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Knox Area Task Force on Eating Disorders Eating Disorders |
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KATFED |
Males and Eating Disorders: Research
Compiled by: Tom Shiltz,MS, CADII Rogers Memorial Hospital, Oconomowoc, WIPrevalence of Eating Disorders Among Males
- Approximately 10% of eating disordered individuals coming to the attention of mental professionals are male (Wolf, 1991; Fairburn & Beglin, 1990).
- There is a broad consensus, however, that eating disorders in males are clinically similar to, if not indistinguishable from, eating disorders in females (Margo, 1987; Schneider & Agras, 1987; Crisp et al., 1986; Vandereycken & Van der Broucke, 1984).
- A national survey of 11,467 high school students and 60,861 adults revealed the following gender differences (Serdula et al., 1993):
- Among the adults, 38% of the women and 24% of the men were trying to lose weight.
- Among high school students, 44% of the females and 15% of the males were attempting to lose weight.
- Based on a questionnaire administered to 226 college students (98 males and 128 females) concerning weight, body shape, dieting, and exercise history, the authors found that 26% of the men and 48% of the women described themselves as overweight. Women dieted to lose weight whereas men usually exercised (Drewnowski & Yee, 1987).
- A sample of 1,373 high school students revealed that girls (63%) were four times more likely than boys (16%) to be attempting to reduce weight through exercise and caloric intake reduction. Boys were three times more likely than girls to be trying to gain weight (28% versus 9%). The cultural ideal for body shape for men versus women continues to favor slender women and athletic, V-shaped muscular men (Rosen & Gross, 1987).
- In general, men appear to be more comfortable with their weight and perceive less pressure to be thin than women. A national survey indicated that only 41% of men are dissatisfied with their weight as compared with 55% of women; moreover, 77& of underweight men liked their appearance as opposed to 83& of underweight women. Males were more likely than females to claim that they were fit and exercised regularly, they felt good about their bodies. Women were more concerned with aspects of their appearance, particularly weight (Cash, Winstead, & Janda, 1986).
- Gymnasts, runners, body builders, wrestlers, jockeys, dancers, and swimmers are particularly vulnerable to eating disorders because their sports necessitate weight restrictions (Andersen, Bartlett, Morgan, & Brownell, 1995). It is important to note, however, that wright loss in an attempt to improve athletic success differs from an eating disorder when the central psychopathology is absent.
- Nemeroff, Stein, Diehl, and Smolack (1994) suggest that males may be receiving increasing media messages regarding dieting, and ideal of muscularity, and plastic surgery options (such as pectoral and calf implants).
- DiDomenico and Andersen (1988) found that magazines targeted primarily at women included a greater number of articles and advertisements aimed at weight reduction (e.g., diet, calories) and those targeted at men contained more shape articles and advertisements (e.g., fitness, weight lifting, body building, or muscle toning). The magazines most read by females ages 18-24 had 10 times more diet content than those most popular among men in the same age group.
- Males with anorexia display a considerable degree of anxiety with regard to sexual activities and relationships. Fichter and Daser (1987) compared males and females with anorexia and found that males displayed significantly more sexual anxieties than did females. The authors noted that 80% of the males in their study grew up in families that regarded sex as a taboo subject. Corresponding with the reported sexual anxiety, low levels of sexual activity among the males with anorexia were also noted.
- Burns and Crisp (1984) found that males with anorexia in their study admitted "obvious relief" at the diminution of their sexual drive during the acute phase of their disease.
- Eating-disordered males differed significantly from eating-disordered females in terms of sexual experience in a study conducted by Herzog et al. (1984). Males with eating disorders were significantly less likely to have had sexual relations before the onset of their eating disorder, or to be involved in a sexual relationship at the time of evaluation than were females with eating disorders. Males with bulimia, however, appear to be more sexually active than males with anorexia, both premorbidly and at the time of their illness.
- A study by Andersen and Mickalide (1983) suggests that a disproportionate number of males with anorexia may have persisting or preexisting problems in testosterone production.
- Fichter and Daser (1987) found that males with anorexia saw themselves and were seen by others as more feminine than other men, both in attitudes and behavior. In general the males with anorexia appeared to identify more closely with their mothers than with their fathers.
