Anorexia in Men: Signs, Causes, & How to Get Help

What Is Anorexia?

Anorexia is a type of eating disorder that is fueled by a fear of gaining weight. People with anorexia severely limit their consumption of food and become underweight. This comes from a distorted sense of self in which a person with anorexia may still see themselves as fat or overweight, when they are actually underweight.

How Common Is Anorexia in Men?

Research shows that men account for about 20% of people with anorexia nervosa and 55-77% of people with other specified feeding or eating disorders (OSFED), which can include atypical anorexia.² However, the exact prevalence may be unknown, as underreporting and misdiagnosis of eating disorders in men continues to be an ongoing problem.

Why Is Male Anorexia Associated With Gay Men?

Rates of male anorexia may be higher among gay and bisexual men compared to straight men. Research shows that gay men tend to statistically experience greater dissatisfaction with eating patterns and higher rates of weight-based self-worth.³ This may have to do with community norms focused on certain body image standards. However, it’s important to note that eating disorders are not a matter of someone’s sexual orientation.

Anorexia Symptoms in Males

Men with anorexia present at a low body weight or are significantly underweight. They persistently restrict their caloric intake but may also engage in binging/purging cycles. There is a prevalent preoccupation with food, body size, and weight. Severe anorexia can significantly impact all areas of a man’s functioning.

Symptoms of male anorexia can include:

• Severely malnourished or underweight: Anorexia is characterized by low weight and/or significant weight loss. This can result in malnourishment.
• Decreased sex drive: Anorexia often reduces sex drive in both men and women.
• Lowered testosterone: Anorexia can impact testosterone levels as well as other hormonal imbalances.
• Depression: Anorexia may coincide with depression, and symptoms of both conditions may exacerbate one another.
• Dizziness: Electrolyte imbalances and malnutrition may result in dizziness.
• Hair loss: Inadequate nutrition can result in hair loss.
• Mental confusion: Failing to eat enough each day may cause “brain fog” and other memory problems.
• Exhaustion: Persistent fatigue is a common symptom of anorexia.
• Disrupted sleep: Insomnia, hypersomnia, irregular sleep patterns, and night terrors may coincide with anorexia.
• Irregular heartbeat: Electrolyte imbalances or bradycardia can result in cardiovascular problems like irregular heartbeat.

Outward Signs of Anorexia in Males

Men may exhibit different signs of anorexia nervosa than females, like a preoccupation with weight lifting. Physical changes may also be masked for longer periods in men vs. women due to the general shape of the male form.

Common signs of anorexia in men include:⁴

• Preoccupation with weightlifting or bodybuilding, and being distressed when they missed a workout
• Avoiding eating with others
• 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, body checking, or weighing constantly
• Exhaustion
• Anger or irritation when questioned about behavior or appearance
• Hair loss

Causes of Anorexia In Men

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.

The underlying causes of eating disorders in men can include:

• Genetic causes: Genetic factors may play a role in the development of eating disorders. This may be one explanation as to why eating disorders often run in families.
• Biological aspects: Neurotransmitter imbalances and brain structure may impact someone’s likelihood of developing anorexia.
• Environmental factors: Cultural pressures, peer influence, and experiences with bullying or low self-esteem may contribute to eating disorders in men.

Other Risk Factors for Male Anorexia

Other risk factors for anorexia in men include:^1,5

• Stigma and cultural norms regarding anorexia as affecting more females and gay men
• Unrealistic ideals of what the male body should look like (i.e., muscular, ripped)
• Sexual objectification of men in the media
• Onset of puberty
• 25% of men perceive themselves to be underweight
• 90% of teenage boys exercise to become more muscular
• Muscle dysmorphia (believing that one’s body isn’t muscular or lean enough)

Commonly reported triggers or life events that lead to eating disorders in men include:⁶

• Bullying or teasing about appearance (like body shaming or fat shaming) during childhood
• Success or failure in sports (especially sports like wrestling, running, and gymnastics), sometimes leading to anorexia athletica
• 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

Differences in Male Anorexia Vs. Female Anorexia

Men are subject to the influence of societal pressures to achieve a perfect body just like women, even if the resulting physique is different. Body dysmorphia is a key element in most eating disorders, especially anorexia (i.e., how they think they look vs. how others think they look). It increases the risk of eating disorders due to extreme measures someone will go to pursue an “ideal” body.

The ideal, muscular male that is presented to men by the media is nearly impossible 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.⁷

Why Does Anorexia Often Go Undiagnosed in Men?

Despite nearly 25% of all anorexia cases being male, men tend to go untreated for lengthier periods of time than their female counterparts.⁸ This could be due to bias, stigma, and lack of research, among other things.

Reasons for undiagnosed anorexia in men include:

• 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 male 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, making it harder for males to be diagnosed

What Are the Consequences of Untreated Anorexia in Men?

Self-concept, relationships, finances, and employment are often negatively impacted by anorexia in men. In addition to these types of consequences, eating disorders and anxiety, along with eating disorders and depression, can often co-occur. The degree to which these consequences are a direct or secondary result of anorexia is unclear.

