Eating disorders are traditionally thought to be conditions that primarily impact women. Despite this misconception, roughly one in three people with eating disorders are men. In the USA, 10 million men will be impacted by anorexia in their lives.16 Anorexia is most often diagnosed during adolescence, but men can struggle with eating disorders at any stage of development.
What Are Signs of Anorexia in Men?
Men may exhibit different signs of anorexia than females with the same disorder. Physical changes may be masked for longer periods in men than in women due to the general shape of the male form.
Common signs of anorexia in men include:2
- Preoccupation with weightlifting or bodybuilding
- Anxiety associated with missing a workout
- Working out when injured or ill
- Decreased interest in sex
- Severe dieting
- Severely malnourished or underweight
- Taking body measurements or weighing constantly
- Exhaustion
- Anger or irritation when questioned about behavior or appearance
- Hair loss
Causes & Risk Factors for Anorexia in Men
Risks associated with anorexia in men are serious The National Eating Disorders Association (NEDA) reports that the mortality rate in males with anorexia is greater than that of women. This risk is why it is critical to seek professional assistance as soon as an eating disorder is suspected or discovered.
Other risk factors for anorexia in men include:
- Stigma and cultural norms regarding anorexia being a female or gay disease
- Unrealistic ideals of what the male body should look like (muscular, ripped)
- Sexual objectification of men in the media
- Onset of puberty
- Genetic predisposition (28-74% of risk for ED is genetic)19
- 25% of men perceive themselves to be underweight16
- 90% of teenage boys exercise to become more muscular16
- Muscle dysmorphia (believing that one’s body isn’t muscular or lean enough)
Many of the causes of male anorexia are similar to those in women. There is no single cause of anorexia in men.
Some of the most often reported triggers or life events that led to the development of eating disorders in male patients are:3
- Bullying or teasing about appearance (weight, height, shape, etc.) during childhood
- Success or failure in sports (especially sports like wrestling, running and gymnastics)
- Body dissatisfaction (height, weight, shape, hair loss, aging, etc.)
- Increasing body weight and/or fat
- Media influence regarding ideal body shape that differs from their own
- Sexual issues related to appearance
- Appearance/weight prejudice in social or occupational situations
- To improve a relationship
- To avoid medical issues such as heart disease, diabetes, or high blood pressure
Men & Body Image
Body image disturbance is a key element in most eating disorders, especially anorexia. This is a distorted perception regarding a person’s body or aspects of their appearance which differs from how they look to others. This distorted body image increases the risk of eating disorders such as anorexia due to the extreme measures an individual will go to in the pursuit of an ideal body. Men are subject to the influence of societal pressures to achieve a perfect body just as women are even if the resulting physique is different.
“You’re out of shape is a refrain heard by many men from their friends, wives, bosses, doctors, teachers, and, of course, the media.” (Anderson, Cohn, & Holbrook, 2000, pg. 30). The ideal, muscular male that is presented to men by the media is nearly impossible for most to achieve. For some who are unable to reach this ideal, spending hours in the gym, taking steroids, using protein supplements, and following fad diets seem like the only options to gain success and acceptance.
Men suffer from muscle dysmorphia related to a fear that they are not muscular enough. This is true of weightlifters who are observably quite muscular and large. This is akin to female anorexics who believe they are too big despite being quite thin. Because male patients with muscle dysmorphia engage in excessive exercise and eating disorder behaviors designed to manipulate body weight and shape, researchers categorize muscle dysmorphia as a version of anorexia nervosa more closely aligned with traditional male gender norms.14
Why Does Anorexia Often Go Undiagnosed in Men?
Despite nearly 25% of all anorexia cases being male,7 men do tend to go untreated for lengthier periods of time than their female counterparts.
There are many reasons for this including the following:
- Bias by professionals leading to less likelihood of eating disorder diagnosis in males
- Stigma associated with males seeking help for what has traditionally thought to be a female or gay male disorder
- The disorder not being recognized by family members
- The males not seeing their behaviors as problematic
- Minimal attention to male eating disorder symptoms and predominantly female language in most eating disorder assessment measures
- Most research and subsequent funding have historically excluded males from studies
- Predominantly feminine branding of eating disorder treatment centers and exclusion of males in their milieus
- Until recent changes in the Diagnostic and statistical manual of mental disorders (DSM-V), diagnostic criteria were gender based, such as amenorrhea, making it harder for males to be diagnosed
What Are the Consequences of Untreated Anorexia in Men?
