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Men in general are less likely to seek counseling for psychological problems than women, and men with eating disorders are even less likely to seek treatment.
A male's physical and psychological condition may be more serious than females at the time of intake evaluation, because men have often struggled with their eating disorders for longer periods of time before seeking help.
There are several reasons why men may be reluctant to seek treatment, including:
- Men may associate eating disorders with women, and therefore, do not consider themselves at risk for an eating disorder
- Telling others about their eating disorder is usually very embarrassing
- The thought of disclosing feelings, especially covert one's, typically provokes overwhelming anxiety
- They may rationalize their compulsive dieting and exercising as "just being" health conscious
- Men do not menstruate, therefore, unlike women, stoppage of menses is never a concern for seeking medical attention
- Men may not have sufficient financial resources and medical insurance to pay for therapy or they fear therapy will drain them financially
More men with eating disorders will reach out for help when they understand:
- Men are just as vulnerable to eating disorders as females
- They are not alone. Other males have eating disorders, too
- Support is available to them through professional counseling and other support networks
- Their eating disordered attitudes and behaviors are based upon reason and are not senseless nor should they be the cause of shame. Men need to realize they use an eating disorder as a coping mechanism for dealing with problems, conflict, and stress in their lives.
- Treatment providers will accommodate clients by working out a payment plan that fits their budget
Those with eating disorders should be encouraged to seek treatment sooner, rather than later. Those who experience eating disorders for longer periods of time will be more entrenched in their eating disordered thinking and behaviors than those who are affected by an eating disorder for a shorter period of time.
Those who experience an eating disorder longer will have their identities more entangled in the eating disorder. Their “being” will be dependent upon the continuation of their illness. Relinquishing one's past identity for a new, healthier identity will be one of the individual's greatest life challenges, as it involves setting aside one's old roles and rules of what has in the past felt comfortable and safe.
Delays in seeking therapy will likely require more extensive treatment later for a longer time frame. Furthermore, the potential for medical complications increases.
Therapy should empower the client to work toward improved health and happiness.
It is important for men to view getting professional help as the “glass half full,” rather than the “glass half empty,” meaning they must recognize their strengths and good qualities and view counseling as an opportunity to improve themselves, not view themselves as “messed up,” a failure, needing to be “fixed.”
The therapist should encourage the client to utilize his strengths and healthy and positive qualities to extinguish his maladaptive behaviors and ineffective thought patterns. Emphasis on what the client “does well” helps build his self-esteem.
Empowering the client entails helping him in therapy in such areas as:
- Resolving conflicts
- Dealing with problems
- Developing a healthy body-image
- Working through identity issues
- Developing positive thinking patterns
- Learning new coping and stress reduction skills
- Reducing social anxiety
- Reducing sexual anxiety
- Building and maintaining healthy relationships
- Dealing with control issues
- Developing independence and autonomy
Eating disorder treatment is based on three fundamental models: a psychodynamic, cognitive behavioral, and an addiction/disease model. Generally the first two models are used in combination to varying degrees.
Within the scope of the psychodynamic model there are different prevailing theories developed to explain the causes of eating disorders and treatment-styles. Regardless of the psychodynamic theory followed, all aim to help the client discover the underlying causes of his or her illness and to understand the function or purpose the eating disorder serves. With this knowledge, the therapist can help the client deal with and resolve issues.
The essence of the cognitive behavioral model or cognitve behavioral therapy (CBT) is that thoughts (cognitions, thought patterns) influence how one feels and behaves. The work of therapy is to learn what cognitive patterns one operates under, so that new, healthier thought patterns can be established. With positive cognitive patterns established, the client will no longer desire to operate under the negative thought patterns nor continue in the unhealthy behaviors.
Some clinicians may follow the addiction/disease model that views food as an addictive substance. Clients must abstain from the “trigger foods” that cause bingeing. This model holds that those with eating disorders are always in a "state of recovery,” unable to fully recover. This model for eating disorders was originally taken from the addiction model for alcoholics. This model has several drawbacks when applied to eating disorders.
As the executive director of N.A.M.E.D., I do not recommend therapy under this model, although some may find the support from a Twelve Step Program helpful. The Twelve Step support group may be used as an adjunct to therapy, but only under the supervision of a therapist practicing under the psychodynamic and cognitive behavioral models. In my opinion, the addiction/disease model by stating that clients can never be completely healed from their eating disorder is creating a self-fulfilling prophecy. Additionally, the addiction/disease model does not deal with the underlying causes perpetuating the disorder.