Men who are preoccupied with their bodies and exercise will experience negative impacts on personal and professional relationships. 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 life with anorexia.

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 disorders
• Disrupted sleep

Early Treatment Is Best for Male Anorexia

Early intervention is critical due to the serious health consequences associated with anorexia, along with the high mortality risk.⁹ Parents, if you notice that your child or adolescent has stopped eating, has lost significant weight, or has stopped growing, seek professional assistance from a licensed therapist, registered dietitian, or physician with eating disorder expertise.

Any time a child or adolescent either loses or fails to make expected weight gains, it could be a sign of an eating disorder. Additionally, if your child has less energy than normal, is getting sick more frequently, is refusing to join the family at meal time, or is exercising more than is typical, a trip to see a professional is warranted. Other symptoms could include irritability, sleep disturbance, pale or dry skin, hair loss, increased dental issues, or more frequent injuries.

Additionally, if an adult male experiences physical symptoms like lightheadedness, headaches, high blood pressure, rapid heart rate, sleep disturbance, hair loss, increased dental issues, increased injuries after working out, depression, anxiety, or notable changes in their physical or mental health, it’s important to seek out professional assistance.

Treatment for Anorexia in Men

The important first steps when treating anorexia include 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 for Male Anorexia

Individual, family, and group therapies are available on an outpatient and intensive outpatient (IOP) basis for those who don’t require medical monitoring in a hospital setting. Outpatient eating disorder 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, intensive outpatient therapy is the next level of care. Intensive outpatient programs are usually attended three to four times each week for up to 10 hours each week. These programs 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.

The most common types of therapies used to treat anorexia in males include:

• CBT: Cognitive behavioral therapy (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.
• DBT: DBT for eating disorders 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.
• FBT: Family based therapy (FBT), also referred to as the Maudsley Method, 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.
• ERP: Exposure and response prevention (ERP) is used to expose clients to their fears. In the case of an eating disorder, it is often a fear of 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.

Medication for Anorexia

There are no known drugs that are used to treat or cure anorexia, but there are medications that can be used to assist with underlying mental health conditions such as depression and 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.

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).¹⁰ These drugs increase serotonin which is involved in regulating several important functions including sleep, appetite, and body weight. They’re used due to the relatively low rate of side-effects and positive impact on depression, anxiety, and obsessive compulsive disorder (OCD).

It’s 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.

Inpatient Treatment & Hospitalization

Anorexia is one of the most fatal mental illnesses. Critical cases may require a high level of professional treatment. Hospitalization for the eating disorder could be necessary in cases of severe malnutrition or medical instability. It might also be appropriate if someone is refusing to eat, as this can exacerbate dehydration, malnutrition, and other serious medical concerns.

Inpatient treatment refers to 24/7 professional monitoring and supervision. Inpatient treatment may take place at a hospital or residential facility (often known as ‘rehab’). Clients in this type of treatment receive continuous clinical and medical care. Weight restoration is generally one goal, but it’s also important to treat any underlying issues perpetuating the anorexia. Inpatient treatment can range from 1-6 months.

Treatment Timeline for Male Anorexia

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 achieve recovery from an eating disorder regardless of the type of treatment used. However, the longer a person goes without care, the more likely they are to experience periods of partial recovery and relapse requiring additional treatment.

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.

To find a therapist, look through an online therapist directory where you can sort by specialty and insurance coverage. You can also get online treatment through a platform like Equip Health or Within Health.

How to Get Help for a Loved One

If you’re wondering how to help someone with 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 Specialist (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 

4 Ways to Cope With Male Anorexia

Recovering from male anorexia can be incredibly challenging, but there are ways to cope. The most important step is getting appropriate treatment and a care team to help you through the process. From there, developing positive coping skills and a healthy support system can be instrumental in getting better.

Here are four ways to cope while recovering from male anorexia:

1. Practice Regular Self-Care

In the simplest terms, you must learn to replace ineffective behaviors with positive coping skills for their eating disorder. When you can find alternative ways to relax and reduce anxiety, you’ll 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 person while a handy project around the house may be a better option for the next.

2. Develop a Support System

Identify people in your personal life whom you can go to for support in addition to your therapist, your dietitian, and psychiatrist. A few trustworthy people that share common interests can make all the difference in your recovery journey. When you find yourself tempted to engage in eating disorder behavior, spend time with a friend or family member to get through the tough moments of recovery.

3. Manage Your Triggers

To manage your ineffective behaviors, identify your vulnerabilities and triggers. A therapist or dietitian can help you identify these so you can be better equipped to fight them. Your triggers act as a warning system that the eating disorder is close at hand, waiting to rear its ugly head. If you have a plan established to deal with these triggers, you’re more likely to fight them effectively.

4. Attend Therapy Regularly

It’s tempting to taper back on therapies once you start feeling a bit stronger. Naturally, you want to get back to your “normal” life as soon as possible. However, it’s critical to attend your therapy and nutrition appointments until you’re discharged from care to ensure that you’re securely into recovery. Actively planning against relapse is a crucial part of the recovery process.