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Men and Eating Disorders, an epidemic under-reported

In modern times, the struggle to feel comfortable in our skin has become an increasingly uncomfortable issue for young people. Eating disorders such as Anorexia Nervosa and Bulimia have become a pressing point of focus for mental health campaigns and journalists worldwide.

Eating disorders are especially nasty, often leading to suicide and depression, whilst having the highest mortality rate above all other mental illnesses. What’s worrying is they’re becoming increasingly common, too (affecting 1.6 million in the UK) [Beat]. A comprehensive study from Beat, The Uk’s leading charity for their work supporting those suffering from ED, subsidised by accounting magnate, Price Waterhouse Coopers,  showed eating disorders to cost 16.8 billion annually, accounting for loses from those suffering and costs to Health and social services.

While research of Eating Disorders has been extensive, a particular epidemic among all the data appeared to slip through – the so-called “girls disease”, as it was called for most of the century, has become a growing concern for young men unhappy with their bodies and, often, stuck in desperate social circumstances. Historically, accredited studies have failed to independently address ED affecting men, with “99% of books on ED” having a female bias [Cohn 2017]. Beat, bears the responsibility to long-held stereotypes by society of Eating disorders, they say on their website:

“Eating disorders are gender neutral, but they have been routinely characterized as “women’s problems.” The stereotypical person with anorexia nervosa is a rich, white, adolescent girl; which is far from reality, because AN affects all genders, ages, races and socioeconomic classes.”

While data for young men suffering from Eating Disorders, is sparse, it is estimated that men account for up to 25% of individuals suffering from ED. Men who suffer from ED, in addition, have a higher mortality rate [Raevuori, 2014].

anorexic

Credit: medscape.com

The contributing factors to EDs are nuanced and complex, extending far beyond fashion-led beauty standards. To gather insight into the life of somebody suffering from an Eating Disorder I approached James Downs, a Cambridge Medical student and a representative for Mind, Men Get Eating Disorders too and Beat.  James, who is currently filming for a BBC Panorama documentary on the subject, has devoted much of time to raise awareness about Men struggling with EDs and was happy to take an interview discussing how he developed his illness and the impact it has had on his personal life and academia. Following the interview, he granted me permission to print it.

Authors note: The topics discussed below are of a sensitive nature and may be upsetting to some.

How did you come to develop an eating disorder?

“To start, I developed OCD and depression in school around the age of 14/15, and entered Child and Adolescent Mental Health Services at 15 when I had missed nearly a year of school as a result of symptoms around cleanliness and appearance in particular.”

“My anxieties switched from obsessions and compulsions around appearance in general to weight and shape in particular, and I began to control what I was eating in order to influence this. I think in part that this shift happened when I became more and more isolated from peers and attending school, and was losing control in other areas of my life”

“I found school a particularly difficult experience, feeling socially isolated, mentally unstimulated and increasingly anxious about going to school. It was easy for me to retreat into my head and to deal with my anxieties using obsessive compulsive behaviours. As I became more and more isolated and my ability to function and participate in normal life more limited, my mood started to decline and I only fell further into my problems.”

“Initially, I had a restrictive anorexia. I began by reducing my food consumption to around 1000 Kcal per day, which was then reduced and reduced over time as I began to cut out more and more foods / food groups such as carbohydrates and fats. I became incredibly strict about what I would eat and when, and would want to have control over making my own food.”

“I developed severe Bulimia”

James explains his transition to bulimia

James explains his transition to bulimia

“Following weight restoration (the first time) I noticed that I would often want to rid myself of food as I did when I was anorexic and thought I had eaten too much. It became easier to do this after eating larger quantities and I began to binge eat more. I developed severe bulimia where I would eat many thousands of calories in one go of foods I would never otherwise eat such as sweets, crisps, chocolates, cream, cereals, anything really. I began to go shopping for food and at worst would spend £50 in a day, and spend up to 10 hours a day binging and vomiting.”

Do you think changing beauty standards for men in the media are partly to blame?

“Male body image is something that has risen on the media agenda to be something that is a highly visible issue. Whereas previously mostly female bodies were widely objectified, I see more and more the presence of images of the perfect body in the media, which from my perspective has put pressure on me to live up to this ideal. It is something I associate with achievement, likability and sexual success. Being extremely fit seems to be presented as quite normal too.”

Modern male fashion models now promote more feminine features: A skinnier leg profile and a more chiseled frame.

