When people hear the term ‘eating disorder’, societally, it often conjures up the image of an extremely underweight, adolescent female. But this is just one of the many misconceptions surrounding eating disorders.
Eating disorders are serious mental health illnesses. And while they do often affect women, they don’t discriminate. Eating disorders can affect anyone, regardless of age, gender, ethnicity, sexual orientation, weight, or socioeconomic status.
We greatly admire the work of eating disorder charity, Beat. One of our shared aims is to raise greater awareness and understanding about eating disorders to help people get the support and treatment they deserve.
Each year, Beat highlights a different theme for Eating Disorders Awareness Week (27th February – 5th March 2023). This year, the spotlight is on eating disorders in men.
So in this post, Sara Baig, trainee counselling psychologist with Altum Health, talks to us about the stigma surrounding eating disorders in men, the impact this can have, and what can be done about it.
Stigma surrounding eating disorders in men can be extremely damaging, and have serious ramifications. These negative stereotypes can:
- Prevent men from seeking help, often until their eating disorder is much more severe.
- Lead to under diagnosis in men suffering with an eating disorder.
- Lead to inappropriate treatments being recommended.
What proportion of men are affected by eating disorders?
The prevalence of eating disorders in men has increased dramatically in the last two decades.
It’s been commonly cited that 10% of clinical eating disorder cases occur in men (Nicholls, Lynn, & Viner, 2011). However, other data suggests that this number may be as high as 25% (Hudson, Hiripi, Pope, & Kessler, 2007; Madden, Morris, Zurynski, Kohn, & Elliot, 2009).
It’s also been reported (Parker, 2020), that LGBTQ+ men are more vulnerable to eating disorders than heterosexual and cisgender men. Transgender men, in particular, are about five times more likely to develop disordered eating behaviours than cisgender men, and they may present with specific symptoms and issues that may translate into unique treatment needs.
Why eating disorders in men are more prevalent nowadays
While we’re still learning the exact reasons for the increase in the prevalence in men, a few key factors have been identified in contributing to this trend.
One central factor may be the increasing societal and media pressure on men to achieve the ‘ideal male body.’ In the past, the media has predominantly focused its attention on women’s bodies, showcasing unrealistic images of ‘perfection’ focussed on thinness, which many women strive to emulate through diet and exercise.
In recent years, the media has expanded its spotlight to include men’s bodies, too. The ‘ideal male body type’ that is promoted is often an incredibly lean, muscular physique. This has led some men to radically change their diets, exercise excessively and even use steroids to try to achieve this look.
This pursuit of the ‘ideal male body’ is incredibly dangerous and can even lead to a condition called Muscle Dysmorphic Disorder (MDD), a type of body dysmorphic disorder (BDD) that’s sometimes called ‘Bigorexia’. MDD is more common in men, and involves a preoccupation with the idea that one’s body is not lean or muscular enough, regardless of actual appearance. Indeed, BBC news recently reported that 1 in 10 men in training gyms in the UK may be experiencing MDD.
Where does the stigma around men with eating disorders stem from?
Even though there is increased awareness of eating disorders in men, and more men are now being diagnosed than in the past, the stigma does still exist. There can be a number of reasons for this.
- Gender norms
Societal pressures around gender norms may contribute to many men believing or feeling that they should conform to masculine gender norms in order to fit in. For example, society continues to encourage men to repress their feelings and emotions, to be ‘strong and self-reliant’, not reach out for help, and not show vulnerability.
This is perhaps part of the reason why only 36% of men suffering with an eating disorder will seek treatment compared to 62% of women (Thapliyal et al., 2018).
“As soon as I accepted I needed help, my recovery was a lot easier. It was the fear of admitting I needed help which held me back.”
Louis, Altum Health client
A recent study by Sweeting et. al, explored how eating disorders in men were represented in articles published in UK newspapers over a ten-year period. It found the media portrayed eating disorders as “atypical of men”, and atypical of people with eating disorders, who are still usually portrayed as teenage girls. These representations frame a “cultural paradigm in which there is an expectation that men may feel shame about or strive to conceal eating disorders, potentially contributing to men with eating disorders delaying help-seeking, gaining late access to treatments, and reducing chances of successful outcomes.”
Culturally, we need to work harder to change this. Things are moving, and to contribute to a change for the better, we can start by challenging male gender norms and creating safe environments where boys and men are encouraged to express and share their feelings, and where they are shown that asking for help is a sign of strength rather than a sign of weakness.
- The male identity
Can you imagine failing to be diagnosed with the illness you’re struggling with simply because of your gender?
Raisanen and Hunt (2014) found that several men experienced misdiagnosis as a result of healthcare providers not recognising their symptoms in the context of their male gender.
In other words, you may visit your healthcare provider showing signs of an eating disorder, but due to your gender, your illness may not be recognised as such.
