For a long time, eating disorders were thought to mainly affect women. Even in scientific research, fewer than 1% of published papers that relate to eating disorders focus on the way they affect men.
It’s now established, however, that men and boys can also get eating disorders. Around 3% of men now develop anorexia nervosa, bulimia nervosa, or binge eating disorder sometime during their lives, and about one in four eating disorders occur among men and boys.
This means that eating disorders in men and boys are, in fact, relatively common – and need to be understood. Conceptualising the symptoms and patterns specific to male eating disorders is important for both identifying and treating the disorders. Although the causes, development, and path of male eating disorders resemble female eating disorders, there are some clear differences. These differences need to be acknowledged, recognised, and addressed.
The good news is that, in the past two decades, more and more research has focused on eating disorders among men. These studies have contributed valuable knowledge about the conditions, including the causes, risk factors, identification, prevention, and treatment of eating disorders in men and boys.
What Are Eating Problems and Eating Disorders?
It’s normal for people to experience changes in their eating habits from time to time. This might mean eating more food than usual, or not liking specific foods or meals.
However, when someone’s eating habits or thoughts about their body start to negatively impact their daily life, it becomes an eating problem. Eating problems can look very different in one person from another. It might involve:
- Using food to cope with difficult emotions
- Restricting the amount or type of food they eat
- Feeling like they lose control when eating
- Feeling scared of gaining weight
Eating disorders are diagnosed when someone’s eating problem meets a certain set of criteria. There are several types of eating disorder diagnoses, each with a different set of criteria. But it’s important to recognise that eating problems can be very serious even when they don’t fit within a medical diagnosis, and always need professional support.
Some types of eating disorders, defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), include:
- Anorexia nervosa
- Bulimia nervosa
- Binge eating disorder
Men, women, non-binary people and other gender identities can all develop eating disorders. If you’re concerned that a young person might have an eating problem, you should seek professional advice as soon as you can.
How Do Eating Disorders Affect Men and Boys Differently?
When someone is living with an eating disorder, early intervention is crucial. Recognising the problem quickly and accessing effective support prevents the disorders from developing further, allowing the healing to start.
Understanding the specific ways that men and boys experience eating disorders helps parents, friends, and clinicians know what signs to look for.
Ideal Body Image
Social norms and pressures about body image influence the development and course of eating disorders. These norms make young people think that their bodies should look a certain way. When young people become preoccupied with these ideals, they develop disordered eating behaviours.
The social norms surrounding ideal body image vary across the gender spectrum, as well as between cultures. These differences affect the way eating disorders develop according to gender identity and lead to specific characteristics.
For men and boys, Western beauty ideals tend to present an ideal that is adequately muscular, as opposed to having a low body weight. Consequently, men and boys with eating disorders often focus on being muscular, rather than only losing weight. This means that disordered eating behaviours among men may also be directed towards this end.
‘Cheat Meals’
‘Cheat meals’ are more common among young men and boys with bulimia than among other gender identities. Cheat meals refer to meals that contain a large number of calories, consumed as a break from a restricted diet. They usually include types of foods that are usually excluded from their diet.
Cheat meals look similar to binge eating episodes that are symptoms of bulimia, binge eating disorder, and other eating disorders. However, young people often believe that cheat meals actually help them to build muscle. This means that, while they may involve a sense of loss of control, they’re not always followed by the guilt or emotional distress that usually accompanies binge eating episodes.
Cycles of ‘Bulking and Cutting’
Cycles of bulking and cutting are a common feature of male eating disorders. ‘Bulking’ usually involves consuming a set amount of protein every day, often following a strict diet with arbitrary rules. During ‘bulking’ phases, some people start to feel distressed about their body image because they see themselves as not lean enough.
Bulking phases are usually followed by ‘cutting’ phases, when someone consumes very little energy to try and decrease their body weight and increase their ‘leanness’. These behaviours can make it difficult to build muscle or even lead to muscle loss. This may cause even more distress about their body image, pushing them back towards ‘bulking’ phases and continuing harmful cycles of ‘bulking’ and ‘cutting’.
Muscle Dysmorphia
Muscle dysmorphia is a type of body dysmorphic disorder that sometimes accompanies eating disorders, particuarly among men and boys. Young people with muscle dysmorphia are preoccupied with the idea that their bodies are not lean or muscular enough. They often perceive their bodies as much smaller than other people see them.
Muscle dysmorphia can underpin eating disorders, causing young men and boys to restrict their diet or engage in ‘bulking and cutting’ to change the way their body looks. Equally, disordered eating behaviours, combined with underlying traits like perfectionism and low self-esteem, often help maintain muscle dysmorphia.
What Are the Risk Factors for Eating Disorders Among Men and Boys?
There is no one single reason that young people develop eating disorders. However, there are certain risk factors that make developing the conditions more likely. These risk factors may be a bit different among men and boys than other gender identities.
