receive a diagnosis for at least one more psychiatric disorder. The prevalence of psychiatric comorbidity in men with ED ranges widely from 2 to 27% for depression [36, 37] and 32–43% for anxiety disorders [37, 38]. Research has also demonstrated that up to 36% of male veterans with AN are diagnosed with schizophrenia or other psychotic disorders [39]. Other psychiatric comorbidities associated with AN include PTSD, substance use disorders, sexual dysfunction, and self-harming behaviors.
The most common psychiatric comorbidities of BN include MDD (50%), phobias (50%), PTSD (45%), attention-deficit/hyperactivity disorder (ADHD) (35%) [40], personality disorders (31%), anxiety disorders, and substance use problems (overall 61%, including 46% alcohol and 20% cocaine) [29]. Other authors have also reported similar rates of psychiatric comorbidity for men versus women with BN [36, 39].
Studies have shown that about 30% of male patients who have had EDs have been sexually abused in the past. These childhood traumatic experiences cause overall dissatisfaction with appearance and distort eating behaviors in the male population [41, 42]. Finally, 17% of patients with BN reported having suicidal thoughts, so identifying other commodities with EDs is necessary for the treatment of the disease [43].
While EDs can result in significant medical complications within every body system, the greatest impact on health is often observed in the cardiovascular, neurological, and skeletal systems. Table 4 summarizes the comorbid somatic conditions and syndromes associated with AN and BN in men.
Category of symptoms and/or syndromes
Description
General somatic changes
Clinically significant fluctuations in weight and BMI Weakness, fatigue, lethargy Heat/cold intolerance Diaphoresis and/or hyperhidrosis Dizziness, vertigo, syncope/presyncope
Chest pain, palpitations, chest discomfort Arrhythmias, bradycardia, prolonged QTc Orthostatic BP changes, hypotension, and tachycardia Shortness of breath Edema (localized vs. generalized)
Gastrointestinal symptoms
GI discomfort/distress Bloating, meteorism Early satiety (fullness) Reflux with/without heartburn Hematemesis Hemorrhoids and rectal prolapse Constipation or diarrhea
Endocrinopathies and hormonal changes
Hypoglycemia Hypogonadism and infertility Stress fractures Osteopenia
In sports, low body weight and leanness are often regarded as advantageous from a performance perspective. This can be observed in endurance-based sports (e.g., distance running and cycling), weight-based sports (e.g., wrestling and jockeys), anti-gravitational sports (e.g., long jump and high jump), and others where leanness has been associated with improved performance outcomes [44]. Sometimes, sport-related requirements place an unnecessary burden on athletes, resulting in the increased likelihood of developing EDs [45, 46, 47].
EDs are especially common in bodybuilding, as it promotes leanness and muscularity as a method of scoring and performance and encourages the development of exercise and nutrition-related behaviors that may adversely affect one’s overall mental health.
A recent scoping review examined the prevalence of male athletes reporting disordered symptoms, subclinical EDs, and clinical EDs; prevalence rates ranged from 0 to 85.5%, 1.5–11.0%, and 1.3–32.5%, respectively [48]. Furthermore, the prevalence of EDs in male weight-sensitive sports versus less weight-sensitive sports ranged from 5 to 50% and 0–31%, respectively [49, 50, 51, 52, 53]. Interestingly, the prevalence of EDs among the general male population was only 2.2% (range, 0.8–6.5i%) [54].
Men who exhibit behaviors associated with a negative body image (e.g., body image dissatisfaction, preoccupation/obsession with specific body areas, body checking, and negative self-talk), or have psychological or personality features such as low self-esteem, fear of negative evaluation, depression, and impulsivity may be at an increased risk of EDs [44, 55, 56, 57, 58]. Further, socio-cultural factors, such as the ideal male body size/shape (i.e, muscular, lean, and V-shaped physique [broad shoulders and narrow waist]), also contribute to the increased propensity for EDs. This is further pronounced in male sports, whereas outward and physical appearances can impact perceptions related to performance [44, 48].
5.2 Role of sexual orientation
When looking at the possibly distinct viewpoints of males with EDs, one thing to explore is their self-perceived sexual orientation. According to research, LGBTQ adults and youths are more prone to developing mental illnesses because of the increased stress generated by prejudice and stigma [59].
