A Personal Reflection

Few people, certainly within the developed world, will have not heard of Anorexia Nervosa. It is a well-known issue which has in the last thirty or forty years gained more attention. There is still work to be done to challenge the many stereotypes that surround anorexia and other eating disorders, unfortunately stereotypes which hinder people, remain prevalent within society. To illustrate this Klump, Bulik, Kaye, Treasure and Tyson, (2009), some of the most authoritative voices on the subject at that time, wrote a paper titled, ‘Eating Disorders are Serious Mental Illnesses’ entreating people within the health care sector to see eating disorders in the same light as they did other illnesses such as schizophrenia, bi-polar, depression and OCD. Indeed my own parent’s experience mirrors that from when I was on suicide watch in the local mental health unit. The head psychiatrist told them that ‘bulimia and anorexia were not mental illnesses, and nothing could be done until I had gotten over my food fad.’

Most people do not understand Anorexia Nervosa and there is no shame in this. I have suffered from anorexia and I have a PhD based around studying the experiences of men with anorexia. I feel that whilst I know and understand more than I did, what I do not know far outweighs what I do know.

You may raise an eyebrow at my use of the term ‘suffered’ in the previous paragraph. In today’s clinical world eyebrows maybe raised when using the words ‘suffer’ or ‘suffering’. I make no apologies for using this word. My experience of anorexia was that it was hell, I was suffering every minute of every day for a number of years.

suffering in the anorexic behaviours themselves
suffering trying to appear as if nothing was wrong to other people
suffering trying to do my job, knowing my performance was dropping
suffering because as a man I struggled to get treatment
suffering when I finally asked for help and people started treating me differently because they did not know how to deal with me
suffering because I could see I was hurting myself and the people I loved, but did not have the strength to stop

Even today anorexia indirectly affects my everyday life. Several men whom I have interviewed used the term suffering themselves, however we try to be positive in our terminology around mental health as Time to change (2021) suggests. Do not lose sight or trivialise the anorexic’s experiences, nor forget the strength they have shown or will show to seek help and make the changes needed to end their behaviours. One of the men I interviewed stated ‘I would not wish this on my worst enemy’ (Lyons 2018, p.138).

Stereotyping Anorexia

If we have no direct knowledge of something then our initial thoughts are based around second hand information such as urban stereotypes, media stories or a friend who knows a friend! However, the reality of the who, what and how can be quite different from what is expected, anorexia like many things, is very much like that. We hope to provide you with some information concerning anorexia nervosa in men, which you may not have known about before and perhaps you may find a calling to investigate the area further.

Only White Teenage Girls Get Anorexia?

There can often be a grain of truth within stereotypes. Perhaps the biggest stereotype is that the illness only affected teenage middle class white girls. Using NHS data from 2020, around 62% of inpatients with a primary diagnosis for anorexia and a-typical anorexia fell between the ages of 10-19. Whilst we cannot tell ethnicity, social class, or gender, it is safe to assume they were largely females as the ratio between females and males being hospitalised was 94:6 (N.H.S Digital, 2020). The data stream from 2013 showed a similar story with 57% of inpatients being from the 10-19 age bracket and a 93:7 ratio between females and males (N.H.S Digital 2013).

Whilst hospital statistics are helpful, in the case of anorexia they do not demonstrate the full picture as only the most extreme cases will result in hospitalisation and most people will be treated as outpatients. We also must consider people with anorexia nervosa whose primary diagnosis may be physical health related thus the underlying condition goes untreated.

Richard’s Example

For men, the ‘female only’ stereotype can be quite damaging. It can close the mind to awareness of the illness and it can be a shock to men when actually diagnosed. There remains a generalised view that eating disorders are mainly found in women (Richardson & Paslakis, 2020). Whilst there is much more awareness of anorexia nervosa and EDs in other groups now, there is still much to do to promote other people who may have anorexia nervosa. Within the small qualitative sample of men whom I interviewed over half had no idea they had anorexia nervosa before their diagnosis and one man referred a number of times to stereotypes saying “I’m not the 16-year-old sitting in the corner shaking at the thought of a lettuce leaf,” (Lyons, 2018 p. 192). Hay (2017) went so far as to write, that the narrative of ‘Young, white, affluent women seems so outdated as to be laughable – and yet somehow this image persists’

The Only Men Who Get Anorexia nervosa are Gay

There is a further stereotype which needs to be challenged and that is that only gay men get anorexia nervosa. This false assumption comes from a number of areas. Jones and Morgan (2010 p. 23) wrote, ‘Recent research has focused on the assumption and stereotype that eating disorders in men are associated with homosexuality’. Muhlheim (2020) wrote ‘A myth 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 nervosa. Based on this study, it has often been assumed that a male patient with an eating disorder is most likely gay. The UK National Centre for Eating Disorders (2019) states ‘Only 20% of males with eating disorder are thought to be gay. However, the expectation that a male will be regarded by a health professional as gay stops many men from getting the help they need.

Anorexia or Anorexia Nervosa?

Please note, many people refer to Anorexia Nervosa as anorexia. This is technically not correct, for the lay person this may not matter, but in a professional environment it does. Anorexia, literally means “without appetite”, but the term also covers people unable to eat. It is often a secondary effect of other situations such as someone recovering from cancer may have a loss of appetite due to their treatment etc. Anorexia Nervosa however, is a psychological condition which sees the sufferer self-starving and potentially using other methods to reduce body weight.
Dr. Gareth Lyons January 2021