He’d wake before the sun at 4:30 each morning, kick-starting his day with a two-hour work-out—mostly cardio. He’d eat an apple or a piece of dry bread for breakfast. He’d skip lunch most days, or eat another apple. And he’d eat just a small dinner, if anything at all. If he’d eaten much more than his usual calorie count, he’d find the nearest bathroom to throw it all up. He didn’t care if his anorexia killed him.

“I loved being at such a low weight because I was numb and I had control over the weight and shape of my body,” says Colin (not his real name), an alum of the Eating Recovery Center (ERC) which provides comprehensive eating disorder treatment at 25 locations in seven states. “I was a machine and untouchable. I could not be harmed.”

It took nine years for Colin to finally admit his behaviors to his doctor and a couple of female friends, and receive a formal diagnosis. He’d grown up in a troubled home, underweight for most of his preteen years and adolescence. Disordered eating, he says, had ironically become his survival mechanism.

“I was always underweight and my doctor was constantly urging my parents to help me gain weight,” he recalls. “I never did gain weight though, and my eating was often sporadic.”

Things changed, if only for a short time, when Colin left for college and gained the notorious “Freshman 15.” He promptly dropped it all, and kept going until he became severely underweight—again. He was doing cardio two hours every day, weight-training three times a week and counting calories.

Colin’s anorexia settled down during the honeymoon period of his marriage. His weight fluctuated, nevertheless, but he was eating better on balance. However, as the cycle goes, when normalcy resumed, so did his eating disorder.

“I weighed myself constantly,” he remembers. “It occurred to me that I might have an eating disorder, but I dismissed it because I’m a man.” 

Colin is one of the 10 million men in the US who will have an eating disorder in their lifetimes, many of whom dismiss their behaviors because men just don’t get eating disorders. But they do, and many start out as young as 14 years old. In fact, an estimated 10 to 25 percent of people struggling with disordered eating are men. Some might even be people you know.

And, contrary to popular belief, it’s more than a mere vanity disease. The most common eating disorder among men: Binge Eating Disorder. It affects about two percent of men—not far off from the 3.5 percent of women it affects.

“Men with eating disorders frequently hate their bodies and use the eating disorder in a way to control how they look and feel… They can often feel hopeless and look to suicide as the only way to end their suffering,” —Michael Lutter, MD, Ph.D

“I have been dealing with Binge Eating Disorder since early childhood and will continue to do so for the rest of my life, as there is no cure, only methods of maintenance,” says Andy, another ERC alum who has struggled with weight and eating habits for decades. “I look at it like a spider web of sorts… Each strand in the web that is my eating disorder is a different experience, perception or judgment that, when arranged, became my nightmare… The more I struggled, the more stuck I became.”

For Andy, like Colin, food was a numbing agent—the difference was that, rather than depriving himself of it, he found himself reliant on the dopamine that surged with caloric consumption.

“I was miserable,” Andy says. “I didn’t realize it until I had a significant breakthrough in treatment, but I talked to myself in an absolutely horrific way internally… So I pursued the numbing comfort of a binge to clear my mind of everything and allow the dopamine that consequently flooded my brain to do its thing.”

But when the dopamine subsided, Andy felt shame. And shame was followed by sadness, anger, frustration and hopelessness. Of course, he didn’t let that be known.

“It was Oscar-worthy,” he says. “I’ve binged thousands of times in my life, spent more money than I care to calculate and probably put Ronald McDonald’s kids through college; yet no one who knew me ever saw me binge. That’s how it thrives.”

Neither Colin nor Andy could deny their contrasting but equally detrimental habits forever.

“If you have the ability to starve yourself on a prolonged basis, you have an eating disorder,” Colin says of himself. “No healthy person can literally starve themselves for days and weeks on end. Eating disorders are a living hell, and I wouldn’t wish it on my worst enemy.”

A Slowly Changing Stigma
Andy found himself at Overeaters Anonymous meetings and, after a few years of trying to cope on his own, he decided it was time he found professional help.

