The Harsh Stigma - Male Experience with Eating Disorders

When I started out to write a post about eating disorders in males, the first thing I looked up was the prevalence. And already, I was met with the first misconception—while I knew it was higher than most assume, I thought it would be around ten percent. I was surprised to see that the reality is that about a third of people with eating disorders are male. In fact, ARFID is more likely to occur in males and binge eating disorder is almost equally likely to occur in males or females. (Note, gender is a construct and a spectrum. Sources for this article simplify it into these simple categories, so I must, too. I hope to explore gender in eating disorders with more nuance in the future.)

This common misconception—that eating disorders mostly, or even exclusively, occur among females—is a major barrier to males being treated. For one thing, males may not be diagnosed. For example, one study found that the common diagnostic symptom of feeling a loss of control when eating is not present as frequently in males; however, overeating was more likely to be reported in males than females. Some symptoms (ie., body checking) don’t seem to show up as often in males, so the absence might lead to a lack of a diagnosis despite clinical significance of the main factor, impaired eating.

There’s also the cultural expectation—if we see a thin woman, we might think ‘anorexia’, whereas a thin man might be seen as naturally thin or athletic. These expectations can color how we read symptoms and diagnose individuals. (Interestingly, there’s repeatedly been no sex difference found in terms of exercise or musculature hyperfocus. This ties into the above statement—if we expect males to present with eating disorders via a hyper focus on building muscle, then we may not recognize them when this isn’t present.) Another barrier to males receiving treatment is the stigma. When reading anecdotes from males, there is shame around not just having a mental illness, but in having a ‘girl’ mental illness. This leads to denial, to themselves and to others, and can prevent seeking out treatment.

When administering treatment, it is important that it be gender-aware. For one thing, males are taught to not be vulnerable or emotional, so this barrier would need to be overcome to make them comfortable expressing their challenges, and it might need to be addressed in a different way that it would for females. It’s also helpful for males to be able to see others like them to know that there is nothing wrong with them for having the disorder (books such as "Nothing" and "The Art of Starving" are some examples, though nothing beats peer support). Males who receive treatment have favorable outcomes and may even recover more quickly, but the barrier is in being recognized and diagnosed. When we become more aware of this, we're already one step closer to treatment and recovery.