Who Could Have an Eating Disorder? Short Answer: Anyone

Rear view of athletic person of color wearing workout clothing and running up and down stairs outside older building Many people harbor erroneous beliefs about eating and food issues—beliefs that may be encouraged by stereotypes frequently seen in modern media. Some might believe, for example, that eating disorders only develop in women. Others may further limit their incidence to women who are also young, wealthy, and white. Still others may believe them to be a “fake” concern or ploy for attention.

Women, especially young women, do face heavy pressure about their bodies and are consistently exposed to unrealistic and harmful standards and messages about appearance and body image. However, while it is true that women are more likely to develop an eating disorder or disordered eating patterns, it is also true that eating disorders occur with much greater prevalence, and affect a far larger range of individuals, than most people realize.

Development vs. Diagnosis and Treatment

Eating disorders are far more prevalent than many assume, in part because many people are never diagnosed and never receive treatment. According to statistics from the National Eating Disorders Association (NEDA), 10 million men and 20 million women will experience an eating disorder of clinical significance at some point in life. Many more individuals develop disordered eating patterns that do not fit criteria for diagnosis but are still serious.

Simply having an eating disorder that can be diagnosed according to criteria in the Diagnostic and Statistical Manual (DSM) is vastly different from being diagnosed with an eating disorder and beginning to receive treatment for it. An accurate diagnosis is necessary for treatment, but before diagnosis can take place, a number of steps are typically necessary:

  1. A person must be aware of eating disorders and able to recognize them. Further, not all disordered eating patterns align with criteria set forth in the DSM, but individuals who have developed any type of disordered eating may still be helped by treatment.
  2. A person must be able to combat the shame and stigma surrounding eating disorders in order to discuss the topic with someone, particularly a professional.
  3. A person must have the resources to access professional help.
  4. A person must be able to then seek out help and raise the issue with a professional.
  5. The professional must be able to overcome their own biases in order to diagnose a person who does not align with their idea of who develops eating disorders. Even some professionals who specialize in eating disorder recovery may be prone to bias.

This is a lot that has to go “right” before healing can occur. While we—therapists, counselors, and other treatment professionals—might lose people at any step along the way, I believe one of the biggest holes in the road to recovery is the lack of education about the prevalence of eating disorders.

Who, Then, Develops Eating Disorders?

Eating Disorders in Men

Estimates from the NEDA suggest 10% of people with eating disorders are male. Though this is an oft-repeated statistic, recent research from a population-based study suggests as many as 25% of individuals who have anorexia nervosa and as many as 25% of individuals who have bulimia are male.

Even these figures may be underestimates. It is difficult to determine the exact number of men who have eating disorders because men are far less likely to seek treatment. Men may fear the stigma of having what many consider a concern that only develops in women and avoid seeking treatment. Thus, their experience goes unrecognized, and people continue to believe eating disorders occur mostly in women.

Disordered eating patterns may also look very different for males, who have different “ideal” body types promoted to them.  Muscle dysmorphia, a condition of extreme preoccupation with the size and shape of one’s muscles, is highly prevalent in men, for example, though it is not yet considered a “real” disorder.

Eating Disorders in the LGBTQ+ Community

One national sample of college students found rates of self-reported eating disorders, in addition to diet pill use, laxative use, and vomiting in the previous month, were highest among transgender students. Rates were also high among sexual minority students—men as well as men and women who were unsure of their orientation. Research and statistics on eating disorders in the LGBTQ+ community, particularly among non-binary and trans individuals, is still limited, but evidence suggests this population may be underserved.

The many factors that can have a harmful impact on an individual and influence the development of an eating disorder—bullying, discrimination, homelessness, body image ideals, lack of family or community support, and lack of awareness education, to name a few—commonly affect LGBTQ+ individuals. This may increase the incidence of eating disorders in members of this community.

Anecdotal evidence suggests one reason eating disorders may be more likely to develop in trans and non-binary individuals is a desire to more closely align one’s body to gender identity and desired body type.

Eating Disorders in Ethnic Minorities

Eating disorders, which often evolve as ways of managing overwhelming stress, typically include negative thoughts and feelings about the self and generally not only about body shape and size. In the United States, there is not only a “thin ideal” (idea that being thin is better than not thin), but also a “white ideal.” People of color, who often experience daily racism and discrimination, may thus be highly likely to experience negative thoughts and feelings.

Some hold to the notion that, because in other cultures, a thin body may not be upheld as an ideal standard, members of these groups are immune to eating disorders. This is not in fact the case. While it may be true that some cultures favor curvier, fuller bodies, research has shown that the degree to which a person has become acculturated—shifted their values from those of their culture of origin to the host or dominant culture—can have an impact on their susceptibility to eating disorders.