Eating disorders can have a profoundly negative impact on an individual’s quality of life.
Anorexia produces many physical and emotional consequences if left untreated. Long-term starvation has a significant impact on the human body.
Some effects of untreated anorexia in men include:
- Lack of energy
- Slow and/or irregular heartbeat
- Cold extremities
- Dry skin
- Hair loss
- Weakness
- Digestive issues (bloating & constipation)
- Decreased sex drive
- Low testosterone levels
- Bone loss and osteoporosis
- Depression
- Anxiety
- Disrupted sleep
Self-concept, relationships, finances, and employment are often negatively impacted by an eating disorder. In addition to these types of consequences, eating disorders are also associated with co-occurring psychiatric disorders such as mood and anxiety disorders. The degree to which these consequences are a direct result of the anorexia or are secondary is unclear.
Men who are preoccupied with their bodies and exercise will experience negative impacts on personal and professional relationships at some point. A partner becomes second to the eating disorder that consumes the man’s time. It is likely that the eating disorder will create a lack of intimacy and distance in his relationships as well. A man will no longer experience joy in the activities he once loved due to his need to control every aspect of his new life with anorexia.
When Should Someone See a Professional for Male Anorexia?
Parents of young boys or adolescents should seek professional assistance from either a licensed therapist, registered dietitian or physician with eating disorder expertise if you notice that your child has stopped eating, they have lost a significant amount of weight, or if they have stopped growing. Any time a child or adolescent either loses or fails to make expected weight gains, it could be a sign of an eating disorder if combined with other symptoms.
Additionally, if your child has less energy than normal, is getting sick more frequently than usual, is refusing to join the family at meal time, or is exercising more than is typical for him to do, a trip to see a professional is warranted. Other symptoms to be aware of are irritability, sleep disturbance, pale or dry skin, hair loss, increased dental issues, or more frequent injuries.
Many of the same symptoms mentioned with children and adolescents are important to note in adult males as well. Weight changes and food refusal are the obvious signs to look for in anorexia. Additionally, if an adult male is experiencing physical symptoms such as lightheadedness, headaches, high blood pressure, rapid heart rate, sleep disturbance, hair loss, increased dental issues, increased injuries after working out, depression, anxiety, or any other notable changes in their physical or mental health, it is important to seek out the professional assistance of a licensed therapist, dietitian, or physician with eating disorder expertise.
Treatment of Anorexia in Men
Early intervention is critical due to the serious health consequences associated with anorexia along with the high mortality risk.20 The important first steps to treatment of anorexia is medical stabilization, re-feeding and weight restoration when needed. There are many different types of treatment options available for eating disorders and several professionals collaborate with one another to form a multidisciplinary treatment team of therapists, dietitians, medical providers, and psychiatrists.
Therapy
Individual, family and group therapies are available on an outpatient and intensive outpatient (IOP) basis for those who do not require medical monitoring in a hospital setting. Outpatient therapy can be attended one to two times a week with either a licensed professional counselor (LPC) a licensed marriage and family therapist (LMFT) or a licensed psychologist (PhD or PsyD).
If a patient needs more frequent contact than twice weekly therapy sessions, intensive outpatient therapy is the next level of care available. Intensive outpatient programs are usually attended three to four times each week for up to 10 hours each week. These programs can consist of group therapy, individual and family therapy sessions, nutrition counseling, and psychiatry appointments for medication management. If a patient is unable to remain stable at one of these two levels of care, other more intense options are also available.
Common Type of Therapies
The most common types of therapies used to treat anorexia in males include:
- Cognitive Behavioral Therapy (CBT): CBT is a form of psychotherapy that assists individuals in challenging distorted thinking, behaviors, and emotions that serve to maintain their eating disorders. This type of treatment focuses on helping the eating disorder client recognize and change negative thinking and behavioral patterns. Therapists may recommend Enhanced CBT (CBT-E) for some men struggling with anorexia.
- Dialectical Behavioral Therapy (DBT): DBT is designed to help clients develop new skill sets through modules such as emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. These are designed to help individuals deal with anxiety, out-of-control emotions, and other issues that contribute to one’s eating disorder.
