Male Eating Disorders

Experiences of Food, Body and Self

Russell Delderfield

• Publisher: Palgrave Pivot
• Year: 2018
• ISBN:
  9783030025359
• Topic: Social Sciences
• Subtopic: Gender Studies
• Index: Social Sciences

This book takes a novel approach to the study of male eating disorders – an area that is often dominated by clinical discourses. The study of eating disorders in men has purportedly suffered from a lack of dedicated attention to personal and socio-cultural aspects. Delderfield tackles this deficiency by spotlighting a set of personal accounts written by a group of men who have experiences of disordered eating. The text presents critical interpretations that aim to situate these experiences in the social and cultural context in which these disorders occur.
This discursive work is underpinned by an eclectic scholarly engagement with social psychology and sociology literature around masculinities, embodiment and fatness, belonging, punishment, stigma, and control; leading to understandings about relationships with food, body and self. This is undertaken with a reflexive element, as the personal intersects with the professional. This text will appeal tostudents, scholars and clinicians in social sciences, humanities, and healthcare studies, including public health.

© The Author(s) 2018

Russell DelderfieldMale Eating Disordershttps://doi.org/10.1007/978-3-030-02535-9_1

Begin Abstract

1. Why Study Men?

Russell Delderfield¹

(1)

University of Bradford, Bradford, UK

Russell Delderfield

Abstract

Background to the book is elucidated, both personal and empirical and a rationale is established. Current research findings are considered with emphasis on the few qualitative studies on male eating disorders. Concepts such as stigma, gender role conflict, and muscularity-oriented disordered eating are introduced, the latter being peculiar to the male experience. A summary of the reflexive research design is provided.

Keywords

Male eating disordersMuscle dysmorphiaQualitative psychologyInterpretative researchStoriesReflexivity

End Abstract

There are two oft-used openings to research studies on male eating disorders. As papers intone, some of the earliest recorded cases of eating disorders were in men, despite the women-centric trends of the twentieth century. The other is to state that knowledge about males is non-existent or scant at best. These two have become something of a research article cliché.

Cliché or not, to say that anywhere from ten to twenty-five percent of eating disorder cases are male (Sweeting et al. 2015), boys and men are regularly overlooked when it comes to research focus and funding (Murray et al. 2017). Even with our poor handle on prevalence, this still represents many lives affected by these disorders that are known to have high mortality rates (Smink et al. 2012). Therefore, there is a research-informed justification: men are marginalised and we need to know more. However, as I am about to argue, it is not enough to know ‘more of the same’. For male eating disorders research to advance, diversification of approach is required. I propose qualitative research as being one way to achieve this.

Qualitative research does not seek to assess variables on scales or measures, rather it attempts to understand the meaning of people’s experiences without reducing these to statistical values about aetiology, epidemiology, psychopathology or treatment. This type of experiential research is necessary because an over-reliance on a narrow set of methods for knowledge generation has led to glaring gender disparity:

Socio -cultural constructs of eating disorders have been illuminated by feminist theory, but the lack of equivalent discourse addressing male gender identity has left our knowledge of eating disorders in men aetiolated. (Jones and Morgan 2010: 29)

I take this statement as a call-to-action. As a crude but useful comparison, if I wish to find in-depth critical analyses of women’s experiences of anorexia nervosa, their personal stories, and what these reveal about disordered eating and society, I can locate decades of these going back to the 1980s. The same cannot be said about men and it is holding us back. Likewise, I could list male-subject studies that make mention of socio-cultural factors but there are relatively few that actually explore these in any detail (Rodgers et al. 2012; Turel et al. 2018). In short, whilst the study of male eating disorders has, since the first substantial work on the topic (Andersen 1990), stressed the biopsychosocial nature of these conditions, the ‘social’ bit at the end seems to, well … drop off the end entirely.

The aim of this book is to present my modest attempt to tackle this. I set out to explore the experiences of men, achieving depth through the lens of what we know socially and culturally about men. Of course, this book is not able to generate an entire ‘equivalent discourse’ (this would be an enormous task) but it is a beginning step in understanding what men live through, in a way that moves beyond psychiatric data, instead adopting a social psychological approach.

A full comprehensive critical review of literature is beyond the scope of the book and, arguably, this has recently been rendered unnecessary by Murray et al. (2017) who have published this to a high standard (I recommend reading). It is important to make something clear. I am not dismissing the literature that emanates from clinical research. Such work is invaluable and is essential to prevention and treatment. It is included here as I introduce evidence that is pertinent in later chapters. However, I will focus on that which truly is scarce within our field: experiential qualitative research.

The Research Story

Now that diagnostic criteria have been redefined to eliminate biological sex-related symptoms, such as the outdated criterion of menstruation cessation from the anorexia classification, it is reported that the presenting issues across the main disorders (anorexia, bulimia, and binge-eating disorder) are essentially the same. This is borne out by studies that focus on psychopathological features. For instance, personal control and its related issues are found to be similar (Cohn and Lemberg 2014; Kelly et al. 2018). Both anorexia and bulimia tend to feature the personality trait perfectionism (Núñez-Navarro et al. 2012). In the development and diagnosis of binge-eating disorder there are few differences to be found (Shingleton et al. 2015). Similarly, men with anorexia develop osteoporosis (Mehler et al. 2018). ‘Pro-Ana’ and ‘pro-Mia’ online spaces, populated by women seeking to sustain their anorexia or bulimia as a lifestyle choice, are now supporting male participants (Turja et al. 2017).

