Eating disorders in men: update

Online content on eating disorders: a natural language processing study

BACKGROUND

Online content can inform the personal risk of developing an eating disorder, and it can influence the time and motivation to seek treatment. Patients routinely seek information online, and access to information is crucial for both prevention and treatment. The primary aim of the current study was to quantify the readability scores of online content on eating disorders using natural language processing algorithms, across two languages: English and Italian.

METHODS

Unique terms related to single diagnoses were searched using Google®. The content available on Wikipedia was also assessed. Readability was defined according to the Flesch Readability Ease (FRE) and the Rate Readability Index (RIX). The scientific support of retrieved content and the authoritativeness of sources were measured through standardized variables.

RESULTS

In Italian, online content was more likely published by private psychotherapy institutes or by websites that promote diet-advice or weight-loss. In both languages, the most readable content was on Anorexia Nervosa (RIX 4.18, FRE-en 59.6, FRE-it 41.69), Bulimia Nervosa (RIX 3.99, FRE-en 66.27, FRE-it 39.66) or Binge Eating (RIX 4.01, FRE-en 68.10, FRE-it 38.62). English sources consistently had more references than Italian pages (range 35-182, vs 1-163, respectively). and had a higher percentage of citations available in the target language. The content of these references was mainly reflective of peer-reviewed or clinical manuals.

CONCLUSION

Attention should be given to developing online content for Muscle Dysmorphia and Orthorexia Nervosa, as well as improving the overall readability of online content on eating disorders, especially for languages other than English.

Co-producing principles to guide health research: an illustrative case study from an eating disorder research clinic

BACKGROUND

There is significant value in co-produced health research, however power-imbalances within research teams can pose a barrier to people with lived experience of an illness determining the direction of research in that area. This is especially true in eating disorder research, where the inclusion of co-production approaches lags other research areas. Appealing to principles or values can serve to ground collaborative working. Despite this, there has not been any prior attempt to co-produce principles to guide the work of a research group and serve as a basis for developing future projects.

METHODS

The aim of this piece of work was to co-produce a set of principles to guide the conduct of research within our lived experience led research clinic, and to offer an illustrative case for the value of this as a novel co-production methodology. A lived experience panel were recruited to our eating disorder research group. Through an iterative series of workshops with the members of our research clinic (composed of a lived experience panel, clinicians, and researchers) we developed a set of principles which we agreed were important in ensuring both the direction of our research, and the way in which we wanted to work together.

RESULTS

Six key principles were developed using this process. They were that research should aim to be: 1) real world-offering a clear and concrete benefit to people with eating disorders, 2) tailored-suitable for marginalised groups and people with atypical diagnoses, 3) hopeful-ensuring that hope for recovery was centred in treatment, 4) experiential-privileging the 'voice' of people with eating disorders, 5) broad-encompassing non-standard therapeutic treatments and 6) democratic-co-produced by people with lived experience of eating disorders.

CONCLUSIONS

We reflect on some of the positives as well as limitations of the process, highlighting the importance of adequate funding for longer-term co-production approaches to be taken, and issues around ensuring representation of minority groups. We hope that other health research groups will see the value in co-producing principles to guide research in their own fields, and will adapt, develop, and refine this novel methodology.

Stigmatization of binge eating disorder in men: Implicit associations with weight status and femininity

BACKGROUND

Eating disorders are highly stigmatized, but stigma against binge eating disorder (BED) specifically is relatively understudied, especially in men. We compared perceptions of a male target with BED to one with alcohol use disorder (AUD), which shares the key characteristic of subjective loss of control over consumption. We also investigated how participants' eating and alcohol use behaviors and attitudes towards psychotherapy influence perceptions of these disorders.

METHODS

Participants (n = 402) viewed vignettes describing a male target engaged in excess alcohol use or binge eating and rated the target on various attributes and as being responsible for or in control of their behavior and suffering from an addiction warranting treatment. Participants completed the Alcohol Use Disorders Identification Test, Binge Eating Scale, and questions about attitudes towards and experience with psychological treatment.

RESULTS

The BED target was rated as significantly less "thin," more "overweight" and "obese", and higher on several positive attributes and traits traditionally associated with femininity; the AUD target was thought more likely to be suffering from an addiction and in need of psychological treatment (all p < .05), with no differences between targets in ratings of responsibility for or control over the problematic behavior. Ratings were unrelated to participants' attitudes towards or experience with psychological treatment and personal alcohol consumption or binge eating behaviors.

CONCLUSIONS

BED in men appears less stigmatized than AUD but is implicitly associated with weight status and femininity, which may increase reluctance to seek treatment. Both AUD and BED were generally recognized as pathological and warranting intervention.

Emotion regulation difficulties are associated with loss-of-control eating dependent on degree of narcissistic traits in college students

Loss-of-control eating (LOCE) is highly prevalent in college students and may be driven by enduring personality traits. Narcissism is often conceptualized with two broad domains: grandiose and vulnerable. The association between narcissism and LOCE has not been directly assessed, nor the potential influence of emotion regulation deficits, which are differentially associated with grandiosity and vulnerability. This study hypothesized an association between vulnerable narcissism and LOCE in college students by way of emotion regulation difficulties, extending prior findings. Participants (n = 704) completed a survey on pathological eating and body image disturbance, emotion regulation difficulties, and narcissistic traits. Results supported a full mediation effect, such that vulnerable narcissism was positively associated with LOCE by way of emotion regulation difficulties. Present findings suggest the mechanism primarily predictive of LOCE is emotion regulation difficulties, and predisposition to deficits in emotion regulation associated with vulnerable narcissism may increase the odds of LOCE. Additionally, it was noted that grandiose narcissism evinced a fully mediated inverse association with LOCE. Clinical implications and directions for future research are discussed.

Greater negative affect reduction expectancies moderate the interactive relationship between emotion regulation difficulties and distress tolerance in predicting loss-of-control eating

OBJECTIVES

Loss-of-control eating (LOCE) is often conceptualized as a negative reinforcement mechanism. However, LOCE does not consistently reduce negative affect (NA). One explanation for continued LOCE, despite a lack of NA reduction, may be expectations of NA reduction. Emotion regulation difficulties and low distress tolerance often predict LOCE, but have not been examined in the context of NA reduction expectancies.

DESIGN

This study examined the main and interactive relationships between emotion regulation difficulties, distress tolerance and NA reduction expectancies on LOCE in US adults (n = 3331).

METHOD

This study consisted of a battery of surveys administered to a national sample of US adults.

RESULTS

Results indicate NA reduction expectancies are robust, eclipsing the predictive effects of other emotion regulation variables. Distress tolerance was only able to attenuate the relationship between emotion regulation difficulties and LOCE when NA reduction expectancies were low.

