Dangers of Beauty
Beautiful people everywhere…what new club or exotic resort destination can boast this tag line? Your kitchen before the second sip of coffee. Whether we are skimming a magazine, surfing the web, or flipping channels, images of thin women and muscular men without much body fat, are likely to bombard our psyches. While the majority of Americans have increased their waist sizes, the aesthetic ideals promoted by swimsuit and organic health shake ads alike are leaner than ever before.
Men and Eating Disorders
Body image issues surrounding our weight or body shape are very common. And there are huge industries bolstered by our obsession with becoming or staying thin, “fighting” aging and becoming more muscular. For decades women in the United States have increasingly suffered with eating disorder symptoms. Younger and younger females are presenting with severe symptoms, and many men and boys are also receiving diagnoses and treatment for eating disorders. Without question, women have suffered in greater numbers from eating disorders than men. Yet it has been important in recent years for treatment providers to begin to recognize the growing need for awareness of the increasing number of men suffering from these issues. In addition to more men developing eating disorders, there are other hurdles for men regarding eating disorders.
Anorexia Nervosa and Men
Many clinicians are not socialized in their training to assess for eating disorder symptoms in men. Even more striking are gender based diagnosis problems like amenorrhea, being listed as a symptom of Anorexia Nervosa. Clearly men are not ever going to lose their menstrual cycles. Not only does this complicate a diagnosis- it skews the way clinicians see potential sufferers. And as we can imagine it shapes how men who suffer may see their own problems- as something not masculine.
Male Shame
Shame and embarrassment accompany many mental health issues, and eating disorders are no exception. But, these distressing emotions may be even more frequent and intense for men suffering from an eating disorder. While the norms have been changing, eating disorders are still not something that many men people admire have admitted to having. Without any cultural models of someone we respect admitting they suffered and recovered, it makes it more difficult for men to come to terms with the problem and get help.
Combined Obstacles to Treatment
So we have a man who is likely confused, ashamed, and embarrassed with his suffering. Men are already at baseline less likely to share feelings or ask for help from a mental health professional, and that makes diagnosis less likely. Even if an accurate diagnosis and the motivation exist, men often still struggle to find treatment providers. There are obvious reasons, but the majority of eating disorder specialists have had much more experience treating women. Likewise many outpatient groups and even residential eating disorder treatment centers are not equipped to treat men.
Causes of Increase in Male Eating Disorder Diagnoses
It is unclear how much of the increase in male eating disorders is about improvements in clinician diagnosis, increased willingness of men to share symptoms, or changes in the culture that have increased the actual prevalence of symptoms. Hopefully professionals will become more attuned to looking for signs and asking men important questions that reduce embarrassment and shame, and eventually build the trust necessary to express the suffering that is a hallmark of eating disorders. While it is unclear what is causative, there does seem to be a correlation between how men have been depicted in magazines and the increase in eating disorders. Men pictured with their shirts off in magazines increased 11 times from the 1950s to the 1990s. It isn’t clear whether these images are causative or reflective, but it is clear that men’s behaviors have certainly changed over time and that has resulted in changes in their physiques and the numbers diagnosed with eating disorders.
Eating Disorder Research
My hope is that Eating Disorder research will continue to get the funding it needs, and that includes evaluating public policy and educational programs. Changes requiring models to be above a Body Mass Index (BMI) in some European countries are an interesting proposal. If these and other policy changes could be implemented long-term and if evaluations of their impact are significant, it could be a feasible method for preventing the development of the number of eating disorders we are seeing now.
Effective Eating Disorder Treatment
Unfortunately, in terms of treatment, Anorexia Nervosa is still very difficult to treat. But it is critical that anyone experiencing symptoms seek treatment. The Maudsley Family Based treatment approach has some of the best results. Although the clinical and research communities have a long way to go, people with an Anorexia Nervosa diagnosis are well advised to engage a professional for treatment. On a more optimistic note, the scientific literature demonstrates that Bulimia Nervosa and Binge Eating Disorder (BED) are very responsive to treatment. Cognitive Behavior Therapy (CBT) has been effective at treating both of these eating disorders. So if anyone believes she/he may be experiencing distress around eating behaviors and body image issues, I strongly encourage them to contact a qualified psychologist, mental health counselor, social worker, or medical professional with experience using empirically supported treatments for eating disorders.
Despite the obstacles for anyone, male or female, suffering with an eating disorder, there are good reasons for optimism. Aside from the good efficacy rates for Bulimia Nervosa and Binge Eating Disorder, more and more clinicians are being sensitized to the problem. This has been reflected in a few residential treatment centers designing programs that are appropriate for men, and societal attention to the impact our overvaluation of beauty may be having on body image and eating behaviors. There are also a number of research labs investigating integrating different treatment modalities in hopes of finding a more effective treatment for Anorexia Nervosa. Dissemination of cognitive behavioral therapies (CBT) and behavioral therapies to greater numbers of clinicians, who in the past may have hesitated from treating patients, or who may have been using techniques that are not helpful. So greater numbers of sufferers should have access to properly trained therapists. The first step is opening up to the possibility that the suffering may be treatable- and then asking for help.