This statistic is false – males make up one in 10 of those with an eating disorder. But it’s the statistic most frequently quoted in the media. Why? Because this number represents the percentage of males seeking treatment. The reality is males make up at least 1 in 4 of those with anorexia and bulimia (with some studies suggesting 1 in 3), and almost half of those diagnosed with binge eating disorder based on the most recent research studies. But there’s more to this story.
Relatively little is known about males with eating disorders as historically they are almost universally excluded by epidemiological studies and treatment trials. Males make up less than 1% of research to date. What studies have been done show the same level of distress and disability, proving there is a need for this research and treatment.
The problem is males with eating disorders are less likely to be diagnosed and their symptoms are dismissed out of hand simply because of their gender. This reflects the lack of awareness of the disorder among health professionals, as well as a misunderstanding of how males present differently than females.
Here is the key difference: body dissatisfaction in males is typically characterized by a drive for muscularity rather than a drive for thinness. This preoccupation with body weight and shape leads to disordered eating and exercise practices. Studies show more than 90% of adolescent boys report exercising predominantly to increase muscle mass or tone, 66% report changing their diet to increase muscle size or tone, and 15% are using substances like anabolic steroids for the same purpose.
Approximately 8% of young men describe being so driven by their desire for muscularity they will choose “dangerous” means to achieve their goals. In an effort to bulk up and “cut weight,” males report becoming hypervigilant about protein, dietary fat, and carbohydrate consumption. The use of these behaviors and anabolic steroids are now seen as common as, if not more common than, extreme weight control behaviors seen in young women. And they come with the same level of psychological and physical distress. While males do present with stereotypical thinness-oriented presentation of anorexia and bulimia, and in fact may be increasing due to our thin-obsessed societal norms, the majority of males with body image disturbance struggle with concerns about muscularity.
The core issue – regardless of being a male or female, or thinness-oriented or muscularity-oriented fixation – is an over-valuation on weight and shape. The resulting work is to find the origin of this fixation – be it trauma, psychopathology, neurology, biology, environment, culture, or family of origin – and expertly treat the individual. We have to normalize the experience of being a male with an eating disorder, eliminate the stigma of seeking treatment, and get healthcare professionals the tools and education to be able to accurately diagnose the disorder and discuss it with their clients or patients. In time we’ll see that the number, 1 in 10 of those with eating disorders in treatment are male, starts to accurately reflect the reality of the disease.
By Andrew Walen, LCSW-C - Founder, Executive Director, Psychotherapist at The Body Image Therapy Center. If you would like to get in touch with Andrew please call 877-674-2843 or email firstname.lastname@example.org.