CONCLUSIONS

These findings identify NA reduction expectancies as having a strong relationship with LOCE, such that the protective factor of distress tolerance is only relevant when such expectancies are low. Clinical implications suggest that targeting NA reduction expectancies in eating interventions that bolster emotion regulation difficulties and distress tolerance may improve the effectiveness of said interventions. Additionally, stand-alone expectancy interventions should be assessed for the purpose of LOCE reduction. Directions for future research are discussed.

Pathways of association between disordered eating in adolescence and mental health outcomes in young adulthood during the COVID-19 pandemic

OBJECTIVES

The COVID-19 pandemic has been associated with increased mental health problems. We investigated (1) associations between disordered eating in adolescence and mental health problems after one year of the pandemic and (2) the mechanisms explaining associations.

METHOD

We analyzed data from a population-based birth cohort in Quebec, Canada (557 males and 759 females). High and low levels of disordered eating symptom trajectories were previously estimated (age 12, 15, 17, and 20 years). Anxiety, depression, non-suicidal self-injury, and suicidal ideation were assessed at 23 years (March-June 2021). Putative mediators included loneliness and social media use (age 22 years, July-August 2020). Analyses controlled for mental health and socio-economic status at age 10-12 years and were conducted for males and females separately.

RESULTS

Females in the high-level disordered eating symptom trajectory were at increased risk for non-suicidal self-injury (OR 1.60; 95% CI 1.02-2.52) and suicidal ideation (2.16; 1.31-3.57), whereas males were at increased risk for severe anxiety (2.49; CI 1.11-5.58). Males and females in the high-level trajectory were more likely to report severe depression (2.26; 1.14-5.92 and 2.15, 1.36-3.38 respectively). Among females, associations were partially explained (17-35%) by loneliness during the first 4 months of the pandemic.

CONCLUSION

Young adults who experienced disordered eating as adolescents were at increased risk of mental health problems during the pandemic. Loneliness partially mediated the effect, suggesting that pandemic mitigation resulting in increased social isolation may have exacerbated mental health problems among women with a history of disordered eating.

Eating Disorders in Children and Adolescent Males: A Peculiar Psychopathological Profile

(1) Background: Eating Disorders (EDs) are severe psychiatric disorders with high rates of mortality, multiple medical and psychiatric comorbidities associated, and often chronic illness. Historically, EDs are among the most gendered of psychiatric illnesses, and male presentations have been perceived as rare and unusual. This perception resulted in the systematic underrepresentation of males in research on Eds, and as consequence, in a scarcity of research investigating clinical and psychological features in this population. (2) Methods: The present study aims to evaluate clinical and psychopathological features in a sample of 287 children and adolescents, 27 males and 260 females with EDs, in order to identify similarities and differences. (3) Results: Males were younger than females, with similar medical and clinical conditions, but a different distribution of typology of EDs in middle childhood and middle adolescents. The Eating Disorders Inventory-3, TAS-20 for alexithymia and CDI for depressive symptoms' profiles are similar, while males showed higher scores at the global indexes of Symptom Checklist 90-Revised test in early adolescence. (4) Conclusions: Results suggest gender-specific similarities and differences in clinical and psychological features in children and adolescent males, which may require specific diagnosis and treatment.

Comparison of eating disorders symptoms and body image between individual and team sport adolescent athletes during the COVID-19 pandemic

BACKGROUND

COVID-19 has significantly disrupted the routines of school sports for adolescent athletes, which can affect their usual eating behaviors and body image. Specific pressures of individual sports (which tend to emphasize "leanness" as a means to improving performance), versus team sports (which tend to not require "leanness" for an athlete to be competitive), may further increase the risk of disordered eating (DE), eating disorders (ED), and distorted body image. An additional factor to consider is the gender of the athletes, with participation in "lean" sports associated with increased DE and body dissatisfaction for male, but not female, athletes.

METHODS

Participants of the study included 124 Iranian male adolescent athletes residing in Mazandaran province (one of the most affected areas of Iran during COVID-19), who played in 1 of 6 sports (3 individual, 3 team). ED symptoms were assessed by the Eating Attitudes Test-26 (EAT-26), and body image was assessed by the Body-Esteem Scale for Adolescents and Adults (BESAA).

RESULTS

The individual athlete group (n = 62) had significantly higher EAT-26 subscale scores for Bulimia and Food Preoccupation (p = 0.019), as well as significantly higher BESAA subscale scores for Appearance (p = 0.001), Weight (p = 0.001), and Attribution (p = 0.001), compared to the team athlete group (n = 62). However, there were no significant differences between the two athlete groups on the EAT-26 Dieting and Oral Control subscales.

CONCLUSIONS

COVID-19 presents specialized issues for adolescent athletes, particularly those at risk for, or experiencing, DE, ED, and distorted body image. While individual athletes had significantly higher scores than team athletes on most subscales, there were no differences between groups on subscales of dieting and oral control. Overall, the findings highlight the need for sport psychologists, coaches, and other sports professionals working with male adolescent athletes (individual and team) to monitor DE, ED, and distorted body image during COVID-19, in order to provide early intervention, and mitigate the risk of long-term consequences. COVID-19 has significantly disrupted the routines of school sports for adolescent athletes, which can affect their usual eating behaviors and body image. Specific pressures of individual sports (which tend to emphasize "leanness" as a means to improving performance), versus team sports (which tend to not require "leanness" for an athlete to be competitive), may further increase the risk of disordered eating (DE), eating disorders (ED), and distorted body image. An additional factor to consider is the gender of the athletes, with participation in "lean" sports associated with increased DE and body dissatisfaction for male, but not female, athletes. Participants of the study included 124 Iranian male adolescent athletes in Mazandaran province (one of the most affected areas of Iran during COVID-19), who played in 1 of 6 sports (3 individual, 3 team). The individual athlete group (62 participants) had significantly higher scores on measures of ED (Bulimia, Food Preoccupation), and body image (Appearance, Weight, Attribution), versus the team athlete group (62 participants). However, there were no significant differences between groups on other measures of ED (Dieting, Oral Control). Findings highlight the need for sport professionals working with adolescent athletes to monitor DE and body image during COVID-19 for early intervention.

Modified Dual Pathway Model for Binge Eating: The Role of Emotion Dysregulation

We tested a modification of the dual pathway model using two sequential mediators between body dissatisfaction and binge eating: restricted eating and difficulties in emotion regulation replacing negative affect. A total of 435 college students completed an online survey. Results from path analyses indicated that the relationship between body dissatisfaction and binge eating was not mediated by restricted eating for neither women nor men. However, this relationship was mediated first by restricted eating and then by difficulties in emotion regulation for women only. Moreover, this relationship was mediated by difficulties in emotion regulation for both women and men. A post hoc analysis indicated that the above mediation results were still significant after adding negative affect into the model. No mediations through negative affect were significant. Clinical implications include the conceptualization and intervention of eating concerns within an emotion dysregulation framework.

