Anorexia Nervosa is an eating disorder that primarily affects adolescent girls and young adult females, and is considered to be rare among males. It is estimated that 1 in 200 adolescents between the ages of 12 and 18, the high risk group, develop anorexia nervosa and 90% of those affected are females (NIMH, 1987). There has been a steady increase in the reported incidence of male anorectics, from approximately 5% in 1985 (DSM III) to as much as 10% in 1987 (NIMH, 1987). Due to the cultural pressures for girls to be thin, professionals and parents are alert to the potential for risky dietary behavior; however, many male anorectics remain unnoticed.
A national survey (Gallup, 1985) found that 1 teenage girl in 8, and 4% of teenage boys had serious symptoms of anorexia nervosa and bulimia, and that one-third of both adolescent boys and girls have engaged in food binges. It also found that more than half of these adolescents resort to vigorous exercise, fasting, vomiting, and using purgatives to control their weight. Thus, contrary to common perception, these statistics indicate that boys as well as girls are engaging in destructive dietary practices.
The effects of anorexia nervosa can be devastating to the family and friends of the anorectic. More importantly, approximately 5% of the victims die prematurely due to starvation and its complications (DSM III). Anorexia nervosa in males may even be more prevalent than the reported estimates indicate. Like the female the male denies that he is ill. If he does seek professional help, it most likely will be for an endocrine or gastrointestinal problem, which is a consequence of anorexia nervosa. The physical problem may conceal the eating disorder from the clinician who generally suspects anorexia nervosa only in females. Thus, there may be more male anorectics receiving medical attention, but who are not diagnosed as anorectic. Thus, whenever an adolescent boy or young adult male presents with significant weight loss, the possibility of a diagnosis of anorexia should be considered.
Anorexia nervosa results from cultural, physical, and psychological pressures on vulnerable adolescents or young adults. The victims have a distorted and irrational attitude toward eating, food, and body weight. Some clinicians believe that anorexia nervosa may vary in severity, which makes it difficult to identify among the large number of adolescent dieters.
The essential features of anorexia nervosa include: intense fear of becoming obese; disturbance of body image; significant weight loss; refusal to maintain body weight beyond the minimal normal weight based on age and height; and no known physical illness that could account for the weight loss (DSM III). In general, primary anorexia nervosa is similar for both males and females, except for one symptom females experience amenohea, a cessation of menstruation.
Course of the Disorder
The teenage boy or young adult male will announce that he is going on a diet to lose a few pounds. He begins by reducing his intake of carbohydrates and fat-containing foods. In addition, he will exercise to further reduce his weight. Even after he reaches his weight-loss goal, he continues dieting and weighs himself frequently. He often declares that he is "fat." Parents and friends become concerned about his weight loss and encourage him to eat more, but he refuses. He will adamantly declare that he is still "too fat." The anorectic suffers from a body image disturbance; he cannot recognize that he is too thin or when the disorder progresses, that he is emaciated.
Some anorectics lose control over their severely restrictive diet and binge. A binge can be defined differently by anorectics. For some, a binge may consist of straying from their diet by as little as one calorie; for others a binge may involve hundreds of calories. Intense anxiety may be experienced after a binge which the anorectic may reduce by immediately eliminating the food, either by self-induced vomiting, laxatives, or vigorous exercising. …