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Fichter et al. (65) defines atypical anorexia nervosa
in males as that occurring in males who fulfill some,
but not all, criteria of anorexia nervosa and who manifest
atypical symptoms or characteristics.
Of four cases of male anorexia nervosa reported by
Fichter et al. (65) two atypical male cases with obsessive-compulsive
features were noted. One patient had anorexia, bulimic
episodes, and obsessive-compulsive behaviors (hand washing
rituals). The onset of illness occurred after a driving
accident. The second patient, age 28, developed an obsessive-compulsive
neurosis after his father's death, with obessive thoughts
of aggressiveness and with rituals to undo his evil
deeds and thoughts. He starved himself and made several
suicide attempts. However, body image disturbances and
weight phobic symptoms were not present.
Another patient, with full criteria for anorexia nervosa,
had a depressive-apathetic syndrome, secondary conflicts
with his homosexual partner which produced labile personality
changes, and depressive reactions (65).
In addition to weight loss, another patient developed
disturbances in swallowing of psychogenic origin and
displayed personality features seen in anorexia nervosa
(rigidity, social anxiety, achievement orientations)
(65).
Atypical Eating Disorders in Males
Andersen and Mickalide (60) noted that 21 percent
of male patients who were referred to Johns Hopkins
Eating Disorders Clinic had an eating disturbance with
weight loss or abnormal eating patterns in the absence
of criteria of DSMIII anorexia nervosa.
One group had a swallowing phobia (fear of choking)
with significant weight loss, previously misdiagnosed
as anorexia nervosa. An earlier choking episode (often
vaguely recalled) and a second, more recent choking
episode resulted in a sustained fear of choking associated
with severe dietary restrictions of solid food. Blinder
(70) noted that this syndrome may be a variant of anorexia
occurring in a post traumatic context; he found patients
who exhibited similar fears after mouth injury or dental
surgery. Choking and aspiration, associated with a rare,
chronic ruminatory disorder, may also lead to food restriction
(71).
Andersen and Mickalide (60) also noted patients who
had a classic panic disorder with an associated preoccupation
with fears of public vomiting, leading to food restriction
and diminished weight. In contrast, a patient with general
anxiety had specific overeating episodes unassociated
with the fear of obesity (60).
These atypical eating disorders are differentiated
from anorexia nervosa, since full DSMIII criteria for
anorexia nervosa re not present, and may be defined
as a mild form of anorexia nervosa.
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