Examination of Athlete Triad Symptoms Among Endurance-Trained Male Athletes: A Field Study

Background: Studies examining the physiological consequences associated with deficits in energy availability (EA) for male athletes are sparse.

Purpose: To examine male athlete triad components; low energy availability (LEA) with or without an eating disorder risk (ED), reproductive hormone [testosterone (T)], and bone mineral density (BMD) in endurance-trained male athletes during different training periods.

Methods: A cross-sectional design with 14 participants (age: 26.4 ± 4.2 years; weight: 70.6 ± 6.4 kg; height: 179.5 ± 4.3 cm; BMI: 21.9 ± 1.8 kg/m2) were recruited from the local community. Two separate training weeks [low (LV) and high (HV) training volumes] were used to collect the following: 7-day dietary and exercise logs, and blood concentration of T. Anthropometric measurements was taken prior to data collection. A one-time BMD measure (after the training weeks) and VO_2max-HR regressions were utilized to calculate EEE.

Results: Overall, EA presented as 27.6 ± 10.7 kcal/kgFFM·d-1 with 35% (n = 5) of participants demonstrating increased risk for ED. Examining male triad components, 64.3% presented with LEA (≤ 30 kcal/kgFFM·d-1) while participants presented with T (1780.6 ± 1672.6 ng/dl) and BMD (1.31 ±.09 g/cm²) within normal reference ranges. No differences were found across the 2 training weeks for EI, with slight differences for EA and EEE. Twenty-five participants (89.3%) under-ingested CHO across both weeks, with no differences between weeks.

Conclusion: Majority of endurance-trained male athletes presented with one compromised component of the triad (LEA with or without ED risk); however, long-term negative effects on T and BMD were not demonstrated. Over 60% of the participants presented with an EA ≤ 30 kcal/kgFFM·d-1, along with almost 90% not meeting CHO needs. These results suggest male endurance-trained athletes may be at risk to negative health outcomes similar to mechanistic behaviors related to EA with or without ED in female athletes.

The minority or the misunderstood? A young man's journey with anorexia nervosa

INTRODUCTION

Despite findings that 1 in 4 eating disorder sufferers are male (Beat, 2017), they continue to be known as "female" disorders, an association which delays diagnosis in males and prevents them from seeking the help that they need to recover.

AIM

The current paper aimed to challenge this misconception by enabling and supporting Ben, a young male diagnosed with Anorexia Nervosa aged 16, to share his experience of seeking and receiving treatment for the disorder.

METHOD

It achieved this by exploring how his disorder developed, his experience of a child and adolescent inpatient service and the events leading up to this, and his life post-discharge, all in collaboration with Ben himself and using his own words.

DISCUSSION

The paper concludes with some implications for future practice, including that eating disorders should not be skewed towards any gender, treatment programmes need to ensure full inclusivity of males, and more gender sensitive information is required to raise awareness of this population and thus reduce the stigma and isolation they experience at present. It is hoped that these, along with the rest of the paper, will be accessible to and utilized by both professionals and non-professionals alike.

ACCESSIBLE SUMMARY

● Around one quarter of people diagnosed with an eating disorder are male, yet they continue to be known as "female" disorders. Because of this, young males are often missed by the system and as a result, receive treatment later than they should. They are currently underrepresented in services. ● This paper challenges the association above by supporting a young man who suffered with a type of eating disorder known as Anorexia Nervosa to share his journey from his personal perspective. It provides great insight into what it is like to be a male with an eating disorder, including how it felt to be the only male in an inpatient facility surrounded by females with the same disorder. ● The paper also provides important information for professionals working in the area. For example, eating disorders, including Anorexia Nervosa, should not be associated with one specific gender, and treatment programmes for young people with eating disorders should ensure they are appropriate for both females and males. As a society, we need to challenge the stigma which exists for males in admitting when they are struggling and asking for help, and we need to do everything we can to ensure that young men are picked up earlier in the system, in order to give them the best chance of recovery. ● It is hoped that Ben's story and the recommendations from it can go on to help other males who might be struggling.

Men's experiences of eating disorder treatment: A qualitative systematic review of men-only studies

WHAT IS KNOWN ON THE SUBJECT?: There is a widespread perception that eating disorders are predominantly women´s illnesses. Most studies in the field of eating disorders include predominantly women. Current eating disorder programmes are tailored to meet women´s needs. At the same time, studies show that the rate of eating disorders among men is rising. Men tend to seek help for their eating disorder late in the course of their illness; even when they do seek treatment, they run risk of being undiagnosed by health professionals. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We assessed the current knowledge on how men think and feel about their eating disorders and explored how this may affect their help-seeking behaviours and how they go about managing their eating disorders. Men experience unique symptoms and issues that may translate into unique treatment needs. There is a call to re-evaluate the current status quo for men with eating disorders regarding access to and receiving treatment for their eating disorders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is becoming an increasing priority to effectively treat men with eating disorders. Men need to be recognized as stakeholders in eating disorder-associated health care delivery. Healthcare professionals should receive training about the nature of eating disorders in men. Eating disorder-specific treatments will require adaptations to mirror the needs of individuals rather than particular gender/sex entities. ABSTRACT: Objective Despite the widespread perception that eating disorders (EDs) are predominantly experienced by women and girls, the incidence rate among men has risen substantially in recent years. Men may face unique challenges accessing treatment, which can negatively affect prognosis. The present paper aimed to review men's thoughts and feelings about their ED, and their experiences of ED treatment. Method We conducted a systematic search for qualitative articles focusing on the treatment experiences of men with EDs. Results Nine studies met inclusion criteria. Key themes that emerged across the studies were as follows: (a) recognition of the ED, (b) help-seeking, (c) treatment characteristics and (d) patient characteristics. Given that EDs are widely regarded to exclusively affect women and girls, men were reluctant to recognize their EDs, faced minimization of their symptoms by health professionals and had difficulty finding treatments that were tailored to their unique needs and preferences as men. Conclusions The present findings may serve as reference points to design future ED-specific interventions that are more inclusive of men. Further studies are needed to explore the differential experiences of men across diagnostic categories and treatment types, as well as elucidate the potential role of men-only services.