The Maudsley Approach is a treatment model for eating disorders to be used with children under 18. It is a family-based approach that focuses on taking action, rather than placing blame on patient or parents. This model received its name from the Maudsley Hospital in London where it was developed in the 1980s.
Treatment under the Maudsley Approach involves three phases lasting about a year. Initially, the parents take responsibility for re-feeding the child (- preparing food and sitting with him while he eats). The parents need to provide the child with encouragement and support, rather than being critical and punitive. The parents can use functional rewards to encourage the adolescent to be cooperative with the program, such as by granting certain privileges for progress made. After a period of time, the parents will transfer the control of the food (- what to eat, how much to eat, and when to eat) back to the adolescent. Family issues and dysfunctional communication are addressed in therapy and appropriate boundaries are established between the client and parents. The therapist encourages the client to become independent and take personal responsibility for himself.
According to studies, the Maudsley Approach has shown remarkable success for children under 18. The studies reported about two-thirds recovery rate by participants at the end of treatment, which typically lasted no longer than one year. At a five year follow-up
75-90% had reached and maintained a healthy weight.
Opponents of the Maudsley Approach criticize it for not addressing the root causes of the eating disorder. But, supporters claim these issues surface in the course of therapy as the individual learns healthy eating habits.
The Maudsley Approach may not be appropriate for all adolescents, so it is important to consult with a therapist who has experience with this method of treatment to find out if it is appropriate or not to use this method with a particular client.
The most effective method of treatment involves a multidisciplinary approach to therapy, in which professionals of various expertise work together as a team to provide the best possible treatment for a patient or client. The core treatment team usually consists of a psychotherapist for individual counseling, a nutritionist/dietician with training in eating disorders, a psychiatrist for medication treatment, and a primary care doctor who monitors medical complications. Other professionals may be included in the treatment team according to one’s individual treatment needs, such as family therapist, group therapist, art therapist, body trainer, body image therapist, yoga instructor, career guidance counselor, etc. Men with eating disorders should discuss with their therapist what other options are available to them for treatment and support to supplement their treatment plan.
Dr. Arnold E. Andersen, editor of Males with Eating Disorders (1990, p. 160) states that although certain aspects in the treatment of eating disorders are the same for both sexes, “there exist also unique and special aspects of diagnosis and treatment pertinent to males with eating disorders.”
Most therapists treating eating disorders are unaware of the unique aspects faced by male clients with this disease and how to specifically address their special needs. This is why it is critical that men inquire about a therapist's or treatment program's experience in treating males with eating disorders.
According to Andersen (1990, pp. 148-152) effective psychological treatment for males with eating disorders has three principle characteristics:
- It focuses on resolving a “central dynamic formulation,” which states the purpose the eating disorder serves in the client's life.
- It's multimodal in scope by integrating individual, nutrition, group, and family therapy along with medication treatment.
- It's sequential in its techniques according to the client's needs. Andersen believes the most helpful psychotherapy sequence starts with supportive and educational psychotherapy, followed by cognitive-behavioral work, then to psychodynamic psychotherapy, and finally to existential psychotherapy.
Regarding using a cognitive-behavioral approach, Andersen (1990, p. 151) explains, “The fundamental concept underlying cognitive psychotherapy is first to identify the abnormal patterns of thinking (‘cognitive grids') that distort neutral information and lead to painful emotional consequences, and then to confront and change these abnormal thinking processes so that positive emotions and healthier behaviors will result. . . . Some of the abnormal cognitive patterns characterizing many eating disorder patients are overvaluing the benefits of thinness; using all-or-none reasoning; catastrophizing; employing the mechanisms of projection and intellectualization."
There are four types of treatment available to a person with an eating disorder: inpatient, residential, partial hospitalization, and outpatient treatment. Inpatient hospitalization is for patients whose physical health is seriously compromised by their eating disorder. The main purpose of inpatient hospitalization is to stabilize the person’s weight and any other medical complications.
