Finding specialist care for your child, teenager or young adult who has been diagnosed with an eating disorder or who is at the beginning of the treatment journey can be difficult. Finding support for parents who have concerns about their children and teenagers and looking for assessments and advice on eating disorders can be equally challenging – and doing so for boys and young men is an additional hurdle.
Eating disorder specialist programs are difficult to locate, with just a handful of truly specialist adolescent programs outside of the US. This shortage of specialist care can leave young people and families with repeated ineffective admissions in general hospitals or in the dangerous position of not receiving adequate treatment within an appropriate timeframe.
Eating disorders in boys are often overlooked
Eating disorders are rising more quickly in teenage boys than in teenage girls of similar ages. It is often a challenge to identify eating disorder behaviours in boys and men as presentations can be easily dismissed as more typical teen behaviours.
Boys are less likely to present for treatment and may or may not develop the smaller body size more commonly seen in young girls and women.
A lack of specialized eating disorder treatment programs
There is a global shortage of eating disorder specialists, particularly in The Gulf Region, with very few dedicated specialists in eating disorders in Dubai, Kuwait, Abu Dhabi, Oman and Saudi Arabia. The Wave Clinic in Dubai is the specialist in the region, with links to residential treatment programs, assessments and critical care for those in need of the highest levels of care. The Wave International in Dubai can be reached on +60128282762.
A similar situation exists in Singapore, Malaysia, Hong Kong and across Asia. There is a gap in both treatment and knowledge of eating disorders in Asia, with minimal education within the psychiatric, psychotherapeutic and dietician communities. This can leave parents feeling misunderstood and lead to prolonged illness and long-term medical and psychological consequences.
Early intervention by eating disorder professionals is the key to improved outcomes for young people.
In London and the UK as a whole, there are more treatment options, although bed numbers are low and waiting lists are high. Many teenagers and young people diagnosed with eating disorders and Personality Disorders will find themselves admitted to pediatric wards or general psychiatric wards with little in the way of specialist care. Admissions will often manage the critical medical period and offer very limited psychological interventions or programs aimed at long-term recovery.
Eating disorder treatment is lengthy. Short-term hospitalizations can certainly avert a medical crisis but are unlikely to make any headway into the long-term recovery for teenagers and young people. In many cases, the young person can feel invisible and the admission becomes either a part of a larger relapse cycle or in some cases part of a trauma pattern that furthers the illness.
Early intervention is key
Eating disorders are severe mental health conditions. Teens with eating disorders always require specialist treatment that is tailored to their age group and their specific needs.
Often an eating disorder is fairly well established by the time it is noticed in the home or family setting or, later still, when a diagnosis is made. It is better to intervene early than to wait for extreme medical consequences.
Finding the best eating disorder treatment in your area
Your family doctor or GP can be a good place to discuss your initial concerns and to find recommendations for eating disorder specialists in your area. In areas with less than adequate resources, parents may find an internet search will collate information on national and international eating disorder specialists. Eating disorder organizations and professional registration bodies often have eating disorder specialist directories.
The International Association of eating disorder Professionals (IAEDP) is a good place to start. Having a dedicated international chapter allows professionals around the world to assist young people in locations that may have fewer specialist ED Units.
Having an eating disorder Specialist Therapist, a dietician (EDRD) and a psychiatrist who specializes in eating disorders will be essential team members for the care of your teen or young adult.
An eating disorder specialist will carefully assess your teen or young adult to address any immediate needs and recommend the most appropriate treatment for your child and your family.
My son has an eating disorder. Where can I find treatment?
Finding treatment for boys with eating disorders can be a lonely journey for parents, with few professionals having the expertise and resources to be able to support boys and young men in their journey to recovery.
The Wave in Kuala Lumpur hosts eating disorder programs that are both single-sex and co-ed to encourage sharing, community and mutual recovery while acknowledging that there are aspects to male recovery that are explored in boys’ groups.
The Wave has boys-only houses in the secondary care programs at Transitions House, which encourages further independence, personal development and peer connection.
An increasing number of males with eating disorders
Approximately one in three people with eating disorders is male. This number is rising.
Despite eating disorders being incorrectly labelled as a primarily female illness, the reality is that boys are affected by eating disorders in steadily increasing numbers across the world.
