The aim of this article is to discuss critical issues in treating males with eating disorders, and to present assessment and treatment outcome data for 111 males who received residential treatment for moderate to severe eating disorders. Males with eating disorders are often not included in eating disorder research as the population of individuals with eating disorders has historically been predominantly female. Whether this is due to actual lower prevalence of this disorder among males or to fewer males seeking treatment is not clear. In any case, there is limited empirical research on the particular treatment issues of males, and in treatment environments males are frequently in the minority. We have found that an all-male treatment environment is helpful in allowing males to benefit from treatment with less stigma. Data are presented which characterize psychiatric co-morbidity, excessive exercise, body image, sexuality, and spirituality in males. Treatment outcomes for males in this environment are positive.
"Despite the lower prevalence rate of diagnosable EDs in men, many engage in harmful eating and body shape/weight regulation strategies (Cohn & Lemberg, 2013; Reas, Øverås, & Rø 2012; Stanford & Lemberg, 2012). Hence, there is as strong likelihood that health professionals who treat individuals with EDs will be called on to assess, treat, or engage in the prevention efforts of subclinical or clinical EDs in men during their careers (Cohn & Lemberg, 2013; Weltzin et al., 2012). "
[Show abstract][Hide abstract] ABSTRACT: In recent years research employing female samples has indicated that although body dissatisfaction may be necessary for the onset of an eating disorder, it is not sufficient. This study examined body surveillance and difficulties in interpersonal domains (attachment anxiety and social anxiety) as potential moderators of the body dissatisfaction-eating disorder symptomatology relationship amongst Italian college men (N = 359). As expected, all examined variables were found to intensify this relationship such that body dissatisfaction was strongly related to men's eating disorder symptomatology when each moderator was at its highest level (i.e., 1 SD above the mean). Practical implications are discussed.
[Show abstract][Hide abstract] ABSTRACT: Abstract. Historically, empirical research exploring body image concerns, their antecedents and consequences, has been primarily focused on women and their desire to become thinner resulting in less knowledge of eating and body-related disorders in men. Recently, there has been an increasing awareness of the existence of males with clinical or subclinical eating disorders. According to etiologic models and meta-analytic data, body dissatisfaction is the most consistent and robust risk factor for eating psychopathology. Although men, like women, actually seem to experience similar levels of over-concern about physical body, their body concerns are qualitatively different. Whereas women typically want to become thinner and are focused on losing body fat from the waist-down (e.g. thighs, buttocks, hips), men are dissatisfied with their upper body (i.e., chest, shoulders, arms) and desire to have a muscular physique. These differences suggest that the use of questionnaires measures of body image attitudes primarily designed to capture women’s body concerns and conformity to female’s body shape ideals may lead to invalid assessment of men’s body experience. The preoccupation with enhancing musculature termed as ‘‘drive for muscularity” is closely associated with negative affect, social physique anxiety, pathological exercise behaviour, dysfunctional eating patterns and muscle dysmorphia. Muscle dysmorphia (MD), a form of body dysmorphic disorder, is described as a cluster of dysfunctional cognitions, attitudes and behaviours (i.e. dietary restriction, inflexible rule regarding the type and amount of food to be eaten, compulsive exercise to the point of impairing social, occupational, or recreational activities, anabolic-androgenic steroid abuse) experienced mostly by men who believe that one’s physique is small and not muscular enough, even though they are often more muscular than average people, accompanied by a strong need to control and change it. Although the validity of MD as a clinical entity is demonstrated, several scholars and clinicians have repeatedly questioned its diagnostic placement (i.e., somatoform disorder vs. eating disorder spectrum). In this chapter we elucidate the gender differences on body images concerns, the factors that contribute to male body dissatisfaction with particular focus on media imagery, which variables interact with body dissadisfaction to predict men’s eating disorders symptoms, how similar or dissimilar are males and females with regards to eating disorderd behaviours and the concept of muscle dysmorphia (known also as reverse anorexia).
Handbook on Body Image: Gender Differences, Sociocultural Influences and Health Implications, Edited by Leroy B. Sams and Janet A. Keels, 09/2013: chapter Current Considerations for Eating and Body-Related Disorders among Men: pages 195-216; Nova Publishers., ISBN: 978-1-62618-359-9
[Show abstract][Hide abstract] ABSTRACT: Research has shown that eating disorder (ED) patients who abuse substances demonstrate worse ED symptomatology and poorer outcomes than those with EDs alone, including increased general medical complications and psychopathology, longer recovery times, poorer functional outcomes and higher relapse rates. This article provides a broad overview of the prevalence, aetiology, assessment and management of co-morbid EDs and substance use disorders (SUDs).Review: The co-occurrence of EDs and SUDs is high. The functional relationship between EDs and SUDs vary within and across ED subtypes, depends on the class of substance, and needs to be carefully assessed for each patient. Substances such as caffeine, tobacco, insulin, thyroid medications, stimulants or over the counter medications (laxatives, diuretics) may be used to aid weight loss and/ or provide energy, and alcohol or psychoactive substances could be used for emotional regulation or as part of a pattern of impulsive behaviour. A key message conveyed in the current literature is the importance of screening and assessment for co-morbid SUDs and EDs in patients presenting with either disorder. There is a paucity of treatment studies on the management of co-occurring EDs and SUDs. Overall, the literature indicates that the ED and SUD should be addressed simultaneously using a multi-disciplinary approach. The need for medical stabilization, hospitalization or inpatient treatment needs to be assessed based on general medical and psychiatric considerations. Common features across therapeutic interventions include psycho-education about the aetiological commonalities, risks and sequelae of concurrent ED behaviours and substance abuse, dietary education and planning, cognitive challenging of eating disordered attitudes and beliefs, building of skills and coping mechanisms, addressing obstacles to improvement and the prevention of relapse. Emphasis should be placed on building a collaborative therapeutic relationship and avoiding power struggles. Cognitive behavioural therapy has been frequently used in the treatment of co-morbid EDs and SUDs, however there are no randomized controlled trials. More recently evidence has been found for the efficacy of dialectical behavioural therapy in reducing both ED and substance use behaviours.
Future research would benefit from a meta-analysis of the current research in order to better understand the relationships between these two commonly co-occurring disorders.
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