Skip to main content
SpringerLink
Log in

Sex-specific issues in eating disorders: a clinical and psychopathological investigation

  • Original Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Objective

To highlight the characteristics of eating disorders (ED) in males, with particular attention to sex-related clinical features and psychiatric co-morbidities.

Method

Out of 280 persons, referred to our outpatients ED clinic between January 2011 and June 2014, 267 with complete information were included in this retrospective observational study.

Results

The men/women ratio was one to five (male 16.5% vs female 83.5%) with an increasing proportion of male patients over the years. The most frequent ED in males was binge eating disorder, whereas in females anorexia nervosa and bulimia nervosa prevailed. Excessive exercising and fasting were the most common compensation behaviours in males; while self-induced vomiting and laxative–diuretic abuse were more typical in females. Among women, the most represented psychiatric co-morbidities were mood and somatoform disorders, whereas among men, anxiety and psychosis spectrum disorders were the most frequent ones. Borderline and histrionic personality disorders were prevalent in female ED, while narcissistic and antisocial personality disorders prevailed in males.

Discussion

ED in men is a growing phenomenon. Male ED, compared to female ED, show differences in clinical presentation, symptoms and co-morbidities. Despite the use of clinical and psychometric evaluating tools targeting female patients, sex differences do exist and additional studies are required to investigate male specific issues in ED.

Level of Evidence Level V, cross-sectional descriptive study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Blashill AJ (2011) Gender roles, eating pathology, and body dissatisfaction in men: a meta-analysis. Body Image 8(1):1–11. doi:10.1016/j.bodyim.2010.09.002

    Article  PubMed  Google Scholar 

  2. Wills TA, Simons JS, Sussman S, Knight R (2016) Emotional self-control and dysregulation: a dual-process analysis of pathways to externalizing/internalizing symptomatology and positive well-being in younger adolescents. Drug Alcohol Depend 1(163 Suppl 1):S37–S45. doi:10.1016/j.drugalcdep.2015.08.039

    Article  Google Scholar 

  3. Currin L et al (2005) Time trends in eating disorder incidence. Br J Psychiatry 186:132–135. doi:10.1192/bjp.186.2.132

    Article  PubMed  Google Scholar 

  4. Dahlgren CL, Stedal K, Ro O (2017) Eating disorder examination questionnaire (EDE-Q) and clinical impairment assessment (CIA): clinical norms and functional impairment in male and female adults with eating disorders. Nord J Psychiatry 71:1–9. doi:10.1080/08039488.2016.1271452

    Article  Google Scholar 

  5. Hudson JI et al (2007) The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 61(3):348–358. doi:10.1016/j.biopsych.2006.03.040

    Article  PubMed  Google Scholar 

  6. Carlat DJ, Camargo CA Jr, Herzog DB (1997) Eating disorders in males: a report on 135 patients. Am J Psychiatry 154(8):1127–1132. doi:10.1176/ajp.154.8.1127

    Article  CAS  PubMed  Google Scholar 

  7. Fairburn CG, Beglin SJ (1990) Studies of the epidemiology of bulimia nervosa. Am J Psychiatry 147(4):401–408. doi:10.1176/ajp.147.4.401

    Article  CAS  PubMed  Google Scholar 

  8. Munno D, Sterpone SCM, Zullo G (2005) L’anoressia nervosa maschile. Una review. Giorn Ital Psicopat

  9. Sundgot-Borgen J, Torstveit MK (2004) Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med 14(1):25–32

    Article  PubMed  Google Scholar 

  10. Russell CJ, Keel PK (2002) Homosexuality as a specific risk factor for eating disorders in men. Int J Eat Disord 31(3):300–306. doi:10.1002/eat.10036

    Article  PubMed  Google Scholar 

  11. Strober M et al (2006) Are there gender differences in core symptoms, temperament, and short-term prospective outcome in anorexia nervosa? Int J Eat Disord 39(7):570–575. doi:10.1002/eat.20293

    Article  PubMed  Google Scholar 

  12. Blinder BJ, Cumella EJ, Sanathara VA (2006) Psychiatric comorbidities of female inpatients with eating disorders. Psychosom Med 68(3):454–462. doi:10.1097/01.psy.0000221254.77675.f5

    Article  PubMed  Google Scholar 

  13. Bulik CM (2002) Anxiety, depression, and eating disorders. Eating disorders and obesity: a comprehensive handbook. The Guilford Press, USA

    Google Scholar 

  14. Striegel-Moore RH et al (1999) Eating disorders in a national sample of hospitalized female and male veterans: detection rates and psychiatric comorbidity. Int J Eat Disord 25(4):405–414. doi:10.1002/(SICI)1098-108X(199905)25:4<405:AID-EAT5>3.0.CO;2-F

