Common misconceptions about eating disorders suggest that they exclusively impact young, cisgender women. Nonetheless, the reality is that eating disorders can affect anyone, albeit some individuals are more vulnerable than others. While eating disorders are commonly associated with females, it is important to acknowledge that a considerable number of men and transgender people also face these challenges. Unfortunately, due to stigma, gender biases, and insufficient awareness, many people remain undiagnosed and untreated.
This article aims to provide detailed information about eating disorders in men, including risk factors, symptoms, and treatment options. Additionally, it covers the unique challenges faced by men, transgender, and non-binary individuals in seeking help, and offers resources to support recovery.
What are eating disorders?
Eating disorders are complex mental health conditions characterised by unhealthy and often dangerous attitudes, behaviours, and thoughts about food, eating, weight, and body image.
They involve a significant disruption in eating habits, often driven by emotional, psychological, or social factors, and can lead to serious physical and psychological consequences.
These disorders are not solely about food; they often involve deep-seated psychological issues such as low self-esteem, anxiety, or a need for control.
Prevalence and Risk Populations
General Male Population: Studies suggest that 25% of individuals with eating disorders are male.
LGBTQ+ Community: Gay and bisexual men are particularly at risk, with higher rates of body dissatisfaction and eating disorders.
Transgender Individuals: Reportedly higher prevalence due to gender dysphoria and societal pressures.
Over a million Australians live with an eating disorder, and of these people, 3% report having anorexia nervosa, 12% bulimia nervosa, 47% binge eating disorder and 38% other eating disorders.
Males account for an estimated 25% to 37%, or approximately one third of all eating disorder cases. This equates to around 20% of people living 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 and 67% of people with avoidant/restrictive food intake disorder. These figures are likely under-estimations due to non-reporting and help-seeking.
Eating Disorders in Transgender and Non-Binary Individuals
Transgender and non-binary individuals are also affected by eating disorders, with body dissatisfaction and the desire to conform to gender ideals playing significant roles. Studies show higher rates of disordered eating in transgender and non-binary individuals compared to cisgender individuals, often tied to experiences of dysphoria and societal pressures.
Key features of eating disorders
Preoccupation with Food and Weight: Individuals with eating disorders often have an intense focus on food, body shape, and weight.
Distorted Body Image: A person’s perception of their body may not align with reality, leading to feelings of dissatisfaction and self-criticism.
Extreme Behaviours: These can include severe food restriction, binge eating, purging, or excessive exercising.
Physical and Psychological Impact: Eating disorders can cause serious medical conditions, including heart problems, digestive issues, hormonal imbalances, and emotional distress such as anxiety and depression.
Common Types of Eating Disorders in Men
Eating disorders in men can take various forms, each with unique symptoms and associated risks. Here are the main types outlined in the Diagnostic Statistical Manial 5 TR (DSM-5-TR) used to diagnose mental health conditions such as eating disorders:
Other Specified Feeding or Eating Disorder (OSFED)
Atypical Anorexia Nervosa
Bulimia Nervosa of Low Frequency/Duration
Purging Disorder
Night Eating Syndrome
1. Anorexia Nervosa (AN)
Anorexia Nervosa is characterised by persistent restriction of energy intake, intense fear of gaining weight, and a distorted body image. People with Anorexia often see themselves as overweight, even when they are underweight, leading to dangerous and potentially life-threatening weight loss.
Example: Matt, a 19-year-old university student, becomes preoccupied with losing weight after joining a new gym. He cuts out entire food groups, skips meals, and feels guilty if he eats over a certain number of calories. Despite losing a significant amount of weight and showing signs of fatigue, he insists he still has "fat to lose." Matt avoids social events involving food, fearing he’ll lose control over his diet.
2. Bulimia Nervosa (BN)
Bulimia Nervosa is defined by recurrent episodes of binge eating followed by inappropriate compensatory behaviours to avoid weight gain. These behaviours can include vomiting, fasting, laxative misuse, or excessive exercise.
Examples:
Purging (Self-Induced Vomiting): Jason, a 27-year-old teacher, binges after stressful days, consuming large quantities of junk food. To prevent weight gain, he vomits afterward, often rushing to the bathroom immediately after eating. He feels trapped in a cycle of guilt and shame.
