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Why do so few males seek eating disorder treatment?

By Andrew Walen, LCSW-C, LICSW, CEDS

It took 20 years for me to get help for my eating disorder. The signs were there all along – body image disturbance, restriction, compulsive exercise, food preoccupation, binge episodes, guilt, shame, depression, anxiety, and the like. I saw therapists and med providers in Baltimore, D.C., Boston, and Nashville. Some were attached to world famous facilities, yet none made the diagnosis. I was a man, and that seemed to mean I was simply “depressed.”

By age 30, I finally found someone who identified my struggle. That someone was me. I was a graduate student studying to be a clinical social worker. Discussing the issues of eating disorders with classmates, it became clear my eating disorder thoughts and behaviors began about age 10 when I became a regular target for bullying. I spent much of my pre-adolescence emotionally self-soothing with food and the result was a round belly that attracted ridicule. I was crash dieting soon after, cycling into binge behaviors and more restriction.

The teasing I experienced throughout my teen years included being called a “fat-ass” and other similar terms. In middle school, I began to be ridiculed for developing male breasts; I was nicknamed “Tits” on my high school swim team. By my senior year, the binge and restrict cycles became more and more tied to my emotional dysregulation, poor body image and negative self-worth. I was weighing myself daily, then multiple times a day, and after I would go to the bathroom to see if the number changed. The fixation was not on weight loss though. Let me be very clear, the fixation was if I was masculine enough.

My father and mother both wanted the best for me, but rather than tell me it’s okay to have the body I had, they both encouraged weight loss and more time in the gym. I don’t blame them though. My mother grew up the daughter of a Yiddish Theater actress prized for her petite femininity, something my mother was not. My mom developed anorexia at age 12 and struggled her whole life with the same undercurrent of unworthiness due to the body she had. My father had to learn to be the tough kid who beat people up to get respect as he moved to a new school every year of his childhood until he was 15. Being a man meant being tough, macho, strong, driven, and sexually desirable. A soft body was none of those things to my father, and he worked at being a rugged man his whole life. My father’s sister dealt with the constant relocation differently, and anorexia became a pervasive part of her life from her teen years on.

I was hit with a double dose of genetic predisposition and aesthetic acculturation. I didn’t want to be thin though; I wanted to be built like my father. I wanted round biceps, strong jaw, a V-shaped swimmers’ body, and to be considered sexually desirable by women. I wanted to be the definition of masculine I saw in mother’s Playgirl magazines and underwear ads featuring the Orioles pitcher Jim Palmer.

I spent years trying to force my body to be something it wasn’t genetically meant to be. And because I couldn’t achieve the unachievable, I labeled myself weak and worthless and fat – terms that played on a loop in my brain. My therapists kept saying I was depressed and perhaps I should work out more and eat healthier, which only fed my eating disorder further.

Once I finally concluded it was more than depression that I needed help with, my search for treatment hit an immediate roadblock. No programs existed that would accept me because I was a man. No support groups would let me participate because I was a man. I found a couple of outpatient providers, and only one was able to work with my financial limitations being a new dad, a grad student, and broke. I had to make my own way to cobble together treatment resources, scraping the far corners of the nascent internet to find anyone who resembled my experience. I found a book or two and a few journal articles, but not much else. The path to recovery was one I had to forge on my own.

Over the course of my career, I have learned how common my experience is. Males suffered, but were misdiagnosed and/or turned away from care at incredible rates. They were also emasculated by peers and loved ones, often meant playfully, but damagingly nonetheless, with admonitions to “man-up” and put on your big-boy pants. Others were told: just eat; exercise through the pain; binge eating is normal, worrying about it is for girls; purging is normal, wrestlers do it all the time; just exercise off that Big Mac; I wish I had abs like that. Gyms are filled with men who normalize compulsive exercise, a fixation on muscle size, definition and striations, and abuse of appearance and performance enhancing drugs. Our expression of “normal” manly behavior seems to be normalizing eating disorder pathology.

Males develop eating disorders, period. Latest statistical models suggest it affects millions of American males every year. So why do we see so few in treatment? Because so few are properly assessed and diagnosed; the behaviors are often seen as “normal” in popular culture; the stories they often read online are about being the “only man in the treatment program” and feeling awkward, different, and otherized; and in our hyper-masculine culture, males evade care to avoid being chastised for being feminine, gay, or weak.

What can we do then? First, I encourage everyone to recognize there’s a language difference when talking about eating disorders that misses the mark where men are concerned. Men don’t see their eating disorder behaviors as framed in thinness and weight. Rather it’s about masculinity defined by prowess, power, exceptionalism, and its manifestation in physical norms. And we have to honor the fact that men do have deep feelings and thoughts, but many are not given a chance to be heard in a field that has only recognized women’s issues and needs. In my work, I’ve encountered males across the globe who want and need to talk about their heart and their soul. They just need a safe place to share and for someone to listen and relate.

We need to educate families, providers, and the public how males with eating disorders think and speak differently about their eating disorder. We need to demonstrate the unique differences and similarities in how these diseases develop and fester. We need to normalize seeking treatment. And we need to have more men speak up and say recovery is possible. I hope you and your loved ones will keep reading and discovering more about males and eating disorders so more men will seek the treatment they need and deserve.

