Eating Disorders in Males

Clinical Characteristics and Treatment

By Theodore E. Weltzin, MD | October 3, 2012

Dr Weltzin is Medical Director of Eating Disorders Services at Rogers Memorial Hospital and Assistant Clinical Professor of Psychiatry at the Medical College of Wisconsin, Milwaukee. He reports no conflicts of interest concerning the subject matter of this article.

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.

Summary

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

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Eating Disorders in Males

Clinical Characteristics and Treatment

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