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Gender Differences and Eating Disorders

Marya Wegenka

Eating disorders have become a part of the culture in which we live. Eating disorders affect people of all socioeconomic classes and both genders. The overall prevalence of eating disorders is 5% (Tenore 2000). The drive to be thin and the desire to be thin are reflected on television, in magazines, and in the movies. We as a culture are inundated with diet ads, diet products, and ways to lose weight. The message is you can never be too rich or too thin. Little girls are brought up playing with Barbie, who’s body proportions are unachievable. There is no question that women in society are told that to be beautiful is to be thin.

Eating disorders are more prevalent among females, but males also suffer from eating disorders. Not until last year, when a male friend revealed that he had been anorexic, did I realize that males also are pressured to have or maintain a certain body image. The questions that I will try to answer in the rest of this paper will look at eating disorders in males. How are eating disordered males similar to and different from females with eating disorders? Are men pressured in the same ways as women to achieve similar body shapes, or do males experience different pressures to obtain a different ideal body?

In 1689, the first case of an eating disorder in a male was recorded. The patient, a 16 year-old had "nervous consumption" (Carlat, Camargo & Herzog 1997). Today there are more reported cases of males with eating disorders. The literature and research on eating disorders still focuses on females, and the research on males is few and far between. One example of this can be found in Surviving Eating Disorders, a book about strategies to identify and deal with eating disorders in a family, the authors assume that the family with the disorder is female and refers to the patient as "she" throughout the book (Seigal, Brisman & Weinshel 1988). The explanation for this disparity in available literature is that males constitute only a small part of the eating disordered population.

Males account for 10% - 15% of bulimic patients, meaning that 0.2% of all males meet the criteria for a clinical diagnosis of bulimia (Carlat, Camargo & Herzog 1997). Males account for 5%-10% of anorectics (Braun, Sunday, Huang &Halmi 1999). It is believed that 40% of binge-eating disorders occur in males (Russell & Keel 2002). The number of reported cases on males might be significantly underreported, because men may be reluctant to seek help thinking that eating disorders only occur in females or fail to recognize the problem as an eating disorder.

Most of the research agrees that eating disordered males are similar to females in the age of onset of the disorder, dissatisfaction with body, and in weight control methods. However, the onset of eating disorders is earlier in females than in males. (One of the explanations proposed for this difference, is the fact that females start puberty before males.) Many studies also agree that the similarities between males and females with eating disorders are greater than the differences. The rest of this paper will explore the eating disordered male and when appropriate will be compared to the eating disordered female. Media influence, bulimia, anorexia nervosa, binge eating disorder, homosexuality, and several general studies on pre-adolescent, adolescent, and adult males will be discussed.

Media and society do influence men and women’s perception of the ideal body image. Bandura's social learning theory says that people learn behavior through observation and modeling. This theory was used as the framework for a study conducted by Harrison and Cantor (1997) to look at the influence that media has on eating disorders among both male and female college students. They found that the exposure of women to the thin ideal portrayed in the media did influence disordered eating. In males, exposure to the thin ideal portrayed by the media, led to thinness and dieting in males. Miller and Pumariega (2001) report that men that develop eating disorders share in the dissatisfaction with their body image that women experience.

There is a larger social emphasis on the ideal female body, which would help to explain why more women develop eating disorders. Males in certain social situations where body weight and shape are important have an increased risk of developing eating disorders and body dissatisfaction. Wrestlers and jockeys are two examples of groups of males that are pressured to maintain a certain body weight.

A study conducted by Leit, Gray & Pope (2001) looked at how the ideal male body is portrayed by the media. This study’s objective was to look at how the images portrayed by the media affected males’ opinions about their appearances. This study consisted of 82 male undergraduates at a private university. There was a control group and an experimental group. Participants were told that they were going to be shown slides, and they would later be asked to remember. The control group saw neutral slides that did not focus on the body or had no humans in them. The experimental group had some 10 neutral slides and 20 slides with the ideal male body image. Then the participants used a computer program that allowed them to adjust the pictures of the men in the advertisements to make them more or less fat and muscular. The participants were told to make the figures look like their current body shape, their ideal shape, average shape of other men, and the way they believed women wanted them to look.

