Men With Eating Disorders Don't Seek Help

The misperception that eating disorders (EDs) are largely a female problem is preventing men with these problems from getting the help they need, new research shows.

A small, qualitative interview study of young men between the ages of 16 and 25 years with EDs, including anorexia nervosa (AN) and bulimia nervosa (BN), showed that men were slow to recognize that their experiences and behaviors were potential signs and symptoms of an ED. In addition, none of the study participants were even aware of what ED symptoms entail.

The study also showed that friends, family, teachers, and even healthcare professionals were also slow to recognize these symptoms.

Lead author Ulla Räisänen, from the HERG Health Experiences Research Group in the Nuffield Department of Primary Care Health Sciences at the University of Oxford in the United Kingdom, told Medscape Medical News that there is "very little research" into EDs in men.

The study was published online April 8 in BMJ Open.

EDs Rising in Men

In contrast to previous studies suggesting that recognizing and seeking help for an ED is a prolonged and complex issue for women, often including ambivalence toward recovery, "our data suggest that men may not even come to consider the possibility of having an ED because it was seen as an 'inappropriate' diagnosis for them as men," said Räisänen.

"Our data also suggest that men experience lack of awareness and readiness among health professionals to diagnose EDs, sometimes even when they were very ill," she said. She added that this finding is especially troubling and demands more attention.

"Clinicians need to be aware that men also do suffer from eating disorders, they may be far more common in men than has been thought, and [clinicians need to be] sensitive to diagnosing eating disorders in patients presenting to them, regardless of their gender."

According to the researchers, AN has the highest mortality rate of all adolescent psychiatric conditions. Approximately 1 in 250 women and 1 in 2000 men in the United Kingdom have AN. However, the incidence of EDs in men is rising, "with some estimates suggesting that men now account for 1 in 4 cases," note the investigators in a release.

"But poor recognition of the signs and symptoms of EDs…is likely to mean that the true prevalence may be higher still," they add.

In the original study, the investigators conducted 50 in-home or meeting room interviews with 39 individuals aged 16 to 25 years who lived in the United Kingdom and who had various EDs. All interviews lasted between 50 minutes and 2 hours.

The first part of the interviews allowed the participants to use uninterrupted, free narrative to describe their ED experiences in as much detail as possible.

Part 2 of the interviews used semistructured questions to explore 4 specific themes. These included recognition of early signs and symptoms of EDs; recognition that there was a problem; getting help for the problem; and initial contact with healthcare services.

For the current analysis, data for just the 10 male participants were assessed.

Results showed that common ED behaviors reported by the men included purging, obsessive calorie counting, excessive exercising, going days without eating, self-harming, and isolating themselves from others.

However, the men did not realize these were symptoms of EDs; 1 participant thought it was just a coping mechanism for dealing with personal issues.

Those who knew of EDs thought of them as something that only affected women or, as 1 participant said, "fragile teenage girls." Another admitted, "I didn't know men could get eating disorders."

Friends, Family Unconcerned

Many of the men reported that friends and family members were not concerned and thought the changed behaviors were due to personal choices.

In fact, 1 participant reported that while being investigated for gastric problems for almost a year, parents and clinicians never suggested that his vomiting and weight loss might be caused by psychological reasons.

Others noted that family members called their eating issues "silly."

"It was only reaching a crisis point or being admitted as an emergency that triggered the realization of what was happening to them," said the investigators in the release.

"They also delayed seeking help because they feared they wouldn't be taken seriously by healthcare professionals, or didn't know where to go for support," they add.

The participants described mixed experiences with health services. Most had to wait for long periods for a specialist referral, several were misdiagnosed (including for depression), and 1 reported being told to "man up" by a physician.

The researchers note that delays in diagnosing and treating EDs may be caused by a "lack of understanding and training among health professionals."

The participants also reported that they received very little information targeted specifically toward men about EDs, and were told that was because it did not really exist.

"Men with EDs are underdiagnosed, undertreated and under-researched," write the investigators.

"Although increasingly common in young men, widespread cultural constructions of EDs as a 'women's illness' mean that men may fail to recognize ED symptoms until disordered behaviors become entrenched and less tractable to intervention," they add.

Therefore, early detection is imperative.

"Until information resources are made more appropriate…health service providers need to be particularly sensitive to men's needs in relation to an illness so strongly associated with women."

NEDA Offers Help

The National Eating Disorders Association (NEDA) has devoted a section of its Web site to the issue of male EDs. There, it lists several prevention strategies, including the following:

• Recognize that EDs occur in both men and women;

• Learn about ED warning signs;

• Understand that sports that emphasize weight restrictions put boys and men at risk of developing EDs;

• Talk to boys, even at a young age, about ways attitudes about the ideal male shape are influenced by the media; and

• Really listen to the thoughts and feelings of young men, and don't dismiss their pain.

The organization adds that they are currently updating its materials, including all handouts and toolkits, to be consistent with updates in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which was released last year.

The DSM-5 now includes several diagnostic criteria changes for EDs, including the new addition of binge eating disorder.

A study published in 2011, and reported at the time by Medscape Medical News, showed that men who binge eat suffer as much distress and impairment as women with the same disorder ― yet are far less likely to seek or receive help.

"Sadly, men are overlooked…when it comes to eating disorders of all kinds," said Lynn S. Grefe, president and chief executive officer of NEDA, at the time.

In addition, "there is often the myth that anorexia only affects women or if a man binges, maybe it's just a 'good appetite,' rather than anyone considering it might be an eating disorder," noted Grefe.

Ulla Räisänen reports having received study funding from a DIPEx charity grant. The other coinvestigator reports having been employed by the UK Medical Research Council until May 2013.

BMJ Open. Published online April 8, 2014. Full article

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Cite this: Men With Eating Disorders Don't Seek Help - Medscape - Apr 15, 2014.