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It is estimated that males generally account for 5% to 10% of reported cases of anorexia nervosa (Alexander-Mott, 1994; Anorexia Nervosa and Related Eating Disorders, Inc., 1998). These figures must be viewed with caution however, because this disorder is likely underreported and misdiagnosed in the male population.
Current literature is saturated with numerous explanations, causes, treatments, and prevention of anorexia nervosa. Despite voluminous articles, papers, and books written on this topic, little mention is ever made to males. Keel, Fulkerson, and Leon (1997) reported their search of the literature revealed no studies of eating disorders in early adolescent males, and most research on predictors of eating disorders has been based on female samples. As a result, these findings may not generalize to males. In fact, there may be other factors present in predicting poor body image, low self-esteem, and resulting eating disorders in males. It is essential to determine the existence of any gender differences that might be affecting body image as a means of providing more appropriate prevention and intervention in this population. Kinzl, Mangweth, Traweger, and Biebl (1997) lamented the lack of studies performed with males. Keel et al. (1997) suggested how boys feel about their bodies can influence their tendencies toward anorexia. The factors that may determine this are still unknown, because the variables used in their study were determined by previous research based on females. Carlat, Carmago, and Herzog (1997) contended that in the past 300 years since anorexia nervosa was first described, there continues to be very little written regarding males and eating disorders and that the majority of the research has been limited to case reports or case-control studies.
Unique Aspects In The Development Of Male Anorexic Behavior
Anderson (1992) reported that while the disorders may appear the same for both males and females, the course for getting there is quite different. "When individuals are very ill, suffering from emaciation or abnormal electrolytes and other medical complications, they appear very similar and require similar treatment ... but as patients become medically healthy and the symptoms are deconstructed, the individual life story behind each patient unfolds to reveal differences between the sexes in predisposition, course, and onset". Anderson (1992) suggested that males who develop eating disorders differ from females in three major areas of dieting behaviors. The first involves the reasons for dieting. He contended females diet because they feel fat, whereas males diet because they have been overweight at some point in their lives. Secondly, males more often than females diet to attain certain goals in sports or to avoid some type of sports-related injury that would be related to a weight gain. Thirdly, there is a greater preponderance of men who diet to avoid potential medical problems. Males may think that dieting and exercise will allow them to feel more masculine and more in control which, in turn, will lead to greater respect from others. A higher incidence of homosexuality or gender-identity confusion has also been reported among males with disordered eating patterns with estimates as high as 21% of affected males being homosexual (Anderson, 1999; Anderson, 1990; Siever, 1994). Kearney-Cooke and Steichen-Asch (1990) reported that males with eating disorders tend to have close relationships with their mothers and are more likely to have experienced ridicule from their peers in response to their physical appearance.
Social And Cultural Influences
Implications For Mental Health Professionals
To assist mental health counselors who have infrequent contact with eating disordered males, a checklist with common features of male anorexia may be useful for diagnosis and treatment. Male anorexics like their female counterparts possess high body dissatisfaction (Goldfield et al., 1998; Pope, Katz, & Hudson, 1993; Pope, Olivardia, Gruber, & Borowiecki, 1999). In contrast to female anorexics, the majority of males have been overweight prior to the development of anorexia nervosa (Anderson, 1990). In addition to dieting, excessive exercise is often a precursor to anorexic behavior (Paxton et al., 1991; Davis, 1999). Sexual orientation and sex role identification may be a concern (Anderson, 1999; Braun, 1997; Herzog, et al. 1990; Siever, 1994). Social withdrawal or the tendency to be a "loner" is common (Levine, Petrie, Gotthardt, & Sevig, 1990). Characterological traits are often present with borderline, obsessive-com-pulsive, dependent, passive-aggressive, and avoidant features being the most prominent (Braun, 1997; Kearney-Cooke & Steichen-Asch, 1990). Dysphoric mood is common (Anderson, 1990; Mickley, 1994). The production of testosterone gradually decreases in anorexic males as a result of starvation (Anderson, 1999; Burge et al., 1997; Herzog et al., 1990). A loss of sex drive is experienced and sexual function diminishes (Anderson, 1990; Herzog et al., 1990). Like females, male anorexics are often perfectionists with low self-esteem, living life to the extreme while engaging in all-or-nothing thinking (Pelch, 1992).
Reflection Exercise #11