MALES AND EATING DISORDERS

William Harryman

DO MEN SUFFER FROM EATING DISORDERS?
GENDER CONSIDERATIONS Eating disorders have been consistently found to be more common among women than men. Only 5% to 10% of patients are men. Other studies suggest anorexia nervosa among males may be as little as 0.02% per year and the prevalence of current bulimia nervosa in men is between 0.1% and 0.5% (Hoek & van Hoeken, 2003). Differences attributed to cultural factors; however, biologic and psychodynamic factors may also play a role.

Former model: Jeremy Gillitzer, 88 lbs

Defining symptom (amenorrhea) not relevant in men.

UNDERSTANDING EATING DISORDERS:
SIMONA GIORDANO (2005)
Males represent around 8 per cent of the anorexic sufferers, 15 per cent of the bulimic sufferers, and 20 per cent of binge-eating disorder sufferers.
Manfred Fichter and Heidelinde Krenn, ¶Eating Disorders in Males·, in Janet Treasure, Ulrich Schmidt, and Eric van Furth (eds.), Handbook of Eating Disorders (2nd ed., Chichester: Wiley, 2003), pp. 369²83.

The age of onset of anorexia in males is reported as ranging between 15.5 and 17.2, whereas bulimia normally manifests later.
Faccio, Il disturbo alimentare, 30, 32; Mara Selvini Palazzoli, S. Cirillo, M. Selvini, and A. M. Sorrentino, Ragazze anoressiche e bulimiche: La terapia familiare (Milan: Cortina 1998), ch. 2

According to other studies, the age of onset for eating disorders in males is 18²26, as compared to 15²18 for females.
Fichter and Krenn, Eating Disorders in Males, 369²83.

MANOREXIA?
As of 2008, in England, the number of men being treated for anorexia has gone up by 67 per cent in the past five years. 137 men suffering the most severe cases of anorexia saw specialists in the past year ² up from 82 during 2001/02 ² this is only the tip of the iceberg ~ British Department of Health The increase is being blamed partly on the rising popularity of lifestyle magazines for men featuring pictures of trim sportsmen such as David Beckham.

MORE ACCURATE NUMBERS
Twenty years ago it was thought that for every 10-15 women with anorexia or bulimia, there was one man. Today researchers find that for every four females with anorexia, there is one male and for every 8-11 females with bulimia, there is one male. (American Journal of Psychiatry 2001; 158: 570-574) Binge eating disorder seems to occur almost equally in males and females, although males are not as likely to feel guilty or anxious after a binge as women are. Clinics and counselors see many more females than males, but that may be because males are reluctant to confess having what has become known as a "woman's problem." Also, health professionals do not expect to see eating disorders in males and may therefore underdiagnose them.

RISK FACTORS FOR MEN
They were overweight as children. They have been dieting. Dieting is one of the most powerful eating disorder triggers for both males and females - up to 70% of high schoolers diet to improve appearance Living in a culture fixated on diets and physical appearance Members of the gay community who are judged on their physical attractiveness, lean and muscular as ideals They participate in a sport/job demanding thinness:
« « « « Runners & jockeys at higher risk than football players & weight lifters. Wrestlers who try to compete in a lower weight category Body builders depleting fat & fluid for high definition Male models, actors and entertainers

Stats on last two slides from United Health Care fact sheet.

EATING DISORDERS IN MALES:
A REPORT ON 135 PATIENTS (1997)
One hundred thirty-five males with eating disorders were identified:
« « « 62 (46%) were bulimic 30 (22%) were anorexic 43 (32%) met criteria for an eating disorder not otherwise specified

There were marked differences in sexual orientation by diagnostic group:
« « 42% of the male bulimic patients were identified as either homosexual or bisexual 58% of the anorexic patients were identified as asexual

Comorbid psychiatric disorders were common:
« « « Major depressive disorder (54% of all patients) Substance abuse (37%) Personality disorder (26%)

Many patients had a family history of affective disorder (29%) or alcoholism (37%)
~ Carlat, Camargo, Jr., & Herzog. (1997). Eating Disorders in Males: A Report on 135 Patients. Am J Psychiatry 154:8, August 1997 .

BIGOREXIA = MUSCLE DYSMORPHIA
Bigorexia, reverse anorexia, The Adonis Complex (Pope, Phillips, & Olivardia, 2000), and now, Muslce Dysmorphia (MDM), a form of Body Dysmorphic Disorder Men become obsessed with muscle size and appearance From The Adonis Complex:
« 17% said that they would give up three years of their life to achieve their weight goal 11% said they would give up five years of their life

«

MDM IN THE NEW CENTURY
In the 1970s, about 15% of men said they were dissatisfied with their body. In the 1980s that doubled to about 34%. In the 1990s it went up to close to 50%, If you survey men now it·s probably over 50%. The Adonis Complex looks at men who are endangering their lives in pursuit of the perfect body They will work out five hrs a day lifting weights, take steroids, engage in unhealthy eating habits in order to gain more muscle

DIAGNOSIS AND PREVALENCE
Muscle dysmorphia is a type of body dysmorphic disorder: DSM-IV-TR The mean age of onset is 19.4 years (SD = 3.6) - Three main components (Olivardia, 2001): (a) a preoccupation with the idea that the body is not muscular or lean enough (b) a clinically significant impairment in life activities (always at the gym, food), continued harmful behaviors (steroids) due to preoccupation with insufficient musculature, and (c) the preoccupation is focused on having insufficient musculature or being too small and not on other aspects of appearance (Olivardia, 2001). (Olivardia, 2001; Olivardia et al., 2000; Pope et al., 1997).