Laxatives: Tom, a 22-year-old gym enthusiast, frequently uses laxatives after meals he believes are too high in calories. He’s developed digestive issues but continues using them because he fears gaining weight.
Diet Pills and Supplements: Lucas, a 25-year-old office worker, relies on diet pills to control his weight after binge eating. Despite side effects like jitteriness and headaches, he believes they are necessary to stay lean.
Over-Exercising: Mark, a 30-year-old personal trainer, engages in strenuous workouts after episodes of binge eating. He exercises multiple times a day, pushing his body to the limits to "burn off" the calories.
3. Binge Eating Disorder (BED)
Binge Eating Disorder is characterised by recurring episodes of consuming large amounts of food in a short time, accompanied by feelings of loss of control. Unlike Bulimia, there are no regular compensatory behaviours.
Example: Aaron, a 34-year-old IT worker, finds comfort in food after stressful workdays. He often eats large amounts of "junk" food alone, rapidly consuming whatever is available. After bingeing, he feels ashamed and vows to "diet" the next day, but the cycle repeats during stressful periods.
4. Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID involves avoiding or restricting food intake without concerns about body weight or shape. This can be due to sensory sensitivities, fear of choking, or a lack of interest in food, leading to significant nutritional deficits.
Example: Charlie, a 12-year-old boy, refuses to eat foods with strong textures or mixed consistencies. His diet is limited to dry, simple foods like crackers, bread, and plain pasta. Mealtimes are stressful, and his parents rely on nutritional supplements to make sure he gets enough vitamins and minerals.
5. Other Specified Feeding or Eating Disorder (OSFED)
OSFED is a category for eating disorders that cause significant distress or impairment but do not meet the full criteria for another specific disorder. It includes subthreshold or atypical cases of Anorexia, Bulimia, and BED.
Examples:
Atypical Anorexia Nervosa: Ben, a 29-year-old designer, restricts food and exercises rigorously, yet maintains a normal body weight. He obsesses over calories and feels a constant pressure to be thinner, despite reassurances from friends that he looks healthy.
Bulimia Nervosa of Low Frequency/Duration: Sam, a 23-year-old university student, binges and purges infrequently during high-stress times like exams. He feels intense guilt after each episode but doesn't meet the frequency required for a full diagnosis of Bulimia.
Purging Disorder: Kyle, a 32-year-old barista, purges after normal-sized meals to maintain his current weight, despite not engaging in binge eating. He struggles with constant dental problems and frequent sore throats due to his behaviour.
Night Eating Syndrome: Liam, a 40-year-old project manager, frequently wakes up during the night to eat. He consumes large amounts of food when everyone else is asleep and often feels lethargic the next day.
6. Pica
Pica is an eating disorder characterised by the persistent eating of non-food substances for at least one month. These substances may include dirt, chalk, soap, paper, or other non-nutritional items.
Example: Alex, a 45-year-old construction worker, finds himself eating small pieces of drywall while working. He finds the crunch satisfying and struggles to stop, despite occasional stomach cramps and nausea. Alex keeps this habit secret, feeling embarrassed.
7. Rumination Disorder
Rumination Disorder involves the repeated regurgitation of food after eating. The food may be re-chewed, re-swallowed, or spit out and is not due to a medical condition. This behaviour must persist for at least one month.
Example: Patrick, a 15-year-old high school student, often regurgitates food shortly after eating. He re-chews and swallows it, finding the behaviour calming during stressful times. Patrick is embarrassed about his habit and avoids eating with friends, resulting in noticeable weight loss.
Warning signs
Men may show signs of an eating disorder through various indicators, such as:
Behavioural Changes: Men may withdraw from social interactions, experience mood swings, and exhibit heightened anxiety during mealtimes.
Changes in Eating Habits: This may include skipping meals, adhering to strict diets, eliminating entire food groups, counting calories or macros, fasting, or obsessively planning meals.
Fitness Preoccupation: Constantly striving to tone or build muscle, using muscle-enhancing substances, fearing muscle loss, and dreading excessive weight gain are common signs.
