We’ve all seen or heard of an anorexia case on occasion.

Almost always the image that comes to mind when talking about this disorder is that of a teenager in the middle of puberty or a woman recently entered into adulthood, with an obsessive fear and/or refusal to increase or maintain her current weight and a distorted image of her body that provokes an overvalued idea of the need to lose weight.

However, although the female sex is the most common in clinical practice, the existence of a relevant sector of men suffering from this disorder should not be forgotten. We are talking about the existence of male anorexia.

Facing the concept of anorexia: what are we talking about?

To understand this disorder it is necessary to visualize what is being talked about. Anorexia is one of the most common eating disorders, with a prevalence that has increased from about 0.5% to 5% of the world’s population in a few years, a percentage that continues to rise over the years. Of this percentage, 90% of the cases are female (generally around 14-18 years of age), and 10% of them are male. This is the mental disorder with the highest risk of death in adolescence, being one of the few psychiatric disorders capable of producing the death of the affected person by himself.

The symptoms that lead to the suspicion and diagnosis of this disorder are the refusal to maintain a minimum body weight, fear of gaining weight, a distorted perception of one’s own body image that induces weight loss through different strategies, either by ceasing to eat, this type of anorexia being restrictive, or through compensatory strategies (vomiting or exercise) in the case of purgative/compulsive type anorexia. These phenomena have led to the loss of at least 15% of body weight, and there is no feeling of illness. In addition in the case of females there is also the presence of amenorrhea or lack of menstruation .

Epidemiology of male anorexia

As mentioned, 10% of anorexia cases occur in males. Within the male population suffering from anorexia, according to the studies carried out, there seem to be some groups at risk.

Gay population

Studies show that the gay (as well as, although to a lesser extent, bisexual) population presents a greater risk of suffering from anorexia , with a high proportion of cases in this sector of the population. A hypothesis on the reason for this higher prevalence proposes that it is due to the existence of a great emotional tension in the stage of formation of one’s identity when assuming one’s sexual orientation. This high tension and fear of rejection facilitates vulnerability to eating disorders by trying to reduce them through fixation on one’s image.

Social rejection

Another group with a high number of cases is that of bullying and social rejection . Those individuals with a history of social rejection due to overweight have a higher risk of developing male anorexia. As in the previous case, a great deal of tension is caused during identity formation that leads to vulnerability and a fixation with one’s own body shape and the ideal of male beauty.

Elite sportsmen/models

A last high-risk group is that of child athletes , who, when faced with the establishment of too high performance expectations by adults, tend to have a lower tolerance for failure, attempting to correct it with a lower intake and a higher level of physical exercise.

Distinguishing features of male anorexia

Male anorexia, although it shares most of its characteristics with its female counterpart , presents a series of peculiarities that are beginning to be explored.

Social perception of illness

One of the differences derives from the lack of social perception of this disease in men . Given the high prevalence of eating disorders in the female sex, there is a social perception that these disorders do not occur in men, that there is no male anorexia. While in the case of females anorexia has been established as a high priority and important problem, in the case of males this disorder has often been underestimated, receiving little attention and being researched.

Self-perception

Likewise, the gender role traditionally attributed to the male implies that he should act as a protector , having to show strength and hide weaknesses. This means that as a rule the individual does not actively seek help to deal with these problems, nor when it comes to expressing his emotions.

There is often a sense of weakness and social judgment that leads to secrecy of behavior even when they become aware of illness. Also, many of the acquired behaviors, such as excessive physical exercise, are seen by those with the disease as something they could not live without, so there is a high resistance to seek professional help. There is also a tendency to underestimate the effects and severity of the symptoms of the disorder and their effects.

Behavioral Pattern

In the case of men, the typical behavioural pattern also changes. As with women, society and the prevailing canon of beauty in today’s society means that there is constant pressure on body image. In the case of women this canon induces them to be thin. In the case of men, however, in addition to thinness, there is the need to maintain a toned and muscular body.

Thus, although in women the most frequent subtype of anorexia is restrictive anorexia, in which they reduce their intake and eat a variety of diets , in the case of male anorexia the most frequent subtype is purgative/compulsive , in which they try to reduce weight by means of behaviours that compensate for the caloric gain and also generate muscle mass. Thus, it is more common for males to exercise compulsively.

Treatment of male anorexia

There are also some variations in the treatment of anorexia in men.

Male anorexia, as indicated above, tends to be underestimated and under-diagnosed, with the result that men with this disorder often do not receive treatment and support appropriate to their needs. As a general rule, men tend to take longer to attend consultations due to this problem, which in principle makes it difficult and slower to overcome the disorder.

However, male anorexia has a slight advantage over its female counterpart. The response to treatment tends to be faster in males in the first phase of therapy, which is more behavioral, due to an apparent better understanding and follow-up of direct treatments. It should be noted that this type of disorder in men is often associated with a sense of personal weakness or extravagance. This means that a specific diagnosis often brings some relief, given the better understanding of what is happening to them. This is why they have a better reaction.

Treatment of this disorder is a complex phenomenon. The basic goals of treatment would be the restoration of weight to a healthy level, the treatment of physical and psychological complications, the improvement of motivation and eating patterns, and the modification of the perception of body image, adjusting to reality. In this sense common treatments used are systematic desensitization, exposure with response prevention and modification of body image. The improvement of the support network and the prevention of relapses are also considered.

In conclusion, it should be noted that anorexia nervosa in both males and females is a serious disorder that can lead to the death of the patient and should be treated with the highest priority, seriousness and respect.

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Belloch, Sandín and Ramos (2008). Manual of Psychopathology. Madrid. MacGraw-Hill (vol. 1 and 2). Revised edition.
  • Räisänen, U. & Hunt, K. (2014). The role of gendered constructions of eating disorders in delayed help-seeking in men: a qualitative interview study. BMJ Open., 4, 4.
  • Corbeil-Serre, L.; Meilleur, D. & Turgeon, M.È. (2014). Mental anorexia in adolescents and young adults of the male sex: a review of the literature. Laboratoire des troubles de la conduite alimentaire, département de psychologie, université de Montréal.
  • Greenberg, S.T. & Schoen, E.G. (2008).Males and eating disorders: gender-based therapy for eating disorder recovery. Prof Psychol Res Pract;39:464-71.
  • Rosen, D.S. (2003). Identifying and treating eating disorders. Pediatrics;111:204-11.
  • Bramon-Bosch, E.; Troop, N.A. & Treasure, J.L. (2000). Eating disorders in males: a comparison with female patients. Eur Eat Disord Rev 2000;8:321-8.
  • Morgan, J.F. & Arcelus, J. (2009) Body image in gay and straight men: a qualitative study. Eur Eat Disord Rev 2009;17:435-43.
  • National Institute for Health and Care Excellence (2004). Eating disorders: care interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. London: National Institute for Health and Care Excellence.