- Homosexuals are over-represented in many samples of eating disordered men. While the proportion of male homosexuals in the general population cross-culturally is estimated to be 3%-5% (Whitman 1983), samples of eating disordered men are commonly twice as high or greater (Fichter & Daser, 1987).
- Several authors have noted that homosexual conflict preceded the onset of an eating disorder in up to 50% of male patients (Scott, 1986; Dally 1969; Crisp, 1967).
- Conflict over gender identity or over sexual orientation may precipitate the development of an eating disorder in many males (Crisp, 1983). It may be that by reducing their sexual drive through starvation, patients can temporarily resolve their sexual conflicts (Crisp, 1983).
- Homosexual men may be at an increased risk for developing an eating disorder because of cultural pressures within the homosexual community to be thin (Schneider & Agras, 1987). Herzog et al. (1990) found that homosexual men weighed significantly less than heterosexual men, were more likely to be underweight and to desire an underweight ideal weight. Compared to the heterosexuals, homosexual men were less satisfied with their body build, and scored significantly higher on the "Drive for Thinness" scale of the Eating Disorders Inventory (EDI).
- Body image concerns may be important predictors of eating disorders in males. Wertheim et al. (1992) found that a desire to be thinner was a more important predictor of weight loss behaviors than psychological or family variables, for both males and female adolescents.
- Kearney-Cooke and Steichen-Asch (1990) found that the preferred body shape for contemporary men without eating disorders was the V-shaped body, whereas the eating disordered group strove for the "lean, toned, thin" shape. The authors found that most of the men with eating disorders reported negative reactions from their peers. They reported being the last ones chosen for athletic teams and often cited being teased about their bodies as the times when they felt most ashamed of their bodies.
- Kearney-Cooke and Steichen-Asch (1990) found that men with eating disorders tend to have dependent, avoidant, and passive-aggressive personality styles, and to have experienced negative reactions to their bodies from peers while growing up. They tend to be closer to their mothers than their fathers. The authors conclude that "in our culture, muscular build, overt physical aggression, competence at athletics, competitiveness, and independence generally are regarded as desirable for males, whereas dependency, passivity, inhibition of physical aggression, smallness, and neatness are seen as more appropriate for females.Boys who later develop eating disorders do not conform to the cultural expectations for masculinity; they tend to be more dependent, passive, and non-athletic, traits which may lead to feelings of isolation and disparagement of body."
Andersen, A.E., & Mickalide, A.D. (1983). Anorexia nervosa in the ale: An undiagnosed disorder. Psychosomatics, 24, 1067-1075.
Andersen, R.E., et al. (1995). Weight loss, psychological and nutritional patterns in competitive male body builders. International Journal of Eating Disorders, 18, 49-57.
Andersen, R.E. (1995). Eating Disorders in Males. In Brownell, K. & Fairburn, C.G., (Eds.), Eating Disorders and Obesity: A Comprehensive Handbook. New York: Guilford Publications, Inc.
Burns, T. & Crisp, A.H. (1984). Outcome of anorexia nervosa in males. British Journal of Psychiatry, 145, 319-328.
Cash, T.F., Winstead, B.A., & Janda, L.H. (1986). The great American shape-up. Psychology Today, April, 30-37.
Crisp, A.H. (1967). Anorexia Nervosa. Hospital Medicine, 1, 713-718.
Crisp, A.H. (1970). Anorexia nervosa, "feeding disorder," "nervous malnutrition," or "weight phobia?" World Review of Nutrition and Dietetics, 12, 452-504.
Crisp, A.H. (1983). Some aspects of the psychopathology of anorexia nervosa. In P.L. Darby et al., (Eds.), Anorexia Nervosa: Recent Developments in Research (pp. 15-28). New York: Alan Liss.
Crisp, A.H. et al. (1986). Primary anorexia nervosa in the male and female: A comparison of clinical features and prognosis. British Journal of Medical Psychology, 59, 123-132.
Dally, P. (1969). Anorexia Nervosa. London: Heinemann Medical Books.
DiDomenico L., & Andersen, A.E. (1988). Sociocultural considerations and sex differences in anorexia nervosa. In Andersen, A. (Ed.), Males with eating disorders (p. 31). New York: Brunner/Mazel.
