- Anorexia Nervosa (AN) is characterized by a restriction of food intake that leads to a significantly low body weight and accompanied by an intense fear of gaining weight or becoming fat. There is a disturbance in the way one's body or shape is experienced. There are two types: Restricting Type and Binge-Eating/Purging Type.
- Bulimia Nervosa (BN) is characterized by recurrent episodes of binge eating followed by recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, misuse of laxatives or diuretics, restricting food intake, or excessive exercising. Self-evaluation is unduly influenced by one's body weight or shape.
Binge Eating Disorder (BED) is characterized by recurrent episodes of binge eating without inappropriate compensatory behaviors, in which the individual: (1) Eats in a discrete period of time an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances and (2) the person has a sense of lack of control over eating during the episode, such as by feeling that one cannot stop eating or control what or how much one is eating.
FEEDING OR EATING DISORDER NOT ELSEWHERE CLASSIFIED
- "Feeding or Eating Disorder Not Elsewhere Classified" will be the classification used in DSM-5 starting in 2013 to take into account the Conditions and Disorders that have clinical significance, but do not meet the criteria for the other Feeding and Eating Disorders listed in DSM-5. These other Conditions and Disorders may be associated with distress and impairment, and therefore, warrant intense clinical intervention. Physicians need to be prepared to diagnose under this classification for other feeding and eating disorder syndromes as well as for feeding and eating disorders listed in DSM-5 in which the patient does not meet all of the criteria (such as when a patient does not meet minimum weight requirements for anorexia or when a patient who purges or binges does not meet the criteria for frequency or duration of symptoms).
MALES WITH EATING DISORDERS
- EDs are clinically similar in females and males, but differ in gender specific aspects, such as in predisposition, course, and onset.
- Males are often reluctant to seek treatment for eating disorders due to the shame they often feel with having an illness stigmatized as a "female" disease.
- While heterosexual and homosexual males are both affected by eating disorders, gay males appear to be at higher risk for eating disorders.
- Studies have found a high rate of depression and substance abuse among males with eating disorders.
- Males are often in denial of their ED and may give a plausible reason for dieting and compulsive exercising, such as to improve sports performance or avoid illness.
- The terms males use may differ from females in how they describe their ED. For example, males tend to express more concern with achieving a muscular body shape than with weight.
While some males are concerned with losing weight, others want to gain weight in the form of muscle. Some males may develop muscle dysmorphia, a disorder in which the individual becomes obsessed with the idea that he or she is not muscular enough. They tend to hold the delusion that they are "skinny" or "too small" despite often being above average in muscularity.
Most ED assessment tests were written for females, and males are typically underscored in areas such as body dissatisfaction and drive for thinness because of terminology oriented toward women.6
The numbers of males seeking treatment for an ED has significantly increased in recent years, but researchers are not sure if that indicates an increase in male EDs or that more of those who have issues are seeking help.7
Male-only therapy groups are preferred when possible.8
Most males with eating disorders exhibit problematic exercise behaviors, such as excessive exercise.8
Spiritual interventions, such as attending weekly spiritual groups (ie. church going) or reading spiritual literature, is significantly less common among men than women in treatment for an eating disorder.8
Testosterone replacement therapy is recommended during weight restoration in males with anorexia nervosa.9
- Are you satisfied or dissatisfied with your weight, size, and appearance? If dissatisfied, why?
- Are you trying to lose or gain weight?
- If you are trying to lose weight, do you diet or use other compensatory weight reduction methods, such as restricting food intake, purging, using laxatives, diuretics, diet pills, suppositories, stimulants or other medications, enemas, or excessively exercising?
- If a type 1 diabetic, do you restrict or omit your insulin dose to lose weight?
- How often do you weigh yourself?
- If you are trying to gain weight or muscle, do you binge, take supplements, or steroids?
- Do you feel guilty about what you eat?
- Do you feel out of control when you eat or are you very rigid about what you eat?
- Can you tell me what you eat (to include food item and amount) in a typical day?
- Are there foods or food groups you avoid eating or consider "unsafe"?
- How much do you exercise in a day/a week? What type of exercise do you do?
- Do you feel depressed? If so, explain?