- Family Based Therapy (FBT): FBT is also referred to as the Maudsley Method. This is an approach that is effective with young patients and adolescents. It involves putting a family member in charge of the refeeding process for weight gain or maintenance and recovery. The family is an integral part of the team and works to re-establish healthy eating patterns and interrupt unhealthy behaviors such as purging and over-exercise. The family member prepares and serves meals until the client can function on their own again at an age-appropriate level.
- Exposure and Response Prevention (ERP): ERP is used to expose clients to that which they fear. In the case of an eating disorder it is often fear foods and situations that create anxiety related to body image. ERP is designed to reduce the amount of emotional and physical distress a client experiences when confronted with a specific thought or situation.
Intended Treatment Outcome & Timeline
The timeline for treatment of an eating disorder involves a multi-step cycle beginning with recognizing the developing symptoms of an eating disorder, seeking out professional help, diagnosis of a possible eating disorder, waiting for specialized care and confirmation of an eating disorder, participating in treatment, recovery, and in some cases a relapse leading back to the first step of the cycle.
The intended outcome when treating any eating disorder is for the individual to be free from most or all symptoms. Professionals attempt to assist the person in getting to a place in which their disorder is no longer impairing their physical and emotional health or interfering with social, educational, or vocational pursuits.
There are no standard lengths of care to achieving recovery from an eating disorder regardless of the type of treatment used. The longer a person goes without care, the more likely they are to experience periods of partial recovery and relapse requiring additional treatment.
Lifestyle Changes
In addition to the formal treatment a person receives for anorexia including therapy and medication, there are lifestyle changes that can be helpful as well.
Some lifestyle changes that can help manage an eating disorder and related conditions include:
- Social Contact: Spending time with family and friends to increase support and accountability
- Self-Care: Making sure to get adequate sleep to reduce stress, anxiety, and depression
- Stress-Reduction: Participating in activities that increase relaxation and decrease stress such as meditation, listening to music, yoga, art, or massage
- Limiting Social Media: Reducing exposure to social media to decrease anxiety, depression, sleep disturbance, and exposure to a culture of dieting and over-exercise
- Support System: Joining a support group or increasing circle of friends to help with feeling less alone, judged, or isolated while dealing with treatment and recovery
Medication
Anorexia can cause many medical and psychological conditions. Medications are used at times to address the complications associated with the disorder. These medications range from over the counter supplements and vitamins to psychiatric medications such as antidepressants and drugs designed to reduce anxiety. These medications are best used in conjunction with care from a licensed therapist and registered dietitian as medication alone is not an adequate treatment for anorexia.
There are no known drugs that are used to treat or cure anorexia. There are medications that can be used to assist with underlying mental health conditions such as depression and anxiety.
The most common class of drugs used off-label to treat those with anorexia are selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft).8 These drugs increase serotonin which is involved in regulating several important functions including sleep, appetite, and body weight. These medications are used due to the relatively low rate of side-effects and positive impact on depression, anxiety, and OCD.
When combined with psychotherapy, SSRI’s are a helpful addition to the treatment plans of eating disorder patients. If a patient does not respond favorably to an SSRI, doctors may prescribe other medications off-label such as olanzapine (Zyprexa) which is an antipsychotic drug which is commonly used to treat schizophrenia. In some, this drug has been found to assist with weight gain and obsessive thinking.12 An off-label use of a medication is when they are not FDA approved for the indication, but doctors prescribe them because they believe they can provide a safe and effective treatment when another medication is not available. It is recommended that eating disorder patients on psychotropic medications are seen by either a psychiatrist or nurse practitioner with training and experience specific to eating disorders due to the unique needs of this population.
How to Get Help for Male Anorexia
Anorexia can be a life-threatening condition so if you or a loved one is dealing with this or any other eating disorder, it is imperative that you seek out professional help. An initial assessment with either an eating disorder therapist or registered dietitian is a good starting point. These individuals are trained to recognize and diagnose all eating disorders.
They will make appropriate recommendations for additional providers if necessary. In the most severe cases, professionals may refer to treatment facilities or hospitals specializing in the care of those with anorexia including intensive outpatient programs, partial hospitalization programs, or inpatient facilities.
