Eating Disorders in Men Are Frequently Missed

Article excerpt

NEW ORLEANS -- Eating disorders in men are much more prominent than is generally appreciated, Dr. Arnold Andersen said at the annual meeting of the American Psychiatric Association.

Although there are significant barriers to diagnosis and treatment, the condition does appear to respond well to appropriate therapy, added Dr. Andersen of University of Iowa, Iowa City.

To maximize treatment effectiveness, however, gender differences in psychodynamics and presentation must be considered.

The pressure of maintaining a proper body image--to which men are as subject as women--is an important trigger in initiating and sustaining eating disorders. In men, altering body shape--to be thinner, more muscular, and to increase the chest-waist ratio--is likely to be the concern that drives abnormal eating behavior. Weight manipulation appears to be only a means to achieve the ideal shape.

The prevalence of full-blown eating disorders, however, is substantially greater in women than men: 4:1 for anorexia, and 11.4:1 for bulimia nervosa. Partial syndromes--for example, chronic concern about diet and weight maintenance--are more evenly divided: 1.5:1 for anorexia and 1.8:1 for bulimia, Dr. Anderson said.

That the prevalence of eating disorders among homosexual men is about fourfold higher compared with heterosexual men is believed to reflect possible social influence.

Other groups subjected to an unusual degree of pressure, such as high school wrestlers, also are greatly overrepresented, he commented.

Among the factors that make eating disorders difficult to detect in men are clinician ignorance and patient shame. The association of these disorders with homosexuality and women drives many men to conceal any symptoms of the disorder that they may have as well as any associated distress. …