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Men's eating disorders emerging from shadows

June 29, 2017
by Gary A. Enos, Editor
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The ratio of women to men presenting for treatment for an eating disorder has often been placed at 10 to 1, but there are signs that the gap is narrowing. The co-director of The Center for Eating Disorders at Sheppard Pratt says more men today are able to self-identify with eating disorder symptoms, despite the fact that eating disorders still get widely perceived as a women's illness.

“We do not have enough research to identify if there is a difference in recovery response between the genders,” Steven Crawford, MD, tells Addiction Professional. “The current mindset is that there is not a difference.”

The renowned Maryland behavioral health facility's eating disorders center was established in 1989 and offers outpatient, intensive outpatient and inpatient levels of care (its inpatient capacity is 23 beds for patients 16 and older and 11 beds for younger patients). Crawford says the therapeutic techniques used with male and female patients are relatively similar, although the presenting issues can differ greatly.

In one item of particular importance for the substance use treatment community, “The research has shown that men with eating disorders have a higher comorbidity of substance use disorders,” Crawford says.

Body image differences

The body type ideal that is described for young men differs from that for young women, so the messages delivered in treatment must differ as well. For men, work is done to assist them in understanding the unachievable nature of the lean, muscular body type for which some strive. “Their bodies are not at the point in development to support the muscle mass,” says Crawford.

He says his program does not see any greater reluctance to receive treatment in the males who make it through the door. Most of that resistance occurs earlier on.

“Unfortunately, eating disorders historically have been a very under-recognized issue for men,” Crawford says. “The screening tools that are generally used were identified from a feminine perspective.”

But that appears to be gradually changing, to the point where Crawford suggests that the ratio of women to men presenting for treatment now might be approaching 4 to 1. “We're seeing increasing numbers of men coming in,” he says.

A possible barrier in reaching young men who might have an eating disorder has been the traditional perception of a link between eating disorders and a gay sexual orientation. This perception does not play out in the actual data, Crawford says.

The research has demonstrated that a combination of genetic vulnerabilities and environmental factors, such as low self-esteem and high body image dissatisfaction, often contribute to the development of an eating disorder.

Link with exercise, sports

A good number of the males who present with eating disorder symptoms have been engaging in compulsive exercise with a focus on bodybuilding, often to the exclusion of other priorities in life, says Crawford. They are more apt to be using certain bodybuilding supplements as well.

Some competitive sports might place young male athletes at greater risk, he says, although the presence of eating disorders in men is by no means limited to the athletic world. He cites as examples wrestling, where participants sometimes will engage in extreme behaviors to remain in their assigned weight class, and diving, which puts a premium on appearance as well as technique.

Also contributing to this, “Our society holds athletes up as the most healthy of the healthy individuals,” Crawford says. He adds, “Some runners are told that the lighter you are, the faster you run, which is a myth.”

Therapeutic strategies

Crawford considers cognitive-behavioral therapy the foundation of the Sheppard Pratt center's clinical approach to eating disorders treatment. Aspects of Dialectical Behavior Therapy and mindfulness also are used, and family-based interventions are an important component. The average inpatient stay in the program is around three weeks, with generally another four weeks or so of outpatient care after that.

On a broader level, the organization prioritizes raising awareness about a disease with comparatively high mortality rates. “These illnesses do tend to be illnesses of secret,” says Crawford, explaining that Sheppard Pratt is involved in an awareness campaign to educate the public about warning signs.