Reprinted from Eating Disorders Review
July/August 2001 Volume 12, Number 4
©2001 Gürze Books
Because eating disorders are more commonly reported among women than men, it has been argued that the illnesses must be atypical in men and that there may be something different about males who develop an eating disorder, such as homosexuality.
The results of a large Canadian study dispute these arguments. After evaluating men with full or partial eating disorders, women with eating disorders and men without eating disorders in a community study, researchers found few differences between men and women with eating disorders. However, they reported striking differences between the men with and those without eating disorders (Am J Psychiatry 2001; 158:570).
The study compared 62 men with eating disorders with 3,769 men with no eating disorders and 212 women with eating disorders. The subjects were identified from a community epidemiologic study in Ontario, Canada. (Mental Health Supplement to the Ontario Health Survey). Subjects were interviewed in person by trained interviewers using the Composite International Diagnostic Interview, which generates both DSM-III-R and International Classification of Diseases (ICD-10) diagnoses. The government-sponsored study did not investigate sexual orientation.
The presence of a lifetime full or partial eating disorder was defined in the same way for men and women. Criteria for anorexia nervosa included abnormally low body weight (15% below the Canadian standard weight for age and height), overconcern with weight and shape, a self-perception of being overweight when others felt the person was too thin and, for women, 3 consecutive missed menstrual periods.
For partial syndrome anorexia, the subject had to meet the low body weight criterion but could have one negative response to the remaining criteria. A diagnosis of full and partial syndrome bulimia nervosa required recurrent episodes of binge eating; to meet the criteria for full syndrome, the subjects had to have been binge eating at least twice a week for 3 or more months before the study.
Prevalence and gender
The prevalence rate (weighted) of full and partial eating disorders for men was 2.0%, compared with 4.8% for women. For full or partial anorexia nervosa, the female: male ratio was 2.0:1; for full or partial syndrome bulimia nervosa, it was 2.9:1. There were few differences in rates of comorbidity between men and women with eating disorders, aside from expected gender-specific rates of higher depression among women and higher substance abuse rates among men with eating disorders.
The rate for full syndrome eating disorders (anorexia nervosa and bulimia nervosa combined) in men was 0.3%, compared with 2.1% in women. There was a significant difference in the overall rates of full and partial syndrome in men and women; when broken down by type of eating disorder, the most marked differences were lower rates of full syndrome bulimia in men than in women; the reverse was true for partial syndrome bulimia.
Men with eating disorders and those without
The men with eating disorders had more psychiatric disorders and appeared to have greater dissatisfaction with life than the men without eating disorders. The authors point out that the significantly higher rates of psychiatric diagnoses in men with eating disorders could be explained as a consequence of the eating disorders, but could also represent a factor leading these men to be more vulnerable to the development of an eating disorder. The quality of life of men with eating disorders was not as good as that of men without, which is an understandable reaction to the existence of a serious chronic illness such as an eating disorder—rather than to factors that might have existed before the eating disorder developed.
In the past, eating disorders were assumed to be gender-bound and, because they were so rarely reported in males, it has been suggested that there must be something different about males who develop an eating disorder. Most larger controlled studies of men and women with eating disorders have shown few differences in clinical presentation, psychometric measurements, or treatment response (J Psychosom Res 1994;38:471).