EXAMINING THE DIFFERENCES BETWEEN
MALE & FEMALE EATING DISORDERS
This page answers the question are eating disorders in males different than in females, and if so, what are the differences?
Eating disorders are clinically or fundamentally similar in both genders in terms of symptoms and there potential for medical complications. Those who dispute that eating disorders in males are different from eating disorders in females, perhaps do so for these three reasons:
- Anorexia and bulimia are less common in males, and therefore, must somehow be different
- The pursuit of thinness is considered as a feminine trait
- Lack of menstruation is one of the criteria given for having anorexia
Most large controlled studies of males and females with eating disorders have found few differences in their clinical presentation, psychometric measurements and treatment responses.
One large Canadian study by D. Blake Woodside and colleagues supported the findings of these other studies. They observed few differences between males and females with eating disorders. However, they reported striking differences between men with eating disorders and men without eating disorders. Men with eating disorders showed higher rates of psychiatric disorders and appeared to experience greater life dissatisfaction than men without eating disorders, but it was not clear whether the psychiatric and psychosocial problem differences put individuals at greater risk for eating disorders or they developed these problems as a result of their illness.
EACH ED IS UNIQUE
It is important to recognize that each person’s experience with an eating disorder is as unique as a fingerprint. There are an infinite combination of predisposing biological, social, and economic factors; rituals, behaviors, and ways of thinking; personality characteristics; relationship dynamics; strengths and weaknesses; and so on that influences how a person expresses and experiences his or her eating disorder. So, no eating disorder in an individual is exactly the same as in others. It is important for therapists to recognize the unique features of the eating disorder’s expression in each client.
It is important to remember that any differences noted here between the genders are generalizations that typically, but not always, apply to individuals of a specific gender.
Arnold Andersen, Leigh Cohn, and Thomas Holbrook, authors of Making Weight: Men’s Conflicts with Food, Weight, Shape & Appearance write, “Eating disorders in males have many features in common with females, but differ in gender-specific aspects, including social, biological, and developmental contexts.”
The existing differences between male and female eating disorders are primarily related to gender-identity. The expression of one’s gender identity expressed in terms of masculinity or femininity influences one’s perspective and experience with an eating disorder.
The masculine physical ideal is to be tall, fit, have good muscle tone, and be lean, while the feminine ideal is to be petite, thin, and beautiful. Besides physical attributes, culture dictates how each gender should act. For example, men are expected to be dominant, competitive, assertive, leaders, logical, and taught not to express their emotions. These cultural ideals for the genders play a role in how an eating disorder is expressed and experienced.
One example of these gender differences can be shown by findings from Cash, Winstead, & Janda, (1986), who found that males were more likely than females to claim that if they were fit and exercised regularly, they felt good about their bodies, whereas females were more concerned with aspects of their appearance, particularly weight.
The preceding example demonstrates the different thinking perspective between the masculine and feminine genders. Those aspiring to the masculine ideal want to be fit and muscular, and those aspiring to the feminine ideal want to be thin and petite.
PREDISPOSITION, COURSE, AND ONSET
Arnold E. Andersen editor of the 1990 book, Males with Eating Disorders stated that although males and females exhibit the same symptoms, there are “differences between the sexes in predisposition, course, and onset”.
Arnold Andersen, Leigh Cohn, and Thomas Holbrook in their book Making Weight give four primary reasons males develop anorexia that usually are not the reasons given by females for developing anorexia:
1. To avoid being teased again for being overweight, as they had been in the past
2. To improve sports performance
3. To avoid developing a medical illnesses of their father, such as heart disease
4. To improve a gay relationship
These four reasons demonstrate events that may contribute to the onset of an eating disorder in a male. The reasons mentioned above may be given by males for why they obsessively exercise and/or diet. On the surface they may seem rational (and even admirable), and therefore, the eating disorder may go undetected by doctors and others for a long period of time.
FEELINGS OF SHAME
In general, men are less likely to seek treatment for mental illness than women, and this is especially so for eating disorders that are perceived as a “female” disease and further stereotyped as a “gay” disease in the event a man does get an eating disorder. These misconceptions tend to result in males experiencing an even greater sense of shame over having an eating disorder than female’s experience. These myths are misleading as eating disorders do not discriminate between gender, sexual orientation, race, economic class, or on any other basis.
Just as in the past, we learned that HIV is not exclusively a “gay” disease, so too, in the present the public and healthcare professionals are learning that eating disorders are not exclusively a “female” disease.
