We all have our go-to strategies for coping with stress, and some strategies are healthier than others. I’d like to explore each area in detail, and share how certain strategies impact our eating and provide resources for hope.
Studies have shown that body image concerns can lead to a range of mental health issues, including depression, anxiety, and eating disorders.
Awareness, prevention, education, and treatment are key aspects for mental health wellness. For men, factors such as social norms, reluctance to seek help, stigma, lack of culturally-competent care, or minimization of symptoms can make it difficult to get treatment for these common mental health problems that are prevalent among men.
For those who struggle with body image concerns, this time of year can bring additional challenges and negative thoughts in managing body checking behaviors, comparisons to other people, and being present when engaging in summer activities such as going to the beach.
When you become so preoccupied with food and weight issues that you find it harder and harder to focus on other aspects of your life, it may be an early sign of an eating disorder. Without treatment, eating disorders can take over a person’s life and lead to serious, potentially fatal medical complications. Eating disorders can affect people of any age or gender, but rates are higher among women. Symptoms commonly appear in adolescence and young adulthood.
Eating disorders are a group of related conditions that cause serious emotional and physical problems. Each condition involves extreme food and weight issues; however, each has unique symptoms that separate it from the others.
Anorexia Nervosa. People with anorexia will deny themselves food to the point of self-starvation as they obsesses about weight loss. With anorexia, a person will deny hunger and refuse to eat, practice binge eating and purging behaviors or exercise to the point of exhaustion as they attempts to limit, eliminate or “burn” calories.
The emotional symptoms of anorexia include irritability, social withdrawal, lack of mood or emotion, not able to understand the seriousness of the situation, fear of eating in public and obsessions with food and exercise. Often food rituals are developed or whole categories of food are eliminated from the person’s diet, out of fear of being “fat”.
Anorexia can take a heavy physical toll. Very low food intake and inadequate nutrition causes a person to become very thin. The body is forced to slow down to conserve energy causing irregularities or loss of menstruation, constipation and abdominal pain, irregular heart rhythms, low blood pressure, dehydration and trouble sleeping. Some people with anorexia might also use binge eating and purge behaviors, while others only restrict eating.
Bulimia Nervosa. People living with bulimia will feel out of control when binging on very large amounts of food during short periods of time, and then desperately try to rid themselves of the extra calories using forced vomiting, abusing laxatives or excessive exercise. This becomes a repeating cycle that controls many aspects of the person’s life and has a very negative effect both emotionally and physically. People living with bulimia are usually normal weight or even a bit overweight.
The emotional symptoms of bulimia include low self-esteem overly linked to body image, feelings of being out of control, feeling guilty or shameful about eating and withdrawal from friends and family.
Like anorexia, bulimia will inflict physical damage. The binging and purging can severely harm the parts of the body involved in eating and digesting food, teeth are damaged by frequent vomiting, and acid reflux is common. Excessive purging can cause dehydration that effect the body’s electrolytes and leads to cardiac arrhythmias, heart failure and even death.
Binge Eating Disorder (BED). A person with BED losses control over their eating and eats a very large amount of food in a short period of time. They may also eat large amounts of food even when he isn’t hungry or after he is uncomfortably full. This causes them to feel embarrassed, disgusted, depressed or guilty about their behavior. A person with BED, after an episode of binge eating, does not attempt to purge or exercise excessively like someone living with anorexia or bulimia would. A person with binge eating disorder may be normal weight, overweight or obese.
Eating disorders are very complex conditions, and scientists are still learning about the causes. Although eating disorders all have food and weight issues in common, most experts now believe that eating disorders are caused by people attempting to cope with overwhelming feelings and painful emotions by controlling food. Unfortunately, this will eventually damage a person’s physical and emotional health, self-esteem and sense of control.
