he history of anorexia nervosa begins with early descriptions dating from the 16th and 17th centuries and the first recognition and description of anorexia nervosa as a disease in the late 19th century. In the late 19th century, the public attention drawn to “fasting girls” provoked conflict between religion and science. Such cases as Sarah Jacob (the “Welsh Fasting Girl”) and Mollie Fancher (the “Brooklyn Enigma”) stimulated controversy as experts weighed the claims of complete abstinence from food. Believers referenced the duality of mind and body, while skeptics insisted on the laws of science and material facts of life. Critics accused the fasting girls of hysteria, superstition, and deceit. The progress of secularization and medicalization passed cultural authority from clergy to physicians, transforming anorexia nervosa from revered to reviled. However, due to the nature of the disease, the numbers could actually be much larger. Their unhealthy behavior is kept secret and sometimes help is not sought until serious health problems arise. Just as with females, the disorder usually begins during their youth, with the onset commonly between 14 and 17 years old. These are the types of patients that Thomas Linscheid Ph.D, the head psychologist at Nationwide Children’s Hospital in Columbus, sees everyday. He said that anorexia inside a male’s mind is a fear. “It gets to be an irrational fear,” he said. Anorexia can be triggered in many ways; sometimes it is because of a comment that was made about the individual from a peer. “A guy not too long ago, somebody told him that his butt was too big,” said Linscheid, describing a patient. “And it really wasn’t, but it got him thinking about it, deciding that he didn’t want to have any part of his body thought of as unusual.” Other times these young males start off by simply wanting to improve their outward appearance. “The kids that I’ve seen,” said Linscheid, “it’s usually some decision to say ’I’m getting a little over weight, I want to be buff, I want to be trim.’ While most people can diet and keep their weight-loss within normal limits, some can take it too far by striving for perfection, and never finding it. The classic anorexic can be described as somebody that has trouble with their self-image. “They’re usually very smart and talented, but they never feel good about themselves,” said Linscheid. “They put a lot of pressure on themselves to be as good as they can, to be perfect. It’s part of their personality trait. They have a lot of self-control that probably comes from that negative self-image.” These types of people are perfectionists and are the same kinds of students that feel as if they are a failure if they do not receive straight A’s in every class, and think of themselves as a “loser” if they do not go above and beyond their expectations. Their raging perfectionism can also be ritualistic and even strange at times, continuing for several years, ultimately contributing to their death.
The term ‘’Anorexia Nervosa’’ was established in 1873 by Queen Victoria’s personal physician, Sir William Gull. That year, he published his paper “Anorexia Nervosa (Apepsia Hysterica, Anorexia Hysterica),” in which he described two cases of young women he treated for severe weight loss and two others treated by other physicians. It is estimated that 8 million people in the United States are suffering from an Eating Disorder, and of that number 10% are men. Professionals suggest that the percentage suffering that are men is much higher, but because of the old fashioned idea that this illness strikes only women, few men come forward to find the help they deserve. To date, the evidence suggests that the gender bias of clinicians means that diagnosing either bulimia or anorexia in men is less likely despite identical behaviour. Men are more likely to be diagnosed as suffering depression with associated appetite changes than receive a primary diagnosis of an eating disorder. In addition, there may often be shrouds of secrecy because of the lack of therapy groups and treatment centers offering groups specifically designed for men. They may feel very alone at the thought of having to sit in a group of women, to be part of a program designed for women, and even at the prospect that a treatment facility will turn them down because of their sex. Men who participate in low-weight oriented sports such as jockeys, wrestlers and runners are at an increased risk of developing an Eating Disorder such as Anorexia or Bulimia. The pressure to succeed, to be the best, to be competitive and to win at all costs, combined with any non-athletic pressures in their lives (relationship issues, family problems, abuse, etc.) can help to contribute the onset of their disordered eating. It is not uncommon for men suffering with an Eating Disorder to also suffer with alcohol abuse and/or substance abuse simultaneously (though many women also suffer both disordered eating and substance abuse problems, combined). This may be due to the addictive nature of their psychological health, combined with the strong images put out by society of men’s overindulgence in alcohol. There may also be a link between ADHD, with male sufferers of Anorexia, Bulimia, and self-injury. More research still needs to be done in this area.
