For my Intro to the Health Care System Class, I had to write a paper on the health disparity of my choice. I picked male ED’s.
Eating Disorders in Men
Eating disorders are mental disorders with staggering effects on the human body. Anorexia Nervosa, for example, has the highest mortality rate of any mental illness. As stated by Heidelinde Krenn of the Department of Psychiatry at the University of Munich, the health disparity of male eating disorders is a topic of interest because ” very few disorders in psychiatry or in general medicine show such a skewed gender distribution” (2003).
Eating Disorder Diagnoses
The most well known eating disorders are Anorexia Nervosa and Bulimia Nervosa. Binge Eating Disorder and Eating Disorder Not Otherwise Specified (an umbrella diagnosis for those who do not meet the criteria for the other disorders) are the most common diagnoses.
According to the National Eating Disorder Awareness Association, Anorexia Nervosa refers to both restriction of calories and distorted body image in patients that “refuse to maintain a minimally normal body weight”. Patients with Bulimia Nervosa engage periodically in episodes of binge eating, followed by life-threatening compensatory behaviors such as self-induced vomiting, excessive exercise, or use of laxatives. They may be underweight, overweight, or exhibit no weight problems at all. Health complications of these disorders include “cardiac irregularities, severe dehydration, thinning hair, bruising skin, osteoporosis and sensitivity to cold” (Goode, 2000.)
Binge Eating Disorder refers to recurrent binging without purging behaviors (NEDA, 2013.) It is important to note that binge eating is triggered by the same issues as Anorexia, Bulimia, and EDNOS. Patients grapple with ” low self-esteem, past trauma or weight-related bullying, or use food to numb emotions and cope with stress” (Ross, 2012.) Binge Eating occurs almost evenly amongst males and females, but only ten percent or reported cases of Anorexia and Bulimia occur in men (Ross, 2012.)
Since the 1980’s, there has been a marked increase in the diagnosis of eating disorders in males. (Olivardia, 2012.) The amount of male patients admitted to the inpatient eating disorder program at the New York Presbyterian Hospital in Westchester Country climbed from 2% to 9% between 1984 and 1997 (Krenn, 2003). Some facilities and support groups have rejected male patients entirely, due to their inability to accommodate them. Others design programs for males exclusively. Rogers Memorial Hospital, which has five locations in Wisconsin, has a separate unit for men. Despite these trends, male eating disorders are far more likely to go untreated and undetected than those in females.
The under diagnosis of male eating disorders may occur for a variety of reasons. According to Greta Noordenbos of the Department of Clinical Psychology at Leiden University in the Netherlands, general health practitioners are influenced by stereotypes. It is still widely believed that eating disorders are more common in Caucasian females of the middle class. A male with all the symptoms of an eating disorder may be entirely overlooked (2003). These myths may discourage men from reporting their own symptoms due to feelings of shame and emasculation (Olvidaria, 2012 ).
Today most studies of psychotherapy and psychopharmacology include only female participants. This is done to maintain uniformity of tests subjects and simplify data analysis. Studies that do include male participants are often done through surveys, although a professional may be required to properly asses these symptom. (Krenn, 2003)
Consumerism and mass media may play role in the development of male eating disorders. Jane Jakubczak was a dietician at the student health center at the University of Maryland. She reported in 2001 seeing approximately four males a year who experienced weight and body image concerns. In 2004, she reported seeing at least one male student a week (Wiggins, 2004). According to Dr. Arnold Andersen, a professor of psychiatry at the University of Iowa College of Medicine, there has been a “tremendous increase” of body dissatisfaction amongst men in the United States (2000.)
Andersen believes that men are “following a decade or two behind women”, due to a recent shift in the depictions of the male form in mass media (2000). “For women, it comes from the Twiggy generation,” says Randi, Wortman, a clinical psychologist in Bethesda, Maryland. “Since the fitness craze with the glossy health magazines, mean have become part of society’s overinflated version of what is the ideal body type” (Wiggins, 2004). Mannequins in male clothing stores have reportedly shrunk as well (Albers, 2010). In recent years the “V-shaped muscular body” is portrayed most desirable. (NEDA, 2013) Fitness is valued more highly today than it was decades ago, and reports of obesity circulate through the media (Olvidaria, 2012 ).
