There is a misconception that eating disorders are a female issue. Yet recent figures from the NHS reveal the number of men referred for treatment for an eating disorder has risen by more than 40% in the last two years and the number of boys receiving treatment for eating disorders has doubled. Some studies go as far to suggest that up to a quarter of eating disorder sufferers are male but the stigma around eating disorders, and around male sufferers, means that many men may go undiagnosed.

Experts blame the growing numbers of male sufferers on pressure from social media, but they also pointed out that increasing awareness of the condition may be prompting more males to come forward who historically would not have sought help. In July 2017 Rugby union referee Nigel Owens revealed his struggle with the eating disorder bulimia nervosa is not over and remains an ongoing battle for him.

Eating disorders are highly complex psychological illnesses and there are many different factors which may contribute to their development. A mixture of biological, psychological and social factors can trigger an eating disorder and these vary for every individual. The symptoms of eating disorders will also vary from person to person as well as the treatments that contribute to successful recovery. Understanding that every aspect of an eating disorder is unique to the individual suffering is extremely important. With men, eating disorders can present themselves slightly differently to the ‘traditional’ or ‘typical’ understanding of these illnesses. There are certain risk factors that are more male orientated to be aware of for example: experts are noticing a condition called “bigorexia”, that is becoming increasingly common among boys and young men, influencing an obsession with muscle definition and body shape. Rather than restricting their diet these men, affected by anorexia are focusing on over exercising. Additional specific risk factors for men include:

  • Being in a job that may require the male to be thin, i.e. actors or models (James Corden famously talked about the limited choices of roles he was offered as an actor due to his weight and build)
  • Participation in sport that requires thinness (runner or jockey)
  • Being teased or bullied about their weight or height when they were a child

Below we have listed information on the most common eating disorders:

Anorexia nervosa.

The three main characteristics of anorexia are:

  • Extreme weight loss
  • Difficulties maintaining an appropriate body weight for height, age, and stature
  • In many individuals, distorted body image. 

People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat. Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Historians and psychologists have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years. 

The disorder most frequently begins during adolescence but, an increasing number of children and older adults are also being diagnosed with anorexia. You cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling with anorexia. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against obesity and a lack of understanding regarding the psychological element of anorexia.

Signs and symptoms of anorexia

  • Dramatic weight loss
  • Dressing in layers to hide weight loss or stay warm
  • Preoccupation with weight, food, calories, fat grams, and dieting
  • Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
  • Making frequent comments about feeling “fat” or overweight despite weight loss
  • Complaining of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
  • Denial of feeling hungry
  • Development of food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate)
  • Cooking meals for others without eating
  • Consistently making excuses to avoid mealtimes or situations involving food
  • Expressing a need to “burn off” calories taken in
  • Maintaining an excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury
  • Withdrawal from usual friends and activities and becoming more isolated, withdrawn, and secretive
  • Seeming concerned about eating in public
  • Resistance or inability to maintain a body weight appropriate for their age, height, and build
  • Intense fear of weight gain or being “fat,” even though underweight
  • Experience of body weight or shape, undue influence of weight or shape on self evaluation, or denial of the seriousness of low body weight
  • Displays a strong need for control
  • Demonstrates inflexible thinking

Treatment for anorexia

It is possible to recover from anorexia, but it may take time and recovery will be different for everyone. Treatment plans are tailored to individuals and support should be provided for other conditions such as for depression or anxiety. If you are over 18, you should be offered a type of talking therapy to help you manage your feelings about food and eating so that you are able to eat enough to be healthy. Talking therapies that are commonly used to treat anorexia in adults include:

Cognitive Behavioural Therapy (CBT)

Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)

Specialist Supportive Clinical Management (SSCM)

Bulimia

People who have bulimia go through periods where they eat a lot of food in a very short amount of time, this is called binge eating. Binge eating is a period of time, normally within two hours, when an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances is consumed. Binge eaters have a 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).

Having consumed the food people suffering from bulimia often make themselves vomit, use laxatives, do excessive exercise, or a combination of these, to try to stop themselves gaining weight. As with any eating disorder, anyone can suffer despite age or gender.

Symptoms of bulimia include:

  • Eating very large amounts of food in a short time, often in an out-of-control way 
  • Making yourself vomit, using laxatives, or doing an extreme amount of exercise after a binge to avoid putting on weight – this is called purging
  • Fear of putting on weight
  • Being very critical about your weight and body shape
  • Mood changes – for example, feeling very tense or anxious

These symptoms may not be easy to spot in someone because bulimia can make people behave very secretively. Bulimia is often a vicious cycle of binging and purging, triggered by things such as hunger, sadness or stress. People with bulimia often have set themselves very strict rules for dieting, eating or exercising. The failing to keep to these can then lead to periods of excessive eating and loss of control after which they feel guilty or ashamed. This results in a purge to get rid of the calories, leaving them feeling hungry again and so the cycle continues.