THE DRIVE FOR MUSCULARITY SCALE
The scores were normed on an adolescent population (M = 37.78, SD = 12.20).In studies of convergent validity, an ANOVA found that higher DMS scores were related to subjects' attempts to gain weight. The frequency of weight training was positively but weakly related to DMS scores (r = .24). In terms of discriminant validity, the DMS had no significant correlation with the drive for thinness construct of the Eating Attitudes Test (r = -.05) and had a slightly negative correlation with the Body Dissatisfaction Scale (r = -.15). 1: Always 2: Very Often 3: Often 4: Sometimes 5: Rarely 6: Never

1. I wish that I were more muscular. 1 2 3 4 5 6 2. I lift weights to build up muscle. 1 2 3 4 5 6 3. I use protein or energy supplements. 1 2 3 4 5 6 4. I drink weight gain or protein shakes. 1 2 3 4 5 6 5. I try to consume as many calories as I can in a day. 1 2 3 4 5 6 6. I feel guilty if I miss a weight training session. 1 2 3 4 5 6 7. I think I would feel more confident if I had more muscle mass. 1 2 3 4 5 6 8. Other people think I work out with weights too often. 1 2 3 4 5 6 9. I think that I would look better if I gained 10 pounds in bulk. 1 2 3 4 5 6 10. I think about taking anabolic steroids. 1 2 3 4 5 6 11. I think that I would feel stronger if I gained a little more muscle mass. 1 2 3 4 12. I think that my weight training interferes with other aspects of my life. 1 2 3 4 13. I think that my arms are not muscular enough. 1 2 3 4 5 6 14. I think that my chest is not muscular enough. 1 2 3 4 5 6 15. I think that my legs are not muscular enough. 1 2 3 4 5 6
Source: McCreary, D.R., & Sasse, D.K. (2000). An exploration of the drive for muscularity in adolescent boys and girls. Journal of American College Health, 48, 297-304.

5 6 5 6

TREATMENT
Treating Eating Disorders The basic principles for treating women with eating disorders also apply to men (1) Work toward weight restoration (2) Disrupt maladaptive behaviors (3) Treat comorbidity (4) challenge thoughts related to weight and shape (5) Teach ways to adapt to sociocultural and gender roles (Andersen, 2002) CBT and DBT most common approaches Multidisciplinary care in collaboration w/ dietician and psychiatrist most successful 12-step approach in combination with integrated approach also works Treating Muscle Dysmorphia Medications: Prozac, Paxil, and other antidepressants are useful due to comorbidity w/ depression and anxiety Hudson & Pope (1990) suggested that MD, OCD, bulimia, anorexia, and some anxiety disorders may share a common physiological abnormality Thus MD might be a member of this "family" of affective spectrum disorders Drive for Muscularity Scale (DMS), a 15-item, self-report questionnaire, is useful Psycho-education (steroids, nutrition, rest); Social History; CBT; cognitive distortions

REFERENCES
Carlat, Camargo, Jr., & Herzog. (1997). Eating Disorders in Males: A Report on 135 Patients. Am J Psychiatry 154:8, August 1997 . Leone, J.E., Sedory, E.J. & Gray, K.A.. (2005). Recognition and Treatment of Muscle Dysmorphia and Related Body Image Disorders. Journal of Athletic Training; OctDec 2005; 40, 4; ProQuest Psychology Journals, pg. 352. Manfred Fichter and Heidelinde Krenn, ¶Eating Disorders in Males·, in Janet Treasure, Ulrich Schmidt, and Eric van Furth (eds.), Handbook of Eating Disorders (2nd ed., Chichester: Wiley, 2003), pp. 369²83. McCreary, D.R., & Sasse, D.K. (2000). An exploration of the drive for muscularity in adolescent boys and girls. Journal of American College Health, 48, 297-304. Morgan, J.F. (2008). The Invisible Man: A self-help guide for men with eating disorders, compulsive exercise, and bigorexia. New York: Routledge. Olivardia, P. (2001). Mirror, Mirror on the Wall, Who·s the Largest of Them All? The Features and Phenomenology of Muscle Dysmorphia. Harvard Rev Psychiatry; 9:254²59. Olivardia, R, Pope Jr., H.G., Borowiecki III, J.J & Cohane, G.H. (2004). Biceps and Body Image: The Relationship Between Muscularity and Self-Esteem, Depression, and Eating Disorder Symptoms. Psychology of Men & Masculinity; Vol. 5, No. 2, 112²120. Pope, Phillips, & Olivardia, (2000) The Adonis Complex. New York: Free Press.

WEB RESOURCES
Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED) http://www.anred.com/ Empowered Parents: http://www.empoweredparents.com National Eating Disorders Association : http://www.NationalEatingDisorders.org National Eating Disorders Screening Program (NEDSP): http://www.mentalhealthscreening.org/eat.htm National Association of Anorexia Nervosa and Associated Disorders (ANAD): http://www.anad.org Muscle Dysmorphia; Eating Disoder Recovery Center; http://www.addictions.net/default.aspx?id=33

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