Anorexia requires treatment from many professionals collaborating with one another to provide specialized care. There are varying levels of care available to treat those with anorexia depending upon the severity of the individual’s condition. Individual therapists, dietitians and even treatment centers are available who have specialized experience in treating men with eating disorders.
How to get Help for a Loved one
If you suspect that a loved one is suffering from an eating disorder, encourage them to schedule an appointment with their primary care physician or locate an eating disorder specialist through their insurance carrier. When searching for specialists, a credential to seek out is a therapist who is a Certified Eating Disorders Specialists (CEDS). These therapists are certified by the International Association of Eating Disorders Professionals (IAEDP) due to their highly specialized training and years of experience in the field of eating disorders.
Online resources are also available through some of the following agencies:
- National Eating Disorders Association (NEDA)
- Alliance for Eating Disorders
- ED Referral
- Eating Disorder Hope
Statistics for Anorexia in Men
Consider the following statistics regarding anorexia in men:
- It is estimated that 25% of those with eating disorders are male6
- Over 80% of college men are body dissatisfied7
- 25% of normal weight males perceive themselves to be underweight17
- 90% of teenaged boys exercise with the goal of bulking up17
- A recent study says 22% of young men turn to dangerous means to bulk up muscle with disordered eating behaviors15
- Men with anorexia nervosa may face “harsher stigmatization from their peers or go undiagnosed” because of the stereotype that anorexia nervosa is a “female” disorder, a recent study found21
- Studies show that risk of mortality in eating disorders is higher in males than in females16
- In the USA, 10 million males will be impacted by anorexia in their lives16
- 10% of male, college athletes are at risk for anorexia17
- 51% of boys exercise to lose weight or to avoid gaining weight17)
- Nearly 1/3 of teenage boys use unhealthy measures such as skipping meals, fasting, smoking cigarettes, vomiting, or taking laxatives to control their weight7
Four Ways to Cope With Male Anorexia
For males struggling with anorexia, our culture can be one fraught with challenges and unhealthy messages regarding nutrition and exercise that make recovering from an eating disorder one of the hardest things he will ever face. Our society promotes an ideal of a muscular and toned male who is physically fit, sexually appealing, and successful.
There are several ways to cope with our culture while recovering from an eating disorder:
1. Practice Regular Self-Care
In the simplest terms, the male anorexic must learn to replace ineffective behaviors with positive coping skills. When you can find alternative ways to relax and reduce anxiety, you will be able to avoid eating disorder behaviors far easier. These alternative coping skills will be different for each person based on what works for them. A leisurely walk may work for one man while a handy project around the house may be a better option for the next.
2. Develop a Support System
It is important to identify people in your personal life that you can go to for support in addition to your therapist, your dietitian and psychiatrist. When you find yourself tempted to engage in eating disorder behavior, spending time with a friend or family member can be the distraction that you need to get through the tough moments of recovery. A few people that share common interests and who are trustworthy confidants can make all the difference in one’s recovery journey.
3. Manage Your Triggers
To manage your ineffective behaviors, it is important to identify your vulnerabilities and triggers. A therapist or dietitian can assist you in identifying these so that you can be better equipped to fight them. Once you identify your triggers, they act as a warning system for you that the eating disorder is close behind waiting to rear its ugly head. If you have a plan established to deal with these triggers, you are more likely to fight them effectively.
4. Attend Therapy Regularly
It is tempting to taper back on therapies once you start feeling a bit stronger. It is understandable that you want to get back to your “normal” life as soon as possible. It is critical to attend your therapy and nutrition appointments until you are discharged from care to ensure that you are securely fixed into recovery. Actively planning against relapse is a crucial part of the recovery process.
Tests, Quizzes, & Self-Assessment Tools
Only a licensed mental health professional or physician can diagnose an eating disorder. Any self-assessment tool that may be available online is only designed to provide a starting place in the information seeking process and should not be substituted for professional advice. Eating disorders can be life-threatening conditions. If you or someone you care about suspects an eating disorder, please seek out a mental health or medical professional for a consultation.
A licensed therapist, dietitian, or psychiatrist will conduct a thorough interview to determine whether an individual has an eating disorder. A medical examination and lab work may accompany this assessment to determine whether any underlying medical complications are present and require attention.
For Further Reading
The following are helpful additional resources for anyone impacted by anorexia in men:
Anorexia in Men Infographics
