Magazine article Clinical Psychiatry News

Eating Disorders Missed, Misdiagnosed in Men

Magazine article Clinical Psychiatry News

Eating Disorders Missed, Misdiagnosed in Men

Article excerpt

The 15-year-old swimmer who came into Dr. Joel Jahraus' office recently could hardly be accused of not eating much--after all, he was consuming up to 4,000 calories daily. Unfortunately, even that many calories weren't enough to keep up with his frantic exercise schedule.

"He was so intensively swimming and working out in the gym that he was ... burning 6,000 calories," Dr. Jahraus said. "Here's a kid who's eating like crazy but dropping weight substantially and not able to support his activities. He was emaciated, and so out of it that he wasn't even making sense when he was talking to me."

This patient was exhibiting one of the classic symptoms of an eating disorder in a male: compulsive exercise, said Dr. Jahraus, who is medical director of Remuda Life Programs in Phoenix, Ariz., which treats patients with eating disorders. The patient, who was eventually treated successfully for his problem, illustrates one of the differences between males and females when it comes to eating disorders: presentation.

The exercise culture is part of the reason that men may have difficulty realizing they have a problem, said Dr. Alexander Sackeyfio, director of the eating disorders program at Beaumont Hospital in Royal Oak, Mich. "If you look at wrestlers, they throw up a lot, so much so that it's part and parcel of the whole wrestling world," he said. "Jockeys do the same thing. Both groups look at it as normal behavior. They forget it does the same harm to them as everyone else: It destroys kidneys, hearts, teeth, even interpersonal relationships."

Another difference between males and females with eating disorders is the body image issues involved, according to Dr. Jahraus: "Males want great big shoulders, a 'six-pack,' and tiny waist. Women just want to be smaller."

There are also similarities. The males who come into Dr. Jahraus' clinic are trying to micromanage their caloric intake, "but they almost always err on the side of too few calories to support their body functions and activity level," he said.

Statistics on males with eating disorders are hard to come by, but estimates are that of the 1 million or so Americans with anorexia, 5%-10% are male, as are 10%-15% of the 7 million with bulimia, Dr. Jahraus said. Many of these patients remain undiagnosed for several reasons.

"As far as society is concerned, men don't have eating disorders," Dr. Jahraus continued. "Most clinicians are not trained in eating disorders, and clinicians who do know about it are in general practice. They're busy, and getting involved with eating disorders is a hassle."

Psychiatrists and primary care physicians both could do a better job at diagnosing eating disorders, according to experts. "A lot of general physicians don't pick up eating disorders, and I think that's because they don't have it at the forefront of their consciousness," said Dr. Mae Sokol, director of the eating disorders program at Children's Hospital of Omaha (Neb.).

Doctors should not be fooled by a child's appearance. "A bulimic may not have an abnormal weight, but if you ask--in a way the child can understand--whether the child is engaging in any abnormal behaviors or whether they have any concerns about weight or about food, sometimes they will tell you," she said. …

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