Eating Disorders in Biological Males: Clinical Presentation and Consideration of Sex Differences in a Pediatric Sample

By Coelho, Jennifer S.; Lee, Tiffany et al. | Journal of Eating Disorders, November 26, 2018 | Go to article overview

Eating Disorders in Biological Males: Clinical Presentation and Consideration of Sex Differences in a Pediatric Sample


Coelho, Jennifer S., Lee, Tiffany, Karnabi, Priscilla, Burns, Alex, Marshall, Sheila, Geller, Josie, Lam, Pei-Yoong, Journal of Eating Disorders


Author(s): Jennifer S. Coelho[sup.1,2], Tiffany Lee[sup.1], Priscilla Karnabi[sup.1], Alex Burns[sup.1], Sheila Marshall[sup.3,4], Josie Geller[sup.2,5] and Pei-Yoong Lam[sup.1,4]

Plain English Summary

There is limited research on the presentation of males with eating disorders. The overwhelming majority of individuals presenting to specialized eating disorder treatment centers are female; however, there are concerns that eating disorders in males are underdiagnosed and misunderstood. The current study set out to examine the clinical characteristics of a large sample of males who presented for treatment between 2003-2015 at a specialized treatment program for eating disorders. We compared a group of females who had received treatment at this program between 2010-2105 with males who were admitted during the same period. The males who were treated during this period had significant medical complications, with approximately one quarter of the sample presenting with very low heart rate and one third presenting with a low bone mineral density. Sex differences among adolescents with eating disorders also emerged: males were younger than females, and had a younger age of onset than did females. Males were also less likely than females to have a diagnosis of anorexia nervosa or bulimia nervosa. The current diagnostic classification system for eating disorders may not capture some of the eating- and weight-related concerns experienced by males, given the larger proportion of atypical and other eating disorder diagnoses in males.

Background

The published literature on eating disorder presentation in adolescent males has been growing over the past several years. In 2012, a special issue on males and eating disorders was published in Eating Disorders: The Journal of Treatment and Prevention. Male eating disorders were highlighted to be "under-diagnosed, undertreated, and misunderstood" by many clinicians (p. 346), [1]. A small body of literature on the clinical characteristics of males with eating disorders had been established over the past several decades, prior to the publication of this special issue. In one of the largest samples of males with eating disorders (135 adult males), bulimia nervosa was the most common diagnosis, with reports of long delays in seeking treatment [2]. Delays in referrals of males with eating disorder symptoms to specialist services were also highlighted in a sample of adolescents [3].

In contrast to the prevalence of bulimia nervosa in the large adult male sample reported by Carlat and colleagues [2], anorexia nervosa (AN) was the most common diagnosis in a sample of adolescent males, followed by atypical eating disorder diagnoses [4]. In line with this presentation, a sample of 10 males with AN between the ages of 9-22 who were treated in a tertiary hospital setting all presented with very low weight (less than 80% of suggested body weight) [5]. In contrast, in a small sample of males with an early onset eating disorder (i.e., onset at or before age 13), the majority of patients did not meet criteria for AN despite significant weight loss and medical instability [6]. A recent review suggests that the current diagnostic classification scheme for full threshold eating disorders, including AN and bulimia nervosa (BN), may have less applicability for males, given the inclusion of the pursuit of thinness as a prominent feature of the diagnostic criteria [7]. Muscularity-related concerns are one of the purported features of eating disorder concerns in males, which are not currently accounted for in the diagnostic criteria for eating disorders [7]. Muscularity concerns emerged as one of four symptom classes of eating disorder symptom patterns (along with binge-eating/purging, body image, and a mostly asymptomatic group with some muscularity concerns) in a large sample of male youth [8]. The high prevalence of excessive exercise that has been reported in males with eating disorders (e. …

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