Excessive Exercise: Men with eating disorders may exercise despite injuries or illness, feeling distressed if they cannot work out. Some may use exercise to compensate for calorie intake, while others focus on muscle building.
Physical Symptoms: Observable weight changes, gastrointestinal problems, and extreme fatigue can be indicators of an eating disorder.
Contributing Factors to Eating Disorders in Men
Several factors contribute to the development of eating disorders in men:
Social and Cultural Pressures: The "ideal" male body image propagated by media and social platforms often leads to increased body dissatisfaction.
Athletic Backgrounds: Involvement in sports that emphasise weight and body shape (e.g., wrestling, bodybuilding) increases risk.
Mental Health: Co-morbid mental health conditions, such as depression, anxiety, or ADHD, OCD, Borderline Personality Disorder (BPD), substance use disorders, Body Dysmorphic Disorder (BDD), Post-Traumatic Stress Disorder (PTSD) can heighten susceptibility.
Physical health: Several medical or physical health conditions can contribute to the development of eating disorders, such as chronic pain and gastrointestinal disorder.
Impulsivity: Conditions with impulsivity as a feature, like ADHD, can increase the likelihood of binge eating and other disordered behaviours.
Comorbid Conditions
Men with eating disorders frequently have co-occurring mental health conditions, including:
ADHD: Impulsivity and attention difficulties can lead to uncontrolled eating habits.
Depression and Anxiety: Common in individuals struggling with body image issues and eating disorders.
Substance Use: Steroids, stimulants, and alcohol abuse may coexist with disordered eating patterns.
Barriers to Care and Stigma
Men often face stigma when seeking treatment for eating disorders, including:
Stigma and Gender Stereotypes: Eating disorders are frequently perceived as "feminine" issues, leading to underdiagnosis in men. They may experience a sense of shame or embarassment due to gender expectations.
Cultural issues: Societal expectations to adhere to masculine standards frequently worsen disordered eating patterns.
Underdiagnosis: Healthcare providers might fail to recognise eating disorders in men because of insufficient awareness and training, leading to delayed or overlooked diagnosis.
Lack of Male-Specific Resources: Treatment centres and support materials often cater to women, which can deter men from seeking help. Resources geared towards women can feel alienating or irrelevant to men.
Discrimination: Men may feel less validated in their experiences, impacting their willingness to continue treatment.
Eating disorder risk factors for LGBT people
The NEDA in the US identifies risk factors that can contribute to disordered eating and eating disorders within LGBTIQA+ communities. These factors include:
Fear of rejection or experiencing rejections from friends, family, and co-workers
Internalised negative messages/beliefs about oneself related to sexual orientation, non-normative gender expressions, or transgender identity
Exposure to violence and post-traumatic stress disorder (PTSD), which significantly raises the risk of developing an eating disorder
Discrimination based on sexual orientation and/or gender identity
Being bullied due to sexual orientation and/or gender identity
Conflict between biological sex and gender identity
Inability to conform to body image standards in certain LGBTQ+ cultural environments
Available Treatment Options
Treatment for eating disorders in men includes a combination of therapies and support options:
Cognitive Behavioural Therapy (CBT): A widely used therapy that helps change unhelpful thought patterns and behaviours.
Family-Based Therapy (FBT): Involves the family in the recovery process, often used for younger individuals.
Inpatient and Outpatient Programs: Hospitals offer both inpatient and outpatient treatment options, depending on severity.
Dietary Counselling: Involves working with a dietitian to develop a healthy relationship with food.
Support Groups: Group therapy and peer support can be beneficial in reducing isolation and fostering recovery.
Treatment Plans and Rebates in Australia
If you believe you might have an eating disorder, it's important to speak with your GP, psychologist or psychiatrist.
The following are treatment plans that might be available to people with eating disorders, and can enable rebates from Medicare in Australia. These can be accessed by speaking with your doctor or psychiatrist.
Mental Health Treatment Plan (MHTP): A GP can develop a Mental Health Treatment Plan, which allows access to up to 10 subsidised psychological sessions per calendar year.
Eating Disorder Plan (EDP): Specific for individuals diagnosed with an eating disorder, which allows up to 40 subsidised psychological sessions per calendar year.