    Article  CAS  PubMed  Google Scholar 

  15. Bramon-Bosch E, Troop NA, Treasure JL (2000) Eating disorders in males: a comparison with female patients. Eur Eat Disord Rev. doi:10.1002/1099-0968(200008)8:4<321:aid-erv355>3.0.co;2-g

    Article  Google Scholar 

  16. Woodside DB et al (2001) Comparisons of men with full or partial eating disorders, men without eating disorders, and women with eating disorders in the community. Am J Psychiatry 158(4):570–574. doi:10.1176/appi.ajp.158.4.570

    Article  CAS  PubMed  Google Scholar 

  17. Sharp CW et al (1994) Clinical presentation of anorexia nervosa in males: 24 new cases. Int J Eat Disord 15(2):125–134. doi:10.1002/1098-108x(199403)15:2<125:aid-eat2260150204>3.0.co;2-o

    Article  CAS  PubMed  Google Scholar 

  18. Burns T, Crisp AH (1990) Outcome of anorexia nervosa in male. In: Andersen AE (ed) Males with eating disorders. Brunner/Mazzel, New York, pp 163–186

    Google Scholar 

  19. Weltzin TE, Weisensel N, Franczyk D (2005) Eating disorders in men: update. J Men’s Health Gend. doi:10.1016/j.jmhg.2005.04.008

    Article  Google Scholar 

  20. Weltzin T, Bean P, Klosterman E, Lee HJ, Welk-Richards R (2015) Sex differences in the effects of residential treatment on the quality of life of eating disorder patients. Eat Weight Disord 20(3):301–310. doi:10.1007/s40519-014-0162-z

    Article  PubMed  Google Scholar 

  21. Drewnowski A, Yee DK (1987) Men and body image: are males satisfied with their body weight? Psychosom Med 49(6):626–634. doi:10.1097/00006842-198711000-00008

    Article  CAS  PubMed  Google Scholar 

  22. Anderson AE, DiDomenico L (1992) Diet vs. shape content of popular male and female magazines: a dose-response relationship to the incidence of eating disorders? Int J Eat Disord. doi:10.1002/1098-108x(199204)11:3<283:aid-eat2260110313>3.0.co;2-o

    Article  Google Scholar 

  23. Gila A et al (1998) Subjective body-image dimensions in normal and anorexic adolescents. Br J Med Psychol 71(Pt 2):175–184. doi:10.1111/j.2044-8341.1998.tb01378.x

    Article  PubMed  Google Scholar 

  24. Gila A et al (2005) Anorexia nervosa in male adolescents: body image, eating attitudes and psychological traits. J Adolesc Health 36(3):221–226. doi:10.1016/j.jadohealth.2004.02.039

    Article  PubMed  Google Scholar 

  25. Nieuwoudt JE et al (2015) Symptoms of muscle dysmorphia, body dysmorphia disorder, and eating disorders in a nonclinical population of adult male weightlifters in Australia. J Strength Cond Res 29(5):1406–1414. doi:10.1519/jsc.0000000000000763

    Article  PubMed  Google Scholar 

  26. Forman-Hoffman VL, Watson TL, Andersen AE (2008) Eating disorder age of onset in males: distribution and associated characteristics. Eat Weight Disord 13(2):e28–e31. doi:10.1007/bf03327505

    Article  CAS  PubMed  Google Scholar 

  27. Strieghel-Moore RH, Wonderlich SA, Walsh BT, Mitchell JE (2011) Eating disorders. APA, Arlington

    Google Scholar 

  28. Siegel JH et al (1995) Medical complications in male adolescents with anorexia nervosa. J Adolesc Health 16(6):448–453

    Article  CAS  PubMed  Google Scholar 

  29. Torgrimson BN, Minson CT (2005) Sex and gender: what is the difference? J Appl Physiol 99(3):785–787. doi:10.1152/japplphysiol.00376.2005

    Article  PubMed  Google Scholar 

  30. Spitzer RL, Williams JBW, Gibbon M, First MB (1990) Structured clinician interview for DSM-III-R Axis II disorders (SCID-II). American Psychiatric Press, USA

    Google Scholar 

  31. Beck AT et al (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571. doi:10.1001/archpsyc.1961.01710120031004

    Article  CAS  PubMed  Google Scholar 

  32. Cuzzolaro M et al (2006) The body uneasiness test (BUT): development and validation of a new body image assessment scale. Eat Weight Disord 11(1):1–13. doi:10.1007/bf03327738

    Article  CAS  PubMed  Google Scholar 

  33. Spielberger C, Gorsuch RL, Lushene PR, Vagg PR, Jacobs GA (1983) Manuale per la state-trait anxiety inventory. Consulenza Psicologi Press, Inc., Italy

    Google Scholar 

  34. Ulfvebrand S et al (2015) Psychiatric comorbidity in women and men with eating disorders results from a large clinical database. Psychiatry Res 230(2):294–299. doi:10.1016/j.psychres.2015.09.008