NOTE - Be aware that most laboratory tests in ED patients are normal despite serious illness, but these tests should still be done:
Complete blood cell count
- Measurement of serum electrolytes, calcium, magnesium, and phosphorus
- Liver function tests
- Measurement of Thyroid Stimulating Hormone
- Supine and standing heart rate and blood pressure
- Oral temperature (looking for less than 96 degrees F)
- Height and weight measurements
- Determine Body Mass Index
- SCREEN – Screen for EDs as part of an annual health exam and for children also during pre-participation sports exams by monitoring weight and height longitudinally.
- EDUCATE – Educate about healthy eating and behaviors and building self-esteem. Warn against excessive dieting, compulsive exercising, and other unhealthy weight management methods.
- MONITOR – When EDs occur, treat the medical symptoms and monitor the patient's condition.
- REFER – Be prepared to refer patients out for psychological evaluation and treatment to clinicians who treat eating disorders.
- "Eating Disorders Guide to Medical Management, 2nd Edition" Report 2011 by the Academy for Eating Disorders (AED).
- "Clinical Report Identification and Management of Eating Disorders in Children and Adolescents" by David S. Rosen & the Committee on Adolescence in Pediatrics, the official journal of the American Academy of Pediatrics (AAP). Published online on 11-29-10. http://www.pediatrics.org.
- The National Eating Disorders Association (NEDA) has information for physicians
- J. F. Morgan, F. Reid & J. H. Lacey, "The Scoff Questionnaire: Assessment of a New Screening Tool for Eating Disorders", BMJ, Dec. 4, 1999; vol. 319, p. 1467. See http://www.bmj.com/content/319/7223/1467.full.
- M. A. Cotton, C. Bal & P. Robinson, "Four Simple Questions Can Help Screen for Eating Disorders," Journal of General Internal Medicine, Jan. 2003; 18(1), p. 53–56. See http://www.onlinelibrary.wiley.com/doi/10.1046/j.1525-1497.2003.20374.x/full.
- The National Association for Males with Eating Disorders (NAMED) has information about males with eating disorders at http://www.NAMEDinc.org.
- The Renfrew Center Foundation for Eating Disorders, Eating Disorders
101 Guide: A Summary of Issues, Statistics, and Resources, 2003.
- Crow, Peterson, Swanson, Raymond, Specker, Eckert & Mitchell, American Journal of Psychiatry, Dec. 2009, 166 (12), p. 1342-1346.
- J. I. Hudson, E. Hiripi, H. G. Pope & R. C. Kessler, "The Prevalence
and Correlates of Eating Disorders in the National Comorbidity Survey
Replication," Biological Psychiatry, Feb. 1, 2007, 61 (3), p. 348-358.
- Matthew B. Feldman & Ilan H. Meyer, "Eating Disorders in Diverse
Lesbian, Gay, and Bisexual Populations", International Journal of
Eating Disorders, April 2007, 40 (3), p. 218-226.
D. Blake Woodside, Paul E. Garfinkel, Elizabeth 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, 158 (4),
Stevie Stanford & Raymond Lemberg, "A Clinical Comparison of Men and Women on the Eating Disorder Inventory-3 (EDI-3) and the Eating Disorder Assessment for Men (EDAM)," Eating Disorders: The Journal of Treatment and Prevention (In press, Fall 2012), 20 (5).
Eric Strother, Ray Lemberg, Stevie Stanford & Dayton Tuberville, "Eating Disorders in Men: Under-diagnosed, Undertreated, and Misunderstood," Eating Disorders: The Journal of Treatment and Prevention (In press, Fall 2012), 20 (5).
Theodore E. Weltzin, Tracey Cornella-Carlson, Mary E. Fitzpatrick, Brad Kennington, Pamela Bean & Carol Jefferies, "Treatment Issues and Outcomes for Males with Eating Disorders," Eating Disorders: The Journal of Treatment and Prevention (In press, Fall 2012), 20 (5).
Philip S. Mehler, MD & Arnold E. Andersen, MD, Eating Disorders: A Guide to Medical Care and Complications. Baltimore: The Johns Hopkins University Press, 1999.
The National Association for Males with Eating Disorders (N.A.M.E.D.)
Compiled by N.A.M.E.D.'s Males with Eating Disorders Professional Group