Detecting eating disorders early is crucial for effective treatment. The signs may be subtle, and a child or teen need not meet all criteria for an eating disorder to benefit from intervention, Brown said. Simply being more aware that body image and eating concerns also occur in boys and men is an important part of the process, she noted.
This awareness needs to start happening as early as elementary school, said clinical psychologist Doug Bunnell, PhD, a clinical adviser for the Denver-based Eating Recovery Center and Pathlight Mood and Anxiety Center, an international center for eating disorders and mood, anxiety, and trauma-related disorders recovery.
“We need to do a way better job at making sure front-line primary-care providers, including pediatricians, nurses, school counselors, are thinking about eating disorders as a significant risk for kids, both boys and girls,” Bunnell said. He added that psychologists and counselors also need to be mindful of it with all their young patients.
“It’s often the case that a clinician will treat someone for anxiety or depression, and several years later the client tells them they have been binging, purging, starving, overexercising, using laxatives. It has to be something that we’re always asking about,” he said.
Potential warning signs of an eating disorder include an intense fear of weight gain; ongoing concerns with body weight and shape; unusual or rigid rituals, rules, or routines around food; inability or refusal to maintain a healthy weight; episodes of binge eating or purging; preoccupation with calories/macronutrients, eating, or body weight and shape; and excessive or strict exercise/weight-lifting routines.
Brown noted that while taking steps to eat more healthily and exercise more often are certainly positive and, on the surface, should not be cause for concern, if it gets to a point where it’s becoming excessive, it may be time for parents to start paying closer attention.
“If a teen starts to rigidly apply certain food or exercise routines, and it’s starting to impact their social functioning, their ability to go to school or class, or engage in coursework, those are things that would be the kinds of things to look out for,” she said.
When it comes to treatment interventions, Lavender noted that some men will do well in an eating disorder treatment developed largely in the context of this female-centric lens. But for others, they are likely to benefit from treatment that is better tailored to the unique considerations and factors that influence boys and men with eating disorders.
Bunnell agreed, adding that “there are things we can do to make treatment more accessible to men, more inviting to men, and to be careful not to just assume that things that your female patients were worried about are actually the words and concepts that he’s worried about.”
Rather than assuming a male patient is undereating to get thinner, boys and men may use terms such as “fitter,” “trimmer,” and “more defined,” Bunnell said, adding that he encourages younger practitioners or those who aren’t experienced in this area to start treatment by simply asking patients, “What does it feel like to be a boy these days?”
Prevention efforts in schools, within student athletic programs, and at home that focus on challenging cultural standards around what an “ideal man” looks like may also prove to be effective in reducing eating disorder and muscle dysmorphia risk factors in boys and men, suggests a pilot study led by Brown (International Journal of Eating Disorders, Vol. 50, No. 8, 2017).
“It’s about having boys and men think about their own values and really try to challenge whether life would actually be that much better if they were to somehow achieve this lean, muscular body ideal. Probably not,” Brown said.
