Last year I ran a workshop in Serbia where I did an in-depth examination of anorexia nervosa and a variety of other clinical states. At the beginning of each different condition I gave the usual statistics about the condition. For anorexia one was that 95% of anorexics are female.
A little later on in the workshop one of the participants asked me about the nature and psychodynamics behind the male anorexic to which I had to answer that I did not know. I cannot recall ever reading such a thing nor recall ever working with such a person.
Well as it happens in the last month I have a new client who could be considered to have some of the criteria of anorexia and he is male. As you can imagine he is of considerable interest to me. Upon some reflection it seems that the way anorexia is currently defined it rules out the vast majority of males. So one reason why 95% are female is simply because how the condition is defined.
Thus one could argue that there are indeed more anorexic males but they are not diagnosed because of how the condition is currently defined. Its not that male anorexics don’t exist its simply a definitional problem for the condition that is heavily weighted towards the female psyche.
The usual criteria of anorexia is:
Refusal to maintain a minimal normal body weight for age and height
Intense fear of gaining weight or becoming fat
Disturbance in the way one perceives ones body weight, shape and size.
In females the absence of at least three consecutive menstrual cycles.
This man is in his late 20s and is currently quite thin. He reports that he has had trouble gaining weight since his late teens. At times he has been dangerously thin. He has never been hospitalised but he has always led a very isolated life so he is unlikely to be identified as in danger of dying. He reports that he simply does not eat. There have been times where he has eaten nothing for up to 5 days at a time.
He states that this is a rebellious act as in childhood mother was very forceful about him and his siblings eating all their food at the dinner table. There are many memories of mother demanding that he eat up all his food. Physical punishments were used when food was not correctly eaten. He has a low self esteem, a self hatred and passive suicidal urges. That is he does not actively plan suicide attempts but he has consistent and strong wishes that he was dead.
If one looks at the four criteria of anorexia, obviously number 4 is about females. Number 2 & 3 one could argue are much more female oriented. As a group women are more interested in how much they weigh and about their body shape and size. One simply has to survey the media and one sees endless images about female weight, body shape and size. In comparison there are very few images involving men. Cosmetics, clothing, plastic surgery all indicate the same. That women are much more focused on weight, body shape and size compared to men.
As a result one could say that the current definition of anorexia is sexist. Very few men are going to meet the criteria because the intense focus on body weight, shape and size is much less common in the male psyche.
However there maybe men out there who refuse to maintain a minimal normal body weight for age and height but the other criteria are different. Maybe I have begun to identify some of the other criteria with my single male client. Low self esteem, self hatred and suicidal urges. He is but one person and thus one is most cautious in generalising. However, when I run my next workshop on eating disorders and I get a question about the male anorexic I can now at least give a partial answer.