Prevalence of Eating Disorders and Its Associated Risk Factors in Students of a Medical College Hospital in South India

Background and objectives Eating disorders are some of the most under-researched and difficult to diagnose psychiatric conditions, with a high mortality rate, especially among the adolescent age group. The aim of this study is to determine the prevalence and risk factors for eating disorders among students of a medical college hospital in South India. Materials and methods An observational, cross-sectional study was conducted among 332 students of four constituent colleges of a tertiary-care hospital selected by simple random sampling. Their height and weight were recorded. Four major questionnaires were distributed among the students - Demographic details, Eating Attitudes Test (EAT26), Body Shape Questionnaire (BSQ34), and Perceived Stress Scale (PSS). The results were tabulated and analyzed using SPSS software version 16.0 (IBM Corporation, Somers, New York, USA). Results The proportion of students who had a high risk for eating disorders was 13%. It was prevalent almost equally in both males and females. High risk for eating disorders was associated with high stress and severe body shape concerns (p<0.001). Other influencing factors were history of counselling, peer pressure, excessive exercise as well as the history of any behavioral symptoms like the use of laxatives and diet pills (p<0.001). Conclusions Eating disorder risk is prevalent in a high percentage of medical and paramedical students. High stress and body shape concerns are associated with eating disorders. Only if diagnosed early, with screening programs using questionnaires and further psychiatric evaluation, we can hope to mitigate the complications they incur.

Sociocultural Influences, Drive for Thinness, Drive for Muscularity, and Body Dissatisfaction among Korean Undergraduates

For many years, body dissatisfaction was considered a western phenomenon, and was studied mostly in Caucasian women. Recent studies, however, suggest that these issues are also present in men and in other ethnic groups. This research investigated the differential effects of various sociocultural pressures transmitted from the media, one’s parents, and one’s peers on the drives for thinness and muscularity, and body dissatisfaction among 1125 Korean college students (56% male) using structural equation modeling. The results indicate that, after controlling for body mass index and exercise, media pressures exerted the largest effects on participants’ body ideals and, in turn, body dissatisfaction across both genders (β = 0.44, and 0.30, p < 0.05, for females and males, respectively). This study’s results also indicate that there are considerable gender differences in this relationship. Specifically, the results show that parental and media pressure had significant indirect relationships with body dissatisfaction via the drive for thinness among females, while peer and media pressures had significant indirect relationships with body dissatisfaction via the drive for muscularity among males. As body dissatisfaction is known to significantly affect an individual’s mental and physical health, future research needs to identify relevant influential factors in this area, as well as the paths they have leading to increased body dissatisfaction.

The effect of underweight on female and male reproduction

Chronic energy deficiency can impair the hypothalamic-pituitary-gonadal (HPG) axis and lead to hypothalamic anovulation in underweight women. This review presents the syndromes related to underweight status that are associated with infertility, summarizes the underlying mechanisms, and reviews the available treatment options. Eating disorders, such as anorexia nervosa (AN), constitute the most common cause of infertility in underweight women, who, in addition, experience miscarriages, and sexual dysfunction. The relative energy deficiency in sports (RED-S; former terminology: athlete's triad) involves menstrual dysfunction due to low energy availability, which results in anovulation. Moreover, lipodystrophies, malnutrition, starvation, systematic illnesses (malignancies, endocrinopathies, infectious diseases, advanced chronic diseases, neurologic illnesses), and the utilization of drugs can cause excessive weight loss. They may result in fertility problems due to the loss of adipose tissue and the subsequent hormonal disturbances. Each of these conditions requires multidisciplinary management. Nutritional counseling should target the restoration of energy balance by increasing intake and reducing output. Medical treatment, recommended only for patients who did not respond to standard treatment, may include antipsychotics, antidepressants, or leptin administration. Finally, psychiatric treatment is considered an integral part of the standard treatment.

Rates of Help-Seeking in US Adults With Lifetime DSM-5 Eating Disorders: Prevalence Across Diagnoses and Differences by Sex and Ethnicity/Race

OBJECTIVE

To investigate, in a nationally representative sample of US adults, the prevalence of help-seeking in individuals with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) eating disorders (EDs) and to examine sex and ethnic/racial differences.

PATIENTS AND METHODS

The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N=36,309) included respondents who met the criteria for specific lifetime DSM-5 EDs and answered questions regarding help-seeking for their ED symptoms (anorexia nervosa [AN]: n=275; bulimia nervosa [BN]: n=91; and binge-eating disorder [BED]: n=256).

RESULTS

The prevalence (standard error) estimates of ever seeking any help for AN, BN, and BED were 34.5% (2.80%), 62.6% (5.36%), and 49.0% (3.74%), respectively. Adjusting for sociodemographic characteristics, men and ethnic/racial minorities (non-Hispanic blacks and Hispanics) were statistically significantly less likely to ever seek help for BED than were women or non-Hispanic whites, respectively. Hispanics also were significantly less likely to seek help for AN relative to non-Hispanic whites.

CONCLUSION

This was the first study in a nationally representative sample of US adults to examine rates of help-seeking, including by sex and ethnic/racial differences, across DSM-5-defined EDs. These findings emphasize the need to develop strategies to encourage help-seeking among individuals with EDs, particularly among men and ethnic/racial minorities.

Disappearing in a Female World: Men's Experiences of Having an Eating Disorder (ED) and How It Impacts Their Lives

The number of men diagnosed with anorexia has increased, men now representing 25% of those with eating disorders (EDs). Research has mainly been quantitative and female focused, with only two qualitative studies exploring the experiences of men. This study focused on the lived experiences of men diagnosed with an ED, and its impact on 'everyday' aspects of their lives. Qualitative research adopting narrative interviews was conducted with seven men aged 23-34 years old. Narrative analysis was used to interpret each individual story, with thematic analysis used to explore commonalities across all seven narratives. Four themes were identified, 1) The Final John Doe; 2) Help! I need somebody - Bedlam revisited; 3) Masculinity; 4) Not Working 9 to 5. Narratives highlight the need for further research if men are to receive appropriate mental health care and better understanding and acceptance on the part of society, service providers, employers and men themselves.

Psychiatric comorbidity as a risk factor for the mortality of people with bulimia nervosa

BACKGROUND

Bulimia nervosa (BN) is associated with increased mortality. Frequent comorbidities of BN include substance use disorders, affective disorders and personality disorders (PD). These comorbidities may add an additional risk for mortality.

METHODS

We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders over an observation period from January 2007 to March 2016 for 1501 people with BN using anonymised health records data from the South London and Maudsley NHS Foundation Trust (SLaM), retrieved through its Clinical Records Interactive Search (CRIS) data resource. Mortality was ascertained through monthly linkages to the nationwide tracing system administered by the Office for National Statistics (ONS). We used Cox proportional hazards regression to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analyses were also performed to estimate effects when controlling for confounding of age, sex, ethnicity, borough, marital status and deprivation score.

RESULTS

A total of 18 patients with BN died during the observation period. The standardised mortality ratio (SMR) for our study cohort (against the population of England and Wales in 2012 as a standard) was 2.52 (95% CI 1.49-3.97). Cox regressions revealed significant associations of mortality with older age and male gender. Comorbid PD (HR: 3.36; 95% CI 1.05-10.73) was significantly associated with all-cause mortality, even after controlling for demographic and socioeconomic covariates.