    Article  PubMed  Google Scholar 

  35. Crisp AH, Burns T, Bhat AV (1986) Primary anorexia nervosa in the male and female: a comparison of clinical features and prognosis. Br J Med Psychol 59(Pt 2):123–132. doi:10.1111/j.2044-8341.1986.tb02676.x

    Article  PubMed  Google Scholar 

  36. Carlat DJ, Camargo CA Jr (1991) Review of bulimia nervosa in males. Am J Psychiatry 148(7):831–843. doi:10.1176/ajp.148.7.831

    Article  CAS  PubMed  Google Scholar 

  37. WHO (1990) International statistical classification of diseases and related health problems. Tenth revision

  38. Kinasz K et al (2016) Does sex matter in the clinical presentation of eating disorders in youth? J Adolesc Health. doi:10.1016/j.jadohealth.2015.11.005

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ambwani S et al (2014) Interpersonal dysfunction and affect-regulation difficulties in disordered eating among men and women. Eat Behav 15(4):550–554. doi:10.1016/j.eatbeh.2014.08.005

    Article  PubMed  Google Scholar 

  40. Fortes LS et al (2014) A socio-sports model of disordered eating among Brazilian male athletes. Appetite 92:29–35. doi:10.1016/j.appet.2015.05.005

    Article  Google Scholar 

  41. Hannan WJ et al (1995) Body mass index as an estimate of body fat. Int J Eat Disord 18(1):91–97. doi:10.1002/1098-108x(199507)18:1<91:aid-eat2260180110>3.0.co;2-m

    Article  CAS  PubMed  Google Scholar 

  42. Gadalla T (2008) Psychiatric comorbidity in eating disorders: a comparison of men and women. J Men’s Health. doi:10.1016/j.jomh.2008.06.033

    Article  Google Scholar 

  43. Jones DJ et al (1980) Epidemiology of anorexia nervosa in Monroe County, New York: 1960–1976. Psychosom Med 42(6):551–558. doi:10.1097/00006842-198011000-00003

    Article  CAS  PubMed  Google Scholar 

  44. Robb AS, Dadson MJ (2002) Eating disorders in males. Child Adolesc Psychiatr Clin N Am 11(2):399–418. doi:10.1016/s1056-4993(01)00014-1

    Article  PubMed  Google Scholar 

  45. Lampis J, Cataudella S, Busonera A, De Simone S, Tommasi M (2017) The moderating effect of gender role on the relationships between gender and attitudes about body and eating in a sample of Italian adolescents. Eat Weight Disord. doi:10.1007/s40519-017-0372-2

    Article  PubMed  Google Scholar 

  46. Orellana L et al (2016) Dietary restraint and self-discrepancy in male university students. Eat Behav 21:123–128. doi:10.1016/j.eatbeh.2016.01.005

    Article  PubMed  Google Scholar 

  47. Forrest LN, Smith AR, Swanson SA (2017) Characteristics of seeking treatment among US adolescents with eating disorders. Int J Eat Disord. doi:10.1002/eat.22702

    Article  PubMed  Google Scholar 

  48. Zubatsky M, Berge J, Neumark-Sztainer D (2015) Longitudinal associations between parenting style and adolescent disordered eating behaviors. Eat Weight Disord 20(2):187–194. doi:10.1007/s40519-014-0154-z

    Article  PubMed  Google Scholar 

  49. Bentley C et al (2015) Sex differences in psychosocial impairment associated with eating disorder features in adolescents: a school-based study. Int J Eat Disord 48(6):633–640. doi:10.1002/eat.22396

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to all patients referring to our clinic for their constant collaboration and warm support. We are thankful to Diana Tassinari and Estefany Lopez for English revisions of the manuscript.

Author information

Authors and Affiliations

  1. Department of Biomedical and NeuroMotor Sciences-Psychiatry, University of Bologna, Viale Pepoli n 5, Bologna, Italy

    Stefano Valente, Giulia Di Girolamo, Martina Forlani, Anna Biondini, Paolo Scudellari, Diana De Ronchi & Anna Rita Atti

Authors
  1. Stefano Valente
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giulia Di Girolamo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martina Forlani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna Biondini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paolo Scudellari
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Diana De Ronchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anna Rita Atti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefano Valente.

Ethics declarations

Conflict of interest

Valente Stefano declares that he has no conflict of interest; Di Girolamo Giulia declares that she has no conflict of interest; Forlani Martina declares that she has no conflict of interest; Biondini Anna declares that she has no conflict of interest; Scudellari Paolo declares that he has no conflict of interest; De Ronchi Diana declares that she has no conflict of interest; Atti Anna Rita declares that she has no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of institutional committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Valente, S., Di Girolamo, G., Forlani, M. et al. Sex-specific issues in eating disorders: a clinical and psychopathological investigation. Eat Weight Disord 22, 707–715 (2017). https://doi.org/10.1007/s40519-017-0432-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-017-0432-7

Keywords

Search

Navigation