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 behavior.

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.