When I first opened an adolescent intensive outpatient program for eating disorders in Maryland, I expected to have a room full of struggling kids. Mostly girls, they all came with distorted body image, eating disorder behaviors, and underlying mental health concerns trying desperately to manage the demands of life, school, friendships, and family. I also was prepared for some of the moms of these kids to come in with their own history of body image disturbance, pattern of disordered eating, and anxiety and mood concerns. I dared hope they would discover their own personal awakening to these disorders as they help their child through the recovery process. I didn’t expect to see how quickly the father’s opened up to exact same things.
The first time it happened, I was running the multi-family group meeting for perhaps the fourth week since we opened. There were eight adults in the room and four children, and I was amazed that so many fathers were there to help their kids. The topic for the day was on honest communication, and one brave 15-year-old girl said to her father, “You never eat!” It sucked the energy up and we waited for the dad’s response. He was a medical professional, silver-haired, preppy, wearing khakis and a light-blue polo shirt with trendy loafers and no socks. He was the epitome of uncool to the kids, but to the adults appeared to be the definition of successful male. He paused for a good moment, and when he spoke, a new energy filled the room. “I don’t like my body and I’m afraid of being fat,” he admitted.
He recalled from the earliest age being a chubby, lonely, anxious, self-loathing kid. He never discussed his body shame with others, but admitted it was the reason he survived most days eating only one meal, typically dinner, and otherwise used copious amounts of coffee to keep him going through his days at work. Being in the medical field, he felt compelled to have “the right kind of body.” He also ran compulsively, whether he suffered from knee, hip, or ankle pain, which he often did. In the process of sharing his pain, his child let her tears flow, which in turn led to his cascade of tears. But that’s not where things ended.
This group of men had a fellow man share his hurt, and they found their courage in his act. Another father shared he too struggled with the same body image struggles and bullying as a child. He too ran every day without fail to deal with overwhelming anxiety he was unwilling to treat with medication. He wanted to be “in control” of it. That sense of control was something his daughter had often spoke of, but he had never shown empathy for. The momentum continued.
Yet another father discussed how he spent much of his college years frightened of being made fun of by his buddies from his fraternity. He came clean about a history of purging via exercise, which he was just learning about as a tool his own daughter used as her purging mechanism. The cyclical nature of the disease he saw in his daughter was finally something he recognized in himself.
Rather than hide in shame, these men found a space to openly discuss their personal anguish of body image and eating disorder behaviors. I asked if they would have shared this if there were only moms and daughters (and one young man) in the room. The answer was a resounding no. Feeling normalized by other men was the most powerful factor. They also said having a man lead the group was incredibly helpful to them.
I am very open about my own struggle and recovery from a lengthy eating disorder and co-morbid depression and anxiety. The men in the group read my bio where I shared that information before having their child enroll in my program. In private discussions, they admitted to me it was a reason they felt they too could open up. This is not uncommon. Most males in America are raised to avoid any behavior that speaks to being feminine or gay. Emotions, save for anger, are considered feminine. The more you share your feelings, the more feminine you are. In addition, a body that looks soft or feminine is ripe for ridicule, teasing and bullying. This was the case for these men, teased and bullied for having a typical pre-pubescent body with nowhere to turn their anger inward or become bullies themselves. These men developed the same disordered eating behaviors and concomitant problems their children did, but nobody looked at the signs or symptoms of distress and got them help because they were boys. Like me, they were expected to “toughen up,” “man up,” and “don’t be a p&%#&.” There clearly are more men like us than anyone thought.
Since my early experiences as a clinician, the research and meta-analysis of males with eating disorders has come to reflect what anecdotally I came to know – males suffer just as much as females. It was widely stated by eating disorder organizations males make up one in 10 individuals with an eating disorder. According the National Association for Males with Eating Disorders, that number is at least one in four, with some estimates suggesting one in three. For males with Binge Eating Disorder, males make up 40 percent of those diagnosed according to the Binge Eating Disorder Association.
According to Dr. Stuart Murray, a prominent researchers and clinician in the field of males with eating disorders, men who were in his male-only treatment groups at the University of California at San Diego described feeling a powerful sense of safety they didn’t feel in groups predominantly made up of their female counterparts. “There is a salient anecdotal effect of male peer groups upon de-stigmatization of the illness,” Dr. Murray stated in our discussion.
Sadly, there is no research available to validate the clinical implications of a male-only or male-majority groups or having a male lead therapist versus female therapist due to the limited number of men seeking treatment. In addition, there are very few male therapists trained in or simply treating eating disorders, let alone with specific training in males with eating disorders.
What appears clear to me, however, is the need to normalize the experience of male body image concerns, bullying, and the emotional impact it has. Fred Rogers, whom most of us know better as the cardigan sweater-wearing Mr. Rogers, revealed his experience of bullying about his weight in the documentary Mr. Rogers & Me. He was taunted by the neighborhood kids who yelled, “We’re going to get you Fat Freddy!” He was told to tough it by her parents rather than find solace at home. He turned inward, creating his own safer, more caring neighborhood in his mind, which eventually became his cherished TV show Mr. Rogers’ Neighborhood. It was there he endeavored to teach young boys, and girls, the task of seeing the “essential invisible” in themselves and others.
The more men out there provide the same message Mr. Rogers shared – of personal acceptance, finding our humanity including our full spectrum of emotions, and that being a man means owning our flaws and gifts alike – the better off we’ll be in helping boys and men alike seek help for the psychic and emotional wounds they’ve suffered. Like I inadvertently did for the fathers in my family group so many years ago, we all can create a safe space for men to share their hearts and then hopefully experience a beautiful shift into recovery.
By Andrew Walen, LCSW-C, LICSW, CEDS, Founder, CEO 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.