Three Myths About Male Eating Disorders

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The following article is based on a webinar given by Dr. Stuart Murray on Males and Eating Disorders for The Australia & New Zealand Academy for Eating Disorders (ANZAED), recorded on July 29, 2015.  Dr. Stuart Murray is an active eating disorder clinician and researcher and is Co-Director of the National Association for Males with Eating Disorders.

Myth #1:  Eating disorders are exceedingly rare in males

For many years it was believed that eating disorders were rare in males.  On the contrary, recent research has shown a significant rate of anorexia nervosa, bulimia nervosa, and binge eating disorder in males.   Additionally, we see slightly higher rates of ARFID in boys than in girls.  However, because our current assessment measures may not accurately assess males, and because males with eating disorders may be less likely to admit to having one, the overall male prevalence rates may be even higher.

The idea that eating disorders are primarily a female problem is actually a recent misconception.  One of the first clinical descriptions of anorexia nervosa was about a male; in 1689, Richard Morton described a 16-year old boy’s condition of “nervous consumption caused by sadness and anxious cares.”  In 1874, Ernest Charles Lasegue and Sir William Gull made other case reports of males with anorexia.


After these key early cases, males with eating disorders were marginalized and deemed “rare.”  Males were largely absent from the eating disorder literature until 1972, the year in which Peter Beaumont and colleagues studied anorexia nervosa in male subjects.  Dr. Stuart Murray points out that until quite recently, males were excluded from treatment studies that led to the development of diagnostic criteria and to treatments for eating disorders.

 Less than 1% of all eating disorder research focuses specifically on males.  Consequently, we have been looking at eating disorders through a female lense. Under the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (current until 2013), men could not qualify for an anorexia nervosa diagnosis--they could not meet the amenorrhea criteria.  

Myth #2:  Eating disorders present similarly in males and females

Another myth is that an eating disorder looks similar whether it affects a male or a female.   In fact, there are some major differences between male and female eating disorder presentations.  Males with eating disorders demonstrate greater psychiatric comorbidity, a later age of onset, and greater rates of suicidality than females with eating disorders.  Males with eating disorders also have a higher prevalence of previous overweight status.  Men are less likely to engage in typical purging behaviors and are more likely to use exercise as a compensatory behavior.  Finally, because of stigma, males are less likely to seek treatment.

 When they do, it is often after a longer illness and they may thus be sicker and more entrenched in their disorder. 

Dr. Murray postulates that the more common presentation of eating disorders in men is muscle dysmorphia, initially termed “reverse anorexia."  Although this condition has been variously conceptualized diagnostically, many now see this in the spectrum of eating disorders.  In muscle dysmorphia, the desired body type is not thinner, as with traditional female anorexia, but bigger and more muscular.  This corresponds with the traditional societal view of the ideal male body.  The core symptom of muscle dysmorphia is a fear of insufficient muscularity.  The associated symptomatic behaviors often include compulsive exercise, disordered eating characterized by protein supplementation and dietary restriction, and the use of supplements and steroids.   These behaviors carry significant medical risks.

Myth #3:  Homosexuality in males is a direct risk factor for the development of eating disorders

A third misconception is that most males with eating disorders are gay.  A frequently cited study in 2007 showed a higher percentage of gay than heterosexual males with diagnoses of anorexia.  On the basis of this study, it has often been assumed that a male patient with an eating disorder is most likely gay.

While there may be an overrepresentation of eating disorders in the gay male community, the majority of males with eating disorders are heterosexual.  A recent empirical study by Dr. Murray’s group found little connection between sexual orientation and incidence of eating disorders.  Instead, the researchers identified a connection between gender identification and the way the eating disorder presented: those individuals who identified with more feminine gender norms tended to harbor thinness body concerns, while those who identified with more masculine norms tended towards muscularity concerns.

If you or a male in your life is showing signs of an eating disorder, do not fall victim to the myths.  Seek help from an eating disorder professional.  The National Association for Males with Eating Disorders offers support, resources, and information regarding male eating disorders.  Early intervention is key to reducing duration and severity of eating disorders.


Hudson, J,, Hiripi, E., Pope, H., & Kessler, R. (2007).  The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication.  Biological Psychiatry, 61(3): 348–358.

Eddy, K. et al. (2015).  Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network.  International Journal of Eating Disorders, 48(5):464-70.

Murray, S., Rieger,  E.,  Touyz, S., De la Garza, G. (2013).  Muscle dysmorphia and the DSM-V conundrum: where does it belong? A review paper.   International Journal of Eating Disorders, 43(6):483-91.

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