Male anorexia, an invisible disorder
Anorexia nervosa has always been considered a "girl's disorder," but despite its higher prevalence in females, men also experience anorexia. These cases are rare, as statistics show that for every 9 girls with anorexia, there is 1 boy (Treasure et al., 2020). These sex differences are due to both biological and psychosocial factors.
On the one hand, it has been observed that women have a greater predisposition to anorexia nervosa, attributed to certain neurobiological factors such as the earlier onset and manifestation of puberty in women. Female sex hormones, such as estrogen, appear to have an impact not only on the development of physical changes in girls but also on their psychological development (Schorr & Miller, 2017). Thus, the transition from girlhood to womanhood is preceded by a series of behavioral and cognitive changes that can interfere with body image. It is during puberty that some anxiety about these changes may arise, such as a fear of maturing and some body dissatisfaction. In boys, puberty occurs later and does not have such a significant hormonal impact, as it is more gradual.
How do young people feel about their bodies?
From a psychosocial perspective, environmental factors such as gender roles and stereotypes play a significant role in the development of anorexia nervosa. These factors could explain the disproportionately high rates of anorexia among women, but they also influence men. Historically, aesthetic pressure and the objectification of the body have been more pronounced for women than for men, meaning that women are relentlessly judged based on whether or not they conform to established beauty standards. For these reasons, it is crucial to address mental disorders from a gender perspective , as this aesthetic pressure, now known as "aesthetic violence," which has been amplified by the impact of social media, directly affects people's self-concept, body dissatisfaction, and consequently, self-esteem. We know that one of the risk factors for developing anorexia is low self-esteem, in addition to pre-existing body dissatisfaction.
From compulsive exercise to significant food restriction
What about men? Aren't they subjected to aesthetic pressures? Undoubtedly, they are, and increasingly so. Patriarchal society idealizes "hegemonic masculinity" through physical strength , implying an athletic and "not malnourished" body. This may explain why we find fewer cases of male anorexia nervosa, since the inability to maintain a minimum healthy weight (which implies malnutrition) is precisely a diagnostic criterion for this disorder.
This explains why we find more cases of muscle dysmorphia , a condition characterized by an obsession with acquiring a muscular physique , in men. Furthermore, in cases of male anorexia, an obsession with physical exercise is much more frequent than in women (Schorr & Miller, 2017). In fact, initially, the desire to build muscle often predominates over the desire to lose weight. In pursuit of this goal, excessive physical exercise is undertaken, which eventually becomes a compensatory behavior. This type of exercise is the most significant symptom in a boy with anorexia and the most difficult to control. It is compulsive, its sole purpose is to burn calories, it is unhealthy, and it contradicts the healthy and protective values of sport: enjoyment, healthy habits, socialization, and teamwork. Unlike muscle dysmorphia, compulsive exercise combined with significant food restriction causes brain changes and very marked behavioral patterns that trigger thoughts typical of anorexia, such as the fear of gaining weight or the distortion of body image.
Men with anorexia are also subject to more stigma than women with the same disorder (Timko et al., 2019). Most cases still go undetected, and despite beginning in adolescence, they are often treated in adulthood.
What are the risk factors for male anorexia nervosa?
- Childhood overweight or obesity : which involves starting diets, prohibiting foods, and experiencing body dissatisfaction in accordance with current aesthetic standards that idealize thinness in women and a muscular body in men. (Hache et al, 2020)
- High standards, perfectionism, and obsessive personality : boys are more prone to a temperament characterized by high standards, rigidity, and obsessiveness. This is even associated with a higher risk of obsessive-compulsive disorder (OCD) than in girls.
- Competition in elite sport : associated with the demands and pressure that some boys may be subjected to, the body exposure that certain sports involve, the need to follow certain types of strict diets and weight controls.
- School bullying and aesthetic violence : a significant percentage of boys and girls with anorexia nervosa have suffered school bullying, and in more than 50% of cases, this has been associated with comments about their bodies (Hache et al., 2020) (Wolf, 1990). Fatphobia, LGBTQ+phobia , and racism are the three main causes of school bullying. Furthermore, anorexia nervosa is more frequent in gay boys (Corbeil-Serre et al., 2014) (Nagata et al., 2020). This psychosocial aspect has been extensively studied. On the one hand, the process of accepting a particular sexual identity could generate conflict in adolescents between what they feel and what society expects them to "be and feel." In addition, it appears that aesthetic pressure may be greater in the LGBTQ+ community.
We are still far from having a society tolerant enough for teenagers to feel and freely experience their sexuality and accept their sexual identity without experiencing psychological distress. One of the keys to preventing anorexia nervosa could be education in equality and diversity, as well as promoting the development of a critical perspective on the unattainable and imposed beauty standards that impact our psyches daily through social media.
Featuring