Most characteristics of males and females with EDs appear to be similar; however, homosexuality or bisexuality appears to be a risk factor in males, specifically for those with BN. In a study conducted at Massachusetts General Hospital, 42% of male bulimic patients were identified as either homosexual or bisexual, and 58% of anorexic patients were identified as asexual [28]. Biologically, there may be similarities in brain structure between homosexual men and heterosexual women, and homosexual men may react to environmental stressors in a feminine way, thus increasing their risk of EDs [28].
Because of stigma, prejudice, and proximal stresses, homosexuality plays a role in males’ appearance and the progression, or severity of EDs. As a result, they have been largely ignored in therapy and diagnosis, contributing to the disorder’s severity [34]. ED stereotypes impede the provision of evidence-based treatment for males, thus falling short of the success of gender-specific conditions. Compared to females with EDs, the general population may see men with ED as gay or bisexual and label them as “weak” or mentally disabled. Males are expected to hide their weaknesses in today’s environment, especially shame and despair, which relate to the stigma of being “feminine.” In homosexual and bisexual males, “minority” stress and stigma are also linked to binge eating behaviors [59].
Reportedly, 54% of LGBT male teenagers have been diagnosed with EDs [60]. They are caught in a vicious loop of exercising for weight reduction to improve their health, only to end up on a “runaway diet” that leads to self-starvation [60].
5.3 Identification, assessment, and differential diagnosis
Risks of disordered eating and associated clinical EDs should not be discounted among male patients, and increased vigilance regarding the screening and subsequent management of both subclinical and clinical conditions is warranted. Male EDs are present in a range of settings, and collateral information should be obtained to justify the diagnosis. Underreporting ED symptoms impedes appropriate diagnosis, treatment, and research in this area.
When assessing an eating disorder, the clinician is expected to use all available methods to determine whether a male patient has an eating disorder. However, standardized diagnostic tools should not be used as the main screening method due to challenges with reliability and variability in clinical presentations. Figure 1 outlines the standardized rating scales for EDs in men.
Figure 1.
Standardized rating scales for EDs in men [61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75].
It is recommended to avoid using single measures such as BMI, the degree of weight loss/gain or duration of illness in the justification of the diagnosis. General medical conditions and other psychiatric disorders can simulate the binging, purging behaviors, disturbed food intake, and other compensatory reactions seen in EDs. Healthcare providers are expected to assess patients’ physical health, the possibility of underdiagnosed medical conditions, and evaluate the risk factors associated with disturbed eating behaviors.
Figure 2 outlines the differential diagnoses of AN and BN in accordance with their presentations.
Figure 2.
Differential diagnosis of AN and BN in men.
Approaching EDs using a multidisciplinary approach (e.g., the inclusion of a healthcare provider, dietitian, mental health specialist, etc.) allows for a patient-centered approach to care and should be prioritized. Sometimes, men with AN and BN may require a higher level of care due to medical instability. These challenging patients require a unique collaboration between many specialists, and general hospital units or inpatient psychiatric facilities may not be set up to provide appropriate care. The decision to hospitalize should be made only when all psychiatric and medical factors are considered. One of the most important factors is a progressive decline in oral intake and weight despite interventions, a history of weight instability, and comorbid psychiatric and/or medical conditions.
More than 50% of male adolescents with EDs who present to the clinic for treatment result in the need for immediate hospitalization due to significant delays in treatment [76]. The American Academy of Pediatrics released the criteria for inpatient treatment in 2014 [77]. Unfortunately, gender-specific criteria for hospitalization are still unavailable. Generally speaking, the patient is expected to be hospitalized when one or more of the following criteria are met:
<75% median BMI for age and sex
Dehydration
Electrolyte disturbances (hypokalemia, hyponatremia, or hypophosphatemia)
ECG abnormalities (e.g., prolonged QTc or severe bradycardia)
Physiologic instability
Severe bradycardia (HR <50 BPM daytime; <45 BPM at night)
Hypotension (90/45 mm Hg)
Hypothermia (body temperature, 96°F, 35.6°C)
Orthostatic hypotension
Failure of outpatient treatment
Acute or persistent food refusal
Uncontrollable binge eating and purging
Acute medical complications of malnutrition (e.g., syncope, seizures, cardiac failure, pancreatitis, etc.)
