Eating Disorders in Women vs Men

Eating disorders, such as bulimia nervosa, anorexia nervosa, and binge eating disorder, are serious mental health conditions that can result in severe medical complications. Although they occur more often in females than males, they can affect a person of any age or gender. Eating disorders may present differently from person to person.

Symptoms of eating disorders often vary depending on the specific disorder and the individual. However, all eating disorders can lead to serious health problems, including malnourishment, cardiac issues, hormone deficiencies, electrolyte imbalances, and cognitive impairments ^[1].

Anorexia is characterized by restrictive eating patterns fueled by an overwhelming fear of gaining weight. Bulimia is characterized by binge eating episodes followed by compensatory behaviors such as purging or laxative abuse. Bing eating disorder is characterized by recurrent uncontrollable binge eating episodes. All of these eating disorders can lead to severe and potentially fatal health complications ^[2].

Are eating disorders more common in women or men?

Historically, eating disorders have been more widely reported in women than men. Reports show that anorexia nervosa and bulimia nervosa are thought to be around three times more likely in women than men ^[1][3]. However, studies of binge eating disorder show this disorder occurs almost equally between men and women ^[1][4].

Research indicates that between 0.7% and 2.2% of males and between 2.6% and 8.4% of females experience an eating disorder during their life, including subthreshold or atypical eating disorders ^[5].

Women

It is thought that the higher prevalence of eating disorders in women is partly due to Western cultural ideals of beauty and an increasing prevalence of thinness in celebrities and idols since the mid-‘90s. This representation in the media is believed to influence attitudes around body image and cause body dissatisfaction and a desire to lose weight ^[3].

There is also research to suggest that women are neurologically more likely to experience a negative emotional response to perceived weight gain. This can potentially cause more body dissatisfaction that can contribute to the development of disordered eating and a strive for thinness ^[6]. This reported neurological distress is thought to be influenced by cultural messages around weight gain.

Men

Although studies show that women are more likely to be diagnosed with an eating disorder, men may be just as likely to engage in disordered eating behaviors. These behaviors may include fasting, purging, or bingeing. However, men are not diagnosed with an eating disorder as often as their symptoms don’t meet diagnostic criteria ^[4][7].

For example, the prevalence of subthreshold binge eating disorder in men has been found to be three times more than in women ^[4]. This indicates that the way in which eating disorders have been defined and the language or criteria used in diagnosis may result in many people not receiving an appropriate diagnosis or treatment ^[5].

With recent research looking at broader definitions and criteria of eating disorders, subthreshold and atypical eating disorders are becoming increasingly recognized and diagnosed ^[1][4].

Similarly, in the last 40 years the number of men with eating disorders has been increasing faster than the number of women, as more recent studies begin to focus on and recognize the experience of men with eating disorders ^[5].

This research indicates that many men do not seek professional advice for their symptoms because of a fear of stigma, the view that eating disorders are predominantly a “woman’s issue”, or they aren’t aware they are experiencing symptoms of an eating disorder. This suggests that the number of men with eating disorders has likely been underrepresented in prior research ^[5][7][8].

As such, men who do seek treatment are often misdiagnosed or take much longer to receive a correct diagnosis due to misconceptions and poor understanding of eating disorders in men. This delay in receiving a diagnosis can lead to severe medical complications, delayed treatment, and worsening physical and mental health ^[1][5].

LGBT

Although research of eating disorders in the LGBTQ+ community is limited, recent studies indicate considerable differences in the prevalence of eating disorders within this population compared to heterosexual and cisgender groups ^{[8][9][10][11][12]}.

For example, compared to heterosexual men, gay and bisexual men are significantly more likely to engage in weight-controlling behaviors such as fasting, purging, and using laxatives. For this reason, they are far more likely to be diagnosed with bulimia and atypical eating disorders ^[10][11][12].

Studies also show that lesbian and bisexual women are more likely to engage in binge-eating behaviors than any other gender and sexuality. This population also reports a higher prevalence of behaviors such as purging and laxative use than heterosexual groups ^[10][11].

Recent research has also shown significantly higher occurrences of eating disorders within transgender and non-binary individuals, both in adolescents and adults, than cisgender individuals. There is also a higher prevalence of severe medical complications and delayed diagnoses, highlighting a requirement for further research into this area ^{[8][9][10][11]}.

Do eating disorders present differently in men and women?

Eating disorders may present differently depending on gender. Women are more likely to strive for thinness and weight gain prevention, while men are more likely to attempt to gain weight and strive for muscularity. This is likely due to the difference in cultural ideals of the feminine and masculine body and the expectations imposed by societal attitudes ^[5][8].

Women with an eating disorder are more likely to see themselves as overweight when at a normal weight, while men with an eating disorder are more likely to see themselves as underweight when at a normal weight. Both are examples of body dysmorphia but of opposing presentations, thereby potentially resulting in different behaviors ^[7].

The way symptoms present across genders may indicate why women are more likely to receive a diagnosis of anorexia. Since they are more likely to present as underweight and engage in eating restrictions, they may meet the criteria of significant weight loss, restricting intake, and a fear of weight gain ^[3][4].

However, these criteria may exclude the presentation of eating disorders in many men. Men often strive to gain weight and muscle, which can lead to compulsive exercising or binge eating behaviors. These behaviors may be considered subthreshold or atypical eating disorders, despite engaging in disordered and potentially dangerous behaviors ^[4][5][9].

Studies suggest that women are far more likely than men to restrict dietary intake, engage in purging behaviors, check their bodies in the mirror, and weigh themselves. However, men may be just as likely as women to engage in binge eating, fasting, use of laxatives, and excessive exercise ^[4][9].

Psychiatric comorbidities may differ between men and women with eating disorders. Women are more likely to experience depression and obsessive-compulsive behaviors than males ^[9].

Studies also show that men often present with more severe medical complications when diagnosed. This is believed to be because their symptoms are often not correctly diagnosed when they initially seek professional help and are only recognized as symptoms of an eating disorder once they become more life-threatening ^[5][7][9].

The difference between men and women with eating disorders stem from the attitudes of the individual around their own body weight and shape as well as the attitudes of others ^[5][8][9].

How do men and women respond to treatment?

Many people who experience symptoms of an eating disorder do not receive appropriate diagnosis or treatment, either because they do not seek professional help due to a fear of stigma or because of a lack of understanding and preconceptions about the ways in which eating disorders typically present ^[8].

For example, it is a commonly held belief that all individuals with an eating disorder are underweight, when in fact, eating disorders can affect people of any weight and many people with an eating disorder experience fluctuations in their weight due to their eating behaviors ^[2].

Similarly, it is often thought that eating disorders affect only women. Because of this, men are less likely to seek treatment, due to stigma and being thought of as less masculine ^[4][8].

Studies show that men and gender diverse individuals often experience more severe medical complications than women, due to delays in diagnosis and prolonged symptoms with no treatment. As such, these groups may require more physical health treatment upon receiving a diagnosis, while also experiencing issues within treatment relating to their gender ^[9][10][11].

There is currently no variation in the ways in which different genders are treated for eating disorders. as there is limited research into the differences in presentations and treatment requirements for each group. As such, men do not receive tailored or men-focused treatment and often report negative experiences during their treatment due to this ^[5][9][10].

However, in general, research has found that men have a similar response to eating disorder treatment as women, although some research shows that men with anorexia respond more positively to treatment aimed at weight gain^[5][9].

As research continues to explore the differences between the experiences of men and women, as well as the differences between the LGBTQ+ population, diagnoses and treatments are likely to continue to evolve and develop to meet more gender specific and individualized needs.