A Brief History of Eating Disorders (ED)
Prevalence of Eating Disorders Among Males
Perspectives on Gender and Food – Feminism, Post-Feminism, and Masculinity
Power and the Body – Bourdieu’s Theory of Power Relations
Understand Prevalence of ED Among Males Through a Lens of Gender and Power
Over the past few decades of research and practice on eating disorders, there has been a severe lack of focus on the prevalence of these disorders among male populations. Given that an estimated 25-40% of males suffer from eating disorders, it is important for research and practice to adopt a nuanced understanding of how and why males are affected by these disorders. This paper provides an analytical lens for understanding the influence of gender and power dynamics in the occurrence of eating disorders among males. By exploring how gender and power manifest on the individual level to influence self-perception and body image, the hope is that this study may contribute to a more nuanced perspective of relevant issues and appropriate methods for prevention, diagnosis, and treatment.
Since the origin of research on eating disorders (ED), there has been a paucity of focus on the occurrence of these disorders among male populations. Given that an estimated 25-40% of eating disorder patients are male, (Miller 2009) it is important for both research and practice to develop an understanding of how and why males are affected by these disorders. Exploring how gender dynamics drive behaviors and perceptions related to body image and eating can provide a useful framework for doing so. As Susan Bordo has observed, “there is no private domain of a person’s life that is not political and there is no political issue that is not ultimately personal… culture’s grip on the body is a constant, intimate fact of everyday life.” (S. Bordo 2003, 17) The purpose of this paper is to expand on this idea by exploring how theories of gender – including feminism, post-feminism, and masculinity – provide a lens to better understand how social and cultural ideals influence manifestations of eating disorders among males.
A Brief History of Eating Disorders (ED)
The diagnostic manual, Diagnostic and Statistical Manual of Mental Disorders-IV-TR and the International Statistical Classification of Diseases and Related Problems, 10th edition creates the basic criteria for diagnosing eating disorders with the best known and researched being categorized as anorexia nervosa and bulimia nervosa. (Dovey 2010, 136) The anorexia criteria include: 1) Refusal to maintain body weight at or above minimally normal body weight for sex and age, 2) Weight less than 85 percent of norm, 3) Intense fear of weight gain and fatness despite abnormally low body weight, 4) Disturbance in the experience of own body weight or denial of the seriousness of current low body weight, and 5) In post-menarche females, amenorrhea. (Dovey 2010, 136) The bulimia criteria include: 1) Eating an amount of food that is definitely larger than most individuals would eat in similar circumstances, 2) Lack of control over binging episodes, 3) Following the binge, a sufferer must employ inappropriate compensatory behaviors (including vomiting, laxatives, restrictive dieting, excessive exercise), 4) Minimum of two binging episodes a week for 3 months, and 5) Obsessive behaviors and thought about one’s body image (body dysmorphia). (Dovey 2010, 136)
In Food Studies: An Introduction to Research Methods, Jeff Miller and Jonathan Deutsch explore manifestations and causes of disordered eating, emphasizing the use of “presentism”, or “using a contemporary lens to view what has happened in the past” to understand social, cultural, political, economic influences of phenomena. (Cairns K 2010, 79) This approach of presentism provides a useful framework to understand eating disorders and potential influences causing or exacerbating them, and how they have manifested throughout history. The modern era of the study of eating disorders began with William Gull, who coined the term “anorexia nervosa” in the 1860s. (Cohn 2014, 6) Gull described the disorder as “emaciation without apparent causation, a specific age and gender distribution, denial of the patient of illnesses, the degree of conscious choice and the sense that the disorder had remedy in behavioral control.” (Macsween 1993, 14-15) The field was further expanded by Gerald Russell, who defined bulimia nervosa in 1979, and by various groups in the 1990s that brought attention to binge eating disorder. (Cohn 2014, 8) Although most people tend to equate the term "eating disorder" with anorexia nervosa or bulimia nervosa, a third category of "atypical eating disorders" (Fairburn 2002, 171-177), also known as "eating disorder not otherwise specified" or EDNOS, has also emerged, defined as eating disorders that do not meet the symptoms of anorexia or bulimia. (American Psychiatric Association 1994) These disorders can include behaviors such as rigid and extreme dieting, binge eating, over-exercise, over-evaluation of eating, or laxative misuse (Ricca 2001), and they are considered as prevalent if not more so than "typical" eating disorders. (Millar 1998)