The results of this study showed that the men in the experimental group had a significantly larger discrepancy between their current and their ideal weight and between their current and the average man’s. There was not a significant difference found between current weight and what women want. The differences were related to musculature, but not to body fat. These results suggest that media influence of muscular male figures in advertisements create body dissatisfaction in men. This study shows a difference in men and women in that women in our culture would probably believe that men desired something different than their current weight, and that men would want the thin ideal body image.

Males account for 10% - 15% of bulimic patients. It is estimated that 0.1% -0.7% of adolescent males and young men have bulimia nervosa. In comparison, females have a higher prevalence of 1.1% - 3.5% (Russell & Keel 2001). Males and females share the same bulimic symptoms, but boys and men have different concerns and feelings about bingeing and purging. Males are less likely to be depressed or feel guilty after a binge. It may be that bingeing is more acceptable for men, because men are expected to eat more than females.

A study conducted by Ricciardelli, Williams & Kiernan (1998) looked at the differences in the factors that describe the overall symptoms of bulimia in male and female adolescents. The participants consisted of 427 girls and 350 boys between the ages of 12 and 17. The Bulimia Investigatory Test (BITE) was used to assess 30 symptoms using yes/no questions (i.e. Do you experience urges to eat and eat?). The results found one general pattern to describe bulimic patterns of girls, but boys were found to have two possible patterns of symptoms for bulimia. The two patterns that describe bulimic patterns for boys include "emotional and rigid/disruptive eating style" and "food preoccupation and bingeing". The males do not fall into the general pattern that females do, because males are less likely to diet or want to lose weight, and are more likely to use bulimia as a way to deal with stress or negative affect.

Anorexia nervosa is the least common of the major eating disorders in males. Males only account for 5% to 10% of all anorectic patients. There is not much research on males and anorexia, and even fewer on medical complications that result from anorexia. Siegal et al. (1995) addressed the medical complications that can occur in adolescent males with anorexia. The sample in this study consists of only 10 patients who were seen over a 12-year period. The method of this study was simply to study the charts of each patient, and run several medical tests including heart rate, blood pressure, blood chemistry and endocrine values, vital signs, electrocardiograms, echocardiograms, brain tomography, CT scans, and blood pressure.

All of the patients weighed 80% or less of their ideal body weights. Nine of the patients had been severely malnourished and required inpatient admission. The significant medical complications found in these patients included supraventricular tachycardia, hypernatremia, and initial cardiopulmonary arrest. Cardiac abnormalities have been documented in other anorexic patients. Four of the patients had high heart rates over 80, and three of these patients were found to be in early cardiac failure. The results of their research show that serious medical complications are common in males with anorexia. One reason that is given for males having many medical complications is that anorexia in males often goes unidentified which cause delays in evaluation, diagnosis, and treatment.

Binge eating disorder (BED) was a newly defined eating disorder category in the DSM-IV. BED is almost as common in males as it is in females. Around 40% of BED cases involve males. Binge eating is viewed differently in men and women because of sex role expectations. Men associate binge eating with negative emotions of anger or depression. Women are more likely to associate bingeing with diet failure.

A study by Barry et al. (2001) looks at the gender differences in patients with BED, comparing how men and women with BED are similar and different in development, obesity, and other eating related features. The sample consisted of 35 males and 147 females that met the criteria for BED. The subjects were given three questionnaires (Three-Factor Eating Questionnaire, Eating Disorder Examination Questionnaire Version, and the Body Shape Questionnaire) the Beck Depression Inventory, and the Drug Abuse Screen Test. The results of these questionnaires and tests showed there are not significant gender differences in many of the developmental variables, including age first overweight, age of first diet, age of onset of binge eating, and number of weight cycles. Men had higher body mass indexes and more likely to currently be obese. Gender differences were not found on measures of binge eating, eating concerns, or weight concerns. Women did report a drive for thinness and greater body dissatisfaction than the male subjects did. No gender differences were found in current depression or self-esteem. Men did report a greater frequency of past drug abuse than females reported.

