Frequently Asked Questions Friday
This weeks question is:
How does treatment differ for males?
This is a great question, and one that does not receive enough attention or discourse. Males are and have been left out of the eating disorder discussion for far too long. As a society, and sometimes even as health professionals, we tend to hold the mistaken belief that males do not struggle with body image, or that they cannot develop unhealthy relationships with food. This is simply not true. The percentage of males that report struggling with eating disorders has been on the rise for years, but my argument is that our current understanding of percentages and numbers is likely very inaccurate, due to underreporting. There is still that strong societal belief that eating disorders are “female illnesses,” which leads a lot of male sufferers to feel shameful and stay silent about their pain.
One important factor to note is that many males develop their eating disorder along their journey to become “fit” versus simply thin. Our society currently holds a different fitness ideal for males than for females. “Fit” for men may imply more of a high muscle-low fat ratio. Currently, the pressure for males to achieve this body-to be “cut”-is astounding. However, this body type is not natural or attainable for the majority of the male population. The term “muscle dysmorphia” has been coined to describe this preoccupation with less fat and greater muscle definition. Hence males can begin to fall prey to the very same behaviors that females do. This shift can be tricky to identify at first, due to the fact that the original intention was not necessarily weight-focused. However, for many of these male eating disordered sufferers, their focus gets lost and the relentless pursuit of thinness takes over. The sport or activity that was once enjoyed then becomes an obsession.
Similarly, males tend to struggle more with legal performance-enhancing supplements — things like whey protein, creatine, and L-carnitine. Studies have shown that the use and abuse of such supplements is on the rise, and up to 22% of males stated that they had replaced meals with said supplements in the quest for a lean frame and large muscles. This behavior is dangerous, eating disordered, and rooted in low self-esteem- however it goes largely unnoticed by the majority of our society. In fact, the use and abuse of supplements seems to be considered somewhat normalized behavior at this point. This is quite problematic because these supplements have been linked to the development of eating disorders, and normalizing their abuse contributes to the trend of ignoring male disordered eating behaviors.
It is also important to note that, just as the thin ideal does not contribute to all eating disorders among women, current male fitness trends do not factor into all male eating disorders either. Many males report experiencing the very same influences as females- bullying, a drive for perfection, a quest to disappear, a desire for control, a need for numbness, a history of trauma-when conceptualizing their eating disorders in treatment. Therapy and treatment must include room for males to explore this part of their eating disorder, instead of simply focusing on body dissatisfaction with a focus on fitness trends.
At the inpatient or outpatient level, male-only groups tend to be helpful. This is because males have concerns regarding social issues, family dynamics, and body image that are vastly different than those of females. Male-only groups are helpful in that they allow males to specifically discuss and lend support around the stigmatization factor to one another. This is not to say that mixed-gender groups cannot be helpful as well. In the end, everyone is suffering with an illness that falls under the same umbrella, so support and camaraderie in general is a healing experience.
Research also suggests that a focus on gender dynamics overall in the treatment for males with eating disorders is important. Individual and societal perceptions of masculinity likely affect one’s experience of disordered eating, and must be explored. Masculinity has been correlated with more negative attitudes toward obtaining mental health help, and may contribute to the reason that males make fewer attempts at seeking help. Hence a therapist may identify this as something to explore further.
Other parts of treatment are comparable across genders. For example, treatment outcomes are similar. The basic principle of treatment (i.e. weight restoration, disrupting maladaptive behaviors, challenging thoughts related to weight and shape) also remain the same. For a more detailed analysis of this, I would suggest looking into the article “Males and Eating Disorders: Gender-Based Therapy for Eating Disorder Recovery,” found in Professional Psychology: Research and Practice, by Greenburg and Schoen.
I believe that if we continue to raise awareness and educate others about the fact that males can and very much do get eating disorders, the intervention and treatment for males will improve drastically. Currently, there are still far fewer treatment center options for males than there are for females. But as awareness continues to spread, more and more centers are beginning to not only accept males, but also provide specific tailored treatment or “male tracks.” This is encouraging progress. There is also NAMAD- The National Association for Males with Eating Disorders, which provides resources, inspiration, support, and articles for males
Conclusively, we still have a long way to go in terms of our awareness and inclusion of males in the eating disorder conversation. But the conversation has begun, and this alone is great progress. Lets keep it going!
Colleen Reichmann is a licensed clinical psychologist, specializing in the treatment of individuals with eating disorders, body image issues, self-esteem issues, and women’s issues. She lives in Virginia Beach with her husband, goldendoodle and (brand new!) sheepadoodle.
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*The views expressed in this posting are based on this writer’s professional knowledge, training, and experience in accord with current and relevant psychological literature and practice. These views do not indicate that a professional relationship has been established with any recipients. Readers should consult with their primary medical professionals for specific feedback about any and all questions.