While there is growing recognition that (surprise, surprise!) men are not immune to eating disorders, men are still underrepresented in the literature about eating disorders. We know comparatively little about what it is like to be a man with an eating disorder, and less still about recovery and life after recovery for these individuals. Recently, Björk, Wallin, & Pettersen (2012) conducted a qualitative study that asked men who had been diagnosed with an eating disorder and completed treatment to describe how recovery factors into their present lives. The researchers interviewed 15 men aged 19-52 (mean age 23) in Norway and Sweden, 10 of whom had been diagnosed with AN, 4 with BN, and 1 with EDNOS. The authors did not specify duration of illness.
The authors used a phenomenographical approach to study recovery among men. Though I am familiar with qualitative methods, this approach was new to me. From what I gather, phenomenography is an approach that focuses on a particular phenomenon (in this case, recovery from an eating disorder), and the similarities and differences in how it is perceived from the perspectives of different individuals (Marton & Booth, 1997; Marton, 1981).
The approach assumes that different people, based on their previous experiences, their individual personalities, and social locations, perceive phenomena and relate to their surroundings in different ways. This makes intuitive sense. In applying this approach, phenomenographers attend to the varied perceptions of phenomena within and between participants, and create descriptive categories based on the information participants provide (Marton, 1981).
To generate data, the authors interviewed the men using a conversational style, asking men about their perceptions of themselves (i.e. whether they see themselves as recovered), where in their lives their recovery featured most prominently, and how it played into their day-to-day experiences. Interviews were coded for aspects related to recovery and life as recovered, as well as for discussions of latent symptoms.
WHAT DID THEY FIND?
The authors offer some general impressions of the interviews, giving some insight into the discussions they had with the men:
- Participants were quite open to the idea of discussing their ED and recovery, but some found the discussion difficult
- Some men had spent time thinking about life before vs. life after recovery
- Many of the younger men identified feeling completely free from food/body image issues, as well as feeling happy with their lives
- Some men saw recovery as being able to balance physical activity and eating, while still struggling with food/body image-related thoughts
- Men who struggled with these thoughts identified feeling vulnerable to relapse
- For some, recovery was related to a decreased focus on body image and performance, and an increased feeling of self-confidence
Men also identified a number of strategies to “stay recovered,” including:
- Eating very regularly
- Maintaining a steady weight
- Keeping physical activity at a moderate level
- Not consuming excessive amounts of alcohol
While these initial observations seem a bit obvious to me, I do think it is interesting that the authors noted that younger men identified feeling free from remaining issues around food and body image. These findings obviously can’t be taken as representative of a trend in the general population of men who have recovered from an eating disorder, but investigating this idea in a larger sample might provide more solid insight.
The wide variation in general observations noted above also reflects the heterogeneity in the experience of recovery from an eating disorder which we might expect to find in any sample, no matter the gender. The authors report on several more “gender-specific” observations, as well, including:
- Feelings of shame associated with being a male with an ED
- Being unwilling to divulge ED history to others
- On the other hand, some noted sharing their stories as a way to help de-stigmatize EDs among males
In addition to these more general findings, the authors identified two main descriptive categories in the men’s responses: body acceptance and self-worth.
This category refers to men’s acceptance of their bodies, where men identified taking on a more relaxed attitude and behaviors relating to their bodies. Men noted:
- The ability to engage in physical activity with a sense of happiness rather than compulsion
- Being more flexible around food and situations where food is present (i.e., not feeling as though their life revolves around food)
- Using a number of strategies to avoid relapse (e.g., not buying large amounts of food all at once, eating regularly, not stepping on a scale)
Some men identified a great deal of body acceptance, whereas others noted feeling as though they would need to engage in trigger-avoidance and push away ED-related thoughts and behaviors indefinitely.
In the process of recovery, men described the development of self-acceptance, autonomy, and greater social engagement. Self-acceptance took several forms for the men interviewed, for example engaging in self-care or feeling free to express themselves. Autonomy referred to feeling less reliant on the judgments of others and relying more on personal desires and opinions. In terms of engaging in social life, men described a sense of ease in social settings, and prioritizing spending time with others.
To be honest, none of these findings seemed particularly shocking to me, nor do they seem to reveal much that is particular to the male experience of having and overcoming an eating disorder. However, as the authors describe, the two main categories into which descriptions of life after an eating disorder fall agree with previous literature exploring life after recovery no matter one’s gender.
The men also focused a fair bit on the strategies they put into place to stay in recovery. The authors note that while this could be taken as a sign of shaky recovery, the men did not frame it this way; it was identified in a more practical way as putting into place a framework to safeguard something they had worked hard to achieve. Recovery was also left undefined by the authors, who left this definition up to the men, some of whom, based on the findings, seemed to see themselves as free from eating disorder-related thoughts and behaviours, while others continued to push back against these thoughts and behaviours.
As I noted earlier, many of these findings require fleshing out in a larger sample in order to make any generalizations. However, given the dearth of literature on eating disorders in males, exploring recovery with a male sample represents a step in the right direction in terms of increasing understandings of the experience of being a man with an eating disorder. Personally, I look forward to reading more about life after an eating disorder for men; hopefully the increased interest in exploring eating disorders and recovery among males will help to reduce the stigma that is still present for men who suffer from these disorders.
Björk, T., Wallin, K., & Pettersen, G. (2012). Male experiences of life after recovery from an eating disorder. Eating Disorders, 20 (5), 460-8 PMID: 22985242