The COVID-19 pandemic, according to an article in People, has led to a surge of eating disorders in boys and young men. I’m not surprised, because the pandemic was a perfect storm of social isolation, disruption of routine, stress, anxiety, and reduced accountability. However, I think it’s important to understand that, while disordered eating is seen a high priority concern among women, men have also been experiencing these issues for quite some time.
In fact, the incidence of eating disorders among men is underreported and largely overlooked. Based on my experience with patients at Caron Renaissance, the numbers are nearly evenly split. The People article references research that 1 in 7 males suffers an eating disorder by the age of 40. That same study found the incidence for women was 1 in 5. So, while eating disorders are slightly more common among women, we must shift the narrative to encompass men as well in order to improve access to treatment.
An eating disorder is considered a process addiction – a coping behavior that alleviates emotional pain in an unhealthy way. Unlike substance use disorders, process addictions such as eating disorders often begin in early childhood as a survival mechanism to experience comfort or control in a chaotic environment, whereas substance use disorders tend to start in the teenage years or later. At Caron, we believe it’s critical to treat a co-occurring eating disorder simultaneously with a patient’s substance use disorder, which greatly improves the chance for a strong recovery outcome in both areas.
Pressure to be Perfect
It’s natural to wonder if eating disorders present differently in men than women, but the behaviors are very similar – restricting, overeating, and purging. Social media platforms such as Instagram and TikTok and an influx of reality shows have also created intense pressure for men to achieve unrealistic physical appearances. As a therapist, I often see men who struggle with steroids and body building, trying to achieve the unhealthy ideal of a “masculine man.”
However, I think there is also significantly more shame involved for men, as there is a misperception that only women experience eating disorders and that struggling in this area is a sign of weakness or failure as a man. This stigma often prevents men from asking for help, or even confiding in friends, which in turn can be extremely isolating and a barrier to treatment.
A Distorted Relationship with Food
There’s another important element to eating disorders that often contributes to men hiding their struggles, and that is the fear that if people find out, their eating disorder might be jeopardized. Many men and women experience an eating disorder similarly to an intimate relationship, one they are extremely fearful of losing. Asking for help would effectively end what they perceive to be their safest, closest connection. For some men who I’ve treated, this relationship with food offered unconditional love and helped them survive an unmanageable situation – often connected to their earliest childhood experiences – which then became more pronounced as they got older and other pressures and stresses took hold.
You see, our relationship with food goes back to the moment we were born, and it gets very convoluted with our childhood memories and experiences. There is a reason we talk about “comfort food.” As part of the treatment process, patients talk about how they would often eat literally to feel emotional warmth, because they weren't receiving affection from their family. Even just the physical sensation of feeling full is soothing. However, over time, it ceases to be helpful and instead becomes harmful – just like a substance use disorder.
Even in a stable home where there's secure attachment and invested caretakers, families need to be mindful of the messages a child picks up, both inside and outside the home. One of my patients grew up in a healthy home environment, but he was bullied in school and turned to bingeing to cope. It’s important to help children, teens and young adults develop healthy coping skills, self-compassion and a narrative that supports self-care.
Parents of teens and young adults especially need to be knowledgeable, to watch for signs. Eating disorders are a problem at any age, but the risk grows in the teen years and peaks at the age of 21. More schools are requiring training for parents on suicide risk, bullying and cyberbullying. Such continuing education should include information on eating disorders, so teachers, parents and health professionals have a chance to prevent the development of a disorder or intervene early if red flags are raised.
Because eating disorders are so isolative, sneaky, and shameful, those who suffer from them typically work hard to hide them. Here are important signs and symptoms to look out for:
- Rapid weight fluctuation. If someone suddenly gains a lot of weight, or loses a lot of weight, that could be cause for concern.
- Becoming much more invested in working out. Exercise can be healthy, but if it’s done to the exclusion of all else – especially eating – it may be shading into unhealthy territory.
- A shift in dietary choices. As a health professional, I encourage eating a healthy diet, but it shouldn’t be done to extremes.
- A fear or discomfort with eating in front of other people or eating in public. If a person is not comfortable eating around others, that could be a sign of an unhealthy relationship with food (This is separate from the COVID-19 pandemic – which could also cause someone not to want to eat around others for safety reasons and not be related to a disorder).
- Mood changes. An eating disorder is often tied closely to emotional issues. Plus, poor nutrition begins to wear on a person’s ability to manage mood swings.
- Emotional difficulties or life struggles. What's happening in the person's life? Is the person experiencing challenges or a lot of stress?
- Defensiveness. This is often present in someone with an eating disorder. If someone expresses concern about their food intake or time at the gym, do the person react with anger, dismissal, or over-explaining?
- Obsession with image. Are they constantly looking at social media feeds or glued to reality shows?
As we continue to see a rise in mental health issues, substance use disorders and digital addictions, we must also keep eating disorder dialogue front and center for both males and females. By raising awareness and providing treatment, we can end the shame and help more people seek treatment. There are many strong resources and an established community of support to help them leave their disordered eating in the past and move forward with a healthy approach to life and self-love.