Unstable psychiatric or medical comorbidity that cannot be treated on an outpatient basis
As many as half of patients who survive hospitalization for ED experience prolonged work absence, financial difficulty, or emotional effects, each of which may further impede recovery. Iwajomo et al. reported that mortality after hospitalization for an eating disorder was five times higher compared to the general population [78]. Specifically, mortality rates were higher for males with AN and BN. Other authors also concluded that mortality rates for male patients with BN were higher than for their female counterparts [79]. Finally, a recent study confirmed that inpatient mortality for males with AN was twice as high as in the female population [80].
The goal of the treatment is to attain improved eating habits and overall physical and psychological well-being. In the treatment process for an ED, one of the first steps is understanding and admitting that the patient has an ED and identifying the need for a change. EDs in men may remain unidentified and undiagnosed as men are prone to hiding their symptoms due to the fear of judgment and shame of having a female disease [34]. It is important to raise public awareness about male EDs and to help motivate male patients to accept and get help.
Studies show a significant difference between the health of men and the health of women, as men are less likely to seek treatment for mental health problems. Many male patients with AN or BN tend to underuse professional services, despite their susceptibility to these types of illnesses. Most male patients deny that they are sick, resist treatment (usually medication and/or talk therapy), and demonstrate indirect support-seeking patterns (e.g., pushed into treatment by spouse) [81].
Multidisciplinary care teams consisting of a physician, dietician, and mental health providers are encouraged. Healthcare providers play a key role in the detection of EDs in men, as they are the first professionals men encounter. Stabilizing nutrition and weight in the early phases of recovery and searching for balance between rest, sleep, and activity are also crucial steps [81]. Interpersonal changes, especially in acquiring more flexibility in social relations, and learning how to distance from difficult relationships, may also be helpful. Another important step is being able to better recognize and understand one’s own personal needs, and have increased self-care and self-regulation, as that can help with opening up strict cognitive schemas, and ultimately lead to a better relationship with food [81].
Unfortunately, there are no gender-specific practice guidelines or standards of care for men with EDs [6]. Table 5 summarizes the general treatment guidelines for anorexia and bulimia.
World Federation of Societies of Biological Psychiatry (WFSBP) [83]
The National Institute for Health and Care Excellence’s (NICE) [84]
Anorexia Nervosa
First-line
Nutritional rehabilitation: restore weight, adjust eating pattern with a goal to achieve consistent weight gain 2–3 lb./week for hospitalized patients and 0.5–1 lb. in outpatient setting
Psychosocial interventions
Promotility agents (e.g., metoclopramide) for bloating and abdominal discomfort that occur during refeeding
No clear evidence to combine psychotherapy with pharmacotherapy
Psychoeducation with eating disorder focused CBT, Maudsley Anorexia Nervosa for adults, or specialist supportive clinical malnutrition
For children and young people, psychotherapy with AN-focused family therapy
No hyperfocus on medications
Consider the impact of malnutrition on medications
Second-line
SSRI are not advantageous for weight gain in patients who are receiving inpatient treatment
SSRI in combination with psychotherapy are recommended for persistent depressive, anxiety and/or obsessive- compulsive disorder (OCD)-like symptoms
Second generation antipsychotics may be considered in patients with treatment-resistant inability to gain weight, severe obsessional/delusional thinking and denial
Adjunctive pharmacotherapy for comorbid conditions
Olanzapine may be considered for weight gain
Low-dose quetiapine may cause improvement with minimal side effects
Prokinetic agents may improve gastric emptying
Zinc supplements may improve weight gain and affective symptoms
Adults: psychotherapy with eating disorder focused focal psychodynamic therapy
Children/young adults: ED-focused CBT; adolescent-focused psychotherapy for AN
Bulimia Nervosa
First-line
Nutritional rehabilitation
Psychosocial interventions: CBT, interpersonal therapy, family therapy
SSRI are safe and effective: fluoxetine is FDA approved for BN.