Drewnowski, A., & Yee, D.K. (1987). Men and body image: Are males satisfied with their body weight? Psychosomatic Medicine, 49, 626-634.
Fairburn, C.G., & Beglin, S.J. (1990). Studies of the epidemiology of bulimia nervosa. American Journal of Psychiatry, 147, 401-408.
Fichter, M.M., & Daser, C. (1987). Symptomatology, psychosexual development and gender identity in 42 anorexic males. Psychological Medicine, 17, 409-418.
Herzog, D.B., et al. (1984). Sexual conflict and eating disorders in 27 males. American Journal of Psychiatry, 141, 989-990.
Herzog, D.B., et al. (1990). Sexuality in males with eating disorders. In Andersen, A. (Ed.), Males with eating disorders (p. 47). New York: Brunner/Mazel.
Kearney-Cooke, A., & Steichen-Asch, P. (1990). Men, body image, and eating disorders. In Andersen, A. (Ed.), Males with eating disorders (p. 47). New York: Brunner/Mazel.
Margo, J.L. (1987). Anorexia nervosa in males: A comparison with female patients. British Journal of Psychiatry,151, 80-83.
Nemeroff, C.J., et al. (1994). From the Cleavers to the Clintons: Role choices and body orientation as reflected in magazine article content. International Journal of Eating Disorders, 16, 167-176.
Pope, H.G., et al. (1986). Bulimia in men. A series of fifteen cases. The Journal of Nervous and Mental Disease, 174, 117-199.
Rosen, J.C., & Gross, J. (1987). Prevalence of weight reducing and weight gaining in adolescent girls and boys. Health Psychology, 6, 131-147.
Schneider, J.A., & Agras, W.S. (1987). Bulimia in males: A matched comparison with females. International Journal of Eating Disorders, 6, 235-242.
Scott, D.W. (1986). Anorexia nervosa in the male: A review of the clinical, epidemiological and biological findings. International Journal of Eating Disorders, 5, 799-819.
Serdula, M.K., et al. (1993). Weight control practices of U.S. adolescents and adults. Annals of Internal Medicine, 119, 667-671.
Shiltz, T. (1997). Eating Concerns Support Group Curriculum. Greenfield, WI: Community Recovery Press.
Vandereycken, W. & Van der Broucke, S. (1984). Anorexia nervosa in males. Acta Psychiatrica Scandinavica, 70, 447-454.
Wertheim, E.H., et al. (1992). Psychosocial predictors of weight loss behaviors and binge eating in adolescent girls and boys. International Journal of Eating Disorders, 12, 151-160.
Whitman, F.L. (1983). Culturally invariable properties of male homosexuality: Tentative conclusions from cross-cultural research. Archives of Sexual Behavior, 12, 207-226.
Wolf, N. (1991). The beauty myth. New York: William Morrow.
Source: Eating Disorders Awareness and Prevention, Inc. "Males and Eating Disorders: Research." Compiled by: Tom Shiltz,MS, CADII Rogers Memorial Hospital, Oconomowoc, WI. Handout. ©1999 EDAP.
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Enhancing Male Body Image
Compiled by: Tom Shiltz,MS, CADII Rogers Memorial Hospital, Oconomowoc, WI- Recognize that bodies come in all different shapes and sizes. There is no one "right" body size. Your body is not and should not be exactly like anyone else's. Try to see your body as a facet of your uniqueness and individuality.
- Focus on the qualities in yourself that you like that are not related to appearance. Spend time developing these capacities rather than focusing on changing the size or shape of your body.
- Look critically at advertisements that push the "body building" message. Our culture emphasizes the V-shaped muscular body shape as the ideal for men. Magazines targeted at men tend to focus on articles and advertisements promoting weight lifting, body building, or muscle toning. Do you know men who have muscular, athletic bodies but who are not happy? Are there dangers in spending too much time focusing on your body? Consider giving up your goal of achieving the "perfect" male body and work at accepting your body just the way it is.
- Remember that your body size, shape, or weight has nothing to do with your worth as a person, or your identity as a man. In other words, you are not your body. Expand your idea of "masculinity" to include qualities such as sensitivity, cooperation, caring, patience, having feelings, being artistic. Some men may be muscular and athletic, but these qualities in and of themselves do not make a person a "man."
