Psychopathology of Males & Treatment of Eating Disorders
When we look at the psychopathology of males and some of the co-occurring issues and comparing that to females, let’s first look at what we know the national trends are in comorbidity rates in eating disorders.
When we look at the co-occurrence of anxiety disorders with eating disorders, we tend to see most studies hover around the 60% mark.
That is, if an individual meets criteria for an eating disorder, there’s about a 60% chance, if not greater, that at the same time that individual will meet criteria for at least one anxiety disorder.
As far as the co-occurrence of depression, it hovers around the 50-70% mark.
What is telling is that, when we look at differences between comorbidity patterns between males and females, what is generally found is no significant difference whatsoever.
In other words, these comorbidity patterns tend not to vary whether we’re talking about males or females with eating disorders.
There is, actually, a little bit of evidence suggesting that the co-occurrence of depression can occur at higher rates in males with eating disorders.
We also know that there’s an unfortunate statistic that the mortality rate is somewhat higher amongst males with eating disorders.
Essentially, the same degree of extreme co-occurring psychopathology that we see in female patients with eating disorders is just as present, if not more, in male patients with eating disorders.
To summarize, when we look at eating disorders in males, we certainly see a lot less emphasis on the thin ideal and a lot more emphasis on having a muscular, athletic physique. There tends to be heightened prevalence of extreme forms of exercise as well as binge eating tendencies.
Again, whether we’re talking about male or female patients, we tend to see similar rates of extensive comorbidity.
Internalization of Societal Views
The psychopathology of males in our male patients with eating disorders, there’s a high degree of internalized stigma surrounding this idea that eating disorders historically, as a society and, really, as a profession, have been viewed as being predominantly female disorders.
It shouldn’t surprise us that this belief is very much internalized by a lot of our male patients.
Many male patients who have gathered up the courage to get themselves to treatment have endured a long and winding process wherein they feel they need to swallow their pride because of that internalized shame and stigma.
From a treatment consideration standpoint, I’d like to go back to the study I mentioned in Part I of this series.
One of the conclusions we formed is that, yes, we see that a lot of eating disorder features tend to present as more severe amongst females but that may not reflect a genuine difference between male and female eating disorders.
What we think is it may reflect a kind of bias.
The instruments that we used, as well-validated as these instruments are, many of them were developed decades ago. Again, at a time when, as a culture, we viewed eating disorders as being really only a female thing.
As such, a lot of the items or questions on these instruments may be a little bit skewed or slanted towards assessing the common features or presentations amongst females of eating disorders.
Basically, we think there’s very good reason to believe that the scores that we derive from a lot of these instruments may actually reflect a pretty significant underestimate of the true severity of the disorder.
Psychopathology of Males and Engaging in Treatment
Part of the psychopathology of males is the stigma of an eating disorder, and it is a very crucial barrier not only to accessing treatment but also to engaging in treatment.
This means male patients actively throwing themselves into and involving themselves in treatment is rare. From a treatment standpoint, this means taking a very gender-sensitive approach is important.
The clinician must understand the unique features of male eating disorders, particularly the unique body image related concerns that male patients have.
A couple of authors have written about how ideal it may be for there to be a separate treatment environment for males.
A place where they can connect with other male patients to develop a sense of camaraderie and understand that they aren’t the only male on the planet, or even in their geographic area, to be struck with an eating disorder.
Such an environment created specifically for males allows space for that shared experience. We know that males may need to be engaged somewhat differently than females.
Females, on average, may be somewhat more willing to talk with a therapist about problems that they’re experiencing whereas males may need to come through the back door, so to speak, to be engaged in the treatment process.
This kind of gets towards what we feel is a very important rationale for using the two behavioral therapy strategies that I’m going to cover in-depth pertaining to men with eating disorders.
It stands to reason that a lot of these guys are going to be much more willing to engage in therapy when there’s more emphasis on being up and out of the chair and doing more active things.
Which is opposed to simply sitting back in one’s chair and talking about the problems they’re experiencing with eating or body image.
We also know that avoidance plays a very crucial role in the maintenance of eating disorders.
Something that is a shared feature between Exposure-Based Therapy and Behavioral Activation is that both of these behavioral therapy strategies are directly trying to target and uproot these significant avoidance behaviors that we see in eating disorders.
Some of the eating disorder features mentioned previously as occurring in higher rates in males with eating disorders, such as binge eating and compulsive exercise patterns, respond very well to behavioral therapy strategies.
Virtual Presentation by Dr. Nicholas Farrell in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html
About the Presenter: Dr. Nicholas R. Farrell, Ph.D. is a licensed clinical psychologist who directs and supervises the treatment of patients in eating disorder programs at Rogers Memorial Hospital. Dr. Farrell specializes in the use of empirically-supported cognitive behavioral therapy (CBT) treatment strategies that are used to help patients in our eating disorders programs.
Additionally, Dr. Farrell is a regular contributor to scientific research on the effectiveness and dissemination of CBT for eating, anxiety, and mood disorders and has published over 20 peer-reviewed journal articles and book chapters. Dr. Farrell has been the gracious recipient of federal grant funding to study the role of social stigma in the context of eating disorders.
About the Transcription Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.
As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on June 10, 2018.
Reviewed on June 10, 2018 by Jacquelyn Ekern, MS, LPC.
Published on EatingDisorderHope.com