Factors that may be involved in developing an eating disorder include:
A person with an eating disorder will have the best recovery outcome if they receive an early diagnosis. If an eating disorder is believed to an issue, a doctor will usually perform a physical examination, conduct an interview and order lab tests. These will help form the diagnosis and check for related medical issues and complications.
In addition, a mental health professional will conduct a psychological evaluation. They may ask questions about eating habits, behaviors and beliefs. There may be questions about a patient’s history of dieting, exercise, bingeing and purging.
Symptoms must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in order to warrant a diagnosis. Each eating disorder has its own diagnostic criteria that a mental health professional will use to determine which disorder is involved. It is not necessary to have all the criteria for a disorder to benefit from working with a mental health professional on food and eating issues.
Often a person with an eating disorder will have symptoms of another mental health condition that requires treatment. Whenever possible, it is best to identified and address all conditions at the same time. This gives a person comprehensive treatment support that helps insure a lasting recovery.
Each person’s treatment will depend on the type of eating disorder, but generally it will include psychotherapy along with medical monitoring and nutritional counseling. Family-based treatment is especially important for families with children and adolescents because it enlists the families’ help to better insure healthy eating patterns and increases awareness and support.
Many people receive treatment for an eating disorder without needing an intensive treatment setting. However, for some people, an inpatient or residential eating disorder treatment center or partial hospital setting is best when they begin treatment. Others may need hospitalization to treat serious problems caused by poor nutrition or for care if they are very underweight.
Support groups, nutrition counseling and medications are also helpful to some individuals.
Psychotherapy should be provided by a mental health professional with experience in treating eating disorders. Because of the complexity, therapy needs to address both the symptoms and a person’s psychological, interpersonal and cultural influences which contributed to the disorder.
Cognitive behavioral therapy (CBT) is often successfully used in the treatment of eating disorders because it helps people understand the relationship between their thoughts, feelings and behaviors. CBT that is developed for the treatment of bulimia is very effective at changing the binge-purge behaviors and eating attitudes.
Wellness and Nutrition Counseling involves professionals helping a patient return to a normal weight. Dietitians and other health care providers can help change old habits and beliefs about food, dieting and exercise with healthy nutrition and eating information and planning. Sometimes planning and monitoring responsibilities are shared with mental health professionals or family members.
Although you may realize that your behaviors are destructive it may be difficult to control them. Treatment can teach you ways to cope. Here are some examples:
Lifestyle. It’s important to begin making changes in your life and remove the reminders and stop negative behaviors associated with the disorder. Resist the impulse to check yourself in the mirror frequently or weight your several times a day. Fight the urge to diet or skip meals.
Steer Clear of troublesome reminders. Identify the triggers–a certain place, challenging situations, some friends-for old behaviors or symptoms and prepare a plan to deal with them.
Accept yourself. Your healthy weight is your ideal weight. Don’t be tricked by ultra-thin models and actresses. Look for healthy role models. Focus on activities and interests that make you feel good about yourself.
Partner with your health care providers. Develop trust and communicate openly. Give your healthcare provider the information they need to help you recover. Don’t skip therapy sessions, and be consistent with meal plans. Ask about vitamin and mineral supplements and which type of exercise, if any, is appropriate for strengthening and rebuilding your body.
Complementary therapies. Alternative and complementary therapies and medicines can have negative or positives effects. Always discuss with your health care providers anything you would like to add to your treatment plan. Weight loss supplements, diuretics, laxatives or herbal remedies are commonly unregulated, and often misused. Other treatments generally considered safe and helpful, including acupuncture, massage, yoga, chamomile tea and biofeedback.
Learn all you can. Read self-help books that offer practical, credible advice. Research helpful topics online, but don’t visit websites that promote dangerous eating habits or showcase very thin, unhealthy bodies, as it could trigger a relapse. For men with eating disorders, check out the National Association for Males with Eating Disorders (N.A.M.E.D.).
Find emotional support from others recovering from an eating disorder. Share your thoughts, fears and questions with other people who have dealt with an eating disorder. Connect with others on online message boards or peer-support groups like NAMI Connection Recovery Support Groups.
