Eating Disorders in Males
ARNOLD E. ANDERSEN
Despite being mentioned among the first case presentations in the English language 300 years ago, males with eating disorders have at times been ignored, neglected, dismissed because of statistical infrequence, or legislated out of existence by theoretical dogma. In this chapter, the basic body of information concerning males with eating disorders is presented in two overlapping but relatively distinct categories: (1) well-established facts based on sound scientific studies; and (2) highly probable information based on less complete studies or clinical experience.
The diagnostic criteria for males with anorexia nervosa are similar to those for females (see Chapter 28), but the symptomatic marker of reproductive hormone abnormality (viz., loss of sexual appetite secondary to lowered testosterone) develops in a gradual manner unlike the more abrupt cessation of menses among females. Doctors are less likely to think of the diagnosis of anorexia nervosa in males. The diagnosis of bulimia nervosa is probably not gender-biased.
Males are affected by similar comorbid psychiatric conditions to those affecting females, especially mood and personality disorders. Contrary to previous assumptions, males are more severely afflicted by osteopenia and osteoporosis, with lower bone mineral density than equivalent female patients.
The notion of “reverse anorexia nervosa,” sometimes called “muscle dysmorphia,” has become well-established. It occurs almost exclusively in males and is characterized by the subjective thinness even when highly muscular. It is often associated with the abuse of anabolic steroids.