Eating Disorders: Do Men and Women Differ?

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!

References

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

Tetyana

Tetyana is the creator and manager of the blog. She has an Honours BSc in Neuroscience and an MSc in Medical Science. She can be reached at tetyana[at]scienceofeds[dot]org.

9 Comments

    • Good question (I also thought that, as I read the paper). I don’t think they specified in that paper, I’ll check in their previous paper and get back to you.

  1. I know this is unscientific and polemical, but isn’t it obvious that living in patriarchal societies women are going to suffer more (in various ways) than men?
    Eating disorders as a coping mechanism make complete sense even in ‘better off’ societies (better off in terms of access and rights etc).

    If women had greater access I guarantee you the prevalence of these disorders would drop. When you’re oppressed and have no recourse to money, property, jobs etc etc you aren’t left with many options. By the way, I know its still widely believed that white women from the upper to middle classes suffer the most but this has been proven to be a myth and potentially says more about the biases IN this area of research than anything else. Studying rich university students is a big issue here. Anyway, getting off topic, but basically, I think it is not useful trying to understand the prevalence of EDs through a comparative gender analysis as this study has. Its a bit like saying ‘oh look men suffer too! so its legitimate now, see!’.

    • Wow, you’re a shitty human being. Eating disorders are widely considered a “women’s issue” and male sufferers are erased in society. You really think that bringing up men is at the detriment to women? That it’s some problem? That the focus should be the people that according to you are patriarchally oppressed and we should just ignore the men because they’re such oppressors? What is wrong with you? You’ve lost all perspective and replaced compassion with radical feminism. You should be ashamed of yourself.

      Men are repeatedly shown in studies to be unlikely to admit to nearly anything from childhood abuse to rape to disorders to depression, and people like you make it worse.

      It’s been statistically proven eating disorders occur more often among the upper classes and most educated in developed countries, people who do have money, property, jobs, etc, because they’re pressured to succeed, not kept down. Take a look:
      http://www.reuters.com/article/2009/09/18/us-eating-disorder-idUSTRE58H4XD20090918

      And there are biological components that make women more likely to develop eating disorders:
      http://www.ncbi.nlm.nih.gov/pubmed/18316679

      If you want to disprove that, cite a study or statistic, not just your own imagination. And yes, poor and non-white women experience disorders. I have, for example. Doesn’t change the disproportionate numbers.

      And stop disempowering me. Women make up 51% of the electorate, have been proven to make decisions to benefit other women while men do not, we make up 80% of consumer spending and own 40% of private companies, while women millionaires are rising by twice the rate as male millionaires. Such patriarchy! I could ream you with endless studies about how awesome we are, but I imagine you’re not interested, because all you care about is ignoring men and disempowering women.

  2. My little sister had an eating disorder and I was always careful to watch my daughter for signs, to raise her with a critical eye toward mass-marketing standards of beauty, etc. She went through a period of horror in middle school but grew through it with no eating disorder. Now I am dealing with my younger son’s eating disorder.

    There is obviously a heritable component going on here; I’ve read that eating disorders are related to OCD, anxiety, depression, and even Asperger’s syndrome/autism in families. There also seems to be an addictive component where the opiate receptors are getting hit–making it all the more difficult to change the behaviors. We certainly have our share of brain-wiring differences in our family.

    I think it comes down to having a sense of control in one’s life. It’s no accident that it tends to appear in adolescence, which is a high-anxiety time of life.

    The notion that women may feel less control over their lives in a patriarchal society than most men certainly holds water. It’s a generalization, though, and while sociological explanations can assist people in their healing, they don’t begin to get to the crux of an individual’s pain. Clearly, men are not exempt from this pain.

    • Thanks for your comment JayDee. I’m sorry to hear that your son is struggling with an eating disorder. How’s that been for you?

      There is definitely a genetic component, for sure, although the point about it having an addictive component is definitely debatable (for one, what actually are people “addicted” to, in the case of EDs). I do think a lot of behaviours become very habitual and may feel almost like an addiction.

      “I think it comes down to having a sense of control in one’s life. It’s no accident that it tends to appear in adolescence, which is a high-anxiety time of life.”

      Yes, and no. Adolescence is also a time of a lot of neurobiological changes and it is a time when a lot of psychiatric disorders appear. I worry that the idea that they are about controlling one’s life have a lot of face validity and seem to be “common-sense” but actually lack scientific/empirical backing. A lot also rests on how we define “control.” I think ED behaviours can become a way for individuals to regulate their affect (i.e., emotions, feelings), and I would argue that is a better way of thinking about ED behaviours than the common “control one’s life” narrative.

      I wholeheartedly agree that men are not exempt from EDs or from any suffering or struggles. I do also think that your mention of the fact that women have less control over their lives in a patriarchal society is interesting, because, as you mention, it doesn’t really explain why many men do suffer with EDs, too. I think my argument in the preceding paragraph might also be useful here, actually. I don’t think it is so much about controlling one’s life as much as it is about regulating emotional states, and of course, that’s something all humans have to do/deal with.

      Again, thanks for your comment!

  3. Interesting, thank you for this. I am a 26, almost 27 year old male, and I’ve been suffering from bulimia for the past 10 years with a few years before that of restrictive eating and overexercise. Bulimia is a daily nightmare and has stolen the past decade of my life. I’ve been in inpatient treatment over 10 times and have tried everything I’ve ever thought may support recovery. I don’t know where I stand on the addictive nature–research certainly demonstrates that parts of the brain (the pleasure center specifically) is highly stimulated by bingeing. I am an absolute junkie in every sense of the word. You name it, I’ve done it.

    As for the sociological arguments, not so sure. I think many things can serve as catalysts for eating disorders and maybe that said oppression plays a part in some women’s eating disorders. I have come to see that mine came about because of numerous factors, some of which I’ve identified and others which are beyond my understanding at this point. I feel closer and closer to death everyday and wish there was a way out of this.

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