If you live with a mental health condition, learn more about managing your mental health and finding the support you need.
Discuss your concerns. If you have concerns about a friend or family member and suspect an eating disorder may be the reason, learn about the different disorders, symptoms and warning signs. When you are knowledgeable, talking with them in a loving and non-confrontational way about your concerns is best. Tell the person you care.
Suggest they see a doctor, counselor or other health professional. This may be tricky, as your loved one may not want to admit or even realize there is a problem, but sometimes seeing a professional who is knowledgeable about eating disorders is the first step in recovery.
Avoid the traps. Conflicts and battles are hurtful. If a person is not ready to acknowledge a problem, you can be a supportive friend. Avoid placing blame, guilt or shame on them about behaviors or attitudes related to the eating disorder. Remember that giving simple solutions minimizes the courage and strength a person needs to recover from an eating disorder.
Be a good role model. Reflect on your attitudes and actions. Do you maintain sensible eating and exercise habits? Also, focus on the other person’s successes, accomplishments or personality.
Parenting. Having a child with an eating disorder places significant responsibility on parents, making them active partners in treatment planning and implementation. Your family needs to feel comfortable and confident in the professional’s approach and abilities, and in discussing the disorder. Finding a mental health professional with experience treating young people or children with eating disorders and their families is important.
Find emotional support. Family support groups provide people with a chance to share thoughts, fears and questions with other people who are in similar situations and understand.
People often think “Eating disorders are a woman’s disease.” This myth is constantly reinforced by character portrayals on television, targeted advertisements, and even studies and articles that draw from exclusively female samples. The sad reality is that eating disorders affect any and all genders, and those who do not identify as female may even suffer more with the very diagnosis of their disease due to the stereotype that eating disorders are feminine. Therefore, although eating disorders affect each individual differently, it is important to consider one’s gender identification in order to increase efficacy for prevention, detection, and treatment of the disease.
Why do men get eating disorders?
While beauty standards for women emphasize thinness, men are taught to prioritize muscle gain. Similar to women’s beauty standards, this fixation on strength derives from cultural gender norms and is perpetuated at a very young age. Throughout the past five decades, the muscles on action figures have been getting significantly larger. Comparable to the physically impossible size measurements of Barbie, the 1998 Wolverine doll had a waist the size of its bicep and half the size of its chest.1 One study confirmed that male college students who were assigned to play with the most unrealistic action figure dolls then reported the lowest levels of self-esteem.2 Another study found that men’s confidence surrounding their physique plummeted after watching music videos that featured hyper-muscular stars. Even more fascinating—researchers still observed this drop in self-esteem after the male participants watched music videos in which the main star did not have outrageous bulging muscles, but rather, was a more realistic depiction of an average (white) American male.3 These unanimous declines in body image indicate that men are deeply susceptible to ingesting harmful media standards, and these standards can take a lifelong toll on their body image.
What do eating disorders look like for men?
These dips in body image can oftentimes lead men to develop an unhealthy fixation on their build or, in some cases, an eating disorder. The estimated rates of men with eating disorders vary. Some studies cite that for every 10 women with an eating disorder there is 1 man with the disorder1, 4, while other studies indicate that 25% of eating disorders occur in men5. The discrepancy in these statistics is due to the fact that many men with eating disorders do not report their disease, due to shame and fear of suffering from a “female” issue. Another stereotype is that the men who are diagnosed with eating disorders are predominantly homosexual. This assumption has been widely disproved, and in fact 80% of men with eating disorders are heterosexual.4 That being said, confusion surrounding sexual orientation can be a contributing cause for eating disorder in some men, so it is important to acknowledge sexuality during the treatment process.
