Bulimia Nervosa and Differences Between Genders

Shannon Gartland, NCC, LPC

Bulimia nervosa affects 1-1.5% of females and there is a 10:1 ratio of females to males suffering from the disorder (American Psychiatric Association, 2013). Some research has been done to determine how risk factors for bulimia nervosa differ between men and women. Even as early as elementary school, differences begin to appear between how boys and girls think about their weight. These differences can be seen in a study done by Phares, Steinberg, and Thompson (2004). In the study, the researchers found that on average girls were more worried about losing weight and had a greater desire to be thin than boys. In addition, they found that girls were more likely to perceive that they were getting messages from their parents about dieting and watching one’s weight. Interestingly, however, boys and girls seemed to be nearly equal in their amount of dissatisfaction with their body and their tendency toward bulimic behaviors. Differences did occur in what seemed to be driving the bulimic tendencies. For girls these behaviors were related to influences of peers, history of eating concerns in the family, and how they viewed teasing by their parents. For boys none of these seemed to be significantly related other than the perception of teasing by parents.

Another study found that the way men and women experience anger is correlated to bulimic symptoms. In particular, the study found that women who tended to suppress their feelings of anger more often were more likely to have bulimic tendencies. In contrast, men who acted on their anger and really experienced it were more likely to have bulimic tendencies than those who did not express it (Meyer et al., 2005). Similarly to the expression of anger, other evidence has been found to see that different personality features of men and women can be risk factors for bulimia. Specifically, when comparing both males and females who had bulimic symptoms, males were more likely than females to have perfectionism and distrust in interpersonal relationships. Females were more likely than males to have a goal of being thin (Joiner, Katz, & Heatherton, 2000). When looking at attachment styles and their relationship to bulimia, researchers found that there was a significance of attachment styles and their relationship to women developing bulimia. Women with a fearful attachment style seemed to be more likely to have bulimia. In contrast, men and attachment styles were not shown to be correlated in any way (Elgin & Pritchard, 2006).

In addition to the gender differences in risk factors and causes of bulimia, there also appear to be differences between men and women in the way the illness manifests. Age of onset differs in that symptoms of bulimia in females tend to increase between the ages of 14 and 16 and then decrease after age 16. For males, bulimia symptoms are likely to decrease between the ages of 14 and 17 and then increase until age 20 (Abebe, Lien, & Soest, 2012). When looking at those with eating disorders, the psychological experiences of men and women differ as well. Compared to men, women expressed a stronger desire to lose weight and a greater fear of becoming fat. Men, in contrast, were more concerned with gaining muscle than they were with weight loss. While they did show discontent with their bodies it was in a much different way than women (Ousley, Cordero, & White, 2008).

Along these lines, men with eating disorders were more likely than women with eating disorders to display the symptom of over exercising. They also had a higher reported number of overeating episodes than women. On the other hand, women were more likely to have felt a loss of control when overeating and to have felt guilt for overeating. Women were also more likely to go to treatment for an eating disorder (Lewinsohn, Seeley, Moerk, & Striegel-Moore, 2002).

In reviewing the literature on the topic of bulimia in males it is evident that bulimia nervosa is very different for males than it is for females. One way this is true is that the thoughts associated with bulimia are not as much about losing weight for males as they are for females (Joiner et al., 2000). In addition, the risk factors are different in that, unlike females, males are less influenced by their peers and by their family’s history of eating problems. They are more influenced by their perceptions of parent teasing (Phares et al., 2004).

While there is still much more research to be done on bulimia nervosa in males, it does appear to be a rising topic of interest. Learning more about the topic could not only help determine effective ways of helping men at risk for eating disorders and increase awareness in the community of how to recognize eating disorders in males, but could also help determine why the disorders are less prevalent in men. In understanding the discrepancy between the number of males affected by eating disorders compared to that of females, researchers could get a better idea of how to reduce the prevalence of the disorder in females as well.

At McCallum Place we treat both males and females. Unfortunately, however, in the general community it seems that people do not always think of eating disorders among males, causing it to be less recognized and possibly even underdiagnosed. By understanding it more fully, we could help raise a greater awareness about it thereby helping reduce the stereotype that eating disorders only affect females. More awareness could lead to less shame for males struggling with eating concerns and ultimately increase their openness to getting treatment.

Abebe, D. S., Lien, L., & von Soest, T. (2012). The development of bulimic symptoms from adolescence to young adulthood in females and males: A population?based longitudinal cohort study. International Journal of Eating Disorders, 45(6), 737–745. doi:10.1002/eat.20950

American Psychiatric Association (2013). Feeding and eating disorders. Diagnostic and Statistical Manual of Mental Disorders (5th ed). Washington, DC: American Psychiatric Association.

Elgin, J., & Pritchard, M. (2006). Adult attachment and disordered eating in undergraduate men and women. Journal of College Student Psychotherapy, 21(2), 25–40. doi:10.1300/J035v21n02_05

Joiner, T. E. J., Katz, J., & Heatherton, T. F. (2000). Personality features differentiate late adolescent females and males with chronic bulimic symptoms. International Journal of Eating Disorders, 27(2), 191–197. doi:10.1002/(SICI)1098-108X(200003)27:2<191::AID-EAT7>3.0.CO;2-S

Lewinsohn, P. M., Seeley, J. R., Moerk, K. C., & Striegel-Moore, R. H. (2002). Gender differences in eating disorder symptoms in young adults. International Journal of Eating Disorders, 32(4), 426–440. doi:10.1002/eat.10103

Meyer, C., Leung, N., Waller, G., Perkins, S., Paice, N., & Mitchell, J. (2005). Anger and Bulimic Psychopathology: Gender Differences in a Nonclinical Group. International Journal of Eating Disorders, 37(1), 69–71. doi:10.1002/eat.20038

Ousley, L., Cordero, E. D., & White, S. (2008). Eating disorders and body image of undergraduate men. Journal of American College Health, 56(6), 617–621. doi:10.3200/JACH.56.6.617-622

Phares, V., Steinberg, A. R., & Thompson, J. K. (2004). Gender Differences in Peer and Parental Influences: Body Image Disturbance, Self-Worth, and Psychological Functioning in Preadolescent Children. Journal of Youth and Adolescence, 33(5), 421–429. doi:10.1023/B:JOYO.0000037634.18749.20