He and Colin are both fortunate they sought help when they did. Eating disorders have a very high mortality rate—the highest among psychiatric disorders. For anorexia, the death by any cause is about 0.5 percent chance of death for every year that one has the illness. That means if you have anorexia for 10 years, you have about a five percent chance of dying. For Bulimia the rate is lower, around 0.2 percent chance of death for every year of having the illness.

There are also high rates of co-occurring illnesses and medical co-morbidities that likely increase mortality, such as depression, anxiety, obsessive-compulsive disorder, low testosterone, osteoporosis, diabetes, cardiovascular disease and electrolyte imbalances like low potassium, which can lead to heart problems. The increased mortality rate is a combination of medical conditions resulting from starvation, obesity or repeated purging (which can be vomiting or laxatives), plus increased suicide rate, which is 24 percent higher in those with eating disorders than in the general population.

“It’s hard to tell if the [suicide] association is due to the eating disorder itself, or just secondary to also having depression,” says Michael Lutter, MD, Ph.D, staff psychiatrist at ERC, Dallas. “From personal experience, I would speculate that men with eating disorders frequently hate their bodies and use the eating disorder in a way to control how they look and feel. When the eating disorder fails to make them feel better, they can often feel hopeless and look to suicide as the only way to end their suffering.”

But finding help before things turn fatal isn’t as easy as it may sound for men who suffer from eating disorders, which are oft-considered women’s diseases.

“Nearly all grants I review exclude men and explain that this is because so few males would be recruited that there wouldn’t be sufficient statistical power to analyze any gender differences,” says Academy for Eating Disorders (FAED) fellow Lisa Rachelle Lilenfeld, Ph.D. “Although there is greater recognition in the general public and among practitioners that eating disorders occur in males, there is still a tendency to assume it is a female illness.”

Because a lot of research is female-oriented, the preconceived notion that eating disorders are a women’s issue has become a dangerous cycle.

“I think there is an additional stigma for men in that it can be considered weak for a man to talk about his struggles at all, much less an eating disorder,” Colin explains. “Many people view men who are struggling as ‘weak,’ ‘emotional,’ ‘failures’ and ‘unable to keep it together.’”

The media is heavily responsible for disseminating a singular, solidified vision of masculinity, as well. “Manly” eating is portrayed by men housing Big Macs and Arby’s. It’s not cool to eat like a bird.

“There is a stigma that eating disorders are ‘women trying to get attention,’” Dr. Lutter adds. “The desire to be thin is not as common in men. More often we hear that the eating disorder started with the desire to be ‘healthy’ or ‘eat right,’ and that this has spun out of control.”

Colin, who had spun out of control and been admitted to the hospital three times in six weeks for anorexia-caused health issues, finally came across ERC after years of denial and then visiting other centers and relapsing. ERC is one of the few treatment centers that actually admit men.

“Many treatment centers and the public at large don’t have the knowledge or resources for male eating disorder treatment,” says Troy Roness, writer and advocate who, in 2009, recovered from an 11-year life-threatening addiction to exercise, anorexia and Body Dysmorphic Disorder. He now works with The National Eating Disorders Association (NEDA), the UK’s Men Get Eating Disorders Too (MGEDT) and Eating Disorders Coalition (EDC) North Dakota. “I don’t believe treatment centers and professionals are unwilling to address men who struggle; after all, statistics for men—and all populations—are rising, unfortunately. There simply isn’t enough research on the different approaches in treating men versus women, and much of the eating disorder criteria are female-oriented.”

That said, centers are starting to see more male admits as awareness increases.

“It is becoming less ‘taboo’ to be a male struggling with an eating disorder,”says Jennifer Lentzke, Director of Nutritional Services at Rosewood Centers for Eating Disorders. “We find that men are feeling more supported by their peers and the ED community, as well as the general population.”

It is more common for eating disorder treatment centers at lower levels of care (partial hospitalization, intensive outpatient and outpatient levels of care) to provide treatment for both men and women. By Lentzke’s estimates, there are only a handful of treatment centers in the country that provide inpatient and residential treatment for males.