In residential treatment patients go to a facility where they live 24 hours a day, 7 days a week for two-three months (or longer, if necessary). Patients eat healthy, balanced, and adequately caloric meals meant to stabilize their weight. They participate in individual and group therapy sessions and may attend other classes, such as body image and cooking classes. Residential treatment is a good option for those whose condition is serious, but not life-threatening. After inpatient hospitalization, patients would be well advised to enter a residential treatment or partial hospitalization program.
Partial hospitalization programs are intense programs that offer the same things as residential treatment except clients are at these programs for several hours, several days a week, and go home afterwards.
Finally, outpatient treatment is for those whose condition is less serious or for those who have been in residential or partial hospitalization programs and are ready to work towards recovery with less supervision. In outpatient treatment, the client meets with the various members of the treatment team once every week or two.
- What is your experience in treating eating disorders (including the number of years treating eating disorders and credentials of the therapist. Does the therapist treat males and if so, how long and how many males currently in counseling with the therapist)?
- What type of therapy do you use?
- Do you work with a treatment team of other professionals to treat eating disorders (such as a nutritionist, psychiatrist, etc.) and if so, who are they?
- When would I be able to schedule appointments (including available appointment times, length of session, how often meet, cancellation policy)?
- What are appointment fees (- does therapist accept your insurance, offer sliding-scale fees or discounts for paying in advance)?
- Do you feel a sense of rapport with the therapist (- does he or she exude warmth and caring, will you feel safe sharing your feelings with this person, do you sense there might be any personality clashes)?
- Does the program treat males with eating disorders, and if so, how much experience and expertise does the staff have in treating males?
- Does the program specialize in your type of eating disorder, for example, anorexia, bulimia, binge eating disorder, orthorexia? If you are an alcoholic or drug addict, does the program also have a detox program? Does the program deal with special issues that are unique to your situation (such as Post Traumatic Stress Disorder (P.T.S.D.)? If you are gay, what is the program’s belief about homosexuality (- is it biological or by choice)?
- What is the program’s philosophy and methods of treatment?
- Are alternative methods of treatment used, such as holistic treatment?
- Does the program believe it is possible to be completely recovered?
- How comprehensive is the program - what types of therapies are offered (individual, group, nutrition counseling, medication treatment, etc.)?
- What are the licenses and accreditations of the treatment center?
- What are the credentials of therapists?
- How many patients has the program treated and what is the program’s success rate?
- Does the facility accept your insurance; how much of the expenses will be covered by your insurance; what is the estimated cost of your stay; what expenses, such as fees by doctors are separate from the fees from the program?
- What is the daily routine like (activities, therapy sessions, classes, meals, free time)?
- What type of meal and snack regiment will one be expected to follow?
- To what extent can family be involved, for example, is there family counseling and can family visit the patient?
- What is the policy for leaving the facility and for visitors?
- What is the expected length of stay?
- Is a Twelve-Step Program used?
- Is this a place you will feel safe?
Does the staff at the facility convey warmth and a sincere sense of caring?
Treatment is hard work, but well worth the effort for the sake of improved mental and physical health.
The length of treatment varies from individual to individual. Two primary indicators of the length of treatment are how long the person has had the eating disorder and the individual's rate at proceeding in his journey to recovery. The longer one has had an eating disorder, the more likely treatment will take longer. Each person differs in their rate and ability to deal with conflict and issues in their lives, to develop more effective thought patterns, and change unhealthy behaviors.
Therapy may take years before substantial progress is achieved. Being transformed into that new person takes time. The client must be patient with himself and others must be patient with him.
The average cost of inpatient care per day is is $1,000 or more. Residential treatment averages about $200 a day (excluding doctor expenses, which are genearlly charged separately). Outpatient treatment including appointments with a psychotherapist, nutritionist, psychiatrist, and a primary care doctor along with medication costs over several years can cost $100,000 or more. But don't lose heart, providers can offer discounts and doctors can provide sample medications. Hopefully, individuals with eating disorders will have health insurance and discount prescription plans to cover most of these expenses.
It is estimated that only 1 in 10 people with eating disorders receives treatment. While the reason so few seek treatment is partially due to their denial of their illness and their profound shame to admit to it, undoubtedly the cost of treatment is a major deterrent to those with eating disorders seeking professional help.
Treatment providers must make treatment financially affordable to their clients through accepting a variety of insurance plans, charging modest fees, using sliding-scale fees for payments, and creating a benefit fund where donations can be collected and used for clients most in need of financial assistance.
