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5. BULIMIA NERVOSA IN MALES

 

 

Bulimia has been reported in male patients [16, 36, 37, 38]. Herzog et al. [16] noted an incidence in males of approximately 4 to 5 percent of a total population of bulimic patients. Gwirtsman found that 10 to 13 percent of male students met DSM-III criteria for bulimia. The mean age of onset ranged from 21 [16] to 24 years [36]. Duration of illness prior to treatment ranged from six years [36] to 7.4 years [16]. This duration is significantly longer than the 4.2 years’ duration of illness prior to treatment for bulimic females [16].

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 [16]. Mitchell’s [36] study noted that patients were employed, that they were functioning well, and that 11 of 12 were married. Mitchell and Goff [36] noted that 11 of 12 bulimics were satisfied with their weight which ranged from 81 percent to 100 percent of ideal body weight (IBW).

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 music) have been related to the onset of bulimia in some male patients [37]. Psychiatric and drug histories in Mitchell and Goff’s [36] series of 12 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 patients reported a history of chemical abuse in at least one first-degree relative, and one had a family history of drug abuse, affective disorder, and anxiety disorder. That patient periodically substituted alcohol abuse for this bulimic behavior. Gwirtsman and associates [37] noted that two of three patients engaged in drug and alcohol abuse, and that all demonstrated some degree of impulsive antisocial behavior.

Herzog [16] 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 [37] mentioned anecdotally that bulimia may be more common in the male gay community than among heterosexuals. Mitchell and Goff [36] 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.

 

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