One risk factor that is thought to increase the risk of eating disorders in men that is not found in women is homosexuality. 10% - 42% of men with eating disorders report being homosexual or bisexual (Russell & Keel 2002). 10% to 42% is a large variation and it may seem that a statistic like that may not be very significant because the range is so broad. However, when you look at the overall rate of homosexuality in males in the general population (6%) even the lower end of the estimate (10%) for eating disorders is almost double what is found the general population. If the 42% estimate is correct, this would be 7 times the rate found in the general population! (Remember though that the 10% to 42% includes bisexuals and not just homosexuals).

A study by Yager et al. (1998) looking only at homosexuals, found that 2.1% of homosexual men could be classified as having had a eating disorder, and this figure in heterosexual males was only 0.33%. This means that eating disorders in homosexuals are more than 6 times what are found in the general population. Two possible explanations for why homosexuals may be at an increased risk for developing eating disorders could be that they have an increased feminine gender role identification or have more pressure to stay thin to attract a male partner.

One of the main differences between males and females is that females are more likely than males to perceive themselves as overweight when they are not. An example of this can be found in a study of college students, where 13% of males believed themselves to be overweight, when in reality only 11% were overweight. When asking a similar number of girls, the results were more were more significant. 50% of females in the sample believed themselves to be overweight, when in reality only 10% were actually overweight (Braun et al. 1999). Females are more likely to perceive themselves as being overweight when they are not, and this may help to explain why females have the majority of eating disorders.

The following two studies look at gender differences in the development of eating disorders. The first study by Vincent et al. (2000) looks at peer and family influences on eating disorders. The study consisted of 306 girls and 297 boys and looked at the influence and quality of family and peer relationships on disordered eating and body satisfaction. Fathers and mothers both play a significant role in the prediction of weight loss concerns in girls. Only fathers played a role in eating problems for boys. The study also found that direct influences and not the quality of relationships, with parents and peers, predicted eating disorders in both boys and girls. A difference between boys and girls was found in how peers and family members influence eating disorders or negative body image. Being encouraged to lose weight by a parent or peers, rather than discussion or modeling of weight loss behaviors, is a predictor of eating problems in boys. Girls on the other hand are influenced by discussion of weight loss with their peers. The main influence for eating disorders in boys resulted from direct encouragement to lose weight, rather than from discussion or modeling (Vincent & McCabe 2000).

The second study looks at males seeking treatment for eating disorders and gender differences. This study consisted of 710 females and 51 males who were admitted to the New York Hospital-Cornell Medical Center to the eating disorders unit between 1984 and 1996. The sample used all 51 males and matched them with 51 females with the same disorder, age at admission, duration of the disorder, and age when the disorder started. Over the 12 years of admitting patients to the hospital, the number of males seeking treatment increased, but there was no indication that there was an increase of eating disorders of males in society. In more recent years, males have become more likely to seek treatment for these disorders.

This study also found that the mean age of onset for eating disorders occurred 3 years earlier in females than in males. This finding is contradictory to other studies that say there is no difference in age of onset between males and females. The argument supporting this finding that female onset is earlier is that females start puberty earlier than boys do. This finding seems to be a legitimate hypothesis to why they found earlier onset in females. Obesity was found to be more common in males that developed eating disorders, than in females. Females with bulimia were more likely to use diet pills and laxatives than bulimic males. Overall the results of the studies show that the similarities in males and females with eating disorders are much more significant than the differences (Braun et al. 1999).

Males and females with eating disorders have both similarities and differences, but how do men with disorders differ from males without eating problems? A study by Woodside et al. (2001) tries to answer this question by comparing males with eating disorders to women with eating disorders and to males who do not have disorders. This study found very few differences between men and women with eating disorders, but they found some notable differences between the two groups of males. Psychiatric diagnoses were more common in men with eating disorders. This could be either a cause or an effect, but there was a definite relationship between eating disorders and psychiatric diagnoses in males. As would be expected, the quality of life for men with eating disorders was not as good as the quality of life for men without eating disorders Woodside et al. 2001).

