This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders.
Males can have Disordered Eating, Too by Jennifer Hancock
For all intents and purposes, males are virtually nonexistent in the eating disorder literature. Most research has focused on female populations, and even then, profiles were limited at best. A common misnomer is that eating disorders are a “white girl’s disease” and little has been done to discredit the stereotype. Current changes in the DSM-5 criteria allow for better inclusion of diverse populations whereas the DSM-IV-TR excluded males by requiring amenorrhea, or the absence of a menstrual cycle for three consecutive months, in postmenarcheal females as a one of the diagnostic criteria for anorexia nervosa or bulimia nervosa. Women historically have been more likely to have an eating disorder, but with diagnostic criteria changes, and improved research participant sampling, men may be closing the gap. Symptom presentation is similar between sexes, although factors including societal roles, drive for muscularity versus thinness, and sexual preference contribute to disorder risk differently for males and females. Typically, males are reported as experiencing an increased drive for muscularity, when compared to females reporting a drive for thinness.
The drive for muscularity, when a person exhibits increased focus on building muscle mass and, is more prevalent in the male population, although it can be seen in varying degrees across all groups. A person’s gender role is a possible contributing factor in the drive for muscularity, with other variables including peer evaluation, valued media images, and parental pressure, for younger individuals (Smolak & Stein, 2006). Additionally, males that are concerned with both increasing muscle mass and decreasing body fat simultaneously may be at higher risk for disordered eating, compared to males seeking to alter one or the other, while the drive for thinness as a single variable can also to disordered eating behaviors (Kelley, Neufeld, & Musher-Eizenman, 2010).
In a study by Smolak and Stein (2006) evaluating drive for muscularity in adolescent males, moderating factors of self-esteem, social comparison, and male physical attributes were compared with sociocultural factors including media influence, along with peer and parental comments and teasing. The male physical attributes scale was created for the purpose of this specific study and contained eight questions rated on a 5-point Likert scale with questions regarding attitudes for male physical attributes and masculine gender role identification (i.e. “it is important for guys to be able to physically defend themselves). Results indicated a relationship between media influence and drive for muscularity, with gender role both contributing as a primary influence and a moderator, suggesting body image is at least partially controlled by gender identification. Parent and peer commentary and teasing played less of a significant role in establishing drive for muscularity (Smolak & Stein, 2006).
The impact of media as a contributor towards negative attitudes towards body image was also demonstrated in a study evaluating the relationship between body image and playing video games. After completing body esteem, muscularity attitudes, and self-esteem scales, participants played a game specifically heralded as realistic and detailed with customizable avatars. The experimental group was assigned an avatar with increase muscular appearance, while the control group’s avatar was average in appearance. Participants in the experimental group reported lower body satisfaction, as opposed to the control group with the average avatar; however, attitudes towards muscularity remained the same, suggesting the video game portrayal of muscular characters has an immediate effect on body image and satisfaction and not on overall attitudes towards muscularity (Sylvia, King, & Morse, 2014). In addition to media, the sociocultural factors that influence sexual orientation, may also contribute to the development of eating disorders in males.
For the most part, males are underrepresented in the eating disorder literature as a whole; however, some statistics do suggest homosexual males experience increased prevalence rates for body image concerns and eating disorders, when compared to heterosexual males (Gettleman & Thompson, 1993). This may be due to the societal stigma for coming out and stereotypic attitudes towards homosexual identity, suggesting sexual identity may promote personal beliefs and social roles. Other potential factors include perceived or experience discrimination, internalized negative beliefs concerning sexual orientation, fear of rejection, and being assaulted or bullied (National Eating Disorders Association). In a study by Gettleman and Thompson (1993) comparing heterosexual and homosexual males and females, results indicated homosexual males more concerned with body image and experienced more disordered eating, when compared to heterosexual males who reported less body image disturbance, implicating sexuality as a possible influence in an elevated risk for eating disorders. Another factor influencing possible diagnosis is men typically refrain from pursuing mental health or other supportive services, when compared to females.
Typically, male help-seeking behaviors are limited compared to females, with more stigma attached to seeking help and many worried about disclosure and a perception of the affect on gender identity and male’s roles in society. Some individuals feel their perceived male-driven masculinity becomes questionable, when admitting to mental health problems or seeking help, therefore creating obstacles to treatment. Although disclosing an eating disorder is reportedly difficult for females as well, research suggests it is likely more difficult for males because of the stereotype associated with eating disorders as being primarily a female issue (Robinson, Mountford, & Sperlinger, 2012). In light of the fact that men reportedly are less likely to seek help for other mental health concerns, this finding is not terribly surprising.
The DSM has already taken great strides at ensuring all populations are included in statistical research and appropriate diagnosis by improving the language and eliminating exclusionary wording the criteria requirements for an eating disorder. The problem is, that may not be enough to ensure mental health evaluations, and services are distributed accordingly until the stigma of eating disorders is reduced. In the meanwhile, determining at risk variables including stressful life events, sexual orientation, body image perception, would shape appropriate preventative strategies and provide useful insight into disorder progression among males. Ultimately, everyone could benefit from proactive methods, instead of reactionary measures.