Eating Disorders In Men: Body Image Concerns And Disordered Eating In Males

Because of the strong association many people have between eating disorders and body image concerns, there can be a widespread assumption that eating disorders impact only women. Although women do make up the majority of eating disorder patients, men can also be affected. 

What are eating disorders?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), includes a category for feeding and eating disorders. The DSM-5 defines such a disorder as “a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.” 

Eating disorders are frequently, though not always, associated with concerns about weight gain and body image, which means they may have common characteristics with other mental disorders that are not considered eating disorders, such as body dysmorphic disorder. Eating disorders are often associated with a number of serious health complications, and, in cases where food intake and calorie absorption are severely restricted, they can be potentially life-threatening. 

Gendered stereotypes of eating disorders

Many people may associate eating disorder behaviors primarily with women. Gendered societal expectations that can lead women to place higher value on their personal appearance and sexual appeal, which they may tie to their weight, might lead to a higher prevalence of these disorders in women, which has been documented by research. 

However, framing eating disorders as primarily a women’s issue can ignore the pervasiveness of eating disorder diagnoses among males. Eating disorders can have severe impacts on health and well-being regardless of the gender of the person affected, and male eating disorders require attention and treatment. 

Common eating disorders

Eating disorders can affect people in a variety of ways physically and psychologically. While there can be some overlap in symptoms, person typically has to meet a set of criteria in the DSM-5, which distinguishes among a variety of eating disorders. The following are some of the most common:

Anorexia nervosa

Anorexia nervosa, usually abbreviated to anorexia, is an eating disorder that typically involves an obsession with food intake and weight gain or loss. People with anorexia may significantly restrict the amount of food they consume and/or attempt to “eliminate” the food they do eat through exercise or laxative consumption. Anorexia can be associated with dangerous levels of weight loss and may require hospitalization to achieve health stability before the underlying mental and emotional causes of the disorder can be addressed. 

Bulimia nervosa

Bulimia nervosa, often referred to simply as bulimia, involves two behavior cycles: binging, or consuming high levels of food in a short period, and then purging, or engaging in compensatory behaviors like vomiting, working out excessively, or using laxatives. People with bulimia often do not demonstrate the same stark levels of weight loss as in anorexia, but that does not mean the disorder is not severe or does not require eating disorder treatment. People with bulimia may have significant gastrointestinal problems due to the constant cycling of their digestive system. 

Binge eating disorder

Although both anorexia and bulimia may be more well known, . Binge eating disorder has some characteristics in common with bulimia in that it typically involves consuming large amounts of food in a single sitting, often associated with feelings of shame and loss of control. However, unlike with bulimia, people with binge eating disorder do not typically engage in compensatory behaviors like vomiting or excessively exercising. As a result, people with binge eating disorder may be overweight.

Muscularity-oriented disordered eating

Muscularity-oriented disordered eating, while not a formal diagnosis in the DSM-5, may be a more common form of problematic eating behavior found in men. It can be related to muscle dysmorphia, a variant of body dysmorphic disorder that occurs almost exclusively in men. Individuals with muscle dysmorphia typically believe their body is too small or insufficiently muscular, despite physical evidence to the contrary. 

People with muscle dysmorphia may engage in muscularity-oriented disordered eating practices like eating only certain food groups, eating on a strict schedule to coincide with workouts, consuming supplements, and taking anabolic steroids, which can have significant health consequences. 

Important information about eating disorders in men

The societal perception of eating disorders exclusively affecting women can have negative impacts for men who are having difficulties with attitudes toward food. These impacts can include delayed diagnosis and treatment, which may complicate eating disorder recovery. 

Why eating disorders in men are often overlooked

Men can be expected to be more independent, stoic, and self-reliant than women, which may mean they are less likely to talk about emotional difficulties or mental health concerns, and they may make attempts to hide any challenges they are experiencing. The co-occurrence of muscle dysmorphia and disordered eating can also warp the perception of a man’s maladaptive eating behavior, as healthcare providers may perceive what they consider to be healthy muscle mass and exercise engagement. 

The role body image plays in male eating disorders

Body image concerns are not solely associated with women. With the rise of social media, more people of all genders may be more likely to compare themselves to others and hold themselves to sometimes unrealistic standards, which could lead to a higher prevalence of disordered eating. 

Muscle dysmorphia and body image

As mentioned above, muscle dysmorphia has a strong association with eating disorder behaviors. Men with muscle dysmorphia may think of themselves as small and weak no matter how much muscle mass they acquire. In addition to the high co-occurrence of disordered eating patterns, muscle dysmorphia can be associated with increased levels of anxiety and depression, which can affect other areas of men’s lives and functioning, including their personal relationships. 

What are warning signs of eating disorders in men?

Warning signs of eating disorders in men can include the following:

• Changes in eating habits, like skipping meals or avoiding some food groups entirely
• Excessive exercise, particularly focused on accumulating muscle mass
• A preoccupation with food, body image, exercise, supplements, diets, etc.
• Social withdrawal, especially in situations where social gatherings are skipped to spend time at the gym or because the person is uncomfortable with body exposure (e.g., not wanting to go to the beach)
• Mood swings
• Irritability
• Physical symptoms, particularly those associated with malnutrition, including dizziness, fatigue, and low blood sugar

Support for men experiencing an eating disorder

Isolation can be a common symptom among people of any gender with eating disorders, but it may be particularly pronounced in men. Men may not be comfortable communicating with anyone in their lives about their mental health difficulties, which means they may need the help of a professional. 

Online therapy

Traditional ideas of masculinity may keep men from reaching out for help, and they may feel intense shame and self-loathing about needing support. This may make in-person communication with a mental health professional difficult. In these situations, online therapy may help to take some of the pressure off of men with an eating disorder. With online therapy, men can choose how to connect with their therapist, including through video chat, phone calls, live chat, and in-app messaging.

Is online therapy helpful for eating disorders?

Research has indicated that online therapy could have comparable outcomes to traditional in-person therapy for addressing eating disorder symptoms. One study examined online therapeutic interventions for bulimia and found that both in-person and online treatments led to symptom reduction.