Eating disorders in adolescent males

Professional School Counseling, Oct, 2004 by Shannon L. Ray

Research indicates that the primary onset of eating disorders occurs in adolescence and that there is a growing prevalence of adolescent males with eating disorders. In this article we describe the eating disorders of anorexia nervosa and bulimia nervosa as they relate to adolescent males. Diagnostic criteria, at-risk groups, and implications for school counselors are each discussed. The importance of the school counselor's role in identification, referral, psychoeducation, and support services for this population is critical.

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In the past several decades, professional and public awareness of eating disorders has increased, although eating disorders have been reported for hundreds of years (Reijonen, Pratt, Patel, & Greydanus, 2003). Commonly perceived to be a female affliction, it is ironic that the first documented clinical case of anorexia was in a male; additionally, males comprise between 10% to 15% of the eating disordered population (Johnson & Connors, 1987; Keel, Klump, Leon, & Fulkerson, 1998; Russell & Keel, 2002; Walcott, Pratt, & Patel, 2003). Specific prevalence rates among males are difficult to determine and may be higher than reported due to the hidden nature of eating disorders and the perception that eating disorders are found solely in females (American Psychiatric Association, 2000; Keel et al.; Patel, Pratt, & Greydanus, 2003; Reijonen et al.; Scheider, 1991). The societal stigma surrounding eating disorders is one of secrecy and shame; as a result, eating disordered males often go to great lengths to hide their condition (Patel, Pratt et al.; Scheider).

The primary age of onset of eating disorders, for both males and females, falls between 12 and 26 years with a peak onset age of 14 to 18 years (American Psychiatric Association, 2000; Phelps & Bajorek, 1991). One study examined prevalence rates for school-age youth and posited that 9% to 11% of all school-age youth met diagnostic criterion for eating disorders (cited in Reijonen et al., 2003). Due to the debilitating side effects of eating disorders--that include morbidity and mortality rates up to 12 times that of the typical adolescent population--appropriate early identification and early diagnosis are imperative (Reijonen et al.). The likelihood of higher than reported prevalence rates of males with eating disorders, in conjunction with the peak age of onset occurring in adolescence, underscores the importance of the school counselor's knowledge base in identifying eating disorders in male students.

This article provides diagnostic descriptions of the risk factors and etiology of eating disorders in the adolescent male population. A discussion of subpopulations that present with heightened risk factors ensues. In addition, implications for school counselors are included that provide information to assist the school counselor with his or her role in providing appropriate referrals, psychoeducational information, and support services. School counselors with an awareness of prevalence rates and etiology of eating disorders in adolescent males can successfully provide front-line assistance to these males in both at-risk and diagnostic groups (Felker & Stivers, 1994; Fischer et al., 1995; Nelson & Hughes, 1999; Patel, Pratt et al., 2003).

DESCRIPTION

The Diagnostic and Statistical Manual of Mental Disorders (4th ed. text rev., American Psychiatric Association, 2000) describes the criterion for the diagnosis of anorexia as the refusal to maintain a normal bodyweight as defined by weight of less than 85% of typical bodyweight for a given height as well as experiencing intense fear related to gaining weight. Young men comprise approximately 10% to 15% of those suffering from the disorder; the peak age of onset for both genders falls between 14 and 18 years. The negative health effects of the disease include: metabolic changes, emaciation, constipation, thyroid difficulty, heart abnormalities, and death (Reijonen et al., 2003). The mortality rate for individuals with anorexia proves greater than any other mental disorder and has been shown to be as high as 15% (American Psychiatric Association, 2000; Phelps & Bajorek, 1991; Reijonen et al.; Scheider, 1991). This alarming statistic, in conjunction with the primary age of onset occurring during the middle and high school years, underscores the importance of the school counselor's role in appropriate identification and understanding of the risk factors of anorexia.

According to the DSM-IV-TR (2000), individuals suffering from bulimia eat a large amount of food in a limited time period, experience a lack of control over eating during that time, engage in inappropriate purging behavior, display maladaptive eating patterns at least two times per week for 3 months, and are hypersensitive to weight fluctuations. Purging methods include: vomiting, laxative use, excessive exercise, or subsequent restricted food intake. Unlike those suffering from anorexia, individuals with bulimia are often of normal body weight and are better able to hide their disease. The currently reported prevalence rates represent 1% to 3% of the population in industrialized countries; however, actual rates may be considerably higher as the accuracy of these statistics remains suspect due to underreporting (American Psychiatric Association, 2000; Keel et al., 1998; Patel, Pratt et al., 2003; Reijonen et al., 2003; Scheider, 1991). Like anorexia, the typical range of onset for both genders occurs in the adolescent years (American Psychiatric Association; Lyon & Chatoor, 1997; Reijonen et al.).