CONCLUSIONS

These results highlight increased mortality in patients with BN and the importance of recognising and treating PDs in patients with BN.

Ethnicity, eating pathology, drive for muscularity, and muscle dysmorphia in college men: a descriptive study

The nature and presentation of eating pathology in ethnically diverse men are not well defined. This study examined associations among ethnicity, body image, and eating pathology in nonclinical college men (N = 343). Analysis of variance analyses indicated that markers of eating, weight, and shape concerns differed by ethnicity: Asian and Hispanic/Latino men reported more pathological levels than European and African American men. Hierarchical multiple regression analyses indicated that ethnicity moderated the relationship between drive for muscularity and body checking, which was strongest for Asian men. Results increase awareness of how ethnicity interacts with body image and eating pathology, which underscores the need for individualized, culturally sensitive treatment for ethnically diverse men.

Long- but not short-term tool-use changes hand representation

Tool-use has been found to change body representation. For example, participants who briefly used a mechanical grabber to pick up objects perceived their forearms to be longer immediately after its use (e.g., Cardinali et al., Curr Biol 19(12):R478-R479, 2009; they incorporated the tool into their perceived arm size). While some studies have investigated the long-term effects of tool-use on body representation, none of these studies have used a tool that encapsulates the entire body part (e.g., a glove). Moreover, the relationship between tool-use and the body model (the representation of the body's spatial characteristics) has yet to be explored. To test this, we recruited 19 elite baseball players (EBP) and 18 age-matched controls to participate in a hand representation task. We included EBP because of their many years (8+) of training with a tool (baseball glove). The task required participants to place their hands underneath a covered glass tabletop (no vision of their hands), and to point to where they believed 10 locations (the tips and bases of each finger) were on their hands (Coelho et al., Psychol Res 81(6):1224-1231, 2017). Each point's XY coordinates was tracked using an Optotrak camera. From these coordinates, we mapped out the participants perceived hand size. The results showed that when compared to the controls, EBP underestimated hand width and finger length of both hands. This indicates that long-term tool use produces changes in the body model for both, the trained and untrained hands. We conducted a follow-up study to examine if 15 min of glove use would change perceived hand size in control participants. Novice baseball players (participants without baseball experience: NBP) were recruited and hand maps were derived before and after 15 min of active catching with a glove. Results showed no significant differences between the pre and post hand maps. When we compared between the two experiments, the EBP showed smaller hand representation for both hand width and finger length, than the NBP. We discuss these results in relation to theories of altered body ownership.

Chubby hands or little fingers: sex differences in hand representation

Disturbed body representation is a condition defined by the perception that one's body size is different from their anatomical size. While equal amounts of males and females suffer from disturbed body representation, there appear to be differences in the direction of this distortion. Females will typically overestimate, whereas males will typically underestimate body size. One part of the body that has been consistently misperceived is the hands. This misrepresentation consists of two distinct characteristics: an overestimation of hand width, and an underestimation of finger length. Many of these studies, however, have used predominately female participants, allowing for the possibility that women are driving this distortion. The aim of the present study was to examine possible sex differences in hand perception. To this end, participants estimated the location of ten landmarks on their hands when their hands were hidden from view. Our results indicate that females follow the characteristic distortion, whereas males only underestimate finger length (albeit more than females). These findings are surprising, because the hands are not an area of concern for weight gain/loss. We discuss these findings in relation to body dysmorphia literature.

Empirically derived classes of eating pathology in male and female college students

BACKGROUND

The empirical structure of eating disorder (ED) pathology has often been studied in female, clinical samples, leaving questions about the structure of ED pathology in males and nonclinical samples.

METHOD

A latent class analysis was performed on data combined from two different studies (N = 1,751) using the behavioral items in the Eating Disorder Examination Questionnaire (EDE-Q; binge eating, self-induced vomiting, laxative use, and excessive exercise), with the addition of an item representing restraint. Validation analyses examined weight, shape, and eating concern among the classes.

RESULTS

Three similar classes emerged for both the men and women's models: very low ED behaviors, binge eating, and high ED behaviors.

DISCUSSION

These results suggest that binge eating occurs within the context of lower symptom and higher symptom presentations, and that the empirical structure of ED symptoms does not differ in men and women in the nonclinical population. Further research is needed to clarify whether ED phenotypes differ in men and women.

Sex-specific issues in eating disorders: a clinical and psychopathological investigation

OBJECTIVE

To highlight the characteristics of eating disorders (ED) in males, with particular attention to sex-related clinical features and psychiatric co-morbidities.

METHOD

Out of 280 persons, referred to our outpatients ED clinic between January 2011 and June 2014, 267 with complete information were included in this retrospective observational study.

RESULTS

The men/women ratio was one to five (male 16.5% vs female 83.5%) with an increasing proportion of male patients over the years. The most frequent ED in males was binge eating disorder, whereas in females anorexia nervosa and bulimia nervosa prevailed. Excessive exercising and fasting were the most common compensation behaviours in males; while self-induced vomiting and laxative-diuretic abuse were more typical in females. Among women, the most represented psychiatric co-morbidities were mood and somatoform disorders, whereas among men, anxiety and psychosis spectrum disorders were the most frequent ones. Borderline and histrionic personality disorders were prevalent in female ED, while narcissistic and antisocial personality disorders prevailed in males.

DISCUSSION

ED in men is a growing phenomenon. Male ED, compared to female ED, show differences in clinical presentation, symptoms and co-morbidities. Despite the use of clinical and psychometric evaluating tools targeting female patients, sex differences do exist and additional studies are required to investigate male specific issues in ED. Level of Evidence Level V, cross-sectional descriptive study.

Military-related trauma is associated with eating disorder symptoms in male veterans

OBJECTIVE

Eating disorders are understudied among male veterans, who may be at increased risk due to the high rates of trauma exposure and experiences of multiple traumatization in this population. This study sought to examine the associations between specific types of trauma (i.e., childhood physical abuse, adult physical assault, childhood sexual abuse, adult sexual assault, and military-related trauma) and eating disorder symptoms in a large, nationally-representative sample of trauma-exposed male veterans.

METHOD

Survey data were collected from N = 642 male veterans. Traumatic experiences in childhood and adulthood were assessed using the Trauma History Screen and the National Stressful Events Survey. Eating disorder symptoms were assessed with the Eating Disorder Diagnostic Scale. Analyses also controlled for age and body mass index.

RESULTS

Multiple traumatization was associated with increased eating disorder symptoms. However, military-related trauma was the only trauma type that was uniquely associated with eating disorder symptoms when controlling for other trauma types. Examination of different types of military-related trauma indicated that this association was not driven by exposure to combat.

