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(8) Anorexia

Does anorexia occur in males as well? Are there any differences in symptoms between males and females?

Yes, in fact, anorexia has been reported in male patients dating back to the seventeenth century, when London physician Richard Morton reported the first two documented cases of anorexia in 1694. One of his patients was a 16-year-old male.

However, due to the current-day disparity in prevalence between the genders, the illness is generally, although incorrectly, regarded as a “female disorder.” This is unfortunate because males do indeed develop anorexia nervosa, albeit much less commonly than females.

Approximately 10–15% of those diagnosed with anorexia are male; however, that number appears to be on the rise. Indeed, one of the fastest growing anorexia patient populations of the past decade is adolescent boys.

Eating disorder specialist Leigh Cohn, coauthor of Making Weight: Men’s Conflicts with Food, Weight, Shape and Appearance, states that therapists are seeing 50% more men for evaluation and treatment of eating disorders than just 10 years ago.

While eating disorder professionals believe that anorexia is under-diagnosed in both genders, additional factors make this of particular concern for males. Of particular note is that the DSM-IV-TR diagnostic criteria for anorexia includes amenorrhea, which is, of course, a strictly female concern (the ICD-10 does include a male gender counterpart criterion of abnormal gonadotropin functioning).

This may be one reason why healthcare professionals are less accustomed to suspecting anorexia in their male patients. Regardless, the danger is that some doctors may overlook, ignore, or misdiagnose male patients with this disorder. Additionally, Cohn and other specialists suggest that some men with anorexia may be unaware that they have an eating disorder, viewing symptoms such as excessive exercise and body shape concerns as just “a guy thing.”

Gender stereotyping (e.g., regarding anorexia nervosa as a “female” condition) may be the root of what causes some males to refrain from seeking treatment. When they do, they will unfortunately find that there are far fewer residential treatment programs available to men than to women. Some Co-ed programs do offer specially designed treatment “tracks” that address uniquely male concerns, but there is a need for many more such programs. Consequently, males with anorexia often report feeling isolated in treatment support groups composed of predominantly female patients. Nevertheless, the course of treatment for males is similar to treatment for female patients and generally has the same rates of efficacy.

We have been making strides in recent years toward improving the diagnosis and treatment of males with anorexia, and this is indeed promising. Certain male subgroups appear to be at a higher risk for anorexia.

Athletes whose weight is a factor in their performance are an especially vulnerable group. Wrestlers, jockeys, runners, gymnasts, and dancers have a higher reported rate of eating disorders than the general population, due in part to the belief that weight loss is a necessary requirement for peak athletic performance in their sports.

A higher rate of anorexia has also been reported in homosexual and bisexual males, with incidence reports as high as 20%. Other studies, however, have found no relationship between homosexuality and eating disorders, so the association remains in question. Researchers also caution that there is nothing about homosexuality itself that increases the likelihood of developing an eating disorder. Instead, higher prevalence rates may be attributed to stereotypes of physical attractiveness within the gay community and to increased help-seeking behaviors among gay males.

Important differences in the literature do exist between male and female eating disorder patients. For example, the research shows that men are more likely to engage in excessive exercise and less likely to engage in self-induced vomiting, use laxatives, or take diet pills to achieve desired weight loss. Some studies suggest that males are more likely to have co-occurring substance abuse. Research also shows that males appear to develop anorexia, on average, at a later age than females. One suspected reason for this is the later onset of puberty in boys.

However, some studies have found a higher ratio of male to female anorexia cases in pre-pubertal aged children (Jacobs and Isaacs 1986). Approximately 10–15% of those diagnosed with anorexia are male; however, that number appears to be on the rise.

Terms:

Gonadotropin - A group of hormones that affect the growth and function of the sex glands.

Efficacy - The extent to which an intervention produces an effect or beneficial result.

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