Modern male fashion models now promote more feminine features: A skinnier leg profile and a slender frame. Credit: newstatesman.com

Do you think the increase in ED among young men is linked with the increase in suicide and depression among young men?

“A symptom soo basic yet profound as being unable to or unwilling to feed yourself in a balanced, un-damaging way is often an indication of dis-ease at a more fundamental, deeper level. So it is no surprise that eating disorders are not purely behavioural issues around eating. They stem from psychological problems which can be very broad and complex, including depression, anxiety, obsessive-compulsive traits and so much more. No one eating disorder will be the same as another, just as two people are not the same. In general, I think we are seeing a trend amongst young people (including young men) towards increasing challenges to mental health and wellbeing, which manifests in increased psychological difficulties across a broad spectrum of diagnosable conditions.”

What was your experience like getting help in the mental health services?

“In terms of resources to help me, I was already in services when I developed AN. However, there was no specialist service that I could access, just generic mental health services for children/ adolescents. When I deteriorated significantly I was put under the care of a non-specialist Community Intensive Therapy team.”

“This team I do not feel were adequately equipped with the specialist knowledge to help me with my eating disorder. I was given large amounts of psychiatric medication which made me gain weight quite rapidly. The only psychological assistance I had was in the form of supervised eating and distraction techniques – all of which was superficial and did not address my underlying problems and distress.”

“When I started to binge eat I tried explaining this to the team and they told me it was just my anorexia talking and that I was probably eating a normal amount. I think this was a huge oversight that any well trained team would be aware of (the progression from AN to BN which is extremely common). There was also little support from my school which were highly stigmatising and misunderstanding, which resulted in me leaving education.”

University and ‘Freshers Week’

freshers

Credit: Independent.co.uk

James, who originally withheld his offer to study Music at Cambridge, spoke about returning to study medicine eight years onwards after having bettered his condition.

What was it like studying at Cambridge, while struggling with an Eating Disorder?

“There are so many ways in which going to university can be a challenging experience. Compared to the sort of great time we think we ‘ought’ to be having the minute we arrive in a new environment, the reality for many students is that adjusting is a struggle. How reassuring it is to discover that you aren’t the only one finding it hard to meet people, feeling an imposter or grappling with keeping up with the demands of your course. It can seem as though everyone around you is hitting the ground running and having the times of their lives, but there are invisible struggles, people whose inner reality is a stark contrast to their outer appearance.”

“This disparity is also a hallmark of those mental health problems which thrive on the combination of being hidden, major life changes and social isolation, and so it is no surprise that new students are especially vulnerable to deteriorations in their mental health. Making the transition to university is widely recognised to be an especially difficult time for people who have experienced eating problems. There are near-perfect conditions for maintaining disordered eating and every reason for needing something to rely on in the midst of so much pressure and uncertainty.”

“Having been through a recovery and being well-versed in the support and skills needed to be well, I still had a major relapse into bulimia after coming to Cambridge in October. Instead of meeting people or engaging with my course, things quickly became about living between trips to Sainsbury’s and spending hours on end in my darkened room eating until the pain of fullness was alleviated by vomiting. Getting back on track only happened following a sobering time in Addenbrooke’s, and vomiting copious amounts of black blood after damaging my stomach, when I was reminded of the fragility of recovery and decided to seek support.”

What was your Freshers week experience like, while suffering from an Eating Disorder?

“It is so easy to retreat into your eating problem and away from the social world around you. Whilst this may help you to avoid having to cope with the activities of Freshers’ Week – which often revolve around the double challenge of consuming food and alcohol alongside people you don’t even know – being isolated from others is no fun either. Either way, Freshers’ Week is hard for people with eating disorders. It hardly meets the expectation that this should be the ‘time of your life’.”

How was the support at Cambridge?

“Despite not hearing anything about mental health in the lengthy inductions at the start of the year (but plenty about bike thefts and Wifi access), I’ve found that excellent support exists in the university, from tutors and nurses to the Disability Resource Centre and Counselling Service. I would encourage anyone with current or past experience of eating problems to think more than I did about the challenges of university life and not be as ashamed as I felt for many years to seek help.”

James raises an interesting point about University, “major life changes” and “Pressure”, as he describes the university environment, is a growing concern for freshers, who may not have even struggled with ED in the past. Moving to University is categorised as a significant change in living circumstances, which can trigger eating disorders among other Mental illnesses and disorders [DSM-5].