DISCUSSION

Noncombat, military-related trauma was associated with eating disorder symptom severity in male veterans. Results highlight the need for better assessment of eating disorder symptoms in this population.

Self-Objectification and Personal Values. An Exploratory Study

Self-objectification occurs when individuals treat themselves as objects to be viewed and evaluated based upon appearance. Literature has largely elucidated links between self-objectification and damaging outcomes in both men and women. The purpose of the present study was to extend past research on the antecedents of self-objectification. We were interested in the role played by specific ideological components, i.e., higher order personal values (self-enhancement, conservation, self-transcendence, and openness to change), in influencing the degree to which individuals internalize the objectifying perspective of the Western cultural milieu, i.e., self-objectify. Undergraduate participants (N = 371, 76.8% women) completed measures of self-objectification (i.e., body surveillance and body shame), and endorsement of higher order values. Regression analyses demonstrated that self-enhancement is linked to higher self-objectification in both men and women, whereas conservation is related only to women’s body surveillance. Self-transcendence seemed to act as a buffer against men’s body surveillance, whereas openness to change resulted as a buffer against women’s body surveillance. Implications are discusses.

Neural response to catecholamine depletion in remitted bulimia nervosa: Relation to depression and relapse

Bulimia nervosa has been associated with a dysregulated catecholamine system. Nevertheless, the influence of this dysregulation on bulimic symptoms, on neural activity, and on the course of the illness is not clear yet. An instructive paradigm for directly investigating the relationship between catecholaminergic functioning and bulimia nervosa has involved the behavioral and neural responses to experimental catecholamine depletion. The purpose of this study was to examine the neural substrate of catecholaminergic dysfunction in bulimia nervosa and its relationship to relapse. In a randomized, double-blind and crossover study design, catecholamine depletion was achieved by using the oral administration of alpha-methyl-paratyrosine (AMPT) over 24 h in 18 remitted bulimic (rBN) and 22 healthy (HC) female participants. Cerebral blood flow (CBF) was measured using a pseudo continuous arterial spin labeling (pCASL) sequence. In a follow-up telephone interview, bulimic relapse was assessed. Following AMPT, rBN participants revealed an increased vigor reduction and CBF decreases in the pallidum and posterior midcingulate cortex (pMCC) relative to HC participants showing no CBF changes in these regions. These results indicated that the pallidum and the pMCC are the functional neural correlates of the dysregulated catecholamine system in bulimia nervosa. Bulimic relapse was associated with increased depressive symptoms and CBF reduction in the hippocampus/parahippocampal gyrus following catecholamine depletion. AMPT-induced increased CBF in this region predicted staying in remission. These findings demonstrated the importance of depressive symptoms and the stress system in the course of bulimia nervosa.

Insights into the Experiences of Treatment for An Eating Disorder in Men: A Qualitative Study of Autobiographies

Eating disorders are increasingly recognized as a problem for men but help-seeking is low and little is known about their treatment experiences. This paper sought to determine the treatment experiences of men who have suffered from an eating disorder using autobiographical data. Inclusion criteria were autobiographies of men who had experienced an eating disorder and sought any form of treatment for this, written in the English language, published between 1995 and 2015, and available for purchase in 2016. The search resulted in six books that were thematically analyzed. Analysis of data resulted in two broad themes (1. Positive experiences; 2. Negative experiences) with sub-themes. With regards to the first theme, factors such as concern of staff members, therapist’s expertise (in treating eating disorders in men), and a collaborative treatment approach were considered favorable for treatment. In contrast to the first theme, apathy of staff members, the authors’ own negative preconceptions, treatment providers being perceived as prioritizing financial concerns, perceived as incompetent and judgmental behavior of therapist(s), and time limitations of sessions were considered unfavorable treatment experiences. In this study, the perceived success of treatment depended on therapist’s features and the form of treatment provided. Further research examining these is indicated.

Short-Term Treatment Outcomes and Dropout Risk in Men and Women with Eating Disorders

This study compared treatment outcomes between men and women with eating disorders (EDs) and analysed clinical predictors of treatment outcome. Our sample consisted of 131 male and 131 female ED patients who underwent cognitive behavioural therapy treatment. ED severity, personality and psychopathology were assessed using standard instruments. We found that the risk of dropout was higher for men with bulimia nervosa (BN) than for women with BN and that men with BN and other specified feeding and EDs were more likely to obtain full remission in comparison with their female counterparts. Predictive models of treatment outcome indicated that higher scores in novelty seeking were a shared factor associated with higher risk of dropout and not obtaining full remission for both men and women with ED. However, only in men, younger age and lower scores in reward dependence predicted higher dropout. Contrastingly, higher persistence scores were predictors of full remission. This study reinforces the effectiveness of using outpatient cognitive behavioural therapy as treatment as usual for men with ED. Nonetheless, placing greater emphasis on strategies targeting gender-specific issues could enhance outcomes. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

The role of personality in body image dissatisfaction and disordered eating: discrepancies between men and women

BACKGROUND

Body image and disordered eating research has focused mostly on the female experience. The present study examined gender differences in the relationship between personality, disordered eating, and body image dissatisfaction.

METHODS

Participants were 238 female and 85 male undergraduates (M_age = 20.52 years, SD = 4.22) at a Canadian university. Materials included a battery of self-report questionnaires pertaining to personality, body image, and disordered eating.

RESULTS

As expected, females reported more body dissatisfaction and disordered eating than males. Personality factors were found to be significantly related to the experience of body dissatisfaction in both genders. Further, several personality traits significantly contributed to the prediction of male (high Neuroticism, low Conscientiousness) and female (high Neuroticism) body dissatisfaction beyond the influence of body mass index (BMI). Interestingly, and contrary to findings with female participants, personality traits were not significantly related to disordered eating scores in men. Among women, disordered eating scores were significantly predicted by high Neuroticism and Extraversion, and low Conscientiousness.

CONCLUSIONS

Although the relationship between disordered eating, body image dissatisfaction, and personality is well-documented in females, this relation may differ for males. The focus on male body image has been increasing in Western society; exploring how males view their bodies may be beneficial to researchers and clinicians alike.

Eating Disorders in Adolescent and Young Adult Males: Presenting Characteristics

PURPOSE

Data on the clinical characteristics of adolescent males with eating disorders are limited. The purpose of this study was to describe the demographic characteristics, presenting vital signs, laboratory results, and relevant risk factors for eating disorders among males presenting to an outpatient adolescent and young adult medicine practice.

METHODS

Retrospective chart review of male eating disorder patients aged of 11-25 years presenting to the University of California, San Francisco Adolescent and Young Adult Eating Disorder Program between June 1, 2011, and November 1, 2014. Charts were reviewed for demographic and clinical characteristics and risk factors for eating disorders.

