Given that eating disorders disproportionately affect women, it is not unreasonable to assume that men differ from women in clinical presentation, personality and psychological characteristics. My guess would be that they differ. My reasoning is this: males and females grow up facing different pressures and expectations. Given that, I’d think there would be (perhaps only slightly) different risk factors that predispose men and women to develop eating disorders. Thus, I’d think that different groups of men and women (i.e. with different personality characteristics, psychiatric comorbidities, and life experiences) would be susceptible to EDs. (Hopefully that makes sense.) To answer that question, Dr. D. Blake Woodside and colleagues compared men with eating disorders vs. women with eating disorders vs. men without eating disorders.
Why are females much more likely to suffer from eating disorders than males? It appears that (at least) two arguments have been put forth:
One argument has been that because eating disorders are so rare in males, the nature of the illness must somehow be atypical in males. The second line of discussion has suggested that there must be something different about males who develop an eating disorder. For example, it has been suggested that a higher proportion of males with eating disorders might be homosexual.
Previous studies suggest that, at least in a clinical setting, men and women with eating disorders don’t really differ in their “clinical presentation, psychological measurements, or response to treatment.” But, what about individuals with eating disorders from a large community sample – not just those that have gone through the hospital doors?
This is precisely what Woodside et al. did. Perhaps most importantly, “this strategy allowed [them] to examine the two questions of interest —is the illness different in men or are men with the illness different—without the confounding factors associated with clinical samples.”
SUMMARY OF MAIN FINDINGS:
The sample size was large: 9,953 random individuals, across the province of Ontario. The rate of anorexia nervosa and bulimia nervosa was 0.3% in males and 2.1% in females.
Prevalence of Eating Disorders in Men & Women
- Anorexia nervosa – full syndrome: 0.16% of males vs. 0.66% of females (female:male ration is 4.2:1); partial syndrome: 0.76% of males vs. 1.15% of females (female:male ratio is 1.5:1)
- Bulimia nervosa – full syndrome: 0.13% of males vs. 1.46% of females (11.4:1); partial syndrome: 0.95% of males vs. 1.70% of females (1.8:1)
- Note the difference in female:male ratios between the full syndromes and partial syndromes
Lifetime Psychiatric Comorbidities in Men & Women
- Men with EDs: significantly higher rates in almost all areas, compared to men without EDs, but mostly similar to women with EDs:
- Men with EDs vs. men without EDS: men with EDs had significantly higher prevalence of major depression, anxiety disorders, social phobia, simple phobia, agoraphobia, panic disorder and alcohol dependence (the only thing that wasn’t different in the disorders evaluated was generalized anxiety disorder)
- Men with EDs vs. women with EDs: women with EDs had significantly higher prevalence of major depression and significantly lower rates of alcohol dependence
Family History & Early Life Experiences
- men with and without EDs did not differ on the majority of variables
- women with EDs reported higher rates of sexual abuse and serious sexual abuse than men with EDs
Relationships & Quality of Life Variables in Men & Women
- overall satisfaction was fairly high, but men with EDs were significantly different from men without EDs (frequency of marital conflicts, satisfaction with family life, leisure activities, housing, incoming and life in general)
- there were no significant differences between men with EDs and women with EDs
In these evaluations, the full and partial syndrome patients were pooled together. Remember that there were many more men with partial syndromes vs. full syndromes, compared to women with partial syndromes vs. full syndromes. (More precisely, for anorexia nervosa , the prevalence of men with full and partial syndromes was 0.16% and 0.76%, respectively.
For women, however, the numbers were 0.66% and 1.15%, for full and partial syndromes, respectively. The ratios are worse for bulimia nervosa: 0.13% and 0.95% for men with full and partial syndromes, respectively, compared to almost no difference for women with full and partial bulimia: 1.46% versus 1.7%, respectively.) This can bias the results and explain why men with EDs often fall in between men without EDs and women with EDs.
What do these findings suggest, particularly with respect to the aforementioned theories about why men are much less likely to suffer from EDs than women?
We found few differences between men and women with eating disorders on the available clinical variables. The similar ratios of anorexia nervosa and bulimia nervosa in the two groups as well as the very similar patterns of age at onset and birth cohort effect add to the now substantial body of evidence suggesting that the illness is the same in nature for both sexes.
Moreover, Woodside and colleagues point out that it is quite striking that there are few differences between rates of comorbid disorders between men and women with EDs (with the exception of “gender-specific differences in the rates of alcoholism and depression.”)
The finding that men with EDs have many more comorbid disorders than men without EDs suggests that these factors could predispose men to develop an ED, or, they are a consequence of the ED itself. It is not possible to resolve this question from the data in this study.
It would have been interesting if sexual orientation was assessed, to see whether findings in this study confirm the notion that homosexuality is more common in men with eating disorders. The reason the authors did not pursue this is, in my opinion, lame: it was “deemed too sensitive a topic for a government-sponsored survey.”
The authors conclude that, overall, the findings in this study support the idea that eating disorders are very similar in men and women. “Our study also shows that the ratio of the occurrence of anorexia nervosa and bulimia nervosa, associated comorbidity, and psychosocial morbidity are very similar in both genders.”
But, of course, we need way more research to understand whether there are other differences between men and women with eating disorders which were not evaluate in this study. More importantly, it is important to examine whether men and women share risk factors that predispose both genders to develop an eating disorders.
This study was published in 2001, so, presumably, was done in the late 1990s. I haven’t looked (yet) at any follow-ups from this study. I simply stumbled upon this one and thought it would be a nice and interesting one to post about. So, I’ll explore further to see if there were any follow-ups.
As always, your thoughts, opinions and questions are always welcome and encouraged!
Woodside, D.B., Garfinkel, P.E., Lin, E., Goering, P., Kaplan, A.S., Goldbloom, D.S., & Kennedy, S.H. (2001). Comparisons of men with full or partial eating disorders, men without eating disorders, and women with eating disorders in the community. The American Journal of Psychiatry, 158 (4), 570-4 PMID: 11282690