The enigma of male eating disorders: A critical review and synthesis

Why is this research important?  

Despite common misconceptions that eating disorders are a ‘female’ illness, it is estimated that one third of people reporting eating disorder behaviours in the community are male (1). By diagnostic group, males account for approximately 20% of people with anorexia nervosa, 30% of people with bulimia nervosa, 43% of people with binge-eating disorder, 55-77% of people with other specified feeding or eating disorder (2) and 67% of people with of avoidant/restrictive food intake disorder (3). The true prevalence of males living with an eating disorder may be much higher, due to underdiagnosis, misdiagnosis, and stigma (4). 

Even though males represent a significant proportion of people experiencing eating disorders, there has been an underrepresentation of males in eating disorder research, and a lack of studies focusing on the experiences of males (5). Murray et al. (5) conducted a review and synthesis of existing evidence relating to eating disorders in males, and identified a number of important findings, including: 

  • While treatment-seeking for eating disorder concerns is low across males and females, males are less likely than females to seek mental health care. This may be related to a lack of knowledge and understanding of eating disorders among males, as well as greater levels of perceived stigma. 

  • Males who do seek assistance for eating disorder concerns are more likely to be misdiagnosed than females and are less likely to receive an eating disorder diagnosis, despite reporting the same symptoms as their female counterparts. 

  • Current diagnostic frameworks for eating disorders may not adequately reflect male experiences of eating disorders, particularly muscularity-oriented disordered eating. The authors hypothesise that the high proportion of males within the ‘other specified feeding or eating disorder’ diagnostic category may reflect the lack of applicability of the current classification schemes to males. 

  • There is a need to develop and validate accurate measures of eating disorder symptomology in males, as current measures may lack sensitivity and specificity in males.  

 These findings highlight important future directions for the field - further research into clinical presentations, management, classification and assessment of eating disorders among males is important to improve prevention, identification, and treatment of eating disorders among this population group.  

 

Abstract/Summary:  

Historically, male presentations of eating disorders (EDs) have been perceived as rare and atypical – a perception that has resulted in the systematic underrepresentation of males in ED research. This underrepresentation has profoundly impacted clinical practice with male patients, in which i) stigmatization and treatment non-engagement are more likely, ii) a distinct array of medical complexities are faced, and iii) symptom presentations differ markedly from female presentations. Further, the marginalization of males from ED research has hindered the assessment and clinical management of these presentations. This critical review provides an overview of the history of male EDs and synthesizes current evidence relating to the unique characteristics of male presentations across the diagnostic spectrum of disordered eating. Further, the emerging body of evidence relating to muscularity-oriented eating is synthesized in relation to the existing nosological framework of EDs. The impact of marginalizing male ED patients is discussed, in light of findings from epidemiological studies suggesting that clinicians will be increasingly likely to see males with ED in their practices. It is suggested that changes to current conceptualizations of ED pathology that better accommodation male ED presentations are needed. 

 

Link:  

Study available here.  

 

Citation:  

Murray SB, Nagata JM, Griffiths S, Calzo JP, Brown TA, Mitchison D, Blashill AJ, Mond JM. The enigma of male eating disorders: A critical review and synthesis. Clinical Psych Rev. 2017;57:1-11.  

 

References:   

1. Mitchison D, Mond J. Epidemiology of eating disorders, eating disordered behaviour, and body image disturbance in males: a narrative review. J Eat Disord. 2015;3(1):1-9. 

2. Hay P, Girosi F, Mond J. Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. J Eat Disord. 2015;3(1):1-7 

3. Eddy KT, Thomas JJ, Hastings E, Edkins K, Lamont E, Nevins CM, Patterson RM, Murray HB, Bryant-Waugh R, Becker AE. Prevalence of DSM-5 avoidant/ restrictive food intake disorder in a pediatric gastroenterology healthcare network. Int J Eat Disord. 2015;48(5):464-70. 

4. Strother E, Lemberg R, Stanford SC, Turberville D. Eating disorders in men: underdiagnosed, undertreated, and misunderstood. Eat Disord. 2012;20(5):346-55. 

5. Murray SB, Nagata JM, Griffiths S, Calzo JP, Brown TA, Mitchison D, Blashill AJ, Mond JM. The enigma of male eating disorders: A critical review and synthesis. Clinical Psych Rev. 2017;57:1-11.  

 

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