Men with an eating disorder who present for treatment with exercise concerns generally fall into 3 groups. First, there are those who use exercise behaviors in an addictive fashion as mood enhancement. These patients report a history of behaviors such as lying about their exercise to family and friends and using exercise to avoid difficult emotions. When exercise is discontinued in a structured treatment environment, patients exhibit moderate to severe symptoms of irritability and sometimes an increase in depression. These patients benefit from exploring the source of their dedication and how it has led to disordered eating.
A second cluster of patients are compulsive exercisers. They have highly ritualized exercise behaviors that result in anxiety when disrupted. These patients often have co-occurring obsessive-compulsive symptoms not related to exercise. Such patients are treated with exposure and ritual prevention as well as experiential therapy.
Finally, the third group is made up of patients whose lives have simply become out of balance with a dedication to fitness and athletics in conjunction with problematic eating. Similar to the first group, these patients also benefit from exploring the source of their dedication and how it has led to disordered eating.
It is likely that rates of eating disorders in males will continue to increase.31While differences exist in risk factors and symptom expression in males with eating disorders, a growing body of evidence suggests that males respond well to treatment. However, treatment needs to be individualized for the male patient, ideally in a setting with other males and with staff experienced in working with males. Obstacles to treatment include a lack of awareness that males are at risk for eating disorders and male perception that having an eating disorder is very stigmatizing.28,32
1. Carlat DJ, Camargo CA Jr, Herzog DB. Eating disorders in males: a report on 135 patients. Am J Psychiatry. 1997;154:1127-1132.
2. Striegel-Moore RH, Franko DL. Epidemiology of binge eating disorder. Int J Eat Disord. 2003;34(suppl):S19-S29.
3. Sundgot-Borgen J, Torstveit MK. Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med. 2004;14:25-32.
4. Di Gioacchino De Bate R, Wethington H, Sargent R. Sub-clinical eating disorder characteristics among male and female triathletes. Eat Weight Disord. 2002;7:210-220.
5. Ferrand C, Brunet E. Perfectionism and risk for disordered eating among young French male cyclists of high performance. Percept Mot Skills. 2004;99(3, pt 1):959-967.
6. Russell CJ, Keel PK. Homosexuality as a specific risk factor for eating disorders in men. Int J Eat Disord. 2002;31:300-306.
7. Carper TL, Negy C, Tantleff-Dunn S. Relations among media influence, body image, eating concerns and sexual orientation in men: a preliminary investigation. Body Image. 2010;7:301-309.
8. Boisvert JA, Harrell WA. Homosexuality as a risk factor for eating disorder symptomatology in men. J Men Studies. 2009;17(3):210-225.
9. Surgenor LJ, Fear JL. Eating disorder in a transgendered patient: a case report. Int J Eat Disord. 1998;24:449-452.
10. Hepp U, Milos G. Gender identity disorder and eating disorders. Int J Eat Disord. 2002;32:473-478.
11. Hospers HJ, Jansen A. Why homosexuality is a risk factor for eating disorders in males. J Soc Clin Psychol. 2005;24:1188-1201.
12. Gueguen J, Godart N, Chambry J, et al. Severe anorexia nervosa in men: comparison with severe AN in women and analysis of mortality. Int J Eat Disord. 2012;45:537-545.
13. Johnson JG, Cohen P, Kasen S, Brook JS. Childhood adversities associated with risk for eating disorders or weight problems during adolescence or early adulthood. Am J Psychiatry. 2002;159:394-400.
14. Striegel-Moore RH, Garvin V, Dohm FA, Rosenheck RA. Psychiatric comorbidity of eating disorders in men: a national study of hospitalized veterans. Int J Eat Disord. 1999;25:399-404.
15. Womble LG, Williamson DA, Martin CK, et al. Psychosocial variables associated with binge eating in obese males and females. Int J Eat Disord. 2001;30:217-221.
16. Zipfel S, Löwe B, Reas DL, et al. Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study. Lancet. 2000;355:721-722.
17. Gadalla TM. Psychiatric comorbidity in eating disorders: a comparison of men and women. J Men Health. 2008;5:209-217.
18. Gadalla T, Piran N. Eating disorders and substance abuse in Canadian men and women: a national study. Eat Disord. 2007;15:189-203.
19. Edwards S, Launder C. Investigating muscularity concerns in male body image: development of the Swansea Muscularity Attitudes Questionnaire. Int J Eat Disord. 2000;28:120-124.
20. Leit RA, Gray JJ, Pope HG Jr. The media’s representation of the ideal male body: a cause for muscle dysmorphia? Int J Eat Disord. 2002;31:334-338.
21. Brownell KD, Napolitano MA. Distorting reality for children: body size proportions of Barbie and Ken dolls. Int J Eat Disord. 1995;18:295-298.
22. Andersen RE, Barlett SJ, Morgan GD, Brownell KD. Weight loss, psychological, and nutritional patterns in competitive male body builders. Int J Eat Disord. 1995;18:49-57.
23. Mangweth B, Hausmann A, Walch T, et al. Body fat perception in eating-disordered men. Int J Eat Disord. 2004;35:102-108.
24. Hausenblas HA, Downs DS. Relationship among sex, imagery, and exercise dependence symptoms. Psychol Addict Behav. 2002;16:169-172.
25. Bean P, Loomis CC, Timmel P, et al. Outcome variables for anorexic males and females one year after discharge from residential treatment. J Addict Dis. 2004;23:83-94.
26. Andersen AE, Holman JE. Males with eating disorders: challenges for treatment and research. Psychopharmacol Bull. 1997;33:391-397.
27. Woodside DB, Kaplan AS. Day hospital treatment in males with eating disorders—response and comparison to females. J Psychosom Res. 1994;38:471-475.
28. Baran SA, Weltzin TE, Kaye WH. Low discharge weight and outcome in anorexia nervosa. Am J Psychiatry. 1995;152:1070-1072.
29. Mehler PS, Sabel AL, Watson T, Andersen AE. High risk of osteoporosis in male patients with eating disorders. Int J Eat Disord. 2008;41:666-672.
30. Braun DL, Sunday SR, Huang A, Halmi KA. More males seek treatment for eating disorders. Int J Eat Disord. 1999;25:415-424.
31. Darcy AM. Eating disorders in adolescent males: a critical examination of five common assumptions. Adolesc Psychiatry. 2011;1:307-312.
32. Robinson, AL, Boachie A, Lafrance GA. Assessment and treatment of pediatric eating disorders: a survey of physicians and psychologists. J Can Acad Child Adolesc Psychiatry. 2012;21:45-52.