This can be contrasted with findings that, regardless of the improved inclusivity of diagnostic criteria and treatments, emphasise the differences. The following examples illustrate this. A key difference is in prevalence. Men continue to be less likely to develop disordered eating (Sweeting et al. 2015). Disordered eating men are still said to have a less deleterious body image than women (Núñez-Navarro et al. 2012). Despite purported similarity, osteoporosis in male anorexia has a profound difference: the levels of bone mass deterioration was found to be worse, even if they had been starving for shorter durations (Mehler et al. 2018).

Causes, Diagnosis, and Treatment

In terms of what leads to a man experiencing disordered eating, consensus states that causes are largely similar to women (Cohn and Lemberg 2014). Earlier I mentioned the biopsychosocial model. This model covers broad socio-cultural factors, for example cultural expectations or the influence of mass media; local and biological factors, such as familial practices around food and eating, through to our inherited genetics; and individual psychological factors, for example, experience of personal trauma, personality traits or deficits in self-esteem. Certain of these elements are said to have gender distinctions, however.

For example, a history of physical, rather than sexual, abuse in the form of domestic violence indicated future problems with eating (Mitchell et al. 2011). Furthermore, in an investigation about influences on eating behaviours, rather than media images being found to impact, there is some evidence that men’s behaviours are more influenced by their friendship groups’ comments. This can result in experimenting with the use of strategies that become damaging, such as fasting or eating and purging (Forney et al. 2012). This has not prevented studies from mentioning the media’s part in the development of disordered eating, although this remains largely unexplored. A notable exception is a study that focuses specifically on the effects of social media on men’s body dissatisfaction and its links with eating disorder symptoms.

Body dissatisfaction is the concept of men being unhappy with their bodies, thin or fat, fit or unfit (Feltman and Ferraro 2011) and it can extend to any aspect of the body, such as height, hair, musculature, chest, legs, buttocks or penis-size. It was asserted that exposure to imagery are related to greater dissatisfaction and adaptive responses in sexual minority men (Griffiths et al. 2018). A final example of difference, is the propensity for male athletes to succumb to disordered eating, depending on expectation within their sport. Wrestlers, swimmers, track running and horse racing, along with instances in football and rugby are said to have increased susceptibility (Blair et al. 2017; Mehler and Andersen 2017).

Men appear to be harder to diagnose (Griffiths et al. 2015). Differential diagnosis is common, with men being assigned to an atypical category. This is often referred to as ‘Otherwise Specified Feeding or Eating Disorder’ (Smink et al. 2014) in research that is informed by the Diagnostic Statistical Manual (American Psychiatric Association 2013). Male patients may not have a recognisable ‘a drive for thinness’ (Murray et al. 2017 transition) or be below underweight thresholds. This drive is usually found to some degree, even in non-anorexia disorders. We know, for instance, that clinicians sometimes fail to diagnose eating disorders because, apart from anorexia, men may not appear greatly underweight or overweight (Bayes and Madden 2011), and overweight men are routinely not referred for an eating disorder consultation (MacCaughelty et al. 2016). Problems with diagnosis are compounded by men avoiding health professionals. Denial, shame and stigma, due to a fear of being perceived as feminine, function as obstacles to accessing help (Cohn and Lemberg 2014; Mehler and Andersen 2017).

Men themselves may fail to perceive that they have problem behaviours (Burlew and Shurts 2013), believing themselves to be idiosyncratic or ‘different’. Eating disorders are shameful (Muise et al. 2003) and involve a great deal of secrecy (Delderfield 2013; Ray 2004) but this is ‘amplified’ in men because “men are reluctant to admit to having a ‘women’s problem’” (Corson and Andersen 2002: 196). This conceptualisation as a ‘female illness’ is not limited to a single study. Rather, it appears repeatedly throughout the epidemiological and therapeutic literature (Bartlett and Mitchell 2015; Bryant-Jefferies 2005; Costin 2007; Harvey and Robinson 2003; Raevuori et al. 2008; Räisänen and Hunt 2014; Smart 2006).

Whilst gender-based therapy has been advocated for in the services that men can access (Greenberg and Schoen 2008), the literature is broadly in favour of the view that services are “failing to reflect the gender diversity of the populations which they serve” (Morgan 2013: 277) because they are based on models that were designed around the majority of patients, women (Cohn and Lemberg 2014). Male self-help groups can be useful in proving to men that they are not alone in their condition (Russell and Laszlo 2013). Russell and Laszlo observe about their male-only space: “…offering men a space to talk about emotions can feel a bit like trying to get a cat to swim, technically it can do it, but it is not the done thing for a cat” (2013: 253). The question as to whether all-male treatments are truly effective in tackling perceived barriers by encouraging men to engage in tailored treatment is redundant as there are so few services (in the UK, at least), that it is impossible to tell.

Actual outcomes for men, in terms of symptom abatement, were thought to be better than women in terms of the remission of purging and restoration of weight (Støving et al. 2011). Nevertheless, men are reported to suffer greater overall functional impairment (Striegel et al. 2012), as such the symptoms may have abated but more men leave treatment having reached medical thresholds for ‘health’ but they continue to experience a poor quality of life, when compared with recovered women (Mitchison et al. 2013). Directly...

Table of contents

• Cover
• Front Matter
• 1. Why Study Men?
• 2. Stoicism and Fugliness
• 3. Fat and the Wrecked Body
• 4. Punishment and Passing
• 5. Control and Colonisation
• 6. Ambivalent Men
• Back Matter