Despite the common misconceptions that eating disorders in men are rare and that eating disorders are primarily a female concern, research has shown that around one-third of people with an eating disorder are male. Research also shows that dysfunctional eating behaviors like fasting for weight loss, binge eating, laxative abuse, and purging are almost as common in men as they are in women.
Eating disorders in men aren’t as well studied as those that occur in women. But according to the National Institutes of Health, males account for around five to 15 percent of people with anorexia nervosa or bulimia nervosa and around 35 percent of those with binge eating disorder.
Eating disorders in men are under-diagnosed, although a review published in the Journal of Eating Disorders found that eating disorders in men are increasing at a rate faster than eating disorders in women.
The most common eating disorders in men are binge eating disorder, anorexia nervosa, bulimia nervosa, and muscle dysmorphia.
Binge Eating Disorder
The most common eating disorder in men, binge eating disorder is characterized by recurring episodes of eating more food in a short amount of time than most people would eat under similar circumstances. Binge eating disorders in men are marked by a sense of loss of control, and they cause intense distress, including feelings of shame, guilt, embarrassment, and disgust.
Binge eating episodes occur, on average, at least once a week for at least three months. Episodes are associated with behaviors like eating until uncomfortably full, eating faster than normal, eating despite not being hungry, and eating alone to hide the amount of food eaten.
Anorexia nervosa is one of the most dangerous eating disorders in men, characterized by weight loss, trouble maintaining appropriate body weight and, in many cases, a distorted body image.
To be diagnosed with anorexia nervosa, an individual must meet three criteria:
Restriction of food that leads to significantly low body weight for one’s age, height, sex, development, and health
Intense fear of gaining weight, even in those who are underweight
A strong influence of body weight or shape on self-esteem and a denial that the current low body weight is a problem
Like other eating disorders in men, anorexia nervosa can cause serious problems, including dangerous electrolyte imbalances; heart attack; low potassium, thyroid and hormone levels; and low blood cell counts.
Eating disorders in men often include bulimia nervosa, which is characterized by a cycle of bingeing followed by compensatory behaviors. These may include excessive exercise, fasting, or purging through self-induced vomiting or laxative abuse.
In order for eating disorders in men to be diagnosed as bulimia nervosa, a person must meet the following criteria:
Engage in recurring episodes of binge eating
Engage in recurring episodes of inappropriate behaviors to compensate for the binge
Binge and purge at least once a week for at least three months
Evaluate self-worth based on body shape or weight
One of the most recently identified eating disorders in men is muscle dysmorphia, which primarily affects male bodybuilders and is characterized by a preoccupation with building muscle. Men with muscle dysmorphia believe that they’re too small or that their muscles aren’t big enough, even if they have an average or very muscular body. Marked by an extreme distortion of body image, muscle dysmorphia leads to compulsions like excessive exercise, spending exorbitant amounts of money on supplements, engaging in abnormal eating behaviors, and using steroids.
Muscle dysmorphia and other eating disorders in men almost always require professional help to overcome.
Having one or more known risk factors for eating disorders in men increases the chances that someone will develop an eating disorder. Risk factors for eating disorders in men include:
Dieting. The famous 1949 Minnesota Starvation Experiment by Dr. Ancel Keys, a researcher at the University of Minnesota, found that dieting changes a person’s body perception and their relationship with food. It also found that dieting resulted in cravings for high-fat and high-sugar foods that weren’t an issue before the diet. In the study, most of the 36 male subjects became obsessed with food and weight, and nine of them developed bulimia, one of the common eating disorders in men.
Personality. Eating disorders in men may be attributed in part to the same personality characteristics that are frequently associated with eating disorders in women. These include a high level of perfectionism and impulsivity, relationship problems, a penchant for thrill-seeking and problems with flexibility.
Athletics. It’s not uncommon to find eating disorders in men who are involved in sports. Athletes who participate in sports that put an emphasis on leanness or that match opponents by weight are at risk for developing extreme dietary restrictions. Studies have shown that high-performance male athletes may engage in disordered eating, have a poor body image, and exhibit dieting behaviors that are similar to those of females with eating disorders.
A history of obesity. While the risk of eating disorders in females is highest among women who believe they’re overweight, the risk of eating disorders in men is highest among those who were overweight before the disorder began. Experts believe this may be due in part to negative comments from others, the pressure to lose weight, and being bullied as children.
The Media and Eating Disorders in Men
Traditionally, men are valued for strength and power, while women are valued for their appearance. The increasing prevalence of eating disorders in men has led some researchers to look to the media for answers. The National Centre for Eating Disorders points out that men are becoming increasingly sensitive to the expanding mass media message to men that being attractive is good and being unattractive is bad. Gym memberships among men have increased in recent years, and men are now more likely than ever to choose cosmetic surgery, go on a diet, and have conversations with other men about dieting and supplements.
Eating Disorders in Men in the Gay Community
According to NEDA, gay males are believed to represent about five percent of the total male population, but 42 percent of men who seek treatment for an eating disorder identify as gay.
Some of the factors that may play a role in the development of eating disorders in men who are gay include:
Rejection or fear of rejection by others
Internalized negative messages or beliefs about one’s sexual orientation
Discrimination or bullying due to one’s sexual orientation
A disconnect between one’s biological sex and gender identity
The pressure to meet body image ideals within one’s LGBTQ+ cultural context
Gay men who have an eating disorder experience more barriers to effective treatment than heterosexual men, including a lack of culturally relevant treatment and a lack of support from others.