OSFED

Other Specified Feeding or Eating Disorder (OSFED) is characterised by the person engaging in a variety of eating disorder behaviours common to anorexia nervosa, bulimia nervosa and binge eating disorder but the person does not meet all the criteria for the diagnosis of an individual category. 

Examples of OSFED include:

  • Atypical anorexia: whereby someone presents with all the characteristics of anorexia nervosa but their weight remains in a normal range. 
  • Bulimia nervosa (of low frequency and/or limited duration): whereby someone presents with all the characteristics of bulimia but the person doesn’t experience the binge/purge cycle for as often or over as long a period of time.
  • Binge eating disorder (of low frequency/or limited duration): whereby someone presents with all the characteristics of binge eating disorder except the binge episodes do not happen as often or over as long a period of time.
  • Purging disorder: whereby someone purges to affect their weight but not in the context of a binge/purge cycle.
  • Night eating syndrome: whereby someone experiences recurring episodes of night eating

It is very important to note that OSFED is just as serious an illness as the other eating disorders and also needs adequate intervention.

Pica

Pica is an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, chalk or coal. Iron-deficiency anaemia, malnutrition, and pregnancy are the most common causes of Pica. In these individuals, Pica is a sign that the body is trying to correct a significant nutrient deficiency. Treating this deficiency with medication or vitamins often resolves the problems.

AFRID

AFRID is characterised by the person restricting their food intake by eating smaller amounts or eliminating certain groups to the extent whereby they do not meet their nutritional needs. AFRID differs to eating disorders such as anorexia and bulimia in that someone affected by AFRID may not necessarily experience the extreme level of body image disturbance that someone with anorexia or bulimia may experience. AFRID does not appear to affect the person’s perception and beliefs about their weight and shape and they will not experience the same fear of weight gain similar to someone experiencing anorexia for example. Someone experiencing AFRID will also be less likely to present with other eating disorder behaviours such as over exercise or purging.

Approaching someone with an eating disorder

Before approaching someone about a suspected eating disorder, inform yourself about the various eating disorders and try to have some resources available to show the person. Let the person know you have concerns and your observations that have generated the concern.

  • Avoid judging, blaming or criticising them
  • Communicate a belief that recovery is possible
  • Focus on how the person is feeling rather than what they are doing
  • Encourage them to speak as openly as possible
  • Accept that their feelings are real and valid
  • Do not be surprised if they deny there is a problem
  • Try and negotiate a way forward together
  • Do not put pressure on them to make immediate changes to their behaviour

Finally remember to support someone else you need to support yourself too.

Help and support

The chance for recovery increases the earlier an eating disorder is detected and the first step in getting help is generally through a visit to your G.P. whereby they can refer you on to specialist services if they suspect you may have an eating disorder. 

Eating Disorders association (N.I) provide a range of services. You can visit their website: www.eatingdisordersni.co.uk Email their support service: info@eatingdisorderni.co.uk Telephone their 24 hour helpline support: 02890235959 or use their drop in service: 3rd floor Bryson house, Bedford St. Belfast for: 1 – 1 support, monthly support groups, and early intervention/ prevention programmes for schools and youth groups

Beat is an eating disorder charity. You can call their adult helpline on: 0808 801 0677 or their youth helpline on: 0808 801 0711.

The Laurence Trust – Proving online information and resources for young men experiencing an eating disorder. Visit their website: www.thelaurencetrust.co.uk or email: thelaurencetrust@hotmail.co.uk

CARED – training for parents and carers (a charge applies for CARED training courses). Visit their website: www.caredni or email:caringaboutrecovery@gmail.com

Support groups in NI: 

Belfast/ South Eastern Trust

Adult Eating Disorder Service Telephone: 028 9504 2900

Child & Adolescent Eating Disorder Service Telephone: 028 9504 2696

Southern Trust

Action for Eating Disorders Helpline Telephone: 028 3834 7535 Website: www.adapteqatingdistress.com Email: info@adapteatingdistress.com

Adult Eating Disorder Service: Trasna House, Lurgan Telephone: 028 3831 1741

Child & Adolescent Eating Disorder Service Telephone: 028 3836 0680

 Northern Trust

Stamp-ED provides online information, resources, carer and peer support groups in Northern Trust area. Visit their website: www.stamp-ED.co.uk

Adult Eating Disorder Service – Holywell Hospital Telephone: 028 9441 3307

Child & Adolescent Eating Disorder Service Telephone: 028 9442 4600

 Western Trust

Defeat-ED Support for residence in Western Trust Telephone: 028 7132 0165

Adult Eating Disorder Service Telephone: 028 7132 0165

Child & Adolescent Eating Disorder Service – Gransha Park Telephone: 028 7132 0165 Rivendell Telephone: 028 8283 5990

 It is important to remember if you, or someone you care about, are suffering from an eating disorder help is available. We urge everyone to seek the support and guidance they need to recover.