Due to the altruistic nature of treatment providers, they do not want to deny anyone access to treatment who wants to heal from an eating disorder. Consequently, many treatment providers will accommodate clients with a payment plan that fits their budget. Large treatment facilities may even have scholarships to apply for.
Those considering treatment should not automatically disregard treatment due to insufficient funds and/or due to having no insurance. People with eating disorders need to explain their income and insurance situation to a potential (or several potential) treatment providers to find out what they will suggest for payment options. Many treatment providers will use a sliding-scale fee that bases the payment amount on one's income level.
If a person with an eating disorder has very few assets and a very low income, he should consider contacting the Social Security Administration at 1-800-772-1213 to find out if he is eligible for Medicaid insurance.
Here are a few organizations that offer scholarships or grants for treatment:
The Gail R. Schoenbach F.R.E.E.D. Foundation - http://www.freedfoundation.org
Manna Scholarship Fund - http://www.mannafund.org
The Kirsten Haglund Foundation - http://www.kirstenhaglund.org
National Eating Disorder Referral & Information Center http://www.edreferral.com/scholarship_foundation.htm
Eating Disorder Recovery Support, Inc. (EDRS) - http://www.edrs.net
Those with insurance should find out if their insurance company covers mental health counseling, and if so, will they cover it for a diagnosis of an eating disorder. If the insurance company covers mental health counseling, but not for an eating disorder, the treatment provider can adjust the claim to reflect services for a secondary diagnosis, such as depression, which will be covered. If the person with the eating disorder will receive coverage, he should find out if he must choose from a list of providers put out by the insurance company. If he must choose from a provider list, but their is no eating disorder specialist or program listed, find out from the insurance company if the primary care doctor can give a referral off of the list that he can receive coverage with, so he can receive the specialized treatment he needs.
For a more detailed explanation on dealing with insurance issues, see the National Eating Disorders Association (N.E.D.A.):
2. Eating Disorders Survival Guide at
3. Insurance Issues at
For individuals with no insurance and limited income consider treatment from mental health centers, community agencies (such as family service centers and hospitals with clinics), and low fee clinics offered by the Psychiatry Departments of Medical Schools. Students paying a Student Health Fee can obtain free counseling at their College Counseling Center or Student Health Services. While treatment by a multidisciplinary treatment team of eating disorder specialists is ideal, these low cost options are better than no treatment at all.
If you need help paying for your prescriptions, go to the RxAssist website at http://www.RxAssist.org fo find out if your medication is covered under a Patient Assistance Program and if so, what is the eligibility critieria.
Despite the challenges, people can fully recover from eating disorders. People affected by eating disorders must realize others have recovered, and they can too! So, they should not lose hope. They need to fight the good fight to recovery.
While some physical damage may be irreversible, other physical complications may be reversed. With recovery comes improved mental and physical health. People with eating disorders will notice a greater zest for life and they will be happier. Their life will be more balanced and healthier, perhaps even more than most people, because they have come to realize the value of nurturing the different parts of themselves.
Recovery is possible with a determined, persistent spirit to get better and with the help of a treatment team of professionals and the support of family and friends. For family and friends of a person with an eating disorder reading this, remember your gentle, patient, and persistent faith in and support of your loved one is invaluable to him in his recovery.
Whether you are a concerned family member or friend, bringing up the subject of your suspicions of someone’s eating disorder can provoke a lot of anxiety. How will the person respond? It is much easier to avoid confronting someone about their eating disorder. However, for the person’s health and well-being and for the sake of your relationship with the person, it is important to have this talk with the individual.
Typically the eating disorder is a very covert part of the person’s life and the person usually feels embarrassed to talk about or admit to it. Consequently, the person with the eating disorder may deny it and refuse help. This is their response to fear of being found out. Listed below are some guidelines on how to approach the fragile discussion of talking to somebody about their eating disorder and encouraging the person to seek professional help.
- Approach the person when you are composed, not when you are emotionally upset.
- Choose a place where you can talk privately without interruption.
- Be gentle and express your concerns for the other person.
- Explain that you genuinely care about him and want the best for him.
- Don’t vent your anger or other negative feelings.
- Use “I statements” rather than “you statements.” For example, “I feel …” rather than“you make me feel …”
- Give specific examples of why you suspect the person has an eating disorder.
