Eating Disordered Adolescent Males

Adolescence, Fall, 2001 by Alexandra O. Eliot, Christina Wood Baker

ABSTRACT

The purpose of this study was to describe a sample of 40 eating disordered adolescent males in order to complete a series of follow-up studies on adolescent females who were seen for evaluation and treatment at Boston Children's Hospital Outpatient Eating Disorders Clinic between 1981 and 1991. The sample was drawn from all males seen at the clinic (between 1981 and 1995) who were eligible for inclusion because of a diagnosis of anorexia nervosa, bulimia nervosa, or eating disorder -- not otherwise specified. Data were collected via retrospective chart review and three self-administered quantitative scales. Although the response rate to the mailed follow-up questionnaires was low, comparisons with the three studies on females were consistent with those of other investigations, suggesting that the course and outcome of these illnesses are remarkably similar for males and females. The findings support the idea that clinicians, coaches, peers, and family members should encourage young men to share concerns about body image and weight at an earlier, less severe juncture, with assurance that these issues are common to both sexes.

For reasons that remain unclear, disordered eating patterns in all age groups continue to be far more prevalent among females than males, which is unusual in comparison to other disease processes except those directly linked to reproductive function or sex chromosomes (Braun, Sunday, Huang, & Halmi, 1999). Clinicians who have treated males as long ago as the seventeenth century (Morton, 1694) have consistently noted that similarities outweigh differences in the symptomatology, course, and outcome of these illnesses (Hsu, 1990; Woodside, Garner, Rockert & Garfinkel, 1990), and that there are no observable gender-dependent differences in clinical presentation, epidemiology, endocrinology, or psychometric profile of these patients (Sterling & Segal, 1985; Crisp, Burns, & Bhat, 1986; Scott, 1986; Schneider & Agras, 1987). Burns and Crisp (1990) go so far as to state that the characteristics of males with eating disorders are indistinguishable from those of females. Nonetheless, Andersen (1990a) cautions that alth ough there are similarities in the treatment of males and females, so too are there special aspects of diagnosis and management which are pertinent to males and which warrant more attention and research.

There is, in fact, more opportunity for diagnostic error in males (Sterling & Segal, 1985; Andersen, 1990a). Males may express conflicts regarding body image in ways which differ from females. They tend to diet more defensively in sports which demand weight control, especially when injury occurs, or when other male family members have been warned about the medical consequences of obesity or illness. Underdiagnosis or misdiagnosis may also occur as a result of the popular belief that anorexia and bulimia nervosa are the exclusive domain of vulnerable females, which may exacerbate the reluctance of males to acknowledge a problem and to seek help (Andersen, 1990a).

The purpose of the present study was to describe a sample of eating disordered young men in order to complete a series of follow-up studies on adolescent and young adult females seen for evaluation and treatment at Boston Children's Hospital Outpatient Eating Disorders Clinic (EDC). The EDC was started in 1981, as a collaborative effort between the Departments of Psychiatry and Adolescent Medicine, by Drs. Piazza and Eliot. Between its inception and the time of data collection for this study in 1995, more than 1,000 patients and their families had been seen, some for initial or second opinion consultation, and many others for ongoing treatment of varying length and intensity (Eliot, 1998).

Three follow-up studies, with a total sample of 328 females, were completed by Eliot in 1988, 1989, and 1991. For purposes of consistency, and because of the literature suggesting possible gender differences in etiology and personality structure (Seaver & Bender, 1972; Ohernin, 1985), males were excluded from these studies. The aim of the present study was to describe this previously unexamined group (including a case history) and offer comparisons with the aforementioned adolescent female studies.

METHOD

Participants

The eligible population for study was all adolescent males who had been referred to EDC between 1981 and 1995 for problems associated with disordered eating. From the EDC master list, 58 males were identified who were between the ages of 12 and 21 years and who made an initial appointment. Of these males, 18 were eliminated because they did not keep the appointment or because they did not meet DSMIV diagnostic criteria (American Psychiatric Association, 1994). This resulted in a nonprobability sample of 40 young men (mean age = 14.7 years, SD = 2.5). Mean duration of illness at the time of presentation was 24.4 months (n = 37, SD = 38.3). Fifty-five percent were diagnosed with anorexia nervosa, 12.5% with bulimia nervosa, and 32.5% were classified as ED-NOS (eating disorder--not otherwise specified), or atypical eating disorder, including compulsive overeating. Thirty-five percent were first-born children and 25% were last-born; 15% were only children.