Eating Disorders in Adolescent Males: An Interview with Dr. Mark Warren, Cleveland Center for Eating Disorders
Eating disorders are difficult and perplexing illnesses that are often misunderstood. One common misconception is that eating disorders are a problem that affects only girls. Dr. Mark Warren, clinical psychiatrist and medical director of the Cleveland Center for Eating Disorders, leads the Males and Eating Disorders special interest group of the Academy of Eating Disorders. Maudsley Parents asked Dr. Warren about eating disorders in boys.
Eating disorders are sometimes thought of as a “girl problem”, but that’s not accurate. Can you tell us a little about eating disorders in boys?
There is very little research on boys with eating disorders and our knowledge base is always growing. With that in mind, here are some general things we believe to be true. Since the diagnoses of eating disorders is affected by gender (that is, some of the DSM IV criteria are specifically for girls, and some of the behaviors of boys are not included in the DSM IV) we really do not know the true occurrence of eating disorders in boys. Using DSM IV criteria, there is probably about one third the rate of ED in boys as in girls. This means that if we use the DSM IV definition of ED, boys make up about 25% of ED patients. However, this number has been growing significantly over time. In the 60’s and 70’s, ED in men was thought to be almost nonexistent, in the 80’s and 90’s about 10% and now 25-30%. So all we know is that it is more prevalent than was previously thought. In addition, boys engage in some behaviors unusual for girls- including steroid use, spitting, and over the counter muscle enhancers. If we include these behaviors, the prevalence of ED in boys may be even higher.
Are there misunderstandings about eating disorders in boys that delay diagnosis or complicate treatment?
Multiple issues exist:
The belief that boys don’t have eating disorders
The differences in activities of boys
The use of gyms and sports as opportunities to engage in behaviors out of sight of parents
The new pressures put on boys by the media around size/shape concerns that did not exist 15 years ago- the focus on six pack abs, body building, thinner male models, new men’s fashions, new male fashion magazines
The presence of behaviors like spitting and running which may be similar to purging in girls
The misperception that eating disorders in boys relate to sexual identity
What are some special concerns of boys with AN and BN and their families?
Generally the issues are similar from a treatment perspective, but boys are often more isolated socially from their peers because of an ED. Boys are less likely to talk to other boys about body/size/food issues so often get less support. Family support, while always needed for all kids, may be especially important for boys.
Do you have any advice especially for parents of boys with anorexia or bulimia?
Take it very seriously. Some studies how boys both lose and gain weight faster than girls. But whether you have a boy or a girl, the faster the ED is treated and the faster they get back to their growth curve, the better the long term prognosis. And if you can find a support group just for boys, see if it is helpful.
Remember, our actual knowledge base is very small. We are doing a literature search right now to collect all published information on the topic on men and boys with ED. If you have any information to share or questions to ask, I am happy to speak with you. Contact email mwarren@edcleveland.com Good wishes and good health.