For all those who suffer, men and women alike, there are many possible co-existing psychological illnesses that can be present, including depression, anxiety, PTSD, self-injury behaviours, substance abuse, OCD, borderline personality disorder, and Multiple Personality Disorders. It is important to remember is that most of the underlying psychological factors that lead to an Eating Disorder are the same for both men and women; low self-esteem, a need to be accepted, depression, anxiety, an inability to cope with emotions & personal issues, and other existing psychological illnesses. All of the physical dangers and complications associated with being the sufferer of an Eating Disorder are the same. A great number of the causes are the same or very similar (family problems, relationship issues, alcoholic/addictive parent, abuse, societal pressure). Most of all, it is important to remember that all people with eating disorders deserve to find recovery, happiness, and self-love on the other side. But why do men get anorexia? Anorexia nervosa is typically thought of as a female disorder. Indeed, it is at least ten times more frequent in women. This difference is thought to reflect the cultural emphasis on the female body. Women are predominantly judged on their appearance and the female body is of greater focus in the media in comparison to the male body. However, while the female body is still undoubtedly in the spotlight, the male body is also becoming a subject of scrutiny. There is more focus on men’s appearance than ever before. The ideal female body that is promoted by the media is unrealistically thin and this is thought to be a primary cause of anorexia nervosa.
While the male ideal is usually seen to be a toned and muscular body there is also an emerging parallel ideal of an equally thin male. Therefore, it is unsurprising that cases of male anorexia are increasing. Male and female cases of anorexia nervosa have been found to have similar symptomatology and patients report similar backgrounds. Therefore, there is not thought to be any significant difference between male and female anorexia and therefore the same treatments are used. Anorexia nervosa is difficult to treat and the risk of death is twice as high as that of other disorders. Death is usually caused by physical complications caused by being extremely underweight or by suicide. The question which obviously arises is why would a male desire a thin figure? There can be many reasons for this. Sometimes even in the course of a normal diet a person could develop anorexic tendencies. Certain professional demands could also be responsible. For instance runners and jockeys have jobs which require a thin frame and thus the chances of them going in for diets and food reduction are more, as compared to, lets say, footballers or wrestlers. In the entertainment field, models and actors have to pay particular attention to the way they look. Thus, most of the men with eating disorders focus more on an athletic appearance or success than on just looking thin. Members of the gay community might also indulge in severe dieting programs to make themselves more attractive to other men. Men often begin an eating disorder at older ages than females do. When dealing with a male anorexic, one has to be extra careful and must handle the situation with delicacy. Though both male and female patients need professional psychological help, for men it is all the more important as they do not wish to confess to suffering from what they believe is a woman’s problem. Researchers say that this reluctance of men to come out in the open could also mean that there are actually more men who are anorexic, than what the officially recorded figures might suggest.
The initial diagnosis should be made by a competent medical professional. “The medical history is the most powerful tool for diagnosing eating disorders”(American Family Physician). There are many medical disorders that mimic eating disorders and comorbid psychiatric disorders. All organic causes should be ruled out prior to a diagnosis of an eating disorder or any other psychiatric disorder is made. The diagnostic workup typically includes complete medical and psychosocial history and follows a rational and formulaic approach to the diagnosis. Neuroimaging using fMRI, MRI, PET and SPECT scans have been used to detect cases in which a lesion, tumor or other organic condition has been either the sole causative or contributory factor in an eating disorder. “Right frontal intra-cerebral lesions with their close relationship to the limbic system could be causative for eating disorders, we therefore recommend performing a cranial MRI in all patients with suspected eating disorders intracranial pathology should also be considered however certain is the diagnosis of early-onset anorexia nervosa. Second, neuroimaging plays an important part in diagnosing early-onset anorexia nervosa, both from a clinical and a research prospective”.
After ruling out organic causes and the initial diagnosis of an eating disorder being made by a medical professional, a trained mental health professional aids in the assessment and treatment of the underlying psychological components of the eating disorder and any comorbid psychological conditions. The clinician conducts a clinical interview and may employ various psychometric tests. Some are general in nature while others were devised specifically for use in the assessment of eating disorders. Some of the general tests that may be used are the Hamilton Depression Rating Scale and the Beck Depression Inventory. There are a variety of medical conditions which may be misdiagnosed as an eating disorder such as Lyme disease which is known as the “great imitator”, as it may present as a variety of psychiatric or neurologic disorders including anorexia nervosa. Addison’s Disease is a disorder of the adrenal cortex which results in decreased hormonal production. Addison’s disease, even in subclinical form may mimic many of the symptoms of anorexia nervosa. Gastric adenocarcinoma is one of the most common forms of cancer in the world. Complications due to this condition have been misdiagnosed as an eating disorder.
Helicobacter Pylori is a bacterium which causes stomach ulcers and gastritis and has been shown to be a precipitating factor in the development of gastric carcinomas. It also has an effect on circulating levels of leptin and ghrelin, two hormones which help regulate appetite. Upon successful treatment of helicobacter pylori associated gastritis in pre-pubertal children they showed “significant increase in BMI, lean and fat mass along with a significant decrease in circulating ghrelin levels and an increase in leptin levels. Hypoparathyroidism and Hyperparathyroidism may mimic some of the symptoms of, can occur concurrently with, be masked by or exacerbate an eating disorder. There are multiple medical conditions which may be misdiagnosed as a primary psychiatric disorder. These may have a synergistic effect on conditions which mimic an eating disorder or on a properly diagnosed. They also may make it more difficult to diagnose and treat an ED. 19 psychiatric conditions have been associated with systemic lupus erythematosus (SLE), including depression and bipolar disorder.