Participation in athletics is also a risk factor. An estimated 33 percent of male athletes are “affected by eating disorders” in so-called “aesthetic sports”. These include, but are not limited to bodybuilding, gymnastics, swimming, and wrestling. Wrestlers in particular often restrict food intake, induce vomiting, and/or abuse laxative and diuretics to “cut weight”. Some have a body fat percentage as low as 3%. (Pearson, 2011). A fat percentage under 8% may be hazardous to the health of men under 40 years of age (Gallagher et al. Am J Clin Nut 2000; 72:694-701).
Males are far more likely than females to experience muscle dysphoria and therefore develop a pathological desire to “bulk up” (Pearson, 2011). While women’s magazines feature diet pills and low calorie snacks, men’s magazines push products for “weight lifting, body-building or muscle toning” (NEDA, 2013). Though eating disorders in all genders occur due to environmental factors, they are thought to be genetic at the root. (Albers, 2010).
There is no clear answer as to how or even if sexual orientation affects the development of eating disorders in men. It’s been suggested that gay men are “overrepresented” amongst male eating disorder patients because they are more likely than heterosexual men to seek treatment. (Goode, 200).
It is also possible that aspects of gay culture and the homosexual lifestyle put individuals at a greater risk. One study found that binge eating and vomiting was found to be more common in both men and women who identified as homosexual, bisexual, or “mostly heterosexual” Yet another found a higher incidence of eating disorders in homosexual men, but no significant difference between homosexual and heterosexual women. Fortunately, respondents who reported feeling “connected” to the gay community had fewer or no eating disorder symptoms. This may serve as an effective deterrent for eating disordered behaviors (NEDA, 2013).
Additional Gender Differences
It is important to note that the long-term health risks for male and female eating disorder patients are the same. Use of the word “Manorexia” may be more hurtful than helpful when it comes to spreading awareness. According to Dr. Susan Albers, “Manorexia is not an clinical [diagnosis].” It is a word used “reflect the previous gender gap in the prevalence of the disorder” (2010).
Comorbidity of depression, anxiety, and substance abuse in eating disorder patients are found in all genders. (Krenn, 2003). Men with Anorexia are, however, more likely, to be diagnosed with Obsessive Compulsive Disorder than women with Anorexia (Olividaria, 2012).
“Changes in the of the pituitary gonadal axis” in women and pubescent girls with Anorexia causes amenorrhea. Physicians are still searching for an “analogous” occurrence in male Anorexia patients (Krenn, 2003). Decrease of testosterone has been observed in emaciated males leading to drecrease ro total loss of libido (Krenn, 2003).
Carlat and Camargo found that the age of onset differs between the sexes. Females often develop eating disorders between the ages of 15 and male. Male symptoms often start between the ages of 18 and 26. This may be due to delayed puberty. Male puberty occurs on average two years later than female sexual development (1991). Men are also more likely than women to be overweight or obese before the onset of these disorders Males also frequently report weight-related teasing from their peers prior to their eating disorder. (Krenn, 2003).
Osteoporosis effects both men and women with eating disorders, though more often those with Anorexia. Male osteoporosis may be a health disparity in itself, because it is most commonly associated with post-menopausal women. (Woolridge, 2012). Testosterone can be a protective measure against loss of bone mass in men (Scurlock, Timimi, & Robinson, 1997). But as previously, stated men who suffer malnutrition often experience low testosterone. (Woolridge, 2012.)
Eating disorders are genetic predispositions that also occur due to environmental influences. It is thought that recent changes in the depiction of the male body in the media have lead to an increase in male eating disorders.
Few illnesses in psychiatry or general medicine have a gender gap as significant as the one association with eating disorders. But eating disorders in males are under diagnosed for many reasons. Even medical doctors are influenced by the stereotype that most eating disorder patients are female. Though the symptoms are more often recognized in women, men experience the same health risks. Due to the high rates of mortality amongst all eating disorder patients, the extent to which they go undiagnosed and untreated in men is reason for concern.