The unspoken shame of male eating disorders
The unspoken shame of male eating disorders
When talking about eating disorders, we tend to think of teenage girls and young women starving themselves to look like underweight models on a catwalk. In other words, a female problem fuelled by the fashion industry.
This is part of the picture, but it’s far from the whole story. Increasingly, these disorders are being diagnosed in men, as pressures on them to meet society’s standards of physical perfection gather pace.
People who have an increased risk of developing an eating disorder include those with self-esteem and identity issues, young people whose families equate their worth with their abilities in sports and academics, perfectionistic personalities, people from a troubled background who’ve experienced abuse or neglect, and those whose career requires them to stay thin such as dancers, jockeys and body builders.
The onset most commonly occurs in adolescence, although it can occur at any age. While roughly a quarter of eating disorder cases are men, the true number is unknown, as men are often reluctant to admit they are struggling with these issues, both to others and themselves, says psychiatry resident Dr Kieran Kennedy.
“Eating disorders are a lot more common in women than men, but what we’re seeing now, especially where society is moving in terms of body image pressures for men too, is that it’s increasing in men and young boys,” he says.
“Generally, it’s quoted that about 25 per cent of all eating disorder cases are men, but there’s a bit of estimating there because a lot of men are struggling with body image and eating disorder issues, they’re not coming forward to talk about it.”
Another problem is recognising the signs. Anorexia nervosa is probably the best-known of these illnesses, involving the patient becoming dangerously underweight. However, a person can have an eating disorder at any size, whether underweight, within normal range, or overweight, says Kennedy.
“When we hear the term ‘eating disorder’, we think of anorexia, and for anorexia, part of the diagnosis is being significantly underweight for someone’s age and height. But there are a whole range of other eating disorders, like binge eating disorder and bulimia, where someone might not visibly be underweight or you might not be able to pick it just by looking at them.”
Dr Scott Griffiths, from the University of Melbourne’s School of Psychological Sciences, says the causes of these disorders can be classified into three broad categories working together: genetic predisposition, social influences from the people in your life, and your environment. This last category encompasses both traditional media and social media.
“When people are growing up and even when they’re older, they have questions in their head that are reasonable to have: ‘Am I attractive? Am I hot? Am I ugly?” says Griffiths.
“You don’t have an objective sense of that. You look to the world around you to try and get an idea. If you log onto Instagram and scroll down and the first 15 of 20 bodies that you see are all conventionally hot, and you compare yourself, you might end up feeling really bad about yourself.”
Binge eating disorder
In fact, anorexia is relatively rare among these illnesses. The most common eating disorder across both sexes is binge eating disorder, with men accounting for roughly 50 per cent of cases.
The condition involves frequently consuming a large amount of calories within a short period of time, and differs from bulimia in that it is not usually accompanied by immediately purging.
Binge eating disorder also differs from the occasional night crashed out on the couch, watching television and scoffing pizza, ice cream and corn chips.
The distinction is in how often you indulge and how you feel about it before, during and afterwards.“There’s nothing wrong with a treats night or cheat day, but with an eating disorder, it becomes a regular thing, and it’s shame-filled, guilt-filled and compulsive,” says Kennedy.
The slide into an eating disorder can be gradual, beginning with restricting junk food in the interest of your health, then becoming problematic as time goes on.
Women in this situation tend to be aiming for a slender physique. In men, the focus is more often on becoming more muscular in the upper body and sculpting a six-pack stomach by upping their protein intake and restricting fats.
Over time, this can develop into anorexia, says Dr Roger Mysliwiec, director of the New Zealand Eating Disorders Clinic. “They might actually start changing their diet by leaving out processed food and food with high carbohydrate and fat content, with a strong emphasis on protein-rich foods,” he says.
“The initial desire is to have a more muscular body type but then the behaviour can get out of control. Their diet becomes increasingly restrictive, and then they almost inadvertently start losing weight.”
This preoccupation in males of building bigger muscles can also stem from a newer eating disorder called muscle dysmorphia. Griffiths says muscle dysmorphia in particular is an eating disorder tending to afflict men.
Those with this illness see themselves as being far less muscular than they actually are, experiencing a mismatch between their self-image and reality, and may turn to anabolic steroids to bulk themselves up.
“When they look in the mirror, they don’t see what you see. They see someone who is scrawny or who is overweight, even though they are clearly very muscular.” There are a number of reasons why eating disorders in males have been traditionally overlooked and underdiagnosed. One is that their more frequent focus on building bulk rather than shedding kilos means their concerns are not as easily identified as an attempt to lose weight.
It’s common for those living with an eating disorder to also have depression and anxiety. Traditionally, men have struggled to open up about having depression and anxiety, although this has been changing.
