Understanding Anorexia Nervosa in Males

Source: Routledge 2016

Recently, I met with a patient who I will call J. As we walked into my office for our first meeting, J’s thin, fragile body and eyes surrounded by dark circles spoke volumes. The family had decided to speak with a mental health provider after J’s mother found her child’s hair, falling away as a result of malnutrition, in the shower drain. In that first meeting, J described being plagued by worries about being “too fat” as well as a brutal exercise regimen, coupled with a diet highly restrictive in both calories and variety, intended to assuage that fear. In many ways, this is a run-of-the-mill description of a patient with an eating disorder. But what if I told you that J’s full name is Josh, and that he is a 14-year-old boy?

Eating disorders are often thought of as a “female problem.” Even researchers, advocates, and treatment providers who are aware that these disorders affect men and boys are plagued by misinformation. For example, it is often stated that 10% of individuals with EDs are male. As it turns out, this often-repeated statistic is highly problematic. When it was published 25 years ago, it represented the number of men and boys in treatment, not in the general population (Andersen, 1990). In fact, the best available data indicates that males account for 25% of individuals with anorexia nervosa and bulimia nervosa and 36% with binge eating disorder (Hudson et al., 2007). Most disturbingly, recent data suggests that disordered eating practices are, for the first time, increasing at a rate faster in males than in females (Mitchinson et al., 2014).

It is essential that we help clinicians as well as the larger public to grasp the unique concerns of males with eating disorders. At the National Association for Males with Eating Disorders (NAMED), we have been working to advocate for this under-recognized and often stigmatized population. And just this month, my book, Understanding Anorexia Nervosa in Males: An Integrative Approach, was published by Routledge. This book presents a holistic way of thinking about males with anorexia nervosa and guidelines for working with this population therapeutically.

In closing, let us return to Josh. The initial states of treatment consisted of educating Josh and his family about the fact that eating disorders don’t only happen to adolescent girls. A multidisciplinary treatment team, which included a psychiatrist, psychotherapist, and nutritionist, was engaged to address each aspect of Josh’s eating disorder. Josh’s parents were an integral component of the treatment team as well, essential to the process of helping him to normalize his eating and exercise. At the same time, Josh had a lot of work to do on his own. Although it took over a year for Josh’s weight to fully stabilize and several more years of treatment for his attitudes toward food, weight, and shape to fully normalize, Josh did achieve full recovery.