The change to university is overwhelming and students often start with “fresher’s week”. Freshers week, which involves excessive drinking over a week, can cause significant upshifts in cortisol levels. Cortisol is a hormone, usually released by the adrenal gland during high moments of stress, but is additionally released after high alcohol consumption. The raised cortisol levels result in increased eating, in particular, cravings of salty, sugary and fatty foods. Raised cortisol levels also contribute to significant fatigue and depression. All in all, Freshers Weeks set students up with an unhealthy body and mind, to begin the most difficult transition they faced in their lives – University. When you factor in loneliness and a loosening of schedule (University hours typically lower than sixth-form hours), an environment is created for eating disorders to thrive.

The royal College of psychiatrists In their “Mental Health of students in Higher Education, 2011” report, found that the levels of ED have increased between 1995 to 2002, and that students are particularly vulnerable to developing such an illness. The report states:

“Eating disorders such as anorexia nervosa and bulimia nervosa are widely recognised in the student population. The high occurrence of these illnesses in higher socioeconomic groups and the peak age at onset in adolescence make undergraduate students particularly vulnerable (McClelland & Crisp,2001). There may be small-scale ‘micro-cultures’ within higher education where students are at particular risk of eating disorders. These include ballet schools and some sports teams and clubs. Studies of the prevalence of eating disorders in students in different countries have highlighted interesting variations. A Spanish study found a total prevalence of eating disorders in a college student population to be 6.4% (Lameiras Fernández et al, 2002). ). A Mexican study showed eating disorders to have a prevalence of 0.49% in 1995 (0.14% for bulimia nervosa and 0.35% for eating disorders not otherwise specified) and 1.15% in 2002 (0.24% for bulimia and 0.91% for eating disorders not otherwise specified) (Mancilla-Diaz et al, 2007)”

Body Image

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It’s undeniable that the desirable body among young men has changed, whereas it used to be about just gaining raw muscle, men now strive for a leaner chiselled frame, skinnier legs and  defined muscles [Labre, 2005] – often referred to as the ‘athletic frame’. This new desired figure not only requires men to work on their musculature, but to watch their weight, too.

Men have also experienced an increase in sexualisation in the media, which could contribute to greater concern for one’s own figure. USC Annenberg and the Harnisch Foundation might validate this claim. Since 2007, the ‘hypersexualisation’ of men on film has increased; in 2014, 8% of male characters were figured in ‘sexualised attire’(up from 4.6% in 2007), whilst 9.1% (an increase from 6.6%) were shot ‘with some degree of nudity’. 2013 marked the high water mark of this trend, with 9.7% of male characters in sexualised attire and 11.7% getting some (or all) of their clothes off.

 The Male Crisis

male crisis

Credit: emilyhopephoto.com

The link between depression and Eating disorders is often co-occurring, however, it has been examined that depression can serve as a ‘gateway’ to eating disorders. The National Eating Disorder Collaboration, claims that Depression can make people ‘more likely’ to feel negatively about their bodies and themselves – ‘this may put them at risk of developing an eating disorder’

Previous point in mind, It’s understandable that the rise in Eating disorders has co-occurred with the rise of depression and suicide among young males, a tragedy coined as the ‘male crisis’.

The Office of National Statistics found in 2013 that men accounted for a worrying 78% of suicides in the UK, while the British Journal of Psychiatrists, warned of an increase in male depression, especially in men with “low education”. The article states:

“Western men will face a difficult road in the 21st century, particularly those with low levels of education. We believe economic and societal changes will have significant implications for men’s mental health.”

“Men’s failure to fulfil the role of breadwinner is associated with greater depression and marital conflict,” the article states. The article also states that as women are now “more likely” to go to university than men so the number of households where the main breadwinner is female will increase.

To me, Eating disorders among young men, aren’t just a clarification that young men are in crisis, but a reminder that the times are changing, and not for the better. As of recent, Men have become victim of beauty standards set by a prowess fashion industry. Men’s failure in the modern workplace and in education – a consequence of aggressive globalisation, has left men with low self-esteem, while the breakdown of the family, due to higher divorce rates, has created a chaotic environment for dysfunction to thrive among young boys. All in all, the rise in eating disorders appears to be a repercussion of 21st century societal changes. The millennial generation of the 21st century, will be the first generation to be poorer than their parents, but we shouldn’t interpret that as just being monetarily poorer, but mentally poorer too.

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