Moving beyond definitions, many studies have explored the influence of various social and cultural influences on disordered eating – primarily among females. For instance, in “Appetite as Voice”, Joan Brumberg explores eating disorders among Victorian upwardly middle class women, who “were repulsed by the implications of food and eating and association with digestion and defecation, as well as sexuality that might counter the incorporated ideal of feminism.” (Brumberg 2008, 150) Writing on more modern manifestations of eating disorders, in 1984 Susan Bordo wrote that eating disorders reflect “the central ills of our culture,” including the historical disdain for the body, a collective fear of loss of control, and the concerning and unrealistic contemporary beauty ideals, and particularly their effects on women. (Bordo 2008, 163) These studies reflect various interpretations of the influence of social as well as gender constructs on behaviors and perceptions surrounding eating disorders.
Prevalence of Eating Disorders Among Males
Since the 1970s, when a focus on eating disorders began to emerge as a study and practice, there has been an uneven focus on females – particularly white, rich, adolescent girls – as the primary population suffering from eating disorders. (Cohn 2014, 5-7) Despite this characterization as “women’s problems”, eating disorders have been found to be much more gender neutral than commonly believed. The National Association for Males with Eating Disorders, in fact, states that 25-40% of people with eating disorders are males. (Miller 2009) This research bias has played a significant role leading males to be under- and undiagnosed for ED, and has led to males being stigmatized for having a disorder characterized as feminine and for seeking help. (Cohn 2014, 6-8) Given increasing recognition of these problems, recently there have been more published studies of the occurrence of eating disorders among males, yet there remains a need for more research to address these issues by promoting a better understanding of how males are uniquely affected by these disorders. (Cohn 2014, 6)
Studies that have focused on the prevalence of these disorders among males point to the male desirability for a body image that is lean and muscular, linked to an obsession with inadequate muscularity and often manifesting in behaviors such as over-exercising, excessive use of supplements, abnormal eating patterns, and use of steroids.” (National Eating Disorders 2016) NEDA further describes the problem of ED in males:
Studies have shown an increase in numbers… In the United States, 20 million women and 10 million men will suffer from ED and other described eating disorders now called other specified feeding or eating disorders. (OSFED)… Subclinical ED (including binge eating, purging, laxative abuse and fasting for weight loss) are nearly as common for males as females. Studies suggest that risk of mortality for males with ED is higher than it is for females and men suffer comorbid conditions with depression, excessive exercise, substance disorders, and anxiety. (National Eating Disorders 2016)
Given the high prevalence of and high risk associated with eating disorders among males demonstrated through studies, there has been an increase in interest for research on the relationship between gender and food studies. As Maine and Bunnell write, changes in gender roles and expectations have occurred that have created changes in the last twenty-five years of globalization, changes that particularly reverberate in the lives of men:
If women turn to their bodies as the way to modulate and resolve stressors and mixed messages, it is only logical that men would also express some of their distress through their bodies and would be at greater risk to develop eating disorders… Men are subjected to more and more media images of idealized male bodies… Confronted daily by the gap between their real bodies and idealized body… men are increasingly dissatisfied with their bodies. Our clinical observations suggest that men tend to focus more on strength, shape, and muscularity rather than on weight or clothing size, characterized in females. (Maine 2008, 187-188)
Studies such as these point to some of the unique manifestations and experiences of eating disorders among males and to the need to understand them through a gendered lens.