Toxoplasma Seropositivity: even in the absence of symptomatic toxoplasmosis, toxoplasma gondii exposure has been linked to changes in human behavior and psychiatric disorders including those comorbid with eating disorders such as depression. In reported case studies the response to antidepressant treatment improved only after adequate treatment for toxoplasma. Neurosyphilis: It is estimated that there may be up to one million cases of untreated syphyilis in the US alone. The disease can present with psychiatric symptoms alone, psychiatric symptoms that can mimic any other psychiatric illness. Many of the manifestations may appear atypical. Up to 1.3% of short term psychiatric admissions may be attributable to neurosyphilis, with a much higher rate in the general psychiatric population. Neurosyphilis like Lyme disease has been given the appellation the “great imitator” for it may present in various ways such as depression and chronic alcoholism.
Dysautonomia: a term used to describe a wide variety of autonomic nervous system (ANS) disorders may cause a wide variety of psychiatric symptoms including anxiety, panic attacks and depression. Dysautonomia usually involves failure of sympathetic or parasympathetic components of the ANS system but may also include excessive ANS activity. Dysautonomia can occur in conditions such as diabetes and alcoholism. There are separate psychological disorders which may be misdiagnosed as an eating disorder. Emetophobia is an anxiety disorder characterized by an intense fear of vomiting. A person so afflicted may develop rigorous standards of food hygiene, such as not touching food with their hands. They may become socially withdrawn to avoid situations which in their perception may make them vomit. Many who suffer from emetophobia are diagnosed with anorexia or self-starvation. In severe cases of emetophobia they may drastically reduce their food intake. Phagophobia is an anxiety disorder characterized by a fear of eating, it is usually initiated by an adverse experience while eating such as choking or vomiting. Persons with this disorder may present with complaints of pain while swallowing.
Body dysmorphic disorder (BDD) is listed as a somatoform disorder that affects up to 2% of the population. BDD is characterized by excessive rumination over an actual or perceived physical flaw. BDD has been diagnosed equally among men and women. While BDD has been misdiagnosed as anorexia nervosa, it also occurs comorbidly in 39% of eating disorder cases. BDD is a chronic and debilitating condition which may lead to social isolation, major depression and suicidal ideation and attempts. Neuroimaging studies to measure response to facial recognition have shown activity predominately in the left hemisphere in the left lateral prefrontal cortex, lateral temporal lobe and left parietal lobe showing hemispheric imbalance in information processing. There is a reported case of the development of BDD in a 21 year old male following an inflammatory brain process. Neuroimaging showed the presence of a new atrophy in the frontotemporal region. Treatment varies according to type and severity of eating disorder, and usually more than one treatment option is utilized. Some of the treatment methods are:
– Cognitive behavioral therapy (CBT), which postulates that an individual’s feelings and behaviors are caused by their own thoughts instead of external stimuli such as other people, situations or events; the idea is to change how a person thinks and reacts to a situation even if the situation itself does not change.
– Acceptance and commitment therapy: a type of CBT
– Dialectical behavior therapy, another form of CBT
– Cognitive Remediation Therapy (CRT), a set of cognitive drills or compensatory interventions designed to enhance cognitive functioning.
– Family therapy including “conjoint family therapy” (CFT), “separated family therapy” (SFT) and Maudsley Family Therapy.
– Behavioral therapy: focuses on gaining control and changing unwanted behaviors.
– Interpersonal psychotherapy (IPT)
– Music Therapy
– Recreation Therapy
– Art therapy
– Nutrition counseling and Medical nutrition therapy.
Medication: Orlistat is used in obesity treatment. Olanzapine seems to promote weight gain as well as the ability to ameliorate obsessional behaviors concerning weight gain. zinc supplements have been shown to be helpful, and cortisol is also being investigated. Self help and guided self help have been shown to be helpful. This includes support groups and self-help groups such as Eating Disorders Anonymous and Overeaters Anonymous. There are few studies on the cost-effectiveness of the various treatments. Treatment can be expensive; due to limitations in health care coverage, patients hospitalized with anorexia nervosa may be discharged while still underweight, resulting in relapse and rehospitalisation. Prognosis estimates are complicated by non-uniform criteria used by various studies, but for AN, BN, and BED, there seems to be general agreement that full recovery rates are in the 50% to 85% range, with larger proportions of patients experiencing at least partial remission. So as you can see, there are different treatments available. But unfortunately not always they work. To many guys around the planet are dying because of this sophisticated disorder. A cruel example is of the fashion model Jeremy Gillitzer at age 38, who succumbed after a long battle with anorexia, throws light on the growing incidence of this wasting disease among males.