Researchers have identified several risk factors for eating disorders in men and boys, including social groups, cultural influences, and psychological traits. These include:
- sexual and gender minorities
- athletes
- racial and ethnic minorities
- experiences of food insecurity
- internalisation of masculinity and gender roles
- personality traits like emotional dysregulation
- co-occurring mental health disorders
- difficult life experiences
Adverse Experiences
Boys and men who have experienced trauma and other difficult life experiences are at an increased risk of developing eating disorders. Research has found that among men, eating disorders are linked to negative experiences like teasing, physical abuse, and alcohol addiction. Adverse life experiences can cause emotional difficulties that underpin eating disorders, including perfectionism or low self-esteem.
Co-Occurring Disorders
Studies have found that men and boys with eating disorders are more likely to also have a co-occurring mood disorder like depression or anxiety. Other mental health disorders that often co-occur alongside male eating disorders include:
- Personality disorders
- Compulsive exercise disorder
- Substance use disorders
Co-occurring disorders can contribute to the development and maintenance of eating disorders. Eating disorders, in turn, can cause or worsen symptoms of co-occurring conditions. They can also make the treatment process more complicated.
This means that it’s important to address co-occurring disorders early in the recovery process, treating co-occurring disorders and eating disorders simultaneously.
Social Norms and Media Influence
The development and course of eating disorders are often influenced by social norms and media portrayals surrounding the ‘ideal body’. Women’s bodies are commonly objectified by society and valued according to their ‘thinness’. Beauty ideals of male bodies are slightly different, often focusing on muscularity rather than only a small body size.
These social norms and ideals are communicated through different media platforms, including social media and online magazines. These platforms often portray male bodies as muscular and lean, damaging men’s and boys’ body images.
Equally, social norms encourage people to place a lot of their self-value on their body shape and weight. This can lead to a preoccupation with body image that may contribute to and maintain eating disorders.
Sexual Orientation
Sexual orientation is also a risk factor for eating disorders. Studies show that homosexual men are more likely than others to receive an eating disorder diagnosis. They also tend to have more body image concerns and disordered eating behaviours.
Gender Minorities
There is still limited research surrounding eating disorders in transgender men. However, studies suggest that transgender men are more likely than cisgender men to develop disordered eating behaviours and experience body dissatisfaction.
Research has found that gender dysphoria treatment, which supports people to live in their preferred gender identity or as non-binary, can decrease body dissatisfaction. This, in turn, reduces the risk of eating disorders.
Preventing Eating Disorders in Boys and Men
Eating disorders are serious mental health conditions that harm the lives of boys and young adults. This means that preventing eating disorders is really important. Until now, institutions and organisations have implemented and offered various kinds of programs to help prevent male eating disorders.
These include:
- School-based programs that focus on addressing risk factors for eating disorders among young people. This might include building self-esteem and encouraging body acceptance.
- Targeted prevention programs that support men who experience body dissatisfaction to move towards body acceptance
- Programs for athletes and other groups who are at a higher risk of developing an eating disorder.
Treating Eating Disorders in Men
Eating disorders can affect men and boys’ relationships with other people, their pursuit of interests and passions, and their enjoyment of daily life. They also harm their health and well-being.
However, with the right support, men and boys can recover from eating disorders and live healthy, fulfilling lives. Unfortunately, structural and individual barriers often prevent men from seeking the treatment they need. These barriers include:
- Internalised stigma
- Fear of judgment and rejection by others
- Lack of knowledge about eating disorder services
- Cultural norms that present eating disorders as a ‘female’ problem
- Delayed recognition from medical providers
There are several different treatment approaches available for the treatment of eating disorders. While these modalities have been primarily developed for – and evaluated among – women, they may be adapted for the treatment of eating disorders in men. This might involve:
- Including discussions about stigma and masculine gender norms
- Speaking about sexual and gender minorities, when it’s relevant
- Addressing male-specific body image concerns, such as leanness and muscularity
- Separating group therapy according to gender
Some of the treatment approaches for eating disorders include:
- Cognitive-behavioural therapy
- Interpersonal therapy
- Family therapy
- Maudsley model of anorexia nervosa treatment
- Cognitive-processing therapy and other trauma-focused approaches
Recovery from an eating disorder isn’t easy, but it is possible. If you think a young person may have an eating problem, it’s important to seek professional support as soon as possible.
Eating Disorder Treatment for Young People at The Wave
At The Wave, we provide specialist mental health treatment programs for children, teenagers, and young adults. Our whole-person approach supports each individual through a transformative journey of self-discovery and growth – helping them reconnect with themselves, build new skills, and rediscover a passion for life.
Our global team of experts brings together deep knowledge and experience in working in child and adolescent psychiatry.
If you want to find out more about our programs, get in touch today. We’re here to support you.
