BSJ

The Butler Scholarly Journal

‘Manorexia’: The Inequality of Diagnosis

By Siri Minsaas

Walk into any newsagent and you will immediately be faced with countless newspapers and magazines vying for your attention, their headlines reporting stories of ‘Beyoncé’s astonishing post-baby weight loss’, Kelly Osbourne’s ‘drastically slimmer frame’ and accusations that Miley Cyrus, Demi Lovato, Selena Gomez and other Disney tween celebrities are literally starving for attention. When, however, was the last time you saw a headline alluding to a male celebrity having an eating disorder?

Contrary to what popular media would have us believe, the prevalence of eating disorders in the male half of the population is far from uncommon. In fact, despite being portrayed as a predominantly female condition, the NHS reports that around 10% of people diagnosed with eating disorders in the U.K. are men, with an estimated 1 million men in this country currently suffering from disordered eating. Indeed, binge-eating appears to affect almost as many men as it does women. Recent statistics suggest that up to 3% of men will be affected by an eating disorder at some point in their lifetime.

Furthermore, male body-builders or wrestlers, or participants in any sport where athletes face pressure to fit into specific weight classes, are at increased risk of developing eating disorders. Runners and jockeys, for instance, are more prone to developing anorexia nervosa, characterised by restrictive eating, or bulimia nervosa, associated with behavioural bingeing and purging. On the other hand, those who participate in weightlifting and similar sports are more likely to suffer from ‘bigorexia’, with disordered eating perhaps manifested by exclusively consuming protein.

According to the DSM-IV – the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders – eating disorders fall into the categories of anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified, although it acknowledges overlap between the identified types. Common to all eating disorders is body dysmorphia; a distorted perception of one’s own body, often related to negative body-image. Whereas the body-type aspired to by women emphasises thinness, the media asserts that for men, muscularity is the prevailing standard..Deviation from this idealised standard impacts upon peoples’ self-esteem and self-worth. It is important to note that although self-induced vomiting is the purging behaviour most commonly associated with bulimia nervosa, excessive exercise is another symptomatic compensatory action. For obvious reasons, diagnostic criteria such as amenorrhea (cessation of menstruation) cannot be applied to men, but excessive exercise and obsessive concern with muscularity are characteristic of eating disorders in men.

Research into the male dimension of eating disorders is a relatively contemporary but growing phenomenon, with studies of ‘manorexia’ gaining prevalence. Previously, with attention largely devoted to female sufferers of eating disorders, many cases of male disordered eating went unreported, resulting in inaccurate data on the male experience of eating disorders and persisting gendered diagnostic criteria and stigmas. Even today, men are more likely to be diagnosed as suffering from a depressive disorder with changes to appetite as an associated symptom, as opposed to being diagnosed as having an eating disorder. With this persisting gender bias, despite identical behaviours, women are still statistically more likely to be diagnosed with an eating disorder.

As it exists, treatment for men suffering from eating disorders takes place in the same environment as that for women. However, especially in smaller or rural communities, the stigma against male sufferers as a result of enduring beliefs of eating disorders as an exclusively feminine disease poses a barrier to effective treatment, diagnoses and reporting of cases. Indeed, with a perceived taboo against ‘manorexia’, how many men would be likely to disclose an eating disorder? Perhaps what is needed is the development of a unique approach to the treatment of men with eating disorders, and a gender revolution in our approach to disordered eating. The urgency of this need is emphasised by recent statistics stating that whilst approximately 75-80% of female patients who receive treatment for their eating disorder ultimately recover, the same is true for less than half of male adolescent patients.

Although the male body image projected by the media is not as homogeneous as that for women and admits for a greater range of body-types, it still emphasises a standard that is unattainable or unrealistic for many, thereby generating the negative self-image and self-esteem that underlies eating disorders in both men and women. If we are to overcome the gendered bias in diagnosing and treating eating disorders, we must challenge the persistent notion that eating disorders are restricted to women. With recent figures indicating a 66% increase male hospital admissions for eating disorders, much progress has been made to conquering gendered perceptions of eating disorders, but there is still a long way to go.

Siri Minsaas is in her second year studying International Relations

  • Fi

    this is fab but I wish you’d have mentioned the difficulty of using media-inspired portmanteaus to describe such a deadly illness – my friend here says it better than I could – http://blogs.independent.co.uk/2010/04/28/the-rise-of-the-made-up-illnesses/
    but aside from that agree 1000% – recognition and treatment for male sufferers is dire, as indeed it is for older sufferers, BME sufferers and those with eating disorders other than anorexia in general. the NHS need to sort it out 😉
    btw where did you get the stat about 75-80% of female patients in treatment recovering? is that just weight restoration? if not I wish it were true for my friends but unfortunately far from it.
    x

  • Siri

    Thank you 🙂
    Really good point about the significance of media portmanteaus. To an extent, such language seems to sensationalise and trivialise such a serious condition. If I were a male sufferer of anorexia, I would probably feel as though my condition wasn’t being taken seriously, and as such I’d perhaps be reluctant to seek treatment.

    You’re absolutely right about marginalised sufferers of eating disorders. Another problem of recognition and treatment is for those with “eating disorders not otherwise specified”. Patients who show both anorexic and bulimic tendencies have difficulties being treated for either. Since you mentioned difficulties associated with older sufferers, I saw an interesting BBC documentary called “Desperately Hungry Housewives” that you might be interested in.

    The 75-80% statistic comes from a study by Maclean (2005) on anorexia specifically in adolescents (16-25). Unfortunately, it refers to weight restoration, which I should have made clear. Sorry to hear about your friends.

    xxx

  • Hi! this is a really good article, I have a couple of male friends who are sufferers, and I know many people overlook the fact that men can have anorexia as well. I do want to say though, that your line about celebs, ‘literally starving for attention’, in practice actually has little to do with anorexia nervosa, whether it is a male or female experiencing it. As an anorexia sufferer myself, I don’t think that celebrity images of being skinny or weight-loss have much to do with anorexia. It is not the celebrities fault for wanting to be thin, it is the industry, and the media, and unfortunately the public who put pressure on celebrities to be thin. Additionally, anyone starving ‘for attention’ probably does not have an eating disorder. An anorexia sufferer is more likely to shift any attention at all away from themselves to hide their problem. Anorexia is a serious mental illness, and more often than not, isn’t about food or weight at all. Think of it more as someone who cuts themself, they do it to turn a mental pain into a physical one as way of coping.

    I’ll definitely be posting this on to the friends I mentioned above! xx

  • Siri

    Hey,
    Thanks for your thought-provoking comment. Also, your article is great, and your determination and insight in your blog is truly inspirational.
    The title “starving for attention” was actually on a real magazine I saw in a newsagent’s recently, and I thought it was such a shocking thing to write that I felt compelled to include it.
    I definitely agree with you that the media and the public – and not celebrities – are the ones largely generating the pressure to be thin. Indeed, it’s upsetting to read about the body image needed to “make it” in Hollywood for both genders. The point was more that the focus of the media on eating disorders too is almost exclusively female, which unfortunately perpetuates the gender-bias we see in reporting, research and diagnosis of eating disorders.
    I’d be very interested to hear what the friends you mentioned think!
    xxx