RESULTS

Thirty-three patients were included; mean age was 16 years. Patients presented with mean heart rate was 58.7 bpm, and orthostatic heart rate change was 22 bpm, with 51.5% meeting Society for Adolescent Health and Medicine hospital admission criteria. Mean percent of median body mass index was 88%. Of patients with available laboratory data, 33.3% were anemic, 23.8% leukopenic, 19.0% thrombocytopenic, and 10.0% neutropenic. Half had a history of a psychiatric disorder; 41.5% had a history of overweight or obesity, and 12.1% had a family history of an eating disorder. The DSM-IV-TR and DSM-5 diagnostic criteria were retrospectively applied to patients, with an increase in diagnosis of anorexia nervosa from 36.4% to 48.5%. Diagnoses of Eating Disorder Not Otherwise Specified, now Other Specified Feeding or Eating Disorder in DSM-5, decreased from 62.6% to 45.5%.

CONCLUSIONS

Male patients with eating disorders presented with significant abnormalities; patients were bradycardic and orthostatic; and more than half met Society for Adolescent Health and Medicine admission criteria. Patients with available laboratory data demonstrated significant abnormalities consistent with malnutrition. Given that eating disorders are less likely to be detected in males, it is important to recognize early signs of malnutrition, particularly in those who present within the normal body mass index range for age.

Disordered eating behavior, health and motives to exercise in young men: cross-sectional population-based MOPO study

BACKGROUND

Being overweight is an increasing problem among young people, among whom disordered eating behavior is linked with weight problems as well as unhealthy weight control. The aim of the present study was to investigate whether health factors and motives to exercise differ in young men by the type of disordered eating behavior.

METHODS

The population-based, cross-sectional MOPO study consisted of 2,096 young Finnish men (mean age 17.9, SD 0.7) attending compulsory call-ups for military service in the Oulu area in 2010, 2011, and 2013. They responded to a questionnaire that included two subscales of the Eating Disorder Inventory-3 indicating drive for thinness and bulimic behavior and questions on health, physical activity, and motives to exercise. The association between disordered eating behavior and related factors was analyzed by binary logistic regression.

RESULTS

Altogether, 6.9 % (n = 145) of the men had symptoms of disordered eating, i.e., 5.4 % had a drive for thinness (n = 114) and 3.7 % had bulimic behavior (n = 77). Drive for thinness was associated with a perception of being overweight (OR 3.7; 95 % CI 2.2-6.1), poor self-rated health (2.3; 1.2-4.4), more leisure sitting time (1.1; 1.0-1.2), and body-related exercise motives (body acceptance: 3.0; 1.7-5.2; weight loss: 2.5; 1.4-4.4). Bulimic behavior was positively associated with poor self-rated health (2.6; 1.1-5.8) and several motives to exercise, i.e., due to another person's suggestion (2.8; 1.6-4.8), competitive sports (2.1; 1.2-3.7), body acceptance (2.1; 1.1-3.9), and weight loss (1.9; 1.1-3.3), but inversely associated with health/fitness-related exercise motives (health promotion: 0.3; 0.1-0.5; muscular strength or physical performance: 0.5; 0.2-0.9).

CONCLUSIONS

In young men, disordered eating behavior was associated with being overweight, having poor self-rated health, and having a greater amount of leisure sitting time as well as non-health-related motives to exercise. In order to recognize those at risk for disordered eating behavior, evaluating these factors could be beneficial.

Systematic review of the diagnostic category muscle dysmorphia

OBJECTIVES

(1) To collect, analyze and synthetize the evidence on muscle dysmorphia diagnosis as defined by Pope et al. and (2) To discuss its appropriate nosology and inclusion as a specific category in psychiatric classificatory systems.

METHOD

A systematic search in the MEDLINE, the PsycNET, the LILACS and SciELO databases and in the International Journal of Eating Disorders was conducted looking for articles published between January 1997 and October 2014 and in EMBASE database between January 1997 and August 2013. Only epidemiological and analytical studies were considered for selection. The methodological quality of included studies was assessed according to the Evidence-Based Mental Health and the National Health and Medical Research Council's guidelines. The support for inclusion of muscle dysmorphia in psychiatric classificatory systems was examined against Blashfield et al.'s criteria.

RESULTS

Thirty-four articles were considered eligible out of 5136. Most of the studies were cross-sectional and enrolled small, non-clinical samples. The methodological quality of all selected papers was graded at the lowest hierarchical level due to studies' designs. Forty-one percent of the publications considered the available evidence insufficient to support the inclusion of muscle dysmorphia in any existing category of psychiatric disorders. The current literature does not fulfill Blashfield et al.'s criteria for the inclusion of muscle dysmorphia as a specific entity in psychiatric diagnostic manuals.

CONCLUSION

The current evidence does not ensure the validity, clinical utility, nosological classification and inclusion of muscle dysmorphia as a new disorder in classificatory systems of mental disorders.

Eating disorders in a multi-ethnic inner-city UK sample: prevalence, comorbidity and service use

PURPOSE

No studies have investigated the prevalence of eating disorders (ED) according to DSM-5 criteria and few have explored their comorbidity and service use in the general population in the UK. We aimed to estimate the prevalence, comorbidity, and service use in individuals with ED in a multi-ethnic inner city sample.

METHODS

A total of 1698 individuals (age 16/90) were screened for ED in the first phase of the South East London Community Health Study and 145 were followed up with a diagnostic interview. Data was weighed for survey design and Chi Square tests were used to investigate socio-demographic distribution, comorbidity and service use in participants with ED.

RESULTS

The point prevalence of ED was 4.4 % (Binge Eating Disorder (BED) 3.6 %; Bulimia Nervosa (BN) 0.8 %) and 7.4 % when including sub-threshold diagnoses (Purging Disorder (PD) 0.6 %; Other Specified Feeding and Eating Disorders (OSFED) 2.4 %). No cases of AN were identified. Purging Disorder was the ED with the highest proportion of comorbid disorders. A minority of participants with ED had accessed specialist care services.

CONCLUSIONS

ED are common, the comorbidity of ED was in line with previous studies and no ethnic differences were identified. Although PD is not a full diagnosis in DSM-5, we found some evidence of high comorbidity with other disorders, that needs to be replicated using larger samples. Service use was low across ED diagnoses, despite high levels of comorbidity.

