Men & Eating Disorders
By Mary Anne Cohen, CSW, Director, The New York Center for Eating Disorders
Joseph called the New York Center for Eating Disorders in some distress, “I think I have an eating disorder and would like to make an appointment. I bet I’m the first man who’s ever called you for an eating problem.”
“Actually,” I responded, “many men have eating problems. They’re just not as brave as you to pick up the phone and get some help.” *
Joseph is expressing a common misconception – that eating disorders are problems of girls and women, not men. In truth, more women than men do have anorexia, bulimia, or binge eating disorders, but men are not exempt from these struggles. Between 10% - 15% of people with eating disorders are estimated to be men, but this figure may be low since many men often suffer in silence and feel too ashamed to come for therapy. Men may also be under-represented in the statistics of eating disorders because they can hide their eating problems better than women. An overweight man is less an object of ridicule than an overweight woman. Our society is more tolerant and forgiving of extra pounds on men, while women are held to a stricter standard. Also, men who are obsessed with working out and building muscle may be admired as strong, masculine guys, and this may camouflage that they are suffering anxiety about their body image.
During his therapy consultation, Joseph, a 21 year old young man, spoke of his girlfriend who had recently left him for another guy. He was depressed, felt quite rejected, and concluded that if he were thinner and more handsome, she would have stayed with him. Joseph embarked on a strict dieting regime to make himself feel more attractive. But his under-eating backfired, and he found himself bingeing and then making himself throw up. Joseph revealed he had always felt clumsy as a boy, was the last to be picked for team sports, and felt inadequate compared to his older brother whom he considered more masculine than himself. Joseph’s story highlights some particular dynamics that may trigger male eating disorders: low self esteem and worries about one’s masculinity, unfavorably comparing oneself with other men, and feeling inadequate in male pursuits such as sports and dating.
Dave was a successful business man with a family of five young children. Although he had been athletic as a younger man, the demands of his business, traveling for work, and supporting his family eroded his time to exercise. Dave described coming home from work and raiding the refrigerator before and after dinner. No matter how much food his wife, Dina, prepared, Dave wasn’t content unless he was stuffing himself throughout the evening. He was gaining weight, and his wife urged him to get help because of her worries about his health.
In his therapy, we identified that overeating was Dave’s way to de-stress, to shift gears after an intense work day. Overeating was his way to reward himself for his grueling schedule, but it was beginning to take its toll on his appearance and health. Dave initially felt selfish for admitting he needed some private time for himself given that Dina took care of the house and children all day. But, much to his surprise, Dina supported his efforts to break the binge cycle by joining a gym and working out with a trainer. We also explored why Dave always put himself at the bottom of the list of people to be taken care of. We discovered how this was related to his having to support his family of origin from an early age because of his father’s ill health. Recognizing this pattern from his youth was illuminating in helping Dave change this behavior with his present day family and provide himself the time and space to take care of himself.
Our media is replete with images depicting what a real man should look like. Advertising still continues to focus on skinny and sexy female models, but now “buff” male models in tight underwear with “buns of steel” and “six-pack abs” are also featured on billboards and magazines everywhere. Sports figures and handsome actors dominate the male imagination. These days men are bombarded with images of muscular, often steroid-enhanced bodies of unattainably perfect male bodies. This can induce the same kind of insecurities that women have suffered with for so long. A recent ad for a men's gym warns ominously, "No pecs? No sex!"
Men are more willing than ever to have “work done” –procedures for men are up more than 300% since 1997 according to The American Society for Aesthetic Plastic Surgery. Some men are so driven to look muscular with bulging chests and slender waists that liposuction to remove “love handles” is now popular. Other men seek saline implants to enhance their chests’ pectoral muscles and also have six saline packets inserted to define the “six-pack” ripped abdomen muscles. Men increasingly believe that plastic surgery may give them an edge in a youth-oriented corporate world.
Herb supplements are another attempt men use to help them get “cut,” and even dangerous steroid drug use is more frequent. In other words, male body image dissatisfaction is rampant.
A new diagnostic category exists called “male body dysmorphia.” This psychological distortion of males is the opposite of anorexia. The male with body dysmorphia views himself as inferior or puny even when he may be well built and muscular. No matter how much he works out, his feelings of smallness and inadequacy still persist. This is the reverse of the anorexic girl who continues to feel too fat even as she becomes more emaciated.
Factors that may make males vulnerable towards developing eating disorders include:
- They were fat or overweight as children.
- They participate in a sport that requires thinness – runners, jockeys, body builders.
- They have a job or profession that requires thinness – male models, actors.
- Some men with eating disorders have anxieties around sexuality.
- Some men with eating disorders have a history of physical or sexual abuse.
The first medical report of a man with an eating disorder was recorded in the year 1694 by a London physician, Dr. Richard Morton. He described a male anorexic patient as suffering from “Nervous Consumption” caused by “Sadness and Anxious Cares.” He prescribed the following treatment: “a resting cure of horseback riding and abstention from studies.” Unfortunately, contemporary treatment approaches don’t much subscribe to horseback riding or neglecting one’s school work or job in order to get better!
Suffering a loss in one’s life such as the death of a loved one, illness, divorce, losing a job, the stress of puberty, a new baby, a family’s negative reaction to “coming out” if a man is gay often triggers eating disorders. Feeling bereft and anxious about these life changes often causes men to start dieting in an attempt to regain a feeling of control. Loss or stressful change coupled with going on a diet frequently sets in motion an eating disorder.
Every person’s eating problem is as unique as a fingerprint. Eating disorder therapy for men, as well as for women, involves creating a comprehensive treatment plan that includes a blend of psychotherapy for resolving emotional stress plus behavioral strategies to change unwanted eating patterns.
Men with eating problems can be helped. Sometimes it takes a little extra courage for them to reach out for that help.
* All names have been changed for confidentiality
Mary Anne Cohen, CSW, is director of The New York Center for Eating Disorders and author of the nationally acclaimed book, "French Toast for Breakfast: Declaring Peace with Emotional Eating"
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