Bulimia has been reported in male patients (38,42,44,69).
Herzog et al. (38) noted an incidence in males of approximately
four to five percent of a total population of bulimic
patients. Gwirtsman found that ten to 13 percent of
male students met DSMIII criteria for bulimia. The mean
age of onset ranged fro 21 (38) to 24 (42) years. Duration
of illness prior to treatment ranged from six years
(42) to 7.4 years (38). This duration is significantly
longer than the 4.2 years' duration of illness prior
to treatment for bulimic females (38).
Approximately two-thirds of bulimic males had a history
of being overweight as compared to one-third of bulimic
females. Socioeconomic classes were equally distributed
in one series (38). Mitchell's (42) study noted that
patients were employed, that they were functioning well,
and that eleven of twelve were married.
Mitchell and Goff (42) noted that eleven of twelve
bulimics were satisfied with their weight which ranged
from 81 percent to 100 percent of ideal body weight
(IBW). Marked fluctuations in weight (36 percent) were
found and ranged from 83 percent to 109 percent of IBW.
Twenty-five percent were obese during adolescence (42),
in contrast to 64 percent of bulimic males in Herzog's
group (38). Only one patient used laxatives weekly for
attempted weight control. None of the twelve patients
admitted to the abuse of diuretics, to the use of enemas,
or to sham eating. Eight of the twelve patients exercised
excessively to control weight, and five of the twelve
skipped meals following binges.
The clinical manifestations of male bulimia are comparable
to female bulimia. Preoccupation with weight control
and associations with the cultural pressures of professional
life regarding personal performance (especially in sports,
fashion, and musci) have been related to the onset of
bulimia in some male patients (44).
Psychiatric and drug histories in Mitchell and Goff's
(42) series of twelve patients reveal that five patients
admitted to alcohol or drug abuse problems in the past
and that four had received chemical-dependency treatment.
Two of the five developed problems with alcohol prior
to the onset of bulimia, and another did so after the
onset. One patient reported the simultaneous onset of
alcohol abuse and bulimia during a stressful period
in his life. Four of these five patients reported a
history of chemical abuse problems in at least one first
degree relative, and anxiety disorder. That patients
periodically substituted alcohol abuse for his bulimic
behavior. Gwirtsman and associates (44) noted that two
of three patients engaged in drug and alcohol abuse,
and that all demonstrated some degree of impulsive antisocial
Herzog (38) discussed sexual isolation, diminished
sexual activity, and conflicted homosexuality in bulimic
and anorexic males, but he did not specifically subgroup
the sexual difficulties in bulimia. Gwirtsman and associates
(44) mentioned anecdotally that bulimia may be more
common in the male gay community than among heterosexuals.
Furthermore, Mitchell and Goff (42) noted that three
out of twelve patients had a history of depression,
and that most patients had markedly disrupted social
situations and were depressed when first seen, but their
mood improved as their bulimia came under control.
Laboratory findings revealed electrolyte abnormalities
9hypochloremic and hypokalemic alkalosis) resulting
from self-induced vomiting and/or laxative abuse (42).
Abnormalities of liver enzymes and amylase were reported
by Gwirtsman et al. (44). Two of three patients had
dexamethasone nonsuppression, and one of three had a
blunted TSH response to TRH. These neuroendocrine data
are comparable in both male and female bulimic patients,
and it is not known if these abnormalities are a consequence
of bulimia or have primary neurobiologic significance.
Although Mitchell and Goff (42) noted a significant
therapy dropout rate (four of twelve), treatment of
eight of the twelve patients was successful in an intensive
outpatient group treatment program meeting several times
per week. Long-term followup data are not yet available.