Eating disorders in males and females may be more similar than they are different, but there is no denying that differences do exist. Eating disorders are more common in females, which explains why most research and literature about eating disorders refers to the patients as "she" and mainly focus only on females. Societal pressures and media images both affect the ways in which men and women view their bodies and contribute to what our idea of the ideal male and female body are. BED is found in males almost as frequently as in females, but anorexia nervosa and bulimia nervosa are much less prevalent in males as compared to females. Homosexuality appears to be correlated with eating disorders in males.

Eating disorders in males may be more prevalent than believed, because many cases may go unreported or undetected. There is little research in regards to males when looking at eating disorders, leaving many questions to be answered. Future studies with males should look at dieting and its role in the development of eating disorders in males. Dieting is a key in research in regards to female eating disorders, but is largely unexplored with males. Social relationships with friends and families is another area of research that can be looked at to determine what role they play in the development of male eating disorders. Substance abuse has been found to be more common in males than females with eating disorders, and more research in this area could further investigate what the relationship between the two is. The role of depression in the development of male eating disorders could be looked at more closely. My male friend that revealed to me that he had been anorexic had a father that was severely depressed, and I expect my friend too may have gone through a period of depression.

Males and females are alike and different in many ways, so it is no surprise to find that eating disorders in males, though similar, are also different from eating disorders experienced by females. More research on eating disorders, especially in males, will probably reveal even more differences and reasons for these differences.

 

References

  1. Barry, D., Grilo, C., & Masheb, R. (2002). "Gender Differences in Patients with Binge Eating Disorder". International Journal of Eating Disorders 31, 63-70.
  2. Braun, D.L., Sunday, S. R., Huang, A., & Halmi, K.A. (1999). "More Males Seek Treatment for Eating Disorders". International Journal of Eating Disorders, 25, 415-424.
  3. Carlat, D., Camargo, C., & Herzog, D. (1997). "Eating Disorders in Males: A Report on 135 Patients". American Journal of Psychiatry, 154:8, 1127 –1132.
  4. Harrison, K., & Cantor, J. (1997). "The Relationship Between Media Exposure and Eating Disorders". Journal of Communications, 47, 40-67.
  5. Keel, P., Fulkerson, J., and Leon, G. (1997). "Disordered Eating Precursors in Pre- and Early Adolescent Girls and Boys". Journal of Youth and Adolescence, 26, 203-216.
  6. Keel, P., Klump, K., Leon, G., and Fulkerson, J. (1998). "Disordered Eating in Adolescent Males from a School Based Sample". International Journal of Eating Disorders 23, 125-132.
  7. Leit, R., Gray, J., & Pope, H. (2002). "The Media’s Representation of the Ideal Male Body: A Cause for Muscle Dysmorphia?" International Journal of Eating Disorders, 31, 334-338.
  8. Miller, M. & Pumariega, A. (2001). "Culture and Eating Disorders: A Historical and Cross-Cultural Review". Psychiatry, 64, 93-110.
  9. Ricciardelli, L., Williams, R., & Kiernan, M. (1999). "Bulimic Symptoms in Adolescent Girls and Boys". International Journal of Eating Disorders, 26, 217-221.
  10. Russell, C. & Keel, P. (2002). Homosexuality as a Specific Risk Factor for Eating Disorders in Men. International Journal of Eating Disorders, 31, 125-132.
  11. Siegel, J., Hardoff, D., Golden, N., & Shenker, R. (1995). "Medical Complications in Male Adolescents with Anorexia Nervosa". Journal of Adolescent Health, 16, 448-453.
  12. Siegel, M., Brisman, J., & Weinshel, M. Surviving an Eating Disorder. (1988). New York: Harper & Row Publishers.
  13. Tenore, J.L. (2001). "Challenges in Eating Disorders: Past and Present", American Family Physician, 64, 367-368.
  14. Vincent, M.A. & McCabe, M.P. (2000). "Gender Differences Among Adolescents in Family, and Peer Influences on Body Dissatisfaction, Weight Loss, and Binge Eating Behavior." Journal of Youth and Adolescence, 29, 205-221.
  15. Woodside, D.B., Garfinkel, P.E., Lin, E., & Goering, P. (2001). "Comparisons of Men With Full or Partial Eating Disorders, Men Without Eating Disorders, and Women With Eating Disorders in the Community". The American Journal of Psychiatry, 158, 570-574.

 

 

 

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