Shining on a light on male eating disorders

From bigorexia to bingeing, more young males are experiencing eating disorders. But the stigma of having what is often seen as a woman’s illness is stopping many from seeking help, writes Sharon Ní Conchúir.

Eating disorders are still commonly seen as conditions that only affect females. However, the life experience of Zayn Malik, Russell Brand, John Prescott, Elton John, Billy Bob Thornton and Welsh rugby referee Nigel Owens prove that this is definitely not so.

Their stories show that men can restrict their calorie intake just as much as women. Zayn Malik recently revealed that he would often go for days without eating when he was in One Direction. It was only after he left the band and moved back in with his parents that he was able to begin addressing his problem.

In the late 1990s, Billy Bob Thornton lost 59lb and was diagnosed with anorexia. He has since recovered and regained the weight.

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These men’s stories show that it’s not just women who binge eat either. Russell Brand, John Prescott, Elton John and Nigel Owens have all struggled with this.

Trish Shiel is the clinical manager of the Eating Disorder Centre in Cork, where they are increasingly seeing an increase in the number of men coming forward with eating disorders. “This may not be because more men are suffering from eating disorders,” she says. “It may be that they are now more prepared to admit to having a problem. When we started in 2008, very few men came forward. Now, it’s at least one in 10.”

While it certainly helps that more and more high-profile men are opening up about their mental health issues, Shiel thinks more needs to be done to encourage boys and men to come forward.

“The likes of Bressie speaking out about mental health has had an impact,” she says. “But the myths are still out there. So many people think that only teenage girls suffer from eating disorders, not boys. Just yesterday, we had a father whose head was reeling from realising his son had an eating disorder. He just couldn’t believe it.”

Dr Clare O’Toole, consultant psychiatrist at St Patrick’s Mental Health Services, which runs eating disorders services for adults and teenagers, believes there is a problem with under-diagnosis of eating disorders in general, especially in males. Doctors, teachers and parents fail to identify the warning signs that they would immediately recognise in girls and women.

“As general awareness increases, hopefully, more men will be identified,” she says. “The recent BBC Panorama programme with Nigel Owens was very helpful in that it showed that men — and even very manly men — can suffer too.”

In the programme broadcast in July, Owens spoke about how he had battled with bulimia for nearly 30 years. He discussed his sexuality and how he struggled to accept he was gay and how this may have led to his subsequent problems with depression and disordered eating.

O’Toole refers to the first documented cases of anorexia in 1689. An English physician called Richard Morton described two cases, one a man and the other a woman.

“This proves that these disorders date back centuries and have always affected men and women,” she says.

However, there are differences between the sexes. HSE statistics indicate that women are more affected than men. Of the estimated 400 new cases of eating disorders that are diagnosed every year, approximately three times as many females as males are diagnosed with anorexia and bulimia and twice as many are diagnosed with binge-eating disorders.

However, according to an analysis of research carried out by a Finnish psychiatrist Anu Raevuoni in 2014, males are at higher risk of dying as a result of their
eating disorders. The suggestion is that this may be because they wait for longer before seeking help.

“What a lot of people fail to realise is that 80 people die from eating disorders in Ireland every year,” says Shiel. “Eating disorders are serious and anorexia has the highest mortality rate of all psychological disorders. If there are men out there suffering in silence, we need to identify them and get them treated as quickly as possible.”

O’Toole thinks a wider discussion about eating disorders would help. “New studies are emerging into issues such as muscle dysmorphia or bigorexia — where a person believes they are too small despite being overly muscular and often exercises obsessively as a result — which shows that it’s skewed towards males. If more women suffer from wanting to be small and anorexia, this could be the flipside, men wanting to be big and suffering from
bigorexia. Disordered eating could be a component of this.”

This should come as no surprise to anyone who has been paying attention to popular media. There are pictures of men with chiselled torsos, washboard stomachs and ripped abs everywhere from magazine covers to Instagram. Boys and men are left in no doubt as to what male perfection looks like and those who don’t measure up are bound to feel the pressure.

Harriet Parsons is the services manager with Bodywhys, the national voluntary organisation supporting people affected by eating disorders. She has seen how issues such as bigorexia are affecting men.

