Myths abound that eating disorders in males are on the increase.1 In reality, it would be more accurate to say that more men are coming forward to share their experiences of eating disorders and receive treatment.2 These disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder and others) vary little from the diagnoses traditionally associated with women, but the male experience of living with these issues receives little attention. The literature attests to female experience, but our understanding of male experience has been diminished by the lack of male voices within the research and clinical literature.3 In turn, this leads to a paucity of understanding for those who may encounter eating disordered men as there is little experiential material to inform counsellors’ knowledge beyond the interaction with their client.
In a university context, then, counsellors will be very familiar with women talking about eating issues, but much less so with men. In order to clarify my interest in this work, I want to disclose that I have an eating disorder, and did so throughout my own university experience. Eating disorders, young men and university are a meaningful blend of topics as there is some suggestion that the age of onset is later in males,4 and therefore more likely to arise when a man leaves home for higher education. So it is not surprising how often university comes up in men’s stories, being a significant life experience for so many young people in the UK.
To offer some insight into relevant findings from my work, and in order to protect identities, I have used pseudonyms and taken themes from across several stories. The vignettes below are composites of the themes I have seen in the lives of men with eating disorders.
Implosion
Greg was already dealing with his eating disorder while deciding to make the move to university. What he encountered in preparing to take a university place illustrates the damage and isolation that can occur when a man with an eating disorder has to adapt to being thrust into an unfamiliar setting. This can be a breeding ground for further self-destructive thoughts which, in turn, fuel the eating disorder as the man struggles to cope. Greg shared his thoughts as he was leaving for university: he did not feel ready to go to. He felt that his life had ‘imploded’ and that his mental state left him with little chance of integrating into a new community. When he arrived, everyone around him seemed to have been privately educated, with mothers who did not need to work, while his own background was of state education with both parents working. He felt that his mental health was very fragile, and applying for a place at university made him doubly aware of how unworthy he already felt.
This man’s life was already in a compromised state even before he arrived at university, and the application process was a traumatic experience for him. The word ‘imploded’ evokes the inward chaos that is felt at the core of the eating disordered individual,5 and Greg was navigating the pressures of study, being away from home, and forging new relationships with this turmoil taking place inside him. Other young men may arrive at university with a similar sense of foreboding about the application process itself, and about undertaking the next step.
Freedom to self-punish
Eric found that the move to university allowed him further freedom to continue avoiding eating, a pattern that had already been established before he left home. He told me in therapy that as he grew older, his interest in food diminished. His anorexia was compounded at university because he was finally able to sideline food completely.
Other men, in my experience, use their new-found freedom to initiate changes that exacerbate an existing eating disorder rather than to solidify existing early behaviours. Moving to university allowed Peter to change his habits for what he saw as the better. His eating disorder developed innocently enough after he decided he would begin a fitness routine. He found that he lost weight and he quite liked that feeling, so he exercised more in his increased spare time, without adjusting his food intake accordingly. He then decided that he could do better if he also worked on his diet. In order to eat healthily, he began an embargo on certain foods. His eating pattern became rigid, with self-inflicted punishments for eating the ‘wrong’ foods. He developed an intense exercise routine – swimming, running, football – which took priority over everything else. He deliberately kept his food intake at a low level and would exercise even when the weather was bad or injury meant he was already unwell.
University gave Peter the freedom to determine his own diet. His behaviours felt natural to him, as many people decide to exercise more while taking care with their diet in order to get fit. However, Peter succumbed to the grip of something that spiralled out of control. Exercise was not enough and self-care gave way to self-punishment.6 When his diet strayed, he would sanction himself. When he exercised, it had to involve physical exertion that others would have found gruelling. He had always been slim, but now his weight plummeted and being underweight became his new ‘normal’. Nothing was permitted to interrupt his regime; even injury could not deter him from his exercise programme.7,8
A life in chains?
Other men find that university does not necessarily lead to freedom to determine new pastimes and coping strategies. Instead, university is where problems that were previously contained become overwhelming. This in turn affects their ability to even complete their studies. Steve said he struggled at university and that he had to leave, because his coping mechanism for dealing with depression and stress – focusing on his weight – became too much to deal with. Steve concentrated on his body instead of dealing with his issues, a long-standing pattern which prevented him from succeeding at university. Marcus, however, made it into his final year and got through his degree, but his memories of that time are marred by his eating disorder. He talked about his final year being deeply unhappy, of feeling suicidal, worthless and ashamed of himself. He withdrew from social contact and now finds it hard to understand how he managed to graduate.