Disordered eating behaviours are thought to affect equal numbers of boys and girls. This may be the use of laxatives, fasting, repetitive dieting, fear of weight gain, purging, bingeing or restricting.
Recent studies have shown that the duration, mortality rate or early death rate for boys with eating disorders is even higher than it is for girls of the same age.
Symptoms of eating disorders in boys. What is bigorexia?
Teens and young people with eating disorders (and sometimes their parents) believe that they are not sick enough for treatment. They often explain to professionals that they have been lower in weight, eaten less, felt more unwell and they always believe that they have superhuman resilience and strength (often despite medical evidence and lab reports to the contrary).
While the usual symptoms of anorexia nervosa in boys can be similar to those seen in girls, there are some additional presentations and medical symptoms for parents to be aware of:
- Following ‘clean eating’ or restrictive diets which may cut out carbs and increase protein for muscle gain
- A focus on being muscular as opposed to thin (while employing similar restrictive patterns and obsessions to anorexia nervosa)
- Using steroids or supplements to minimize body fat and increase muscle mass
- An excessive focus on exercise (even when injured, tired or when they have other commitments)
- Rigidity around eating, rules and rituals with food and exercise
- Eating large amounts of specific food groups and restricting others
- Using the bathroom during meals or just after
- Rituals in the order of food eaten, clockwise or anti-clockwise, food colors or cutting into very small pieces
- Extreme interest in nutrition, counting calories, or preparing food
- Time-specific meal rules or rituals (no food after 6pm, no breakfast)
- Bouts of anger or rage
- Abnormal liver function
- Increased acne or skin outbreaks
- High cholesterol
- Decreased sperm count
- High blood pressure
In young men with eating disorders, additional symptoms may be seen, including low levels of testosterone and Vitamin D and an increased risk of osteoporosis and osteopenia. Testosterone supplementation may be recommended by the treatment team.
Male body image and the desired body and shape and size may be slightly different from the female patterns. Boys and men can become preoccupied with lean and muscular body image and may become obsessive with working out and gym activities or increase protein levels in their diet whilst restricting other food groups. This may lead to the use of steroids, in a dangerous combination of restriction, protein and steroid use. This is sometimes termed ‘bigorexia’.
Boys and young men may also present with:
- Cutting out food groups (meat, protein, carbs, sweets, sugar)
- A fear of weight gain
- Compensatory behaviors (purging, laxative use, diuretics, excessive, anal purging)
The best eating disorder treatment for boys
Many treatment programs are focused on the treatment of girls and young women. Co-ed, mixed or male-only programs are fewer in number and require the treatment teams to be able to understand the specific needs of boys and men. Activities and program staff should be able to provide great care for the young men in the program with a good ratio of male team members.
Boys and men can feel a double stigma when approaching eating disorder treatment and may feel marginalized in care. Treatment programs and even the assessments we use can utilize female-centred language and examples which can result in feelings of not fitting in, shame, or self-loathing. Programs that are experienced with boys and young men will feel much more welcoming.
Eating disorders affect young people of all sexual orientations. Overall more young men who identify as heterosexual are diagnosed with eating disorders, although young men who identify as bisexual and gay are identified as having an increased risk.
The great news is that when young men receive great care and treatment that is designed to meet their needs, they do well in long term and sustained recovery.
Eating disorder treatment at The Wave
The Wave is a co-ed or mixed treatment program that warmly welcomes young people with positive specialization for gender and sexual orientation and provides exceptional eating disorder specialist care. Further information on similarly related topics can be found via our other blogs such as Teen Mental Health Treatment: How to Choose the Best Treatment Program for Your Child.
Fiona Yassin is the International Clinical Director of The Wave Clinic. Fiona is a UK Registered Adolescent and Family Psychotherapist and Clinical Supervisor (Licence number #361609 NCP/ICP), further trained in the specialty of Eating Disorders and Borderline Personality Disorder Treatment. Fiona is trained in FBT (Family Based Therapy), CBTE for eating disorders, FREED (King’s College, London), EMDR for eating disorders (EMDRIA) and has a Post-Graduate Diploma in Neuroscience and Trauma from the University of Tennessee, Knoxville.
Fiona works with international families and family offices from the UK, Dubai, Kuwait, Singapore and Malaysia. Fiona can be contacted by email on firstname.lastname@example.org.