male anorexia is a topic that is not talked or written about very much. anorexia in men is reminiscent of males with a history of sexual abuse, another topic that is underdiscussed, underreported and undertreated. perhaps one thing that they both have in common is a perception of weakness (a very real problem in anorexia, as we’ll see in a later post on this topic). while our ideas and concepts around gender are becoming more and more fluid, at base, the societal image of the male is unfortunately still one that needs to show unequivocal strength, will and power.
here are some findings from a study of male anorexia.
anorexia nervosa is a serious problem that affects over one million males yearly. it is often misdiagnosed and overlooked completely in clinical, medical and school settings because of the misperception that it is a disorder exclusively present in females. the DSM-IV largely contributes to this misnomer due to the gender-biased criteria. for example, one criterion is cessation of monthly periods.
the purpose of this study was to identify the etiology (i.e. causation and history) and clinical characteristics of male anorexia and devise a more comprehensive definition of anorexia nervosa that encompasses both males and females.
an additional purpose was to develop an instrument that identifies risk factors associated with anorexia nervosa in males and aid mental health and medical practitioners in making this diagnosis.
the assessment of anorexia nervosa in males questionnaire (AANMQ) was developed for this study to assess an expert panel’s clinical observations regarding potential misdiagnosis and treatment gaps among males with anorexia nervosa. this panel included one male anorexic, one parent of an anorexic male, and eight mental health and medical practitioners who were selected based on personal and clinical experiences working with male anorexics.
excerpts from the panel’s findings and literature review include these characteristics:
- experts and literature agreed that a distorted body image is characteristic of male anorexia, patients and family did not
- most did not feel that distored body image resulted from a “psychotic-like” mental orientation
- all agreed that anorexia is accompanied by depression. other mental health difficulties that were proposed by some were borderline, obsessive compulsive, avoidant, and dependent personality disorders, posttraumatic stress disorder, and anxiety
- some of the professionals felt that alcohol abuse was part of the problem but most, including patients and their families, felt that was not the case
- similarly, some of the professionals found drug abuse to be a problem but patients and family had not experienced it
- there was no consensus as to whether sexual identity was an accompanying problem
- in terms of physical health consequences, male anorexics seem to experience the same as females, e.g. cardiac and kidney problems, electrolyte imbalances, impaired metabolism, osteoporosis, and gastrointestinal difficulties.
another topic discussed was noncompliance with treatment.
the mental health professionals reported the male anorexic, much like his female counterpart, is often a non-compliant patient who denies having a problem, is resistant to treatment, fails to follow-up on outpatient appointments, and is deceptive in his report of what he eats.
the medical group was divided in their responses to non-compliance and the manner in which it is displayed. the RN and pediatrician both agreed that the anorexic is seldom an accommodating patient but that this is a recognizable feature of the illness.
the psychiatrist and the dietician, however, report that the male anorexic patient is often desperate for treatment and willing to work on his issues. the dietician further remarked that female anorexics are “pleasers” and will “eat their way out of the hospital” only to return again, but male anorexics appear more eager to deal with underlying issues that contribute to the anorexic behavior.
the members of the patient/family group reported noncompliance was not applicable to their experience with any treatment staff in either an inpatient or outpatient basis.
the latter seems logical – if noncompliance had been an issue, the patients and families probably would not have participated in the study in the first place.
in the next instalment on this topic i will give you a summary of the questionnaire and talk some more about the issue of weight itself.