Dosages of SSRIs are higher than those used for depression
Fluoxetine is the best studies option for patients with BN
Antidepressants should be used in doses higher than those required for depression
BN-focused guided self-help
Children/young adults: Individual psychotherapy with BN-focused family therapy
Avoid overprescribing medications
Consider the impact of malnutrition and compensatory behaviors
Second-line
IPT is recommended for patients who do not respond to CBT
SSRIs/SNRls might be helpful for comorbid conditions, obsessions, and some impulse disorder symptoms
Fluvoxamine and sertraline are good alternatives
Topiramate decreases binge behavior with a moderate risk-to-benefit ratio
Ondansetron has efficacy over placebos
Individual BN-focused psychotherapy
Children/young adults: psychotherapy with individual BN-focused CBT
Table 5.
Treatment guidelines for AN and BN.
The traditional treatment for ED has largely been female-focused and sometimes unsuited for men, as they require a gender-sensitized treatment approach [32]. However, some authors have concluded that male and female patients may benefit equally from the same types of therapy [34]. Nevertheless, men want to be treated with dignity and with an acknowledgment of their value as individuals. Many of them do not want to be treated differently because of gender. One of the most widely cited elements of disrespect mentioned by patients is simply failing to pay attention to their needs by leaving them unattended or ignored [85].
Some patients believe that receiving a formal diagnosis can boost their self-image and self-esteem and motivate them to continue treatment [86]. Moreover, good quality therapeutic alliance is one of the most robust predictors of positive treatment outcomes in men with EDs—which is typically a reduction of primary symptoms of EDs [32]. Male patients who are actively engaged in treatment demonstrate improvements in their symptoms and quality of life. Interestingly, success rates are generally higher for men than women [87, 88]. The stigma of men with EDs and body image issues has yet to be overcome.
Gender-specific treatment groups can be considered an important treatment option: sensitive to all of these issues and addressing the unique needs of each patient in a comfortable and supportive environment [85]. Interestingly, most male patients prefer mixed-gender treatment groups [85]. Although gender mismatching (male patient-female therapist) does not impair the therapeutic alliance, male psychotherapists can bring that male-to-male relationship into the treatment process, and that can be extremely transformative. Male patients may need to have therapeutic interventions repeated multiple times before they understand why they are engaged in compulsive exercises or eating in a specific way. Thankfully, male patients with EDs who are engaged in recovery believe that therapy is the best investment that they have ever made [81].
It is important to discuss men’s thinking about wanting to be highly muscular and other potential symptoms of body dysmorphic disorders. Not only do men see themselves as healthy, but most look very healthy from an outward perspective [34]. Research has shown that men with AN and BN disorders experience multiple problems with sexual functioning in both the physiological (e.g., erectile dysfunction) and psychological (e.g., anxiety) dimensions of sexuality [86]. When men enter the treatment process, they do not always give providers the chance to understand the reasoning behind these clinical symptoms and their risks and to find a potential solution. While the presence of erectile dysfunction may signal potentially serious medical conditions, EDs are frequently overlooked.
Despite the widespread penetration of specialized testing in health care, there has been no empirical research to date investigating the impact of quality of evidence on the strength of treatment recommendations for patients with EDs. Previous clinical recommendations for treating men with EDs also emphasized the role of testosterone [89] and genetic vulnerability [90]. However, neither factor is accurate enough at this stage to make individual predictions about how a person’s symptoms will respond to treatment over time.
Demographic survey statistics show that around 10 million men and boys in the United States suffer from EDs and distorted eating practices. AN and BN affect persons of many identities; discrepancies have been discovered in specific marginalized groups, such as gender and sexual minorities. These patients experience various forms of stress, including significant stigma and social victimization. Moreover, men from various sexual minorities are overrepresented in the ED literature because they tend to seek treatment more often than the general population.
Men are disproportionately affected by EDs due to shame, social norms, and prejudice, all of which contribute to the manifestation, prognosis, and severity of bulimia and anorexia. Moreover, underreporting ED symptoms impedes appropriate diagnosis, treatment, and research in this area.
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Written By
Val Bellman
Submitted: 13 July 2022Reviewed: 28 July 2022Published: 01 September 2022
Open access peer-reviewed chapter
