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Male Eating Disorders: Re-Evaluating the Stereotypes

By Meghan Vivo

John is an academically gifted and highly motivated young athlete, who plans to attend an Ivy League college on scholarship in the fall. He is lean and muscular, spending hours in the gym every day after school and meticulously following a strict high-protein, no-fat diet. Although John looks healthy and svelte to an outside observer, he has a disorder as severe and life-threatening as the frail and emaciated woman most people can identify as anorexic.

“Male eating disorders are much more common than people know,” says Brad Kennington, MA, LMFT, LPC, the executive director of Austin Sendero, a comprehensive eating disorder treatment program for men and women in Granger, Texas. While the accepted statistic used to be the National Eating Disorders Association figure that 10 percent of the 10 million eating disorder sufferers were male, a 2007 Harvard study of 3,000 male and female participants showed that nearly one in four incidents of anorexia and bulimia occur in men, and 40 percent of binge eaters are males.

Why Males Have Been Overlooked

While most people understand the prevalence of anorexia, bulimia, and binge eating in females, few recognize that males suffer with the same disorders. One reason for the lack of attention to male eating disorders, according to Kennington, is that these disorders are easily masked in men. While females often use extreme dieting as a gateway into an eating disorder, which can draw suspicion from family and friends, males are more likely to fixate on exercise, which may appear deceptively healthy.

“A guy who works out two or three hours a day may be regarded as ‘disciplined’ or ‘into fitness,’ and may not raise the same red flags as a woman who refuses to eat or looks painfully thin,” Kennington says. “In fact, a slender, muscular man is likely to get positive feedback and praise for his physique, which reassures him that his self-destructive behaviors are ‘paying off.’”

Another factor that complicates the identification and diagnosis of male eating disorders is the fact that the diagnostic criteria for eating disorders are designed for women. For example, amenorrhea (the loss of menstrual period), is one of the diagnostic criteria for anorexia that clearly excludes men.

Despite a new study by Rhode Island Hospital and Brown University suggesting that the DSM-IV criteria for eating disorders have limited clinical utility, and despite researchers’ recommendations to broaden the criteria for bulimia, anorexia, and binge eating disorder, the diagnostic manual is currently disserving thousands of men with disordered eating habits and behaviors.

“Because the diagnostic material doesn’t even address the specifics of male eating disorders, such as a change in testosterone levels or loss of sex drive, the DSM in some ways can be a vehicle of shame,” states Kennington. “Some men see that it doesn’t apply to them and simply close the book.”

Heavy with Shame

It is common for eating disorder sufferers to experience a great deal of shame about the abuse they are inflicting upon themselves. But men face the additional hurdle of struggling with a disorder that has always been seen by society as a “female problem.” Add to that the assumption by the public that only gay men suffer from eating disorders, and it becomes clear why males with eating disorders have kept their suffering quiet.

“For many males, the fear behind acknowledging their eating disorder and seeking treatment is that others will see them as feminine, unmanly, or gay,” says Kennington. “Men tend to be slow to seek medical help anyway, so by the time they seek treatment for an eating disorder, they often are very, very sick.”

Because of the tendency to focus on body image, appearance, and youth in the gay community, homosexual men are especially vulnerable to eating disorders. According to ANRED, gay men are thought to comprise about 5 percent of the male population in the U.S., but they represent up to 42 percent of the male eating disordered population. In addition to overcoming the shame of their eating disorder, these individuals must also overcome any shame they feel around being gay.

“Shame is so toxic to males, regardless of what the issue is or where the emotions stem from,” explains Kennington. “It’s one of the biggest hurdles patients face in trying to overcome these disorders.”

Treating Men with Eating Disorders

Like females, males usually need professional help to overcome an eating disorder. Although the general public has been desperately under-educated about male eating disorders, the treatment community is becoming increasingly responsive to the needs of male patients. Whereas many treatment programs were designed with women in mind or excluded men all together, more eating disorder treatment facilities are tailoring treatment to the needs of male clientele.

At Austin Sendero, one of only a small number of residential eating disorder treatment programs geared toward men as well as women, the staff of eating disorder professionals has developed an expertise in treating male eating disorders. Each member of the treatment team has been hand-selected for their experience working with the male population, and many are well-versed in physical fitness and healthy living.

In an environment that is gender-neutral, with neutral colors, décor, and amenities, the message at Austin Sendero is clear: Eating disorders are a human problem, not a female problem.

A Message of Hope

Kennington holds great hope for the future of male eating disorder treatment. In the past few decades, he has observed greater education and awareness for other diseases translate into more people seeking treatment and recovering from dangerous disorders. For example, alcoholism used to be considered a “man’s disease,” but as more women came forward with their experiences, the public perception changed to acknowledge the struggles of both male and female alcoholics. 

Similarly, the issue of childhood sexual abuse used to be considered a problem that affected only young girls. As more young boys have come forward in recent years revealing the abuse they experienced at the hands of strangers, family members, and even religious figures, more efforts have been made to protect both young boys and girls.

“As people become more aware of the extent and severity of male eating disorders, our hope is that eating disorders will be approached in the same way as alcoholism or childhood sexual abuse, where it is assumed to be both a male and female problem,” says Kennington.

Kennington believes that research will play an important role in normalizing eating disorders in the male population. He also strongly encourages his male patients to share their stories when they are ready, even if only with a close circle of friends.

“It is healing for an eating disorder survivor to share his story and have it well-received,” says Kennington. “There are more books coming out, more speakers at universities and conventions, and more men taking risks and sharing their stories. When coaches, moms, dads, and mainstream culture begin to accept the seriousness of these disorders and their impact on males of all ages and backgrounds, we’re going to start seeing results.”



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