The Male vs. Female ED Experience
This is not a “girl’s disease”
When we talk about eating disorders, there is usually one picture in people’s minds. It is usually that of a frail teenage girl with sunken-in cheeks who looks in a mirror and sees something different than the rest of the world. While there is no doubt this archetype of eating disorder victim exists, its status as a caricature depiction serves only to hold us back from improving treatment options for and spreading awareness of eating disorders.
Currently around 70 million individuals worldwide suffer from an eating disorder (statistics from Mirror Mirror), and of these, there is roughly a 7 million to 63 million ratio of male to female sufferers. And within those 63 million females, there is a breadth of diversity in how each person experiences their eating disorder symptoms. So, we are doing ourselves a disservice by continuing to use this caricature depiction as our reference point for sickness and eating disorder validity.
Today I’d like to speak specifically about the differences in the eating disorder experience between men and women. For a collection of diseases so often painted as affecting only females, the huge number of men who suffer from an ED (which does not even include all of those too scared to come forward about theirs) warrants some further investigation. Let’s look at what specific differences exist between the genders, what similarities exist, and how we can take this information and move forward.
EDs in women
With women, the eating disorder experience is often seen by outsiders as nothing more than a fulfilment of the “emotional woman” stereotype. The persistent stereotype that women are more emotional and attention-seeking easily manifests in how we perceive their experience with eating disorders. Many people assume it’s “just for attention,” especially with younger girls, or that it’s a purely superficial matter (i.e. only caring about one’s body).
Perhaps due to this, ED treatment for women generally assumes a more therapeutic style. Professional therapy assumes women will be more “in touch” with their emotions, and consequently treatment involves a heavy proportion of talk therapy and other such approaches. Also, an overwhelming number of treatment centers, especially residential, will only accept female patients.
In terms of what eating disorder they have, women disproportionately suffer from the more restrictive disorders (i.e. anorexia and ARFID) and those involving purging behaviors (i.e. bulimia, purge-type anorexia, purging disorder, and rumination) (statistics from ANAD). That doesn’t mean these are the only eating disorders women experience, but their disproportionate representation tells us something about psychological onset of the illness and which disorders women are more comfortable coming forward about.
EDs in men
As opposed to the “emotional woman” stereotype that fuels a bias towards therapeutic ED treatment, men are largely boxed into a group of “masculine” expectations, of which suffering from an eating disorder does not fit. Men are expected to be confident, strong, and hard workers. This doesn't jive well with the societal prejudices about eating disorders. We see an eating disorder as fundamentally a confidence deficit, a lack of strength (both psychologically and physically), and - again - an attention-seeking behavior. Even though these beliefs are completely unfounded, their prevalence in modern culture continues to present a barrier for men who want to open up and get help.
Men are often treated for their eating disorders from a more physiological standpoint. A woman who goes to see her PCP and presents with clear symptoms of anorexia will be examined differently than a man in the same circumstances. With the woman, there is an assumption that this is a matter of “body image problems,” “low self-esteem,” and “early maternal conflict.” With the man, the primary concern might be restoring body weight and preventing muscular atrophy.
But that’s only if a man can come forward and seek help. This is incredibly difficult for many men, who fear stigmatisation and misunderstanding from others. Even if they do seek help, though, their options are comparatively less extensive. While there are a decent amount of gender-inclusive treatment centers, this is still uncommon at the residential level of care, and “male-only” facilities are virtually unheard of.
Binge-eating disorder is the most common official eating disorder in men, but “muscle dysmorphia” is another extremely common disordered pattern in this population. The more restrictive disorders are found more so in the gay community, but they can affect any man, regardless of sexual orientation or identity.
What is the same?
Though all of the differences just mentioned are noteworthy and cannot be ignored, we also are badly in need of a reality check regarding the non-discriminating nature of eating disorders. Let’s be clear: Both men and women need food to survive, and so the brain’s feedback mechanisms to constantly prioritize this are not sex-specific. Technically, certain hormones and neurotransmitters are higher in one group than another, but on a practical level, there is no difference in the drive to eat.
So it should be no surprise that eating disorder pathologies do not differ between men and women. If a bulimic man was to be separated from society and observed, his behaviors would be markedly similar to a woman in the same conditions. It is only once we add the external pressures and expectations of society that the story changes.
Most importantly, eating disorder recovery for both men and women is the same. The process is no different, the need for exposures and therapy is no different, and even the “symptoms” of recovery (such as the “extreme hunger” noted deep into anorexia recovery) are no different. This reason alone tells us that continuing to dichotomize the male and female eating disorder experience is not only unproductive; it’s decidedly counterproductive. The more we remove stigma from treatment, the more people we can help, and the more those in treatment can feel like they’re in the right place.
Breaking down the stigmas and prejudices in the eating disorder world is not a group-specific advantage. It is something that has the potential to help all of us. By removing the gender divide and the notion that “men don’t get eating disorders,” we actually validate both groups’ experiences. No longer is the female eating disorder experience stereotyped as being overly concerned with emotions and one’s body. No longer is the male eating disorder experience dismissed and overlooked. Finally, eating disorder treatment can be what every other type of medical treatment is: An objective mission to return patients to good health.
Ari Snaevarsson is a nutrition coach who works primarily with clients who suffer from disordered eating patterns. He also works as a counselor, dietetic technician, and on-call facilities manager at a residential eating disorder treatment center. In both capacities, he helps clients develop positive relationships with food and their bodies. His book, 100 Days of Food Freedom: A Day-by-Day Journey to Self-Discovery, Freedom from Dieting, and Recovery From Your Eating Disorder, outlines a simple, day-by-day process to recovery from one’s eating disorder.