Assessing and Treating Men With Eating Disorders

The occurrence of eating disorders in men remains relatively rare but consistent. This is true despite recent research suggesting that male cases are far more numerous than had been previously thought. This brief article will comment on recent research findings in this area and describe their relevance to assessment and treatment.

Two studies support the notion that eating disorders are more common than had previously been thought (Health Canada, 2003; Woodside et al., 2001). Woodside et al. (2001) reported on the results of a 10,000-person community epidemiologic study. Combining full- and partial-syndrome eating disorder cases for both men and women, the investigators showed an overall rate of three female cases for every one male case-a far cry from the typical 10:1 or 20:1 ratio found in most treatment settings. However, this study assessed only limited Axis II parameters and, as DSM-III-R diagnoses were generated from the data, the prevalence of binge-eating disorder could not be assessed.

More recently, Health Canada (2003) released preliminary results from a national, face-to-face mental health survey of over 30,000 people performed in 2001 and 2002. This survey assessed for full-syndrome eating disorders and reported a ratio of male to female cases of approximately 1:5. This was somewhat higher than the findings from Woodside et al. (2001) but showed many more cases than might otherwise have been thought. The somewhat higher ratio in the Health Canada survey is almost certainly related to only full-syndrome cases that the Woodside et al. survey was too small to allow for.

Studies continue to show that the nature of the illness, when it occurs in men, is essentially indistinguishable from women. In Woodside et al. (2001), the sample of male eating disorder cases in the community was compared to female eating disorder cases in the same sample and a sample of 3,769 unaffected males. There were no significant differences in any variables relating to illness severity. As mentioned, both full- and partial-syndrome cases were included. Previous research showed that partial-syndrome cases did not differ from full-syndrome cases on most eating disorder variables; there was an excess of partial-syndrome cases of bulimia nervosa in males compared to females. This may have been an artifact of the small sample size in the study.

Other studies have examined differences in personality between men and women with eating disorders (Fassino et al., 2001; Woodside et al., submitted for publication). These studies demonstrated that men with eating disorders had lower scores on the Temperament and Character Inventory (TCI) for Harm Avoidance, Reward Dependence and Cooperativeness. Our study also showed lower perfectionism in male cases.

There is an extreme scarcity of literature regarding differential response to treatment in men with eating disorders compared to women. The literature that does exist suggests that men and women receive similar benefit from treatment for their eating disorder (Woodside and Kaplan, 1994). This is an area that deserves much more attention.

We are thus left with a confusing situation: Men appear to suffer from eating disorders with a higher frequency than would be thought, based on data obtained from clinical settings, despite having a similar illness and similar responses to treatment. What could explain these findings and what impact might such explanations have for practicing clinicians?