Individuals who have, for example, internalized dominant American beauty standards of thinness may develop patterns of disordered eating in their aspiration to attain the desired body shape. A number of other factors must also be considered, such as the overall effects of oppression, which may include low self-esteem, anxiety, and depressionEven when a person recognizes their need for help, treatment for an eating disorder can be expensive and often impossible for those without health insurance. Further, people who lack funds and resources may need to deprioritize seeking help in order to manage their day-to-day life. 

Though eating disorders in ethnic minorities are being reported at higher numbers, members of this population are less likely to seek treatment, according to a 2013 review of studies focused on eating disorders in ethnic minorities. Further, referrers were significantly less likely to send ethnic minorities disordered eating specialists.

Eating Disorders in Lower Income Groups

People with low socio-economic status meet roadblocks at every turn when it comes to diagnosis and treatment. One reason may be the scarcity of information and education about eating disorders in this population. Research shows that people with lower incomes are much less likely to recognize an eating disorder and view it as treatable than are people with higher incomes.

Even when a person recognizes their need for help, treatment for an eating disorder can be expensive and often impossible for those without health insurance. Further, people who lack funds and resources may need to deprioritize seeking help in order to manage their day-to-day life.  While organizations that assist people in getting the treatment they need, such as Project HEAL, do exist, a person has to know these resources are available before they can attempt to access them.

Older Adults and Eating Disorders

Eating disorders in midlife are increasingly being recognized as somewhat common. According to NEDA, 13% of women over 50 have symptoms of disordered eating. There is less data available about men, but it is likely that eating disorders in middle-aged men also occur more frequently than previously realized.

Midlife brings with it unique challenges such as raising children, caregiving, financial difficulties, workplace concerns, and household responsibilities.  In the current cultural climate, ideas like “50 is the new 30” can add additional stress in the form of increased pressure to maintain a certain body type at the very same time a body is beginning to slow its metabolism, change its chemistry, and respond to food and exercise differently than in years past.

Many women gain an average of ten pounds a year, simply due to aging, but women who have had children may find that childbirth also changes the body significantly. A desire to maintain a certain body type or shape, coupled with stress and unhelpful coping mechanisms, may contribute to the development of disordered eating habits or an eating disorder that meets diagnostic criteria.

The elder years may also bring challenges such as impending mortality, declining health, and decreased social circles. Disordered eating patterns develop in some for the first time in later life, while others may experience a resurgence of symptoms from their youth as they encounter these new stressors.  Some individuals may have struggled with untreated (or unsuccessfully treated) disordered eating of one form or another for much of their life. This not only effectively excludes them from statistics, it may also lend support to the myth that eating disorders largely occur in young women.

If you belong to one of these oft-marginalized groups and recognize the symptoms of disordered eating in yourself, please do not hesitate to seek help. A compassionate, qualified mental health professional can offer support, treatment options, and recovery assistance, and you can begin your search here.

References:

  1. Ackard, D. M., Richter, S., Frisch, M. J., Mangham, D., & Cronemeyer, C. L. (2013). Eating disorder treatment among women forty and older: Increases in prevalence over time and comparisons to young adult patients. Journal of Psychosomatic Research74(2), 175-178. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23332534
  2. Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolsecent Health, 57(2), 144-149. Retrieved from http://www.jahonline.org/article/S1054-139X(15)00087-7/abstract
  3. Eating disorders affect us all. (n.d.). Retrieved from https://www.nationaleatingdisorders.org/eating-disorders-affect-us-all
  4. Eating disorders in LGBT populations. (n.d.). Retrieved from https://www.nationaleatingdisorders.org/eating-disorders-lgbt-populations
  5. Eating disorders in women of color: Explanations and implications. (n.d.). Retrieved from https://www.nationaleatingdisorders.org/eating-disorders-women-color-explanations-and-implications
  6. Hudson, J., Hiripi, E., Pope, H., & Kessler, R. (2007). The prevalence and correlates
  7. of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348–58. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892232
  8. Sallans, R. (2015, May 27). Gender outside the binary: Eating disorder recovery and my transgender identity. Retrieved from https://www.nationaleatingdisorders.org/blog/gender-outside-the-binary-part1
  9. Sinha, S., & Warfa, N. (2013). Treatment of eating disorders among ethnic minorities in western settings: A systematic review. Psychiatry Danub25, 295-299. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23995197
  10. Types & symptoms of eating disorders. (n.d.). Retrieved from https://www.nationaleatingdisorders.org/types-symptoms-eating-disorders
  11. Von dem Knesebeck, O., Mnich, E., Daubmann, A., Wegscheider, K., Angermeyer, M. C., Lambert, M., Karow, A., Harter, M., & Kofahl, C. (2013). Socioeconomic status and beliefs about depression, schizophrenia and eating disorders. Social Psychiatry and Psychiatric Epidemiology48(5), 775-782. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23052428