FEELINGS OF ALONENESS
While females in recovery can easily find support from other women in recovery, males often find they are the only male in a treatment program or in a therapy or support group. Not having other males to share their experience with makes them feel alone with their illness, as if they are the only male with an eating disorder. Further complicating this issue, some treatment providers do not accept males with eating disorders into treatment.
Because of erroneous perceptions about eating disorders, it is much more difficult for males to admit to their eating disorder and reach out for professional help. Many doctors also caught up in the myth that eating disorders are a disease of females, fail to diagnose their patients with an eating disorder. The patient’s symptoms may be completely overlooked and they may be misdiagnosed.
Consequently, males with eating disorders may never be properly diagnosed or when they do finally get the attention of a therapist or medical professional, they have experienced their eating disorder much longer than females at the point treatment begins. The longer one has dealt with an eating disorder, the more entangled the person becomes in the illness, which often requires more aggressive treatment for a longer period of time.
Arnold E. Andersen explains that the diagnosis of male eating disorders can be further confused by the terminology males use as well as the reasons they give for their unhealthy behaviors, which on the surface seem very plausible. Males are more likely to describe their self-loathing of their body image in terms of being worried about abnormalities in body shape and form, and being intensely concerned about losing “flab” and achieving better “shape” or “building muscle”. Unlike females, males tend to be less concerned with their weight and clothe size.
It is culturally more acceptable for men to overeat and be larger than it is for women. Therefore, it is less noticeable when a man is a binger or compulsive overeater. Society believes males have big appetites. Consequently, males with problems with bingeing and overeating may go undetected, and when they do seek treatment, are more likely to have been bingeing or compulsively overeating for longer periods of time than females.
On the other hand, a thin man without muscle definition is not culturally accepted as an attractive quality in men, hence more shame for those men with anorexia.
“Other studies have shown that men on the whole are as dissatisfied with their body weight as women, but are dissatisfied in different ways. Forty percent of men would like to increase weight, while an equal number would like to decrease weight.” While, 70-80% of women are also dissatisfied with their weight, it is rare that a woman wants to gain weight (unless due to thinness from medical illness) or for an overweight woman to be satisfied with her weight. Generally, men are more concerned about their “shape” than their “weight”.
Often the male obsession with their body image and shape leads them to obsessively exercise and/or bodybuilding. Rosen & Gross, 1987 found that in a sample of 1,373 high school students, girls (63%) were four times more likely than boys (16%) to be dieting to lose weight, while boys (28%) were three times more likely than girls (9%) to be trying to gain weight.
It is estimated that 40% of those with binge eating disorder (BED) are male. BED is the more predominant type of eating disorder among males.
Body Dysmorphic Disorder (BDD) or Reverse Anorexia Nervosa is a condition characterized by the individual imagining he is not big enough or muscular enough. This disorder is almost exclusively present in males. BDD demonstrates an extreme in preoccupation with size, shape, and muscularity.
Males may tend to be more concerned with how specific body parts look than females, such as obsessing over how certain muscle groups look on their body.
While women tend to be more concerned on their appearance from the waist down, men tend to be more concerned in how they look from the waist up.
WEIGHT CONTROL METHODS
Males with eating disorders more often than females with eating disorders start dieting in response to “actually” being overweight. Sometimes, when these individuals get down to a healthy, average weight range, they feel compelled to continue to lose weight to get very thin.
Generally, males are more likely than females to use fasting and exercising as their preferred weight control method. In research by Drewnowki and Yee (1987), they observed that females usually diet to lose weight, whereas males tend to exercise to lose weight.
DEPRESSION & SUBSTANCE ABUSE
Woodside and colleagues found that males with eating disorders exhibited higher rates of depression and substance abuse.2 These findings support the results found by other studies. Interestingly, Woodside and colleagues noted that they unfortunately did not investigate the issue of sexual orientation in their subjects, because such research was deemed too sensitive for a Canadian government-sponsored survey at the time.
According to Herzog, Bradburn, and Newman (1990) more males than females with anorexia and bulimia nervosa experience gender identity confusion and/or a homosexual orientation. In addition to the pressure to live up to a macho physique desired by men of the gay culture, one’s sexual and/or gender orientation crisis can be a traumatic experience putting a male at risk for an eating disorder.
Matthew B. Feldman and Ilan H. Meyer in a 2007 article reported finding that gay and bisexual men had significantly higher prevalence rates of eating disorders than heterosexual men.13
While gay and bisexual males are at higher risk for eating disorders, it is important to remember that no one is immune from eating disorders and that large numbers of heterosexual males are becoming victims of the disease as well.