Not all people with eating disorders are eligible for the EDP. Some may commence treatment with a mental health professional under a MHTP, during which, details of an eating disorder may emerge, enabling a subsequent EDP to be created. However, the maximum number of rebated sessions for an individual during a calendar year is 40 sessions, regardless of whether under an EDP alone, or with a MHTP prior.
Screening Tools for Eating Disorders in Men
Your medical or mental health professional may ask you to complete one or more screening questionnaires to see if you may have an eating disorder, however your results on these do not equate to a diagnosis. Some reliable and evidence-based tools include:
EDE-Q (Eating Disorder Examination-Questionnaire): A self-report tool assessing eating disorder symptoms.
SCOFF Questionnaire: A quick screening tool with five questions designed to identify eating disorders.
Eating Attitudes Test (EAT-26): A screening measure for disordered eating attitudes and behaviours.
To qualify for an Eating Disorder Plan (EDP), it is likely that your doctor will ask you to complete the EDE-Q. InsideOut's online screening tool is quite useful. It includes six questions, and is followed by the EDE-Q if responses indicate a possible eating disorder.
While there can be shame and stigma associated with disordered eating, it is important not to understate your disordered eating experiences when completing screening questionnaires, as doing so may limit the supports available to you.
Helpline and Crisis Lines
For immediate support, individuals can contact:
Butterfly Foundation: 1800 33 4673 - Specialises in eating disorders.
Lifeline Australia: 13 11 14 - For crisis support.
Beyond Blue: 1300 22 4636 - Mental health support.
Men'sLine Australia: 1300 78 99 78 - Men's counselling
Qlife: 1800 184 527 - LGBT counselling and support
Self-Care and Harm Minimisation Strategies
Mindful Eating: Practising awareness during meals to foster a healthier relationship with food.
Body Positivity: Encouraging self-acceptance regardless of body shape.
Harm Reduction: Reducing harmful behaviours gradually, like decreasing gym time, moderated use of supplements, or practices to reduce dental damage.
Male Celebrities Who Have Spoken About Eating Disorders
Zayn Malik: Former One Direction member discussed struggles with eating due to body image pressures.
Russell Brand: Actor and comedian who shared his experiences with bulimia in his youth.
Elton John: Singer who has been open about his battle with bulimia.
Seek Support
The good news is that help is available. If you or a loved one are struggling with an eating disorder, it’s crucial to seek professional help. Consider booking a consultation with a psychologists who specialise in male eating disorders.
Brydan Xavier Psychology offers tailored, evidence-based treatments for men and the LGBT community in a supportive, non-judgmental environment.
Request a 15 minute online introductory call - https://www.brydanxavier.com.au/
Reference List
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Butterfly Foundation. Eating Disorders: Who Does it Affect? Males. Butterfly Foundation.
Center for Discovery. Celebrities Who Battled Eating Disorders. Center for Discovery.
Deloitte Access Economics. (2012). Paying the price: the economic and social impact of eating disorders in Australia. Australia: Deloitte Access Economics.
Dietitians Australia. (2023). Eating Disorders and Disordered Eating. Dietitians Australia.
Eating Disorders Victoria. Eating Disorders in Men. Eating Disorders Victoria.
Eating Disorder Hope. (2021). Russell Brand’s Battle with an Eating Disorder. Eating Disorder Hope.
Eddy KT, Thomas JJ, Hastings E, Edkins K, Lamont E, Nevins CM, Patterson RM, Murray HB, Bryant-Waugh R, Becker AE. (2015). Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. Int J Eat Disord. 48(5):464-70.
Griffiths, S. (2023). Muscle Dysmorphia: The Male Eating Disorder. TEDxSydney.
Hay P, Girosi F, Mond J. (2015). Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. J Eat Disord. 2015;3(1):1-7.
Meacham, S. (2023). The Unhealthy Reason Drawing Men Into the Gym. ABC News.
National Eating Disorders Collaboration (NEDC). Eating Disorders in Males. NEDC.
Smith, A. (2016). Male Eating Disorders: Why Men Struggle to Get Help. BBC News.
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