Illusory Control: The Visibility of Eating Disorders in Men Rises As Diagnoses Increase

Eating disorders are typically considered “girl diseases,” primarily affecting young, usually white, Western women on the cusp of adulthood. Many are surprised to learn that this understanding of the conditions in which eating disorders strike is a fairly recent development; as David Cox writes in The Guardian:

The first recorded case of anorexia was in 1649 when Richard Morton, a London physician, noted the symptoms of a young man. Morton described it as a ‘nervous consumption’ and continued to record cases throughout his life. His notes refer to a ‘wasting of the body without any remarkable fever, cough or shortness of breath’ and speculate on a link to the ‘cares and passions’ of the mind.

In recent years, the increasing visibility and, perhaps, prevalence of eating disorders amongst men have served as a stark reminder that these illnesses do not exist within the boundaries of one specific gender; since 2000, the number of men diagnosed with eating disorders has risen by 27% and men now represent approximately 30% of people with anorexia nervosa and bulimia nervosa, as well as nearly half of those with binge eating disorder. Because only about 10% of men with eating disorders seek treatment, the true number may be significantly higher.

Part of the reason the mythology of eating disorders as a woman’s disorder persists is etiological confusion. Eating disorders, particularly anorexia and bulimia, are commonly understood as maladaptive reactions to aesthetic concerns; the nearly pathological idealization of thinness and cultural patrolling of women’s bodies have no male-targeted equivalents and, thus, it’s assumed that men should not be driven to participate in disordered eating. The fact that women are indeed often conditioned to live in a kind of body-focused panopticon is assumed to be enough to explain the prevalence of eating disorders amongst women and, logically speaking, it’s not an unfair assumption to make. It is, however, an inaccurate one. As Cox points out:

Anorexics themselves often reject the concept that their disorder has been triggered by the predominance of certain body types in magazines and adverts. Instead, it is a gradual process, where they slip into an addictive mindset of associating weight loss with both internal and external approval. This acts as a coping mechanism for some underlying trauma, which may range from the end of a relationship, bullying, loneliness, bereavement or general low self-esteem.

This understanding of eating disorders as an expression of and attempt to seek relief from very real and complex psychological distress illuminates why the illnesses slither across gender lines; emotional pain is universal and so too is the desire to escape it. Troy Roness, now a writer and eating disorders advocate, can clearly trace his own anorexia to the combined stressors of his parents’ divorce and leaving home for the first time at the age of 19. “[I didn’t have] the emotional skills to deal with traumatic events in my life,” he says. “When it comes to interactions with family and friends and your social circle, an eating disorder is a way to control things.” That sense of control, however, is illusory. As Benjamin O’Keefe, who has also struggled with anorexia, tells Salon, “[Not eating] started as such a conscious decision, but it was also something I couldn’t control. People die from this. I had to get to rock bottom before I saw how bad it was.”

Despite the fact that these illnesses cross all manner of socioeconomic and cultural boundaries, gay and bisexual men in particular are at significantly heightened risk of developing an eating disorder. Today, 42% of men living with eating disorders self-identify as gay or bisexual and a full 15% of gay or bisexual men experience an eating disorder in their lifetimes. Some experts believe that this augmented risk is in part explained by the body-conscious and youth-obsessed culture within some parts of the gay community itself. Dr. Ilan Meyer, professor at Columbia University, says:

[The] theory is that the values and norms in the gay community promote a body-centered focus and high expectations about physical appearance so that, similar to what has been theorized about heterosexual women, they may feel pressure to maintain an ideal body image.

This pressure may indeed contribute to the development of eating disorders in some men. In a moving essay for The Advocate, Joseph Holtom writes, “I constantly worried about how I looked so I could maintain my ‘skinny’ identity, the eating disorder took over. Very early on after I came out, the community labeled me a ‘twink,’ which only perpetuated my obsession with my natural physical characteristic of having a small frame.” Dr. Meyer’s own research, however, suggests that “factors other than values and norms in the gay community are related to the higher rates of eating disorders among these men,” including the higher rates of depression and anxiety experienced by gay and bisexual men, internalized negative beliefs as the result of homophobia, and experiences of discrimination, bullying, rejection, and violence. Young men may be particularly at risk as the result of these experiential factors. “We know that gay and other sexual-minority kids are often under a lot of pressure,” says S. Bryn Austin, a professor at Harvard University. “This kind of isolation and victimization can take its toll on a person and one of ways it can play out is in vulnerability to eating-disorder symptoms and a host of other stress-related health problems.” As such, it may be that more gay and bisexual men look toward disordered eating to cope with distress because they have more distress to begin with.