- Help him see not only how his eating disorder affects his physical health, but also help him understand how it affects his relationships and functioning, and interferes with achieving his goals, and how it makes him feel.
- Avoid being judgmental and critical.
- Build-up his self-esteem by emphasizing his good qualities and his strengths, what you admire about him. It is important to do this, because encouraging someone to seek treatment can seem like you are being critical of him and seeing only his flaws.
- Be empathetic.
- Ask open-ended questions (- questions that require an explanation, rather than simply a yes or no response) to encourage him to talk about his thoughts and feelings.
- Encourage him to express his feelings.
- Don’t blame or manipulate him to change with shame or guilt.
- Don’t give ultimatums.
Help him to understand there is no shame in seeking professional help. Help him see therapy as an opportunity to make one’s life better (and you want the best for him).
Remember eating disorders are complex illnesses, so don’t offer simplistic solutions, such as “just eat more.”
- Reaffirm your love or friendship with the person, explaining you like him, but not the eating disorder part of him that is destroying him and your relationship.
- Don’t let this discussion turn into an argument. Rather than argue, simply reiterate your concerns and leave it at that.
- Be persistent (without pestering) in your efforts to encourage him to seek professional help.
- Be prepared to provide contact information of treatment providers and information on eating disorders, if he is willing to seek treatment.
- Offer to accompany him to an initial appointment.
- Tell him you are available for him to confide in you, if he wants to talk to you.
- Explain to him you are ready to support him in whatever way he needs help.
- Respect an adult’s decision to refuse treatment as long as his condition is not life-threatening. If his condition is life-threatening, consult a therapist for an intervention to get him into treatment.
If the person with the eating disorder is a child (under 18), it is the responsibility of the parents to get professional help for their son. This means that the decision for treatment is made by the parents, not the child.
If the child or adult with the eating disorder’s condition is life-threatening due to medical complications, extreme malnutrition, life-threatening symptoms (such as chest pain), or because the person is suicidal, get the person immediate medical attention. If the person refuses treatment when their life is in danger, enlist the support of a therapist who can prepare and conduct an intervention to get the person into treatment.
Tips on How to Support Someone in Treatment
- Be willing to listen when he is ready to confide in you.
- Be empathetic, understanding the challenges in overcoming an eating disorder.
- Be patient with him, realizing that changing thought patterns and behaviors takes time.
- Be honest with him, but not judgmental and critical.
- Respect his freedom to make his own decisions and choices. For example, what he eats or decides not to eat.
- Avoid power struggles over food and other issues. He will only resent you for taking his power of control away from him.
- Do not monitor his food intake and behavior.
- Refrain from giving advice.
- Try to minimize, rather than maximize his anxiety level. For example, don’t bring up subjects at meals that might upset him.
- Make him responsible for his own behavior. For example, cleaning up the bathroom after vomiting or buying food he binges on.
- Don’t be an enabler by inconveniencing yourself to accommodate his eating disorder needs, such as by only preparing foods he will eat or avoiding social eating situations.
- Say things that build his self-esteem, such as pointing out his strengths, his positive character traits, and what you admire about him.
- Acknowledge his progress in therapy by pointing out his changes in his behavior and way of thinking, ability to better connect with others in relationships, and improvements in character, functioning, and mood.
- Don’t make comments, even positive ones, about weight, appearance, eating, or exercise as these may be taken the wrong way. For example, don’t say “you look healthier” as this may be interpreted by the person with the eating disorder as “I look fatter.”
- Be a model of effective coping skills, healthy food attitudes and behaviors, and moderate exercise.
- Watch your language. For example, don’t label food as good/bad, healthy/unhealthy, and safe/unsafe.
- Don’t talk about other people’s appearance and weight and dieting to him or anyone. Talking about these things objectifies people, basing their worth on external, rather than internal qualities.
- If you hear others making comments about someone related to appearance and weight, shift the emphasis to the person’s internal qualities. If someone is talking about dieting in order to lose weight, shift the emphasis to health.
- Educate yourself about eating disorders, so you are better able to help and support the person with the eating disorder.
- Be willing to participate in therapy, if asked.
Be willing to seek professional help for your own issues or to get help coping with your loved one’s eating disorder.
Andersen, Arnold E., ed. Males with Eating Disorders.
New York: Brunner/Mazel, 1990.