Developing an Acceptance-Based Behavioral Treatment for Binge Eating Disorder: Rationale and Challenges

Binge eating disorder (BED), characterized by recurrent eating episodes in which individuals eat an objectively large amount of food within a short time period accompanied by a sense of loss of control, is the most common eating disorder. While existing treatments, such as cognitive behavioral therapy (CBT), produce remission in a large percentage of individuals with BED, room for improvement in outcomes remains. Two reasons some patients may continue to experience binge eating after a course of treatment are: (a) Difficulty complying with the prescribed behavioral components of CBT due to the discomfort of implementing such strategies; and (b) a lack of focus in current treatments on strategies for coping with high levels of negative affect that often drive binge eating. To optimize treatment outcomes, it is therefore crucial to provide patients with strategies to overcome these issues. A small but growing body of research suggests that acceptance-based treatment approaches may be effective for the treatment of binge eating. The goal of the current paper is to describe the development of an acceptance-based group treatment for BED, discuss the structure of the manual and the rationale and challenges associated with integrating acceptance-based strategies into a CBT protocol, and to discuss clinical strategies for successfully implementing the intervention.

It's Not Me, It's You: Perceptions of Partner Body Image Preferences Associated With Eating Disorder Symptoms in Gay and Heterosexual Men

This study explored perceptions of partner body image preferences and symptoms of disordered eating in gay and heterosexual men. Participants were male college students (n = 201; M age = 20.46), and over one third identified as gay. We compared discrepancies between participants' current and ideal body type and participants' current body type and the body type they believed they should have to attract a dating partner. For gay men, the discrepancy between their current body and the body they believed they should have to attract a dating partner was significantly greater than the discrepancy between their current and ideal body types. In gay and heterosexual men, the discrepancy between current body and the body they believed they should have to attract a dating partner predicted eating, shape, and weight concern. Results suggest that perceptions of partner body image preferences may contribute to eating disorder pathology in men.

Self-objectification, body image disturbance, and eating disorder symptoms in young Australian children

Self-objectification has been examined extensively in adult populations. Despite theoretical evidence suggesting that children may also be vulnerable to experiencing self-objectification, whether children do self-objectify has not been determined. Accordingly, the present study examined the degree to which children self-objectify. The prevalence of body image and eating disturbances in this population, and the relationship between self-objectification and these disturbances, were also investigated. Results from over 250 boys and girls aged 6-11 years revealed that young girls report levels of self-objectification that are similar to those observed among older girls and women. Self-objectification was also found to be meaningfully related to body image and eating disturbances in children. A significant proportion of children reported body dissatisfaction and a minority engaged in disordered eating behaviours in the four weeks prior to the assessment. These results suggest that children may be at risk of experiencing the negative psychological outcomes associated with self-objectification.

Mindfulness-based interventions for obesity-related eating behaviours: a literature review

Mindfulness-based interventions (MBIs) targeting eating behaviours have gained popularity in recent years. A literature review was conducted to determine the effectiveness of MBIs for treating obesity-related eating behaviours, such as binge eating, emotional eating and external eating. A search protocol was conducted using the online databases Google Scholar, PubMed, PsycINFO and Ovid Healthstar. Papers were required to meet the following criteria to be included in this review: (i) describe a MBI or the use of mindfulness exercises as part of an intervention; (ii) include at least one obesity-related eating behaviour as an outcome; (iii) include quantitative outcomes; and (iv) be published in English in a peer-reviewed journal. A total of N = 21 papers were included in this review. Interventions used a variety of approaches to implement mindfulness training, including combined mindfulness and cognitive behavioural therapies, mindfulness-based stress reduction, acceptance-based therapies, mindful eating programmes, and combinations of mindfulness exercises. Targeted eating behaviour outcomes included binge eating, emotional eating, external eating and dietary intake. Eighteen (86%) of the reviewed studies reported improvements in the targeted eating behaviours. Overall, the results of this first review on the topic support the efficacy of MBIs for changing obesity-related eating behaviours, specifically binge eating, emotional eating and external eating.

Disordered eating behaviors and body image in male athletes

OBJECTIVE

To identify disordered eating behaviors and body image dissatisfaction, as well as their relationship to body fat (BF), among male athletes in high risk sports for eating disorders.

METHODS

One hundred and fifty-six male athletes were divided into the following categories: weight-class sports, sports where leanness improves performance, and sports with aesthetic ideals. BF was assessed and three questionnaires were used: the Eating Attitudes Test; the Bulimic Investigatory Test, Edinburgh; the Body Shape Questionnaire.

RESULTS

Disordered eating behaviors and body image dissatisfaction were found in 43 (27.6%) and 23 athletes (14.7%), respectively, and an association was detected between the two variables (p < 0.001). Athletes with and without disordered eating behaviors did not differ in %BF (11.0 ± 5.2% and 9.8 ± 4.0%, respectively; p = 0.106). However, athletes with body image dissatisfaction had higher %BF than those who were satisfied (12.6 ± 5.9% and 9.7 ± 3.9%, respectively; p = 0.034). There were no differences in BF, frequency of disordered eating behaviors, and body image dissatisfaction between sports categories.

CONCLUSION

Nearly one-quarter of athletes showed disordered eating behaviors, which was associated with body image dissatisfaction. Athletes with higher %BF were more likely to be dissatisfied with body image. There was no difference in eating behavior and body image between athletes from different sports categories.

Body Dissatisfaction and Eating Disorder Symptomatology: A Latent Structural Equation Modeling Analysis of Moderating Variables in 18-to-28-Year-Old Males

Although body dissatisfaction is recognized as the strongest risk factor for eating disturbances, a majority of young males are body dissatisfied, but do not concomitantly report severe levels of eating disorder symptomatology. The present investigation was designed to examine five theoretically relevant variables (i.e., body checking, emotional dysregulation, perfectionism, insecure-anxious attachment, and self-esteem) as potential moderators of the relationship between body dissatisfaction and two critical components of male eating disorder symptomatology: drive for muscularity and bulimic behaviors. Data collected from 551 Italian males between 18 and 28 years old were analyzed using latent structural equation modeling. The authors found that emotional dysregulation, body checking, insecure-anxious attachment and perfectionism intensified the relationship between body dissatisfaction and each criterion variable representing male eating disorder symptomatology; the interactions accounted respectively for an additional 2%, 7%, 4% and 5% of variance in drive for muscularity and for an additional 6%, 4%, 5%, and 2% of the variance in bulimic behaviors. By contrast self-esteem weakened this relationship and the interactions accounted for an additional 3% of the variance in both drive for muscularity and bulimic behaviors. Implications of these findings for prevention and treatment of male eating disturbances are discussed.

Severe anorexia nervosa in males: clinical presentations and medical treatment

The clinical presentation and medical complications of severe anorexia nervosa among males were examined to further the understanding of this increasingly prevalent condition. Fourteen males were admitted to a medical stabilization unit over the study period. Males with severe anorexia nervosa were found to have a multitude of significant medical and laboratory abnormalities, which are in need of treatment via judicious, nutritional rehabilitation and weight restoration to prevent additional morbidity and to facilitate transfer and admission to traditional eating disorder programs.