- Find friends who are not overly concerned with weight or appearance.
- Be assertive with others who comment on your body. Let others know that comments on your physical appearance, either positive or negative, are not appreciated. Confront others who tease men about their bodies or who attack their masculinity by calling them names such as "sissy" or "wimp."
- Demonstrate respect for men who possess body types or who display personality traits that do not meet the cultural standard for masculinity; e.g., men who are slender, short, or overweight, gay men, men who dress colorfully or who enjoy traditional "non-masculine" activities such as dancing, sewing, or cooking.
- Be aware of the negative messages you tell yourself about your appearance or body. Respond to negative self-talk with an affirmation. For example, if you start giving yourself a message like, "I look gross," substitute a positive affirmation, "I accept myself the way I am," or "I'm a worthwhile person, fat and all."
- Focus on the ways in which your body serves you and enables you to participate fully in life. In other words, appreciate how your body functions rather than obsessing about its appearance. For example, appreciate that your arms enable you to hold someone you love, your thighs enable you to run, etc.
- Aim for lifestyle mastery, rather than mastery over your body, weight, or appearance. Lifestyle mastery has to do with developing your unique gifts and potential, expressing yourself, developing meaningful relationships, learning how to solve problems, establishing goals, and contributing to life. View exercise and healthy eating as aspects of your overall approach to life that emphasizes self-care.
Source: Eating Disorders Awareness and Prevention, Inc. "Enhancing Male Body Image." Compiled by: Tom Shiltz,MS, CADII Rogers Memorial Hospital, Oconomowoc, WI. Handout.
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Strategies for Prevention and Early Intervention of Male Eating Disorders
Compiled by: Tom Shiltz,MS, CADII Rogers Memorial Hospital, Oconomowoc, WI- Recognize that eating disorders do not discriminate on the basis of gender. Men can and do develop eating disorders.
- Learn about eating disorders and know the warning signs. Become aware of your community resources (treatment centers, self-help groups, etc.). Consider implementing an Eating Concerns Support Group in a school, hospital, or community setting to provide interested young men with an opportunity to learn more about eating disorders and to receive support. Encourage young men to seek professional help if necessary.
- Understand that athletic activities or professions that necessitate weight restrictions (e.g., gymnastics, track, swimming, wrestling, rowing) put males at risk for developing eating disorders. Male wrestlers, for example, present with a higher rate of eating disorders than the general male population (Andersen, 1995). Coaches need to be aware of and disallow any excessive weight control or body building measures employed by their young male athletes.
- Talk with young men about the ways in which cultural attitudes regarding ideal male body shape, masculinity, and sexuality are shaped by the media. Assist young men in expanding their idea of "masculinity" to include such characteristics as caring, nurturing, and cooperation. Encourage male involvement in traditional "non-masculine" activities such as shopping, laundry, and cooking.
- Demonstrate respect for gay men, and men who display personality traits or who are involved in professions that stretch the limits of traditional masculinity; e.g., men who dress colorfully, dancers, skaters, etc.
- Never emphasize body size or shape as an indication of a young man's worth or identity as a man. Value the person on the "inside" and help him to establish a sense of control in his life through self-knowledge and expression rather than trying to obtain control through dieting or other eating disorder behaviors.
- Confront other who tease men who do not meet traditional cultural expectations for masculinity. Confront anyone who tries to motivate or "toughen up" young men by verbally attacking their masculinity, e.g., calling names such as "sissy" or "wimp."
- Listen carefully to a young man's thoughts and feelings, take his pain seriously, allow him to become who he is.
- Validate a young man's strivings for independence and encourage him to develop al aspects of his personality, not only those that family and/or culture find acceptable. Respect a person's need for space, privacy, boundaries. Be careful about being overprotective. Allow him to exercise control and make his own decisions whenever possible, including control over what and how much he eats, how he looks, and how much he weighs.
- Understand the crucial role of a father or other male influence in the prevention of eating disorders. Find ways to connect young men with healthy male role models.
Source: Eating Disorders Awareness and Prevention, Inc. "Strategies for Prevention and Early Intervention of Male Eating Disorders." Compiled by: Tom Shiltz,MS, CADII Rogers Memorial Hospital, Oconomowoc, WI. Handout.
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