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ANOREXIA NERVOSA IN MALES

 

 


Also see Bulima in males and Atypical eating disorders in males  

Anorexia nervosa was first described in males by both Morton [20] and Gull [21]. Anorexia in males accounted for approximately 6 percent of cases seen in an eating disorder clinic [16, 22]. The mean age of onset of male anorexia has been reported ranging from as young as 17 years in a British series by Crisp and Burns [23] to 24 years [16, 24]. Crisp found that the illness was present an average of three-and-one-half years and that most patients were mildly obese (127.3 percent of ideal body weight, IBW) prior to the onset of illness. Minimal weight dropped to 67.3 percent of IBW during the acute phase of illness.

Apparently contrasting socioeconomic groups of origin for male anorectics may represent specific populations, seen in various programs. Andersen and Mickalide [25] found a high socioeconomic group at Johns Hopkins, while Herzog [16] in Boston and Vandereycken and Van den Broucke [22] in Belgium found an equal socioeconomic distribution.

Clinical manifestations of male anorexia were reported in several series to be similar to female anorexia [22, 23, 26, 27, 28, 29, 30]. However, in a minority of reports [31, 32] differences were noted; patients were taken from lower socioeconomic groups, feared competition and were not successful either academically or in their vocation. Yates et al. [33] compared male marathon runners to anorectics and found many similar sociocultural and personality characteristics. Runners were found to have a bizarre preoccupation with food, and even when they would achieve a lean body mass of 95 percent with only 5 percent body fat, they would aim for 4 percent body fat. Many have lost greater than 25 percent of their original weight and show a relentless pursuit of thinness or a disturbance of body image. Male anorectic characteristics include perfectionism and obsession [25]. Vandereycken and Van den Broucke [22] noted a high incidence of schizoid/introversion features as well as obsessional, passive/dependent and anti-social features. A comparison to female anorectics showed a higher percentage of undifferentiated- immature psychological structure, hysterical/histrionic features, and anti-social features, but an equal number of schizoid/introversion traits [22].

The etiology of male anorexia is unclear, but Crisp and Burns [23] hypothesize that is related to gender identity problems in the premorbid personality, since the male desire is to be bigger and stronger as compared to the female preference for slimness. Herzog [16] found male anorexic patients experiencing sexual isolation, sexual inactivity, and conflicted homosexuality. He posited that the cultural pressure on the homosexual male to be thin and attractive places him at a greater risk for eating disorders. Hall [26] in a series of nine male patients whose personal family history was reviewed, noted attention directed to bodily concerns caused by being overweight, having close contact with an eating disordered patient, attempting to identify with a thin family member, attempting to treat acne through a stringent diet, and attempting to deal with the fear of having cancer.

Endocrine disturbances present in male anorexia include decreased testosterone and gonadotrophins

(luteinizing hormone-LH and follicle stimulating hormone-FSH) in proportion to weight loss. With weight gain, both testosterone and gonadotrophins increase to normal levels [25, 34, 35]. Anderson and Mickalide [25] noted that two of ten patients studied were infertile.

 

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