Delayed Diagnosis of Eating Disorders in Men

Lack of recognition and a hands-off attitude by clinicians, family, and friends play a role.

Reprinted from Eating Disorders Review
July/August Volume 25, Number 4
©2014 IAEDP

Why don’t men with eating disorders seek help sooner? One reason may be the popular misconception that eating disorders are only found among young women, according to two researchers from Great Britain (BMJ Open. 2014; 4:e004342).

Drs. Ulla Räisänen and Kate Hunt, of the University of Oxford, Oxford, UK, and the University of Glasgow, Scotland, first interviewed 29 women and 10 men with eating disorders. Some of the material the authors hoped to cover included: “How do men make sense of their early (and later) signs and symptoms of disordered eating?” Additionally, they asked the men how they decided treatment might be needed, what ordinarily gets in the way of seeking help, and what their experience with help-seeking had been like.

An early pattern of restricting food (AN) or purging after large meals (BN)

Most of the men diagnosed with anorexia nervosa (AN) described an early pattern of skipping meals, selling their school lunches to others, restricting their food intake, and eventually going for days without food. Patients diagnosed with bulimia nervosa (BN) described a different course, starting with “comfort eating,” and then on to a pattern of purging after unusually large meals. Over months these actions gradually became a “daily routine.”

At first many of the men did not recognize that they had an eating disorder, and attributed this to their misunderstanding about eating disorders as a problem of “fragile teenage girls” only. The men also viewed their disordered eating as a personal coping mechanism rather than as an underlying pathology. Some had never heard of BN, and thought binge eating and purging were their own invention. And it wasn’t just the men who didn’t recognize that they had an eating disorder—their family and friends seldom connected the unusual behavior to a possible eating disorder. One of the interviewees was investigated for gastric problems for years, during which no one, parents and physicians included, suspected the true cause for the man’s gastric problems and weight loss. 

How the eating disorder was recognized

Typically, the men’s symptoms and behaviors continued for months or years before they began to realize that they did have a serious problem. Some men gradually realized they had a problem, while others reported that a sudden physical event had led them to seek help. Another barrier to getting help was the men’s fear of not being taken seriously by healthcare providers. Others reported secrecy, fear of treatment, or fear of being judged.

Once the men sought treatment, the initial consultation seemed to be particularly important and also dictated whether the men would remain in treatment. Some men had positive experiences, which led to treatment. Others, however, described going to their general practitioners several times before they were taken seriously or referred for care and, in a few instances, the diagnosis was missed or the problem misdiagnosed. The quality of specialist care also could be lacking—one man had prolonged vomiting leading to severe weight loss and underwent lengthy physical examinations before his gastroenterologist told him to “man up,” and to “‘be strong and deal with the problem.”

The authors concluded that early detection is imperative to improve the prognosis for men with eating disorders. Primary care physicians are critical to this early recognition. And, finally, the authors suggest that improved awareness of eating disorders at a social level will help correct the misconception that eating disorders affect only young women.