How Eating Disorders in Men Are Treated
There is no single treatment for eating disorders in men that works for every individual. Individualized treatment plans that address a client’s unique needs and problems is essential for the best possible outcome of treatment.
A holistic approach for eating disorder treatment for men addresses issues of body, mind, and spirit and typically includes a combination of traditional talk therapies, complementary therapies, nutritional counseling, and medical and psychiatric monitoring.
Traditional Talk Therapies
Talk therapy is the foundation for treating eating disorders in men.
Acceptance and commitment therapy helps clients detach themselves from negative emotions and accept that anxiety and pain are a normal part of life. Clients identify their core values and set goals that fulfill these values.
Cognitive-behavioral therapy helps clients identify and replace dysfunctional thought and behavior patterns surrounding weight, food, personal values, and core beliefs.
Dialectical behavioral therapy focuses on helping clients develop the skills they need to improve unbalanced eating behaviors. Developing mindfulness skills, interpersonal skills, emotional regulation skills and the ability to be okay with being uncomfortable are essential for successful recovery.
Complementary therapies are those that are shown to be effective in eating disorder treatment for men when used along with traditional therapies.
Yoga and meditation improve mindfulness and promote self-care. Yoga and meditation reduce stress and increase self-awareness and body-awareness. They promote living in the present moment and listening to the needs of the body. Meditation has also been shown to reduce anxiety and depression as well as increase self-acceptance, which can help address eating disorders in men who have a skewed body image.
Remedial massage therapy involves manipulating the soft tissues of the body, which has been shown to increase levels of serotonin and dopamine in the brain, leading to feelings of happiness and well-being. It can also reduce feelings of anxiety and depression and reduce stress levels.
Mindfulness helps individuals respond to negative emotions without judgment. It leads clients to a greater awareness of their thoughts, feelings and bodily sensations. Mindfulness promotes self-acceptance and self-compassion. It also helps reduce the negative emotions, including shame and guilt, that often accompany eating disorders in men.
Nutritional counseling is an integral part of treatment for eating disorders in men. Nutritional counseling helps individuals normalize their eating patterns, including eating enough each day to meet the body’s nutritional needs. It helps clients separate food from negative or distorted beliefs about themselves and develop a balanced relationship with food and eating. Individuals learn to listen to their body and trust their internal cues to identify hunger and fullness.
Nutritional counseling addresses a wide range of issues, including obsessive calorie counting, problems with eating in front of others, labeling food as good or bad, and other dysfunctional behaviors commonly seen with eating disorders in men.
Medical and Psychiatric Monitoring
Medical treatment and monitoring are essential for treating eating disorders in men. Medical treatment helps to reverse the damage done to the body by the eating disorder and ensures the body is getting the nutrition it needs for optimum wellness.
Psychiatric monitoring is essential for eating disorders in men that co-occur with a mental illness like anxiety, depression, or obsessive-compulsive disorder. Medication and talk therapy are highly effective in treating these mental illnesses, which is crucial for successful recovery.
Recovering from Eating Disorders
Treatment is essential for recovery from an eating disorder. But because eating disorders in men are under-diagnosed—and many men are reluctant to seek help for an eating disorder anyway—only a fraction of eating disorders in men are professionally treated.
Why Many Men Don’t Seek Help for an Eating Disorder
Men face a double stigma when it comes to getting help for an eating disorder.
One major reason why men are far less likely than women to seek treatment for an eating disorder is cultural bias. Because the general public’s perception is that eating disorders in men are rare, and that disordered eating is a female problem or a gay male problem, men with an eating disorder are likely to hide their disorder to avoid being labeled or stigmatized.
Men also face stigma surrounding seeking psychological help. Complex issues underlie eating disorders in men, and addressing these issues is crucial for successful recovery. But deeply ingrained cultural norms say that men who need psychological help are weak and that men shouldn’t show their emotions. It may take time before some men are able to open up during therapy and verbally express their emotions, which they often don’t have words for.
Relapse of Eating Disorders in Men
If an individual in recovery from an eating disorder falls back into old, dysfunctional thought and behavior patterns, a relapse of the eating disorder is likely. But a relapse isn’t the end of recovery, and it doesn’t mean treatment didn’t work. Eating disorders in men aren’t easy to overcome, and it can take time to develop the skills needed to stay in recovery for good.
Men who relapse are likely to be very hard on themselves, but this can prevent them from getting back on track with recovery. Approaching a relapse with a positive attitude, keeping in mind the progress that’s been made so far, will help ensure ongoing recovery. Professional help after a relapse helps individuals develop the missing skills that led to it.
Successful Recovery Tips for Eating Disorders in Men
Eating disorders in men take hard work to overcome, but the hard work is worth the peace of mind and stable emotional state that comes from it.
Here are some tips to help promote recovery from eating disorders in men.
Practice good self-care. A high level of self-care is crucial for recovery, especially in eating disorders in men. Get plenty of sleep and adequate exercise, and spend some of your day relaxing and having a good time.
Stay mindful. Being mindful of emotional states is crucial for recovery from eating disorders in men. Stay in tune with your thoughts, feelings and emotions, and withhold self-judgment.
Seek out supportive people. Support from friends and family is essential for successful recovery from an eating disorder, while toxic relationships are detrimental to recovery and should be ended or avoided. Surround yourself with supportive people who love you.
Redefine yourself. Separating yourself from your eating disorder and developing a new self-identity will help promote successful recovery. Find some enjoyable hobbies to engage in, develop relationships with people who make you feel good about yourself, and make good decisions according to your values.
Eating disorders in men are treatable, and the sooner treatment starts, the better the outcome. Treatment works, and it can work for you.