1. GI Joe Meets Barbie: Disordered Eating is Not Just a “Female” Issue
Dr. Mary Pritchard
Boise State University

2. “Just tell her to stop…”
17 years ago …
McCreary and Sasse (2000) changed the way we think about body dissatisfaction
Body dissatisfaction  unhealthy attempts to alter appearance  subclinical eating disorders  clinically diagnosable eating disorders
a pivotal study by McCreary and Sasse changed the way we think about body dissatisfaction and eating disorders in men
Dieting, excessive exercise, steroid and supplement use

3. Body Dissatisfaction
Body Image: “the picture of our own body which we form in our mind”
Body Dissatisfaction: dissatisfaction with one’s size, weight, shape, features, etc.
Discrepancy between perception of reality and perceptions of the “ideal”
Most common cause of disordered eating
Begins to emerge in girls around ages 6-8
Begins to emerge in boys around ages 8-10

4. Body dissatisfaction
Body dissatisfaction has become normative in today’s society, with over 90% of U.S. collegiate women and 80% of U.S. college- aged men reporting body and weight dissatisfaction
In the past, research has suggested that men and women may experience body dissatisfaction in different ways:
Drive for thinness v. Drive for muscularity
However, this oversimplifies the issue…

5. Drive for thinness/Leanness
90-95% of women want to be thinner than they are
2/3rds of men want to lose weight

6. As a result…
Between ages 3 and 5, children know “thin” is good and “fat” is bad
50% of girls and 33% of boys age 6 to 8 want to be thinner than they currently are
1 in 4 children have tried something to lose weight by age 7
80% of 10-year-old girls have dieted to lose weight
But it’s not just wanting to be thinner anymore….

7. Drive for muscularity/tone
McCreary and Sasse’s ground breaking research
Lean and toned - 90% of men want to be more muscular; 78% of women want to be more muscular

8. What we know: Boys
In boys, desire for bigger muscles increases slightly each year across adolescence, beginning at age 9
Adolescent male anabolic steroid use (approximately 4-6%) is comparable to the combined lifetime prevalence of anorexia and bulimia nervosa in adolescent females
35% of adolescent males reported using products to build muscles and improve appearance
By age 16, 30% of boys have tried to gain muscle mass

9. What we know: girls
In girls, desire for muscularity is present to a slightly lesser extent and is stable over time
Similar to boys, about 30% of adolescent females (aged 12-18) want to gain muscle mass
2-4% of adolescent females have used steroids
21% of adolescent females reported using products to build muscles and improve appearance

10. Subclinical eating disorders

11. Body dysmorphic disorder
Sufferers are excessively concerned about appearance, in particular perceived flaws of face, hair, and skin.
BDD is thought to be a subtype of obsessive- compulsive disorder
BDD often includes social phobias. Sufferers are shy and withdrawn in new situations and with unfamiliar people.
Differences in the brains of those who suffer
Deficiencies in visual processing
Working memory deficits
Poorer planning and decision making

12. Body dysmorphic disorder
Very conservative guesstimate: Affects 2% of people in the U.S.
Strikes males and females equally.
70% of cases appear before age eighteen.
BDD sufferers are at elevated risk for depression, anxiety, and suicide.
In some cases they undergo multiple, unnecessary plastic surgeries.

13. Muscle dysmorphic disorder (bigorexia)
People with this disorder obsess about being small and undeveloped.
Marked differences in the brains of those who suffer
Lift weights, do resistance training, and exercise compulsively. They may take steroids or other muscle-building drugs.
A subtype of body dysmorphic disorder

14. Muscle dysmorphic disorder
More common in males than females
Almost everyone with MDD also suffers from depression.
The constant preoccupation with perceived smallness interferes with school and career accomplishments.
In almost all cases, people with muscle dysmorphia are not small at all.

15. Clinically diagnosable eating disorders

16. Anorexia Nervosa
Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or expected.
Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
Disturbance in the way one's body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight.

17. Anorexia Nervosa Subtypes:
F50.01 Restricting Type: During the last three months, the individual has not engaged in binge-eating or purging behavior (self-induced vomiting or misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.
F50.02 Binge Eating/Purging Type: During the last three months, the individual has engaged in recurrent episodes of binge-eating or purging behavior.

18. Anorexia nervosa: the stats
Prevalence rates in Western countries range from 0.1% to 5.7% in female subjects. Depending on the study, lifetime prevalence averages to about .3% in men.
Males represent 25% of individuals with AN
Age range: as young as 6 and as old as 90s

19. bulimia Nervosa
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most individuals would eat during a similar period of time under similar circumstances.
A sense of lack of control over eating during the episode, (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting, or excessive exercise.
The binge eating and inappropriate compensatory behavior both occur, on average, at least once a week for 3 months.
Self evaluation is unduly influenced by body shape and weight.

20. Bulimia nervous: the stats
4% college-aged women have bulimia
Prevalence rates in Western countries range from 0% to 2.1% in males (0.5% average) and from 0.3% to 7.3% in females.
Males represent 25% of individuals with BN
Men are less likely than women to engage in “typical” bulimic compensatory behaviors

21. Binge-eating disorder
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most individuals would eat during a similar period of time under similar circumstances.
A sense of lack of control over eating during the episode, (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

22. Binge-eating disorder
The binge-eating episodes are associated with three (or more) of the following:
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not physically hungry.
Eating alone because of feeling embarrassed by how much one is eating.
Feeling disgusted with oneself, depressed, or very guilty afterward
Marked distress regarding binge-eating is present
The binge eating occurs, on average, at least once a week for 3 months.

23. Binge eating disorder: the stats
1-4% of women in the United States; 2% of men
Approximately 36-50% of those with BED are men
30% of women who seek treatment to lose weight
Men are less likely to report feeling out of control and more likely to report anger triggering a binge than are women

24. Other specified feeding or eating disorder
This category applies to presentations in which symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class.

25. The stats
In the United States, 20 million women and 10 million men will suffer from a clinically significant eating disorder at some time in their life
Depending on the study, female-to-male ratio of current screening criteria is between 4-to- 1 and 2-to-1

26. The stats Here’s the problem: Tests were designed for women
Bias in diagnosis
Men are afraid to admit they have a problem
Masculinity may be threatened
Men may not recognize what they are experiencing is an eating disorder
Researchers are beginning to understand that ED in men are misunderstood, misrepresented, and miscounted

27. Is this a new problem? Sort of…
cases of probable male anorexia nervosa were described as early as the 17th and 18th centuries
But ED weren’t even recognized until late 1880s (anorexia hysteria – females only), then not an official category until the DSM-3 in the 1980s

28. What factors relate to the development of ED in men?
Weight history
Sexual orientation
History of sexual abuse
History of chemical dependency
Depression
Athletic status
Media
more likely to have been overweight at some point

29. Diagnosis and treatment
Because men may not present as “typical” ED patients, diagnosis is challenging
Treatment options:
CBT
All-male group therapy
Pharmaceuticals
Initial reports suggest recovery might be higher in men

30. Future directions Prevention programs targeting boys
Media literacy for boys
Better isolating differences in risk factors for men and women
Need to address social stigmas
More focused study of treatment options for men
Educate health care providers
Better/different training programs for clinicians who treat men with ED