© Copyright 2017 GoodTherapy.org. All rights reserved. Permission to publish granted by Dana Harron, PsyD, therapist in Washington, District of Columbia

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • ramona

    ramona

    February 10th, 2017 at 8:27 AM

    My niece has always been so thin and healthy, but she has recently come forward and admitted to her mom and dad that it is because she has bulimia and she needs help. They are all devastated because she cycles from one minute admitting that she needs help and then the next hiding it all and saying that there is nothing wrong. Their insurance doesn’t want to pay for any kind of eating recover treatment center although several doctors have recommended a residential facility for her. It breaks my heart to see the hurt that they are all going through.

  • Dana Harron, PsyD

    Dana Harron, PsyD

    February 13th, 2017 at 8:57 AM

    I’m sorry to hear that your niece is having a hard time. You might want to look in to Project HEAL, a not-for-profit that helps people who are having trouble affording treatment for eating disorders. Best of luck to you and your family.

  • Leonard

    Leonard

    February 10th, 2017 at 10:34 AM

    It is important to remember that this is something that could affect anyone or any family at any time
    And you don’t want to overlook it if you think that there is a male in the family who is struggling wither because it could be just as likely that he is struggling with this as it would be for a female.
    I think that there are so many people who think that this only affects women but in my experience there are a lot of men who also struggle with body image issues and just like with women this could very quickly involve into something that is even more deadly.

  • Dana Harron, PsyD

    Dana Harron, PsyD

    February 13th, 2017 at 8:58 AM

    Couldn’t agree more Leonard! Check out the National Association for Males with Eating Disorders (NAMED) for more information on this as well.

  • sela d

    sela d

    February 13th, 2017 at 7:41 AM

    I wonder if an eating disorder sometimes can evolve out of someone being depressed about anything for a long period of time? Like maybe they start to feel like the rest of their life is out of control and this is the one thing that they know for sure that they can control?

  • Dana Harron, PsyD

    Dana Harron, PsyD

    February 13th, 2017 at 8:55 AM

    Hi Sela,
    Eating disorders are usually caused by a complex range of factors that include genetics, environment, and emotions. So yes, an eating disorder can absolutely evolve out of depression and can also relate to wanting to feel in control. The key there is to work with a therapist to help to figure out why life feels so out of control and also what less self-destructive ways of finding a sense of control might look like.

  • Riley

    Riley

    February 13th, 2017 at 12:01 PM

    Really struggling with a whole lot right now, food is the last thing on my mind. So not sure if this is going anywhere or I am just feeling stressed. I don’t wanna make a mountain out of a molehill

  • Dana Harron, PsyD

    Dana Harron, PsyD

    February 25th, 2017 at 10:24 AM

    It sounds like you’re having a really hard time. A lot of people don’t want to make “too much” of their problems, but ignoring it is when it really gets out of hand. This isn’t clinical advice of course, but I always think it’s a good idea to check in with a professional. Wishing you well.

  • andrea S

    andrea S

    February 15th, 2017 at 11:51 AM

    If we ever had to wonder why this has become such a thing for so many I think that all we have to do is look at the very unrealistic expectations that society places on women in general. We are supposed to be bubbly and thin and cute and fun… but all at the expense of just being who we really are. I am so tired of seeing these images of what a woman should be versus what most of us really are and I think, you know, those are the things that are tearing us down and for the most part we are all feeding right into it.

  • Dana Harron, PsyD

    Dana Harron, PsyD

    February 25th, 2017 at 10:31 AM

    This is completely true. The idea that women are supposed to embody these so-called ideals is unrealistic and damaging. Let’s also remember that men are hurt by their own set of ridiculous expectations, which people do seem to talk about less – they are supposed to be stoic, unfeeling, and “strong” at the expense of their ability to experience the full range of human emotions. I’ve found that many times men also develop disordered eating and other ways of coping as ways to cope with the unrealistic expectations of the patriarchy.

  • Maria

    Maria

    June 19th, 2017 at 9:38 PM

    I really appreciate the part of the post about how eating disorders affect people across all walks of life. So often eating disorders are seen as only affecting teen and college age women, but that is so untrue. When I was receiving treatment, I was with many middle aged and older women, a few men, various ethnicities, religions, sexualities, all struggling with similar issues. The idea that only upper class, caucasian, (young) females just isn’t true, and I am glad to see posts about it.

  • Dana Harron, PsyD

    Dana Harron, PsyD

    October 30th, 2017 at 4:12 PM

    Thank you very much, Maria. I hope you feel free to share the word by sharing this article on social media if you’d like.

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