Anorexia nervosa is a serious disorder that affects over 1 million males yearly (National Association of Anorexia and Associated Disorders, 2000). Despite this statistic, anorexia is often misdiagnosed or overlooked completely by both mental health and medical practitioners because of the misperception that it is a disorder exclusively present in females. The purpose of this article is to alert mental health counselors to the problem of male anorexia and outline salient features that are unique to these clients. With greater recognition of this potentially deadly disorder in males, more accurate diagnoses and, consequently, treatment will be the outcome.
PREVALENCE OF MALE ANOREXIA NERVOSA
It is estimated that males generally account for 5% to 10% of reported cases of anorexia nervosa (Alexander-Mott, 1994; Anorexia Nervosa and Related Eating Disorders, Inc., 1998). These figures must be viewed with caution however, because this disorder is likely underreported and misdiagnosed in the male population.
Current literature is saturated with numerous explanations, causes, treatments, and prevention of anorexia nervosa. Despite voluminous articles, papers, and books written on this topic, little mention is ever made to males. Keel, Fulkerson, and Leon (1997) reported their search of the literature revealed no studies of eating disorders in early adolescent males, and most research on predictors of eating disorders has been based on female samples. As a result, these findings may not generalize to males. In fact, there may be other factors present in predicting poor body image, low self-esteem, and resulting eating disorders in males. It is essential to determine the existence of any gender differences that might be affecting body image as a means of providing more appropriate prevention and intervention in this population. Kinzl, Mangweth, Traweger, and Biebl (1997) lamented the lack of studies performed with males. Keel et al. (1997) suggested how boys feel about their bodies can influence their tendencies toward anorexia. The factors that may determine this are still unknown, because the variables used in their study were determined by previous research based on females. Carlat, Carmago, and Herzog (1997) contended that in the past 300 years since anorexia nervosa was first described, there continues to be very little written regarding males and eating disorders and that the majority of the research has been limited to case reports or case-control studies.
UNIQUE ASPECTS IN THE DEVELOPMENT OF MALE ANOREXIC BEHAVIOR
Halperin (1996) suggested that unlike girls, boys form an image of their bodies from participation in sports as the socialization of a team activity reinforces an outside source of acceptance. Kearney-Cooke and Steichen-Asch (1990) in their study of male body image and eating disorders found that from birth, boys become indoctrinated with what it means to be a man. They hold the belief that this entails a certain set of attitudes and behaviors that exude independence, a preoccupation with career, competitiveness, physical strength, aggressiveness, and courage. When the young male has difficulty obtaining these goals, emotional isolation occurs, which results in problematic behavior. Research has demonstrated that males with eating disorders exhibit a psychological profile that is analogous to females with eating disorders, encompassing both a sense of interpersonal ineffectiveness and an inability to control their emotions (DeAngelis, 1997).
Anderson (1992) reported that while the disorders may appear the same for both males and females, the course for getting there is quite different. "When individuals are very ill, suffering from emaciation or abnormal electrolytes and other medical complications, they appear very similar and require similar treatment ... but as patients become medically healthy and the symptoms are deconstructed, the individual life story behind each patient unfolds to reveal differences between the sexes in predisposition, course, and onset" (p. …