Men can suffer from any and all types of eating disorders, but some of the most prevalent eating disorders among men are binge eating disorders or exercise addictions. As for the former, American culture is actually more accepting of men with binge eating disorder than their female counterparts. This acceptance is positive for men who may avoid emotional scarring from fat shaming, but it is negative for men who are enabled to continue binge eating because their symptoms are not validated as being disordered eating, and therefore they are significantly less likely to seek treatment. However, the severity of binge eating disorder among men should not be minimized. A recent article, which profiled men with binge eating disorders, included testimony from a man whose early life traumas caused him to weigh 724 pounds by the time he was 34 and from another man who gained and lost 100 pounds 4 times throughout his life.4
Exercise addiction, sometimes called Anorexia Athleticism, is also prevalent among men with eating disorders.1 These addictions usually stem from a cultural aversion to softness, particularly in men.6 Many of the behaviors characteristic of this addiction are similar to those of anorexia, including restlessness, physical over-activity, and self-starvation.1 This addiction can also lead men to develop substance abuse problems, particularly with steroids. Over two million men in the United States have reported using anabolic steroids at some point in their lives, and while these drugs do not have any immediate effects, they can have disastrous physical and emotional long-term effects, such as high cholesterol, depression, and prostate enlargement.1
How do we treat men with eating disorders?
Because there are so few studies on men with eating disorders, there is not enough substantive literature that indicates how (or if) eating disorder treatment should vary between men and women. However, there are some known factors to bear in mind when treating male eating disorder clients. While women are more susceptible to developing eating pathology if they have a history of feeling fat, men have a much greater risk of developing an eating disorder if they were actually obese during childhood.1 Additionally, men who have a history of sexual trauma are more prone to develop an eating disorder due to the body image disturbance that can occur as a result of their abuse.1 Men who experience a sexual assault can also develop a drive to build their muscle mass because they believe that becoming stronger and more masculine will make them more prepared in the event of a future threat.1 Additionally, depression can be a major cause of eating disorders, but since depression is also stigmatized as a “feminine” disease, it can go severely underreported.1
Men who have confusion surrounding their sexuality may find comfort in starvation, especially because anorexia can lower their testosterone levels and lead to asexuality, so by wiping out their sexuality altogether they no longer have to cope with the internal worry.1 However, this can make treatment much more difficult because regaining weight will unleash any sexual feelings they may have been repressing, which restarts the sexual discovery many men dread. Eating disorders are also common among men who identify with an “undifferentiated” or “feminine” gender role. Therefore, understanding the sexuality and gender of a male patient is imperative in order to grasp the underlying influences for one’s eating disorder.
Finally, many male eating disorder clients who engage in excessive exercise have Muscle Dysmorphia, which is categorized as an obsession with one’s body or muscle size.1 However, since there are no official diagnostic criteria relating to food or diet, it is not technically considered an eating disorder, even though the symptoms and treatment suggestions are almost identical to those for eating disorders.1 Therefore, treatment practitioners must be able to identify the ways in which Muscle Dysmorphia manifests and may contribute or cause an eating disorder.1
Although there is still major progress to be made in the depiction of eating disorders as diseases that affect all genders, there is promising evidence to suggest that men can successfully recover from eating disorders. However, because men are taught a completely unique set of beauty standards, their eating disorders manifest in many different ways and they require specialized treatment that reflects these cultural gender differences. The sooner we abandon the stereotypical notion that eating disorders exclusively affect one group of people, the quicker we can pave the way for reduced stigma, access to recovery, and a bright future for all eating disorder clients.
http://www.emilyprogram.com/blog/eating-disorders-in-men
Trigger Warning: Eating Disorders
The holidays can be stressful for someone who is struggling with an eating disorder. We get it. A lot happens this time of year—extra family time, busy schedules, social gatherings—and most of it centers on food.
To help you prepare for the upcoming holidays, our staff has come up with some tips and words of encouragement. Add any or all of them to your recovery tool box for Thanksgiving and other upcoming holiday events.
Wishing you all a happy holiday season!
