Eating Disorders: Techniques for Treating Binging & Purging

At-Risk Groups
There are several sub-populations of adolescent males that present with heightened risk factors. Adolescent males more at risk for developing eating disorders include those involved in athletic activities, struggling with sexual identity conflict, diagnosed with co-morbid mental disorders, or with a family history of eating disorders and a chaotic home environment. Knowledge regarding the heightened risk factors for this population proves important, especially since early identification of eating disorders improves treatment outcomes (Reijonen et al., 2003).

Athletes
Eating disorders occur to a greater degree in athletes than in the general population (Murphy & Gutekunst, 1997; Patel, Greydanus, Pratt, & Phillips, 2003). Adolescent athletes in sports with weight classifications and those engaging in activities where lean body types are preferred are at the highest risk for developing eating disorders (Patel, Greydanus, et al.). Assessing the percentage of male athletes suffering from either anorexia or bulimia proves even more difficult than in the general population due to a myriad of factors that include: methodological limitations from the current literature, assessments that rely on self-report, and lack of uniform criteria across studies (Murphy & Gutekunst; Patel, Greydanus, et al.).

Nelson and Hughes (1999) examined the risk factors of developing an eating disorder and also asserted that male athletes display increased susceptibility. This proves especially true in sports where body size and proportion remain under intense scrutiny. Nelson and Hughes discussed the elevated incidents of anorexia and bulimia in their male sample population and also suggested the likelihood of higher prevalence rates than previously suspected. They reported that there is minimal research literature addressing eating disorders in males and discussed the need for future research endeavors in this area.

Patel, Greydanus, et al. (2003) investigated prevalence rates for adolescent athletes and concurred with previous studies that posited the underestimation of incidents in the male athletic population. Patel, Greydanus, et al. specifically emphasized young men in sports that focus on body weight and body image--wrestling, swimming, track, rowing, and gymnastics. The pressure that these athletes put on themselves leads them to engage in maladaptive eating behaviors that prove dangerous to their physical health such as: excessive exercise, caloric and fluid restriction, laxative and diuretic use, self-induced vomiting, and starvation (Patel, Greydanus, et al.).

Diving, bodybuilding, gymnastics, and running represent additional sports that hold increased risk for the development of eating disorders. In these sports, the impact of body image is emphasized, the athletes are judged to some degree by physical appearance, and to be competitive they often demand extremely low percentages of body fat (Murphy & Gutekunst, 1997; Oliosi, Dalle Grave, & Burlini, 1999; Patel, Greydanus, et al., 2003). The belief of some athletes is that competing in a lower weight division or reducing their body fat index will increase their chances of winning. Both coaches and athletes tend to adopt this belief system to succeed. Ironically, the deleterious side effects of anorexia or bulimia often hinder their performance due to the health risks of disordered eating patterns that physically weaken the athletes and lead to decreased performance (Murphy & Gutekunst). Clearly, the demands placed on athletes to achieve and maintain a certain body weight put them at heightened risk for the development of eating disorders.

Sexual Identity
The relationship between sexual identity and eating disorders remains unclear; however, several studies posit that male homosexuals are at increased risk for developing eating disorders (Buroughs & Thompson, 2001; Walcott et al., 2003). Sexual isolation, sexual inactivity, and disturbed sexual identification have also been linked to the clinical population of eating disordered males. Buroughs and Thompson examined the sexual orientation of anorexic and bulimic males and found that the prevalence of homosexuality in the sample population was significantly higher than that of the general male population. The authors suggested that one possible explanation for their findings was the subversion of sexual conflict resulting from the side effect of decreased libido. Additionally, homosexual males may be more at risk for the development of eating disorders due to a heightened emphasis on physical attractiveness (Walcott et al.).

Manley, Rickson, and Standeven (2000) reported that boys present with anorexia at a significantly higher percentage than adult males, although they point out that the reasons for the growing prevalence in boys remains unclear. They comment on this possibly resulting from burgeoning sexual conflict emerging in the adolescent period. The lack of knowledge regarding the sexual characteristics of boys and men with eating disorders underscores the need for further research (Scheider, 1991; Walcott et al., 2003). Knowledge of the existing research in this area can benefit school counselors by providing them with an awareness of the additional risk that homosexual youth may face for the development of an eating disorder. This knowledge assists the school counselor with identification and represents the first step in the treatment process.

Mental Disorders
Co-morbid mental disorders that may provide warning signs for adolescent males at risk for the development of an eating disorder include: Mood Disorders, Substance Abuse and Dependence, and Personality Disorders (American Psychiatric Association, 2000). Specifically, a plethora of research studies displayed a predisposition to eating disorders among those diagnosed with depression (e.g., Fischer et al., 1995; Lyon & Chatoor, 1997; Moreno & Thelen, 1995; Nassar & Hodges, 1992; Pratt, Phillips, Greydanus, Pratt, & Patel, 2003; Pryor & Weiderman, 1998).

Features of Obsessive Compulsive Disorder are frequently seen in individuals suffering from anorexia and bulimia. The obsessive-compulsive behaviors focus on food, body image, and weight. Also, impulse control issues remain prevalent in males with bulimia; this links with Substance Abuse and Cluster B Personality Disorders such as Borderline, Histrionic, and Narcissistic as individuals with these diagnoses also display poor impulse control (American Psychiatric Association, 2000).

As with Personality Disorders and Mood Disorders, low self-esteem is often reported in eating disordered clients. This has been demonstrated in both subjective and objective accounts (American Psychiatric Association, 2000; Nassar & Hodges, 1992). School counselors aware of the link between eating disorders and the diagnoses enumerated in this section will have relevant information to assist them with accurate identification of students at risk.

Family Issues
Male adolescents who have a history of eating disorders in their family are at greater risk for the development of anorexia and bulimia (American Psychiatric Association, 2000; Felker & Stivers, 1994; Manley et al., 2000; Pratt, Pratt et al., 2003). Additionally, family environments that are tumultuous have been linked to decreased treatment effectiveness for eating disorders (Felker & Stivers; Manley et al.). Any recent intrafamilial loss such as death or divorce has also been identified as a risk factor. Finally, adolescent males in households where appearance and body image are emphasized remain at heightened risk for developing an eating disorder (Manley et al.).
- Ray, Shannon; Eating disorders in adolescent males; Professional School Counseling; Oct 2004; Vol. 8; Issue 1.
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #10
The preceding section contained information about eating disorders in adolescent males.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 24
Why does assessing the percentage of male athletes suffering from either anorexia or bulimia prove even more difficult than in the general population? Record the letter of the correct answer the CEU Answer Booklet.