As a clinical psychologist and supervisor of eating disorder services with Rogers Behavioral Health, we’re very fortunate to be able to share some important clinical tidbits and knowledge from a successful history that we have treating males with eating disorders.
My objective is to help clinicians who may routinely treat males with eating disorders in their practice and provide some guidance on how to go about this treatment effectively.
To give you a little bit of an overview of what I’ll be covering in the presentation today, I’ll start with just a brief review of eating disorders in males.
We’ll talk a little bit about prevalence rates as well as some of the unique features that stand out in males with eating disorders.
We’ll also talk about how these unique features directly contribute to several important treatment considerations.
I will then be spending the majority of my time talking about two particular behavioral therapy interventions that we found to be quite effective in the treatment of males with eating disorders.
Those two interventions are Exposure-Based Therapy and Behavioral Activation.
We’ll talk a little bit about the roots and the history of those treatment strategies and how they’re uniquely applied to this population.
Then to drive some of these key teaching points home, I’ll wrap up with a couple of case examples in hopes of bringing these two behavioral treatment strategies to life.
Prevalence of Males with Eating Disorders
To begin, let’s talk a little bit about the prevalence rates among males with eating disorders.
According to the most recent iteration of the DSM (Diagnostic and Statistical Manual of Mental Disorders), the lifetime prevalence rates for anorexia nervosa, bulimia nervosa, and binge eating disorder are pretty scant, hovering around the ballpark of 0.5% to 1.0%.
What’s a little bit more telling is when we start to look at the entire population of individuals who have been diagnosed with anorexia or bulimia. What we find is that a quarter of those individuals are actually male.
In the context of Binge Eating Disorder, we see that an estimated 36% are male, which is greater than one-third.
One of our newer eating disorder diagnoses, Avoidant and Restrictive Food Intake Disorder (ARFID), is fascinating because we see no gender differences in terms of lifetime prevalence. In fact, there are several studies now suggesting ARFID may be somewhat more prevalent in males.
What this all points to is that eating disorders are significantly more prevalent among males than we had previously imagined.
From the literature, we can currently estimate that close to about 10 million men in the United States will experience an eating disorder at some point throughout the lifespan.
What we know to be more troubling is the increased prevalence of eating disorders as males develop through the turbulent adolescent years.
There is an unfortunate statistic out there showing that from the ages of 12 through the age of 20, the prevalence of eating disorders among males more than doubles.
All of this indicates that, while eating disorders are something we’ve historically thought of as being predominantly a female condition, they are very much a guy thing, too.
Now, let’s look at some of the unique features of eating disorders and how these features manifest in males.
The first important point that should be made is that, unfortunately, very limited research has been done comparing eating disorder features in males versus females.
Based on the limited work that has been done, one very striking finding that we see consistently is that the vast majority of eating disorder features tend to present more severely in females.
These are often some of the more “classic” eating disorder features that we think of such as body image dissatisfaction, the extent of restraint in one’s dietary intake, purging behaviors, preoccupation with thinness or the idealized body type.
Again, the data is very limited, but there do seem to be a few features that we actually see present as more severe in males.
These features include preoccupation with muscularity, engagement in excessive or compulsive exercise aimed at trying to influence one’s physique significantly.
We derived some interesting findings from a recent study that was done with just under 1900 patients. These patients were treated over the last 15 years at various levels of care at Rogers Memorial Hospital.
In this study, we compared a wide variety of eating disorder features among 390 male patients and just over 1500 female patients, all diagnosed with eating disorders.
The two key instruments that we used to assess the variety of eating disorder features were the Eating Disorder Examination Questionnaire (EDEQ), a widely used, well-validated, and accepted measure of global eating disorder severity.
We also used the 3rd Revision (version) of the Eating Disorders Inventory.
In our findings, these key assessment instruments, not surprisingly, corroborated previous conclusions from the literature:
Nearly all of the eating disorder features that we examined in this study were experienced at significantly higher severity levels amongst our female patient group.
However, we did see some evidence for higher rates and intensity of exercising as well as frequency and intensity of binge eating in some of our male patients.
Looking a little bit more globally at the unique nature of body image concerns and our male patients, we see more of a pronounced desire for a very athletic and muscular physique compared to what we think of as the very slender thin ideal that is classic among females with eating disorders.
We know that when healthy, well-functioning males are exposed to any type of media depiction that idealizes this very muscular bulked up physique, this tends to lead to increases in males body image dissatisfaction as well as an increased drive for muscularity.
It shouldn’t surprise us, then, that when we survey adolescent males who routinely exercise and ask them about their intentions or motivations, a significant majority of this group reports that they are trying to bulk up and to gain more muscle mass.
We know that, in very extreme forms, this can manifest as something called “muscle dysmorphia,” or what is more playfully termed “Bigorexia.”
Muscle Dysmorphia is looked at as kind of a strain or variant of Body Dysmorphic Disorder where the body area viewed as concerning from an appearance-related standpoint is the musculature of the body.
Often, individuals who struggle with Muscle Dysmorphia view themselves as insufficiently muscular and engage in a lot of extreme, unhealthy behaviors aimed at trying to bulk up.
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 May 22, 2018.
Reviewed on May 22, 2018 by Jacquelyn Ekern, MS, LPC
Published on EatingDisorderHope.com