As a research assistant at the Columbia Center for Eating Disorders, I spend most of my day speaking on the phone with patients from all over the country calling for treatment. In these phone calls, I hear from patients with a wide variety of diagnoses, from all socioeconomic backgrounds and across the spectrum of genders. Often, men who call express concern that they are alone in their experience as a male with an eating disorder. The reality is that men experience disordered eating and eating disorders more commonly than is assumed. According to a recently published report of a large, nationally representative sample, men with eating disorders make up a smaller portion of the population compared to women, but these data do not diminish the fact that many men consistently struggling with eating disordered thoughts and behaviors. In light of cultural bias against the possibility of men having eating disorders and the shame and alienation many individuals with eating disorders experience, men are much less likely to disclose their symptoms and seek treatment than their female counterparts.
As it turns out, men who engage in eating disordered behaviors share some surprisingly striking similarities to women with these disorders. Central for both men and women with eating disorders including anorexia nervosa, bulimia nervosa, and binge-eating disorder is being overly concerned about body shape and weight. This, and the under-attention paid to eating disorders in men, has meant that historically, there has not been as much research in this subgroup.
Fortunately, the tides are turning in acknowledgment that no one group is fully protected from the risk of eating disorders. A review study of existing research in men with eating disorders fills a few gaps and highlights emerging findings about the role that idealization of muscularity plays across a range of disturbances in eating and eating-related behavior in men. It seems that whereas women tend to engage in behaviors of illness out of a drive for thinness, men are instead often driven by goals of muscularity (Some research has also found links between disordered eating behaviors and the drive for muscularity in women).
Muscularity-Oriented Eating Behaviors
A number of muscularity-oriented behaviors are emerging as especially risky for men. In the review study cited above, data from previously published articles on eating disordered behaviors in men were analyzed and synthesized. Eating behaviors of concern that were highlighted include “bulking, cutting, and cheat meals/days:”
- Bulking phases are imagined to increase muscularity
- The hallmark of this phase is rigid rules surrounding protein consumption-based, for example, on body weight or time of day
- Cutting phases, when almost all dietary energy is restricted, aim to reduce fat and enhance the visibility of muscles
- This phase is also highly likely to reduce muscle mass, leaving people feeling continually dissatisfied with their bodies, and submerging them into a cyclical dieting pattern from which it is difficult to escape
- Cheat meals/days are when those who are engaging in cycles of bulking and cutting allow themselves a meal or day “off” of their plan
- Similar to binge eating episodes, these meals can be planned or spontaneous, and often range from 1,000-9000 calories
- These episodes are occasionally associated with a sense of loss of control as felt by the individual and can also be frequently accompanied by compensatory behaviors such as increased dietary restraint or increased exercise
Implications for Assessment & Research
With a better understanding of distinctions between what drives body shape and weight concern in men and women with eating disorders, the assessment of eating-related thoughts and behaviors has evolved. Many of the original questionnaires tailored to “traditional” eating disorders altogether fail to ask about muscularity-oriented body dissatisfaction. As the field understands more about the presentation of eating disorders in men, new work has been done to develop questionnaires that can capture the experience of muscularity- oriented ideals. Several new measures are being validated and used, including the Male Body Attitudes Scale (MBAS), Bodybuilder Image Grid-Original (BIG-O), Drive for Muscularity Scale (DMS), Drive for Leanness Scale (DLS), Muscle Dysmorphia Inventory (MDI), Muscle Appearance Satisfaction Scale (MASS), and Muscle Dysmorphic Disorder Inventory (MDDI). The Eating Pathology Symptoms Inventory (EPSI) also includes a muscle-building subscale, although the majority of the measure’s subscales focus on more classically defined eating disorder symptoms. Research is ongoing to continue to refine these questionnaires, to help better define the experience of and develop treatments for those experiencing similar clusters of symptoms.
And of course, there are still many questions left to answer about the experience of men who develop eating disorders. For example, some men do express being driven by thinness rather than muscularity and the explanation for these differences remains unclear. The promising news is that with all the work that has already been done to collect and produce research about the male experience eating disorders, we can continue to refine what symptoms we assess, how we ask our questions, and which interventions might help with achieving recovery.
If you or someone you know is struggling with an eating disorder and is looking for treatment, please call the Columbia Center for Eating Disorders at 646-774-8066.