Anorectics are both obsessed and terrified with the numbers displayed on the scale, and the numbers for Jeremy Gillitzer foretold his sad end. Ultimately, the former male model with enviable abs and sculpted physique weighed barely over 60 lbs. Survivors of anorexia are rare, and usually continue to struggle with the disease to some extent throughout their lives. They are at nearly a constant risk of recurrence, brought on by triggers that may be unique to the individual sufferer. For Jeremy Gillitzer, there remains only the sorrow for what might have been, and the grief for the loss of a life that in some ways ended when the demon called anorexia took over his once healthy body. Of course, it is relatively easy to make the connection between a model’s obsession with looks and the anorectic’s obsession with thinness. But it also goes much deeper than that.
Anorexia sufferers may begin with a feeling of almost exhilaration as they see the weight fall off and the numbers on the scale plunge. In fact, the onset of the disease called anorexia may be triggered by an offhand remark like, “You’d look so much better if you dropped a couple pounds,” or “Gee, you look great – have you lost some weight?” From those innocent and perhaps well-intentioned remarks, the seed of this insidious disease can be planted. But almost inevitably, as the disease progresses the mania and exhilaration associated with those shrinking numbers begins to be replaced by a weary acceptance and a growing certainty that there is no perfect number and therefore no possible escape from the self-imposed prison of anorexia.
Sufferers of anorexia know that at its heart, this is not a disease about food, physical appearance, or coveted compliments. Anorexia is not a diet plan or a self-improvement strategy. It is a slow death. It is a tangible wasting away. It is the body willing itself into nothingness, in an often fatal effort to escape from a pain that is unnameable and unimaginable to non-sufferers. We invite you all to pay attention and learn from Jeremy’s sad experience. To better understand the story we invite you to visit Jeremy’s blog and watch on YouTube the videos below. Of course in this article we try to give you a just short overview about this terrible and sophisticated disease and make you to underestand how dangerous is in male too. For specific information please visit a doctor.
he history of anorexia nervosa begins with early descriptions dating from the 16th and 17th centuries and the first recognition and description of anorexia nervosa as a disease in the late 19th century. In the late 19th century, the public attention drawn to “fasting girls” provoked conflict between religion and science. Such cases as Sarah Jacob (the “Welsh Fasting Girl”) and Mollie Fancher (the “Brooklyn Enigma”) stimulated controversy as experts weighed the claims of complete abstinence from food. Believers referenced the duality of mind and body, while skeptics insisted on the laws of science and material facts of life. Critics accused the fasting girls of hysteria, superstition, and deceit. The progress of secularization and medicalization passed cultural authority from clergy to physicians, transforming anorexia nervosa from revered to reviled. However, due to the nature of the disease, the numbers could actually be much larger. Their unhealthy behavior is kept secret and sometimes help is not sought until serious health problems arise. Just as with females, the disorder usually begins during their youth, with the onset commonly between 14 and 17 years old. These are the types of patients that Thomas Linscheid Ph.D, the head psychologist at Nationwide Children’s Hospital in Columbus, sees everyday. He said that anorexia inside a male’s mind is a fear. “It gets to be an irrational fear,” he said. Anorexia can be triggered in many ways; sometimes it is because of a comment that was made about the individual from a peer. “A guy not too long ago, somebody told him that his butt was too big,” said Linscheid, describing a patient. “And it really wasn’t, but it got him thinking about it, deciding that he didn’t want to have any part of his body thought of as unusual.” Other times these young males start off by simply wanting to improve their outward appearance. “The kids that I’ve seen,” said Linscheid, “it’s usually some decision to say ’I’m getting a little over weight, I want to be buff, I want to be trim.’ While most people can diet and keep their weight-loss within normal limits, some can take it too far by striving for perfection, and never finding it. The classic anorexic can be described as somebody that has trouble with their self-image. “They’re usually very smart and talented, but they never feel good about themselves,” said Linscheid. “They put a lot of pressure on themselves to be as good as they can, to be perfect. It’s part of their personality trait. They have a lot of self-control that probably comes from that negative self-image.” These types of people are perfectionists and are the same kinds of students that feel as if they are a failure if they do not receive straight A’s in every class, and think of themselves as a “loser” if they do not go above and beyond their expectations. Their raging perfectionism can also be ritualistic and even strange at times, continuing for several years, ultimately contributing to their death.