Studies have shown that anorexic males, unlike anorexic females, display a considerable degree of anxiety with sexual activities and relationships. A study by Fichter and Daser (1987) showed that anorexic males displayed significantly more sexual anxieties than did anorexic females. Studies have also found that there is usually a low level of sexual activity among anorexic males, before and during the eating disorder, which Fitcher and Daser’s (1987) findings also support. Bulimic males were found to be more sexually active than anorexic males.
TREATMENT NEEDSDue to gender-related experiences with an eating disorder, therapists need to consider male’s special treatment needs. Therapists need to carefully listen to clients and direct their treatment plans to meeting their client’s specific needs.
Therapists need to assure their male clients they are not alone with their illness. Tell them there are other males who have eating disorders too. Be understanding and always make them feel welcome, especially in co-ed support and therapy groups where they are the only male group member.
Whenever possible create an all-male eating disorder therapy or support group or have a client be mentored voluntarily by another male well on the way to recovery or recovered. This will give the client a sense of being connected and supported by someone of the same gender who he can share with and hopefully feel understood by. Refer males with eating disorders as well as family members to the N.A.M.E.D. Online Support Group for Men and Boys with Eating Disorders and Concerned Others.
Some males will need to explore gender and sexual identity issues. Even males with eating disorders who are not questioning their sexual or gender orientation will probably benefit from a discussion addressing any shame they may be experiencing with having an eating disorder.
Because males tend to be afraid to express their emotions, therapists need to help their clients process their feelings, rather than simply allowing their clients to talk their thoughts.
For males interested in weight lifting or working out at a gym, consider having a weight or exercise trainer be part of the treatment team. Refer the client to a trainer who understands the seriousness of eating disorders and is able to guide the client on a healthy, balanced exercise routine.
1. Journal of Psychosomatic Research 1994; vol. 38, p. 471.
2. D. Blake Woodside, Paul E. Garfinkel, Elizbeth Lin, Paula Goering, Alan S. Kaplan, David S. Goldbloom & Sidney H. Kennedy, “Comparisons of Men with Full or Partial Eating Disorders, Without Eating Disorders, and Women with Eating Disorders in the Community”, American Journal of Psychiatry, April 1, 2001; vol. 158 no. 4: p. 570-574.
3. Arnold Andersen, Leigh Cohn, and Thomas Holbrook, Making Weight: Men’s Conflicts with Food, Weight, Shape & Appearance (Carlsbad, CA: Gurze Books, 2000), p. 32.
4. T. F. Cash, B. A. Winstead & L. H. Janda, “The Great American Shape-Up” in Psychology Today, April 1986, 30-37.
5. A. E. Andersen (1992) “Eating Disorders in Males” in Controlling Eating Disorders with Facts, Advice, and Resources by ed. R. Lemberg (Phoenix, AZ: The Orxy Press), p. 1.
6. Arnold Andersen, Leigh Cohn, and Thomas Holbrook, Making Weight: Men’s Conflicts with Food, Weight, Shape & Appearance (Carlsbad, CA: Gurze Books, 2000), p. 33-34.
7. Arnold E. Andersen, ed., Males with Eating Disorders (New York: Brunner/Mazel, 1990), p. 137. This page in “Diagnosis and Treatment of Males with Eating Disorders” chapter written by Arnold E. Andersen.
8. Arnold Andersen, Leigh Cohn, and Thomas Holbrook, Making Weight: Men’s Conflicts with Food, Weight, Shape & Appearance (Carlsbad, CA: Gurze Books, 2000), p. 55.
9. J. C. Rosen & J. Gross (1987), ”Prevalence of Weight Reducing and Weight Gaining in Adolescent Girls and Boys”, Health Psychology, 6, p. 131-147.
10. American Psychiatric Association, Diagnostic & Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) Washington, D.C., 1994.
11. A. Drewnowsi & D. K. Yee (1987), “Men and Body Image: Are Males Satisfied with Their Body Weight?” in Psychosomatic Medicine, 49, 626-634 as reported in Males with Eating Disorders by Arnold E. Andersen, ed. (New York: Brunner/Mazel, 1990) p. 34.
12. Arnold E. Andersen, ed., Males with Eating Disorders (New York: Brunner/Mazel, 1990), p. 40. Statement made by David B. Herzog, Isabel S. Bradburn, and Kerry Newman, authors of chapter on “Sexuality in Males with Eating Disorders”.
14. M. M. Fichter & C. Daser (1987), “Symptomatology, Psychosexual Development and Gender Identity in 42 Anorexic Males”, Psychological Medicine, 17, 409-418 as reported in Males with Eating Disorders by ed. Arnold E. Andersen (New York: Brunner/Mazel, 1990), p. 41-42.