Andrew Walen, LCSW-C, LICSW, CEDS, is the Founder and Executive Director of The Body Image Therapy Center, VP of Eating Disorders Treatment for Refresh Mental Health, and the Senior Advisor on Males with Eating Disorders for the National Eating Disorders Association.

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5 Comments

  1. Deenl

    Andrew, I so much appreciate hearing your story. You will give hope to many, both male and female, the recovery is always possible even after a long period of illness.

    And you are right, the more men who bravely speak out about their experiences, the more normalised it becomes. My own son’s recovery was set back numerous months because the treatment team were predisposed against diagnosing a restrictive eating disorder due to his sex. Luckily, his pediatrician did not suffer from the same blindness and the ADTD forum taught us so much.

    Just a little note on behalf of people with non stereotypical presentation, if I may – my son didn’t / doesn’t have body image issues, he had/has no drive for thinness nor for muscle development. It is absolutely possible to have a horror of an ED without it.

    We are all lucky to have people such as yourself working in the field. Thank you so much for sharing.

  2. Màrius Folk

    MEN SUFFER IN SILENCE. Why can’t society embrace men with eating disorders? Why is there near to none support for men with eating disorders? Ive been suffering in silence for the last year and ask my self these questions everyday. Why does the internet have no men advocating for mental health? Why can’t I reach out to a friend about my eating without feeling like I will be judged for not being masculine. What even is masculinity? why has society placed such high standards on men being mentally perfect and bulletproof? “be a man. Only girls cry” I will feel emotions and share my story because this is who I am, I am Màrius and will not fall to the mercy of stigma.

  3. Màrius Folk

    Eating disorders do not understand gender. Most people, unfortunately, come to think that those with an eating disorder are usually women. However, eating disorders can affect people of any gender, age, weight, body shape, sexual orientation, and ethnicity; thus, men can also suffer from eating disorders because eating disorders do not understand gender. One of the possible reasons why current surveys of patients with eating disorder show more women and fewer men may be undetected. This may be related to the fear, “shame” or stigma that a man with eating disorder may experience because the disease is often associated with the female gender.

    From this observation, it would not be strange for men to live their disorder in solitude, quietly and hiding it, as if it were a secret. Likewise, if they choose not to be aware of suffering from this disease, they do not ask for help and therefore do not carry out any type of treatment. It is sad that there is a whole group of men who suffer this kind of “hell” and do not want to explain why they will say or do not want to ask for help.

    I believe in the need for men, who have any kind of eating disorder, to raise their voices because if it is already difficult as a person to be aware that you are being eaten by an eating disorder, imagine a man who, because of the stigmas imposed by society, associates eating disorders with women, when in fact this is merely a prejudice.

    When I went through that hell I would have liked to find support in men’s testimonies, but I couldn’t find it. I would have liked to know about men who were also going through the same thing as me so that I could understand that what was happening to me was not something improper or strange. I also felt embarrassed to come clean and tell my bad relationship with food to a family member or friend because we have been sold or given to understand that this type of disorder is only suffered by women. Opening up to the people I loved, and explaining to them what situation I was in, was embarrassing and panicky because, on the one hand, I preferred not to involve or worry anyone and, on the other hand, I thought more about what they might think than how they might help me. In other words, a whole set of possible rejections or negative situations that were only a fiction because the reality was different intruded into my mind; the reality was that, by telling all the struggle I had been carrying out in solitude for a long time, I was able to get rid of a dragging weight and finally receive help and understanding.

    Honestly, I think it is time to break with the stigma and prejudice of society!

  4. Leah

    A great piece, and moving response from Marius.

    Marius – in the UK there was a charity called Men Get Eating Disorders Too (MGEDT) but I am not sure of its current status. See short videos with its founder here: http://www.fixers.org.uk/fixing-eating-disorders/supporters/mgedt.php

    The hour-long documentary Living With Bulimia about the struggles of cricketer Freddie Flintoff was shown on the BBC in September and engendered responses like this piece: Like Freddie Flintoff, I am a man who has lived with bulimia. It’s time we stop gendering this life-threatening illness [https://www.independent.co.uk/life-style/health-and-families/freddie-flintoff-bbc-bulimia-anorexia-eating-disorder-men-women-b673917.html]

    Last year the actor Christopher Eccelston went public about his anorexia and dysmorphia and wrote a book, I Love The Bones Of You.

    I’m also heartened to see that there are more articles and surveys out about boys and body-image pressures…

  5. Ken

    I suffered from hardcore anorexia for 30 years and experienced many of the same things like being denied treatment and acceptance into clinics because I was a man. I will say that I did want to be lean and thin and not jacked. My paradigm was the rock stars. I can’t say that anorexia or all male eating disorders is about hyper masculinity. Each person and narrative is different. I did start losing weight to attract women who seemed to gravitate to the lean, wiry men in the rock world. Unfortunately, the weight loss spiraled out of control as my personal life fell apart. Losing weight was how I achieved some control in my life. I would recommend Franz Kafka’s short story “The Hunger Artist” as the blueprint for male anorexia (or anorexia in general) and the search to be the perfect hunger artist, which is central to the illness. This essay is very revealing and honest. Bravo

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