Historically, eating disorders have been considered the domain of women and girls. However, this concept appears to be somewhat outdated, with the growing diagnosis of men living with these life-threatening illnesses.

While anorexia nervosa has received significant attention since the ‘70s, the focus has mostly been on young girls and to date, the disorder has been grossly under-recognised and under-treated in men.

Statistics typically report the incidence of anorexia nervosa as 1-in-10 males. However, recent population studies on adolescents suggest an equal number of men and women are living with the illness in this particular age group.

The stark reality is, when men, of any age, develop anorexia nervosa, the result is a more severe, obsessive

form of the illness which is often taken to an extreme degree, and can even result in death.

According to Dean of the School of Psychology, Flinders University, Adelaide, and key investigator in the Anorexia Nervosa Genetics Initiative (ANGI) – the world’s largest and most rigorous genetic investigation into the illness – Professor Tracey Wade, PhD, eating disorders in males may be increasing at a faster rate than among females and this may be a direct result of a more ‘toxic’ advertising environment.

“In the last five years, there’s been a rapid increase in advertisements propelling an ideal male figure into the mainstream and pegging it against the misguided benchmarks of a perfect female form.

“Campaigns that are based on muscly and taut figures of men, some of which are shockingly almost pornographic, conveying messages that how people look will win love, fame and acceptance, can certainly act as triggers for men who have a predisposition to eating disorders,” Prof Wade said.

“We’ve seen data from former Soviet nations and from the Pacific Islands showing a definite hike in eating disorders following westernisation, and it’s fair to say our social environment is a key activator for anorexia nervosa.”

What’s important to note, is that men who have anorexia nervosa share the same fears as women regarding weight gain and obesity.

“A need for perfection, an obsessive personality, a desire to be in control or alternatively, feelings of ineffectiveness, alienation and inability to cope with life’s challenges, appear just as commonly in men with the illness, as in women,” said Prof Wade.

“Traditionally, however, men have had a greater number of ways to exhibit ‘control’. Men have been able to hunt, to kill or to bring home the pay packet for centuries. So possibly, this influenced the greater number of women seen with anorexia nervosa in the past.

“To stop eating is widely available to everyone. Fasting, having control of food intake, is an ideal that can be as relevant to men as it is to women, boys or girls,” Prof Wade said.

While anorexia nervosa is typically first seen in adolescence, there is a peak in people transitioning from childhood, and again from adolescence to adulthood. Feelings of inadequacy or lack of coping mechanisms, lead to a control through food restriction.

In the post-feminism era, gender equality may be closing the gap on gender imbalance in terms of anorexia nervosa figures between the sexes. However, so too, may the diagnostic criteria being used.

Up until last year, Prof Wade says diagnostic criteria for eating disorders were based on female traits, such as not menstruating for three months, which clearly excluded men and have only recently become gender neutral.

“It’s more about being thin or not being big for men. It’s not about being skinny per se. Low weight is a criterion, but men are also more likely to fall into the ‘binging anorexia nervosa’ group, whereby they restrict food intake, then binge and purge, and engage in driven exercise.

“Where men do not meet the criteria for anorexia nervosa itself, they may meet eating disorder criteria that impact their quality of life, their ability to relate to other people, and to manage their day-to-day activities,” said Prof Wade.

“Spending a lot of time in the gym, taking supplements to achieve a lean, honed physique, known as muscle or body dysmorphia, is only recently being discussed as a possible classification of an eating or psychiatric disorder.”

Participant in the ANGI study, 30-year-old Melbourne solicitor, Nicholas, described living with the illness as a man, as ‘being out of place’.

“I found it incredibly isolating to be a male with anorexia nervosa, given so much of the coverage and treatment at the time related to women.

“I felt out of place as the only male patient at an eating disorder clinic, where the pressure to regain weight and to eat was so overwhelming, I ended up developing bulimia nervosa in its place,” Nicholas said.

Men typically have a more difficult time when it comes to treatment. A lot of men with anorexia nervosa fear stigmas that may be attached to the perceived ‘women’s disease’, such as being branded as gay.

“While improving screening for identifying anorexia nervosa is important, we also need to look at dealing with stigma,” said Prof Wade.

“Many men fear people may suspect their sexuality. Having a feminised disorder makes it even more difficult for men to be diagnosed and treated.”

Studies such as ANGI aim to reduce the stigma for men living with anorexia nervosa, by elucidating the genetic component to the illness.

Pinpointing genes that predispose men and women to the illness will enable a greater understanding of the illness, its vulnerabilities and triggers, and allow health professionals to identify and treat men and women living with anorexia nervosa more effectively.

If you are a man living with anorexia nervosa, or have recovered from the illness and wish to contribute to groundbreaking research, register for the ANGI study:

• Visit www.angi.qimr.edu.au
• Email angi@qimrberghofer.edu.au
• Freecall ANGI on 1800 257 179.