Marcus’ eating disorder provided protection during this time but it also controlled him. He felt compelled to drink excessive amounts of water to fill himself up and rid himself of toxins; he cut out all fats, and continued a gruelling, antisocial exercise regime, placing exercise above all other activities, including spending time with friends. He used university as a ‘safe place’ for bingeing; for example, hoarding chocolates from Christmas, then eating them on his return to university, before punishing himself with a strict diet.
For all these men, the university setting acted as facilitator. Marcus had private time and made his own decisions where he could binge or restrict as he wished. Having complete freedom of choice led to the increasing grip of the eating disorder during his time at university.
Both Steve and Marcus identified their third year at university (often the final year) as the time when their behaviours really came to the fore. The stress and added pressure that degree studies create for men with eating disorders have not, as yet, been adequately researched.
Freedom to recover
On a more positive note, for other men, university provided a wealth of support that is not always available to those outside of campus. Jack wrote about finding a B-eat self-help group, which was extremely supportive and enabled him to talk about his problem for the first time. He found empathy and acceptance within a group of strangers, and this helped him give up his disordered eating.
This presents an alternative to Marcus and Steve’s experiences. Whereas university entrenched their destructive behaviours, Jack, by contrast, discovered support that facilitated and empowered recovery. This features little in our current research about understanding male eating disorders, although evidence has suggested the power of self-help groups for men.9 Here, self-determination and the space to make changes, and embrace fresh decision making can make all the difference to men’s experience of being chained to disordered eating thoughts and behaviours.
Breaking the chains: the restorative role of the university
It is important to note that none of these men’s narratives began at university. Their stories recount early, difficult experiences with bodies and food. The university setting either provided an environment where experiences worsened, as men were left to their own devices, or offered a fresh start, with the tools and support needed to find a more balanced way through the eating disorder.
In a previous issue of this journal,10 I argued that counsellors and therapists at colleges and universities are ideally placed to help challenge the additional stigma that men encounter when they feel they have a ‘woman’s problem’.11 What I hope I have added on this occasion is a richer, if necessarily brief, account of what some of these men have been through. Although we cannot generalise from single sets of recorded experiences, we can develop empathy for men’s feelings and appreciate their depth of pain when negotiating their first taste of freedom after being shackled by the chains of their destructive relationship with food and exercise.
Strumia et al12 evoke an image of male eating disorders as having a dual face, like the Roman god Janus, who looked back while simultaneously looking forward. This duality is represented by the stoic face of masculinity13 that can lead men to avoid seeking help when they need it most,14 at the same time as undergoing painful loneliness, uncertainty and the personal darkness of depression. I would also suggest that the metaphor of Janus reflects the university experience of a man with an eating disorder: it can be either a setting where unhealthy behaviours take root, or it can provide the resources needed to move on and find a more fulfilling way to live, outside the eating disorder. University can offer the space and facilities for change and recovery that may not have been accessible at home. When this happens, university can be a powerfully positive setting for change.
So, what might all of this mean when encountering clients who walk through the door of a university or college service? First, similarities to women’s experiences can be useful: eating disorders in men are still about relationships with food, self-esteem and personal control. Secondly, unlike a female experience, men may be simultaneously dealing with a two-faced problem: the attack on their manhood that the ‘female’ eating disorder represents, and their utter dependence on it to get them through the day. My own research suggests that to be a man with an eating disorder is to not only have a mental illness but to feel like a failed man. Thirdly, when working with men, it is important to acknowledge deeply ingrained stereotypes that can silently pervade a counsellor’s thinking about men who present with issues that are atypical for their gender. For an excellent narrative of such an experience, I recommend Rebekah Smart’s account.15 Her analysis details the insights she uncovered while working as an experienced female counsellor with a disordered eating male in therapy. Although counsellors receive regular supervision, Smart describes how she needed to question many of the assumptions made about male clients with this problem. Finally, the theme of duality that runs throughout this piece is an inescapable one. We do not currently raise men in our society to recognise fragility in themselves or in others, and all of the men I have worked with have suffered as a result. It can be extremely difficult to acknowledge how close to breaking we can feel (I write from personal experience on this point). The counsellor may be the one person who can challenge the notion of ‘being a real man’ and give permission to express the human vulnerability that lies behind the eating disorder.
Russell Delderfield has studied his PhD part time over the last six years, researching experiences of male disordered eating. He has also held a post as trustee of the charity, Men Get Eating Disorders Too. He is currently Senior Academic Skills (Postgraduate skills) Advisor at Bradford University.
References
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