Obscuring the view
In addition, eating disorders are still often seen as a ‘women’s issue’, even by some medical professionals.
According to Griffiths, up until the past decade, the Diagnostic and Statistical Manual of Mental Disorders (DSM) specified the cessation of a regular menstrual cycle as a requirement for the diagnosis of anorexia.
“It was excluding the 25 to 33 per cent of anorexic diagnoses that are men. You either had to give them something else or ignore that criterion even existed because technically it meant that no man could have anorexia.”
Further work is still needed in this regard to identify and communicate how eating-disorder cases present in men. “If the diagnostic criteria would specify what these eatingdisorders look like in males, that would help provide more clarity to the field for researchers and clinicians,” says Mysliwiec.
While there is still work to be done in recognising and treating male eating disorders, it’s important to continue to push for improvements in the field, as the physical and psychological consequences arising from these disorders can be severely damaging and even deadly.
People living with one of these conditions have a mortality rate 12 times higher than someone without an eating disorder.
The impacts of eating disorders on your physical health vary depending on the exact type of disorder, but can include irregular heartbeats and eventually heart failure, stomach pain and bloating, bacterial infections, blood sugar fluctuations, blocked intestines, constipation, bowel problems, and rupturing of the stomach or oesophagus.
Decreased sex hormones can lead to lower bone density and increased risk of broken bones and osteoporosis. Binge eating can also mean your body will become more insulin-resistant, increasing the chances of type 2 diabetes. Your brain will also struggle to get the energy it needs, and you could be left with difficulty sleeping, dizziness and fainting, as well as tingling in your hands and feet.
Eating disorders can also trigger further mental health conditions, says Griffiths. “You could end up with social anxiety because the eating disorder has you in your head worrying about how everyone else is judging you on your appearance, even though they’re probably not thinking about it. That’ll burn you out. This is how mental health conditions often start to metastasise into new ones.”
The good news is that by reaching out and seeking support to get better, people living with eating disorders can make strides towards recovery.“
Generally, people get help and recover and regain a healthy control of their nutritional intake and what their body needs,” says Kennedy. “People can go on to have a really healthy, balanced relationship with food and body image.” Research has shown that the sooner a person seeks treatment, the quicker the recovery time, with your general practitioner being a good first port of call.
Signs that a male might be grappling with an eating disorder can include a preoccupation with weightlifting and bodybuilding, failing to skip a workout when sick or injure lowered testosterone, muscular weakness, decreased interest in or anxiety around sex, conflict over gender identity or sexuality, and using anabolic steroids.
Feelings of anxiety and guilt around food, as well as an obsessive relationship with it where your whole life is structured around it and impacted by it, are also signs that you might be taking things too far and it’s time to seek help.
Seeing the signs
“An increased sense of anxiety and obsessionality around their diet and disengaging increasingly from social and other activities in order to uphold the rules of their lifestyle– I would consider these to be warning signs,” Mysliwiec says. “Often, it might be family members or a partner who notice that in the first instance rather than the person themselves.”
It’s okay to be on a diet, but finding that work and seeing your friends are being pushed to the side to make way for your health goals could be a sign you are taking things too far.
“If it’s starting to impact on their work, if they’re starting to turn down social events because they’re worried about what they might have to eat or what that might do to their body the next day, those are also signs that this is becoming a bit more than just wanting to be careful about what you eat,” says Kennedy.
It’s a fact of life that how we look has an impact on how we move through the world, affecting our job prospects, love life and confidence levels.
We want to present the best possible version of ourselves, and that’s okay, as long as it doesn’t become all we think about.
“Wanting to look better or feel attractive, there’s nothing wrong with that,” Griffiths says. “But it should not be so important that it starts to be the only thing you care about.”
Food fuels our bodies and can bring a lot of enjoyment. Ensuring we have a healthy relationship with it and a forgiving view of our bodies can only boost our happiness. If we’re honest with ourselves and find we’re struggling in this regard, it’s time to talk to someone.
Where to find help and support
For specialised support from a trained counsellor, free call or text 1737 any time or visit 1737.org.nz.
Healthline 0800 611 116, available 24 hours, 7 days a week and free to callers throughout New Zealand, including from a mobile phone.
Eating Disorders Association of New Zealand (EDANZ) 0800 2 EDANZ or (09) 522 2679, [email protected]
For specialised advice, contact The Butterfly Foundation support line on 1800 33 4673 (1800 ED HOPE) butterfly.org.au
Other crisis, counselling and online services:
- Lifeline – 13 11 14 lifeline.org.au
- Kids Helpline -1800 55 1800 kidshelp.com.au
- SANE Australia Helpline 1800 18 SANE (7263) sane.org
- headspace headspace.org.au
- ReachOut reachout.com