“It’s just as hard to be Ken as it is to be Barbie,” she says. “In this era of fitness, healthy eating and people posting pictures of their food on social media, boys are experiencing the same pressures as girls when it comes to body image and feeling good.”

However, she cautions against reducing eating disorders to something as simple as media pressure. “It’s a psychological illness and it’s more serious than just wanting to look a certain way,” she says. “But constantly receiving the message that men should be fit and muscly can affect the more vulnerable and they can turn the pressure inwards and try to control their bodies through disordered eating. We are certainly seeing this in Bodywhys.”

Eating disorders can affect anyone, male or female, old or young, but there are certain risk factors. People who take part in sports where weight is a factor can come under pressure. “People who work in sports where participants have to be lean or fit into certain weight categories such as horse racing and distance running. Professionals should be trained to watch out for jockeys or runners that might have a problem,” says O’Toole.

She also points to studies showing that men are more likely than women to have been overweight before developing an eating disorder and also more likely to suffer from another mental condition such as depression or substance abuse.

Some studies suggest that gay men may be more at risk than their heterosexual counterparts, but Trish Shiel is not convinced. “When we look at our clients, most are heterosexual,” she says.

What she has seen is that males and females who suffer from eating disorders tend to have a high degree of sensitivity. “Comments that other people might brush off can hurt them deeply. A huge number of them have also been bullied.”

Harriet Parsons highlights other factors that cross the gender divide.

“Internal factors that we have seen include poor body image, low self-esteem and a feeling of not being good enough,” she says. “People who suffer from eating disorders also tend to be high achievers and perfectionists who are determined to be the best they can be and not let people down.”

There are external factors too. “Being bullied, suffering from trauma and moments of transition such as moving schools, moving from school to college, or a relationship ending can all be triggers for developing eating disorders,” says Parsons. “Controlling their body is their way of coping with their feelings in these situations.”

While these factors vary from person to person, there are some recurring features. Most people, male and female, develop eating disorders between the ages of 14 and 25.

“It tends to kick in then or at least the anxiety around food is often there at that point,” says Shiel. “It may not manifest itself or be spotted until much later.”

Also, most people keep their eating disorders a secret. “This secrecy serves a purpose,” says Shiel. “They are using their disordered eating as a coping tool and don’t want to tell anyone about it in case they try to stop them.

“Men have an extra reason to be secretive in this regard as they may not feel as comfortable admitting to suffering from a condition that is usually associated with women.” The earlier the eating disorder is detected and treated, the better. If they are not detected in the first few years, they can get their claws in and become very serious, even lethal.”

This is why the Eating Disorder Centre in Cork has done so much work to promote early detection. They have worked with GPs and they have recently done work with dentists.

“If you’re being sick with bulimia, it will affect your teeth and dentists need to be trained to see this,” says Shiel. “It could be what leads to someone getting the help they need early on when it can be most effective.”

The treatment that is available is the same for both genders. “Eating disorders in males and females are more similar than they are different so treatment programmes are the same,” says O’Toole.

“Depending on the severity and stage of the disorder, patients might avail of in-patient intensive treatment, day care or counselling and clinical monitoring on an out-patient basis. Every patient has an individual care plan and the waiting time for this treatment in our service is usually a matter of a few weeks.”

Earlier this year, the High Court heard the case of an anorexic man in his 20s who was applying for funding to attend a specialist centre in Britain. Was this because there were no services available to him in Ireland?

“It’s more complicated than that,” says Harriet Parsons. “We have lots of services here but different treatments work for different people at different times and it can be a case of trial and error to find what works for a particular patient. It may be that this man saw something in the UK centre that appealed to him but nevertheless, I think it’s important that people know that help is available to them here and that they can recover here.”

This applies to men just as much as it does to women and according to Dr O’Toole, this is a message everyone needs to hear. “Eating disorders are serious medical conditions with very serious risks if they are not treated,” she says.

“There’s a double stigma associated with them for men. There’s the stigma around mental health for one and then there’s also the stigma around a mental health issue that is more commonly associated with females. It’s important that we break down this stigma, for the sake of men who are suffering with what can be a potentially lethal disorder.”


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