Saturday, February 8, 2014

The 'Other' 25%: Males with Eating Disorders, by Paul Gallant

My views expressed in this brief article are based on my clinical experience, research and leadership that include supporting health care teams and health agencies. These teams and agencies have helped people with mental illness and particularly eating disorders. My views are also based upon direct individual and group work with persons who have eating disorders – including males with eating disorders.

Eating disorders, as many readers will know, are complex mental disorders that may have serious health consequences and negatively impact quality of life. For example, anorexia, one form of eating disorder has the highest mortality of all mental illnesses. If past statistics continue to represent the future, which we hope in the case of anorexia, they do not, as recent studies demonstrate that one in five persons with anorexia will die as a result of the disorder or its complications. Certainly this number would seem far too high to ignore.

Yet, much of our society, including health professionals fail to recognize or suspect eating disorders in females or males despite the sometimes apparent medical signs, symptoms and the impact of eating disorders upon society. The difficulty to easily “detect” eating disorders in both males and females, the delayed supports as a result of later recognition, plus the often delayed awareness of friends and families, does not exactly help support earlier awareness of the illness- whether a male or female.

Many readers may be surprised that the earliest medical descriptions of eating disorders, by Richard Morton, included a 16 year old boy with anorexia in 1689. Recent studies suggest that more than one in four cases of eating disorders occur in males, yet males are under represented in eating disorders’ treatment, eating disorders’ public information and in eating disorders’ research. Males are known to have all forms of eating disorders including: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified (EDNOS). We know that some males with eating disorders:

• Were teased and/or bullied as a child • Have low self-esteem • Were overweight as a child • Have a drive for muscularity or a drive for thinness • Have co-morbidities such as substance use and depression • Cope emotionally

Who are these men and boys with eating disorders? Sometimes they are a brother, a son, a husband, a boyfriend, a father, a coworker, a student, a boss and of course oneself. Speaking of the twenty or so males I have worked with plus the many I have researched, in what limited research exists, there is at least this common theme. Each male with an eating disorder is an individual. An individual who seeks to be understood without judgment, and who often wants to recover though is uncertain how to begin without any consistent help from health care resources.

“They” cross many cultural, age and socio-economic categories. A 10 year old boy with anorexia to a 75 year old retiree with binge eating disorder, both are included in my limited understanding of the experiences of some males with eating disorders. It is also my understanding that both females and males with eating disorders are ambivalent or hesitant to seek help at various stages of their illness for many complex reasons including loss of control, trust, personal identity, and readiness to change.

Males with eating disorders may be reluctant to seek help for a variety of additional reasons compared to females with eating disorders. The reasons that men reluctantly seek treatment or help include traditionally held ideas of masculinity. Eating disorders present an additional stigma to males. Males with eating disorders may struggle with the added misperception that eating disorders are a “female only” illness.

Resources and supports that help males with eating disorders work towards recovery continue to be lacking. Often those resources that do exist are sometimes located in facilities typically identified with women or with children though indicate they are “open” to serving men as well.

In my view, we need to increasingly focus on health promotion and self-esteem. By building upon community based approaches services that include an increased awareness and early detection of eating disorders in males and females. This includes providing adequate early education in primary schools and support to family doctors and nurse practitioners to help people who have eating disorders. Evidence supports other services in the community including comprehensive approaches to obesity that do not polarize one disorder or illness against another, wellness approaches to whole self, support groups, peer-support, counseling, family therapy, and in certain instances specialist services.

I welcome your comments, feedback and alternative views.

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