“I went to my GP and told him I thought I might have an eating disorder, and he told me that I didn’t fit the criteria for one. He then joked about me not having lost my periods!”
Nate, Altum Health client
Men with eating disorders have said that they “just want to be treated as individuals and not defined by their gender” (Kinnaird et al., 2019).
The solution? Greater knowledge and training for healthcare providers to raise awareness of the stigmas surrounding eating disorders in men to help challenge and improve the status quo.
- Social bias
As we touched on earlier, one common misconception is that eating disorders are a female thing. This can have major repercussions.
Labelling an illness as ‘a female thing’ can not only lead to men not seeking help and misdiagnosis within a clinical environment, but also inappropriate treatments being recommended by healthcare providers.
“Social bias definitely had an impact on me avoiding talking about my eating disorder. It made me feel alone and very insecure about being in my own skin. The awareness regarding young men having food issues is something that has to be spoken about as this leads to more depression and suicide.”
Louis, Altum Health client
The impact of stigma on eating disorders in men
From the ability to seek help, get a proper diagnosis, and receive appropriate treatment, the stigma surrounding eating disorders in men can be far reaching.
- Under diagnosis
Things really need to change. It’s only in the most recent incarnation of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that amenorrhea (the absence of periods) is no longer a required diagnostic criteria for anorexia nervosa.
That is, until recently, healthcare providers have based eating disorder diagnosis on criteria designed for people assigned female at birth. Now, there’s greater emphasis on more inclusive diagnostic criteria as well as healthcare providers using their own clinical judgement.
Another reason why men often go underdiagnosed for eating disorders is due to the fact they may be struggling with an additional mental health illness alongside their eating disorder.
For example, a man may be suffering from not only bulimia, but also, depression and substance abuse. Sadly, healthcare providers can often overlook the eating disorder, and may recommend a course of action and treatment for only depression and substance abuse.
- Inappropriate treatment
“There’s nothing there for guys” (Kinnaird et al., 2019, p.848).
This was true in terms of both the physical space reflecting women’s dominance (Kinnaird et al., 2019) and worksheets/materials being tailored towards women (Lyons et al., 2019).
In terms of available treatment, approaches are often based on interventions developed for eating disorders in women, and there are no male-specific treatment guidelines (Robinson et al., 2012).
Where men’s examples were included, they were in separate chapters or leaflets, mostly addressing cisgender male experiences, which reinforced the idea that women with eating disorders are the norm and men with eating disorders were separate (Kinnaird et al., 2019).
This can lead to men feeling isolated and alienated during treatment even after they’ve pushed past the societal, cultural, and clinical barriers that exist.
Men may experience unique symptoms and issues that may translate into unique treatment needs, such as consideration of masculine identity and gender role conflict (Fernández-Aranda et al., 2009; Greenberg & Schoen, 2008). For example, Louis was focussed on staying lean, building muscle and developing a six pack:
“I would write consistent food diaries, analysing how different foods made me feel mentally. The slow introduction of new foods and realising they were not making me fat was the best feeling. By viewing food as fuel, there to help me through life and enjoy myself, it became a lot easier to recover. Once I was in recovery, the social awareness was completely gone.”
Louis, Altum Health client.
What we’d like to see is men being able to comfortably explore their eating disorder symptoms and issues linked to their masculine identity and gender during treatment, through men-only group therapy sessions, for example.
In terms of one-to-one treatments, studies have reported that men seem to respond well to the same treatments that have been successful for women with eating disorders, especially cognitive behavioural therapy (CBT) for adults and family-based therapy (FBT) for adolescents and young adults (Robinson et al., 2019).
However, as discussed above, men may present with different symptoms than women, and as such, approaches must be tailored to fit their needs. For example, FBT has been successfully applied to adolescents with MDD, focusing more on limiting exercise and preventing excessive protein intake, than on weight gain.
We’d also like to see more gender-inclusive literature to support those seeking help with an eating disorder. It’s important to acknowledge that gender, and in particular gender dysphoria (the distress a person experiences due to a mismatch between their gender identity and their sex assigned at birth), may be a contributing factor to the development and maintenance of eating disorders in some transgender men. Research has not always acknowledged the difference between a person’s sex and the gender they identify with, which can impact how we understand and treat eating disorders in this population. However, this is slowly beginning to change, with more gender-inclusive research being undertaken.
Overall, we want to help reshape the narrative and remove the stigma around eating disorders, by improving knowledge and sharing greater understanding.
We want to help break down the barriers to seeking help, gaining a proper diagnosis, and receiving appropriate help and support, regardless of gender.
Our licensed therapists are specialists in the treatment of eating disorders. If you or someone you know is suffering with one, irrespective of gender identity, please book a free consultation to find out how we can help.