A Review of Eating Disorders in Males

Anu Raevuori; Anna Keski-Rahkonen; Hans W. Hoek

Disclosures

Curr Opin Psychiatry. 2014;27(6):426-430. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Research in eating disorders in males has been active lately compared to the past. This review aims to provide an overview of the recently published studies of eating disorders in males.

Recent findings Publication of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition has outlined more sex-neutral diagnostic criteria for eating disorders. Data of socioeconomic factors, prenatal influences, clinical characteristics, assessment, and mortality for eating disorders have been reported independently for males. Unlike in females, higher parental education showed no association with eating disorders in males, but twin or triplet status and lower gestational age at birth had an independent association with anorexia nervosa in males. Contrary to earlier suggestions, no differences in eating disorder symptoms such as binging, vomiting, or laxative abuse were observed between the sexes. Yet, males tended to score lower on eating disorder symptom measures than females. High rates of premorbid overweight and higher BMIs at various stages of eating disorders have been confirmed repeatedly. Higher age and lower BMI at admission, and restrictive anorexia nervosa subtype predicted fatal outcome for anorexia nervosa in males.

Summary Contemporary research provides grounds for improved recognition, diagnosis, and treatment for males suffering from eating disorders.

Introduction

Eating disorders in males are no longer a niche topic.[1–4] An important milestone was the revised diagnostic classification Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)[5] published in 2013. The diagnostic criteria for anorexia nervosa and bulimia nervosa were broadened, and binge eating disorder (BED) was included as a new diagnostic entity.[6,7] This has particular relevance for males, whose eating disorder symptoms tend not to fit into stringent categories.[8] However, there is still much room for improvement in treatment, recognition, prevention, and reducing stigma of eating disorders among males.[2,9]

This review aims to provide an overview of the recently published studies on eating disorders in males. To review the literature, we searched for articles using PubMed and Ovid MEDLINE(R), using the terms 'eating disorders', 'anorexia nervosa', 'bulimia nervosa', 'binge eating disorder', 'male', and 'men'.

Lifetime Prevalence and Sex Distribution

Eating disorders have a highly skewed sex distribution.[10] The lifetime prevalence of anorexia nervosa is 0.16–0.3%,[11–14] of bulimia nervosa 0.1–0.5%,[12,14] and of BED 1.1–3.1% among men.[12,15] The rate ratio of lifetime prevalence of anorexia nervosa and bulimia nervosa in males vs. females is often reported to be equal or less than 1 : 10,[16] but the figures likely reflect clinical underdetection among males. Epidemiological studies report higher variation: for anorexia nervosa, 1 : 3–1 : 12, and for bulimia nervosa, 1 : 3–1 : 18.[11,12,14] In BED, the male to female rate ratio is more equal, 1 : 2–1 : 6.[12,15]

Risk Factors, Clinical Presentation, and Comorbidity

Eating disorders in males differ somewhat from females in risk factors, clinical presentation, comorbidity, and consequences. Homosexual orientation associates with an increased risk of eating disorders in men.[17] Premorbid overweight is common compared to females,[1,18] and when studying body dissatisfaction in men, it is important to distinguish weight and muscularity concerns[19] as both are common in males,[20,21] and share overlapping features related to vulnerability and behaviors.[21,22] Athletic achievement and excessive exercise appear crucial features among men,[2,23,24] and the rates of psychiatric comorbidity are higher among men than among women.[13,18] Regarding consequences of eating disorders, males may be subjected to double stigma; the stigma of a psychiatric disorder, and an additional stigma of suffering from what is commonly perceived to be a female-specific disorder.[9,25]

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