“We find that men tend to take a more ‘self-sufficient’ approach, adding to the issue of them not seeking treatment,” Lentzke adds. “Hence, most eating disorder centers cater to the female ED population, as the centers are more likely to receive and obtain viable admits.”

There are several organizations dedicated solely to males and eating disorders, including The National Association of Males with Eating Disorders (NAMED) and Men Get Eating Disorders Too (MGEDT), as well as many others that provide screenings, information and essential resources like The National Eating Disorders Association (NEDA), MentorConnect and The National Association of Anorexia Nervosa and Associated Disorders (ANAD).

There are also some treatment centers that offer co-ed programming and male-only programming, including Rogers Memorial Hospital, McCallum Place, Canopy Cove and The Center for Eating Disorders at Sheppard Pratt.

“We have to remember that the control of food, exercise and other eating disordered behaviors are merely that—behaviors,”Roness says. “They are the symptoms of much deeper substantial trauma.”

And the truth is that this trauma can and does affect people of all genders.

“I would love to see people think of this illness as the deadly, life-threatening illness that it is, instead of vanity illnesses that only skinny white girls from affluent families get,” Colin says. “Developing an eating disorder is often due to having a genetic predisposition. This disorder is not one somebody chooses to develop. They are not mere diets. They are serious and deadly illnesses.”

“I would love to see people think of this illness as the deadly, life-threatening illness that it is, instead of vanity illnesses that only skinny white girls from affluent families get.” —Colin

A Daily Struggle
Colin is five years into his recovery journey, with almost three years of what he calls “reasonably solid recovery.”

“I committed to showing up for work: I kept all of my appointments with my therapist and dietitian, no matter how much I didn’t want to,” Colin says. “Even if I was feeling unmotivated to recover that week, or I was struggling in my eating disorder, I committed to at least show up to those appointments. I attended weekly therapy groups. I made it a priority in my day to take time from work to attend these appointments.”

When he was admitted to ERC, he had to give complete control to his treatment team and start re-feeding immediately.

“Emotionally, I was a mess—I felt like I was betraying myself by eating,” he remembers. “I felt as if I lost all control over my body. I had panic attacks, and hyperventilated at the table at one point. It wasn’t uncommon for me to curl up into a ball and sob after eating, or after being required to drink a boost because I did not complete a meal.”

There are myriad psychological studies demonstrating that eating disorders are not a vanity phase people can recognize and simply switch off—even if they realize that those behaviors are causing problems. What Colin needed is called “symptom interruption,” so his brain could recover and learn new behavioral patterns.

“I don’t think a lot of people in the general public believe that eating disorders are medical illnesses caused by brain dysfunction,” Dr. Lutter says. “Brain imaging studies show that people with eating disorders have impaired functioning of regions of the brain involved in habit learning or behavioral adaptability. Essentially, eating disorders cause people to ‘lock in’ their old behavioral patterns even when they are no longer helpful.”

And those old behaviors, even when subdued, can and do come back.

“At some point, it became obvious that my eating disorder is not happy about any of it, and it started to fight back,” Andy says. “The retaliation and consequent continuous battles can be scary and really damn hard, like waging an internal cold war with myself.”

This difficulty is not uncommon, no matter how determined someone might be.

“Understand that, even if [somebody is] fully committed to getting better, eating disorders are vicious mental health disorders and the relapse rate is generally quite high, making them hard to fully treat in the short amount of time [60 to 90 days] that they are at the Center,” Lentzke notes.

The important thing is to try and keep trying with professional help.

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What You Can Do
The good news is that help is becoming evermore readily available to men suffering in silence. As awareness around male eating disorders increases, so does research. With research comes solutions. So, if you or someone you know is or may be suffering, follow these steps and seek help.

1. Be aware of signs.
One of the first signs that eating has become an issue for someone is when he or she becomes rigid and inflexible around meals, according to Dr. Lutter. This is because eating is a highly social process, and most people are able to adjust their schedules around meals in order to be with family and friends.

Patients who binge also tend to be secretive about eating because of the shame they experience when they can’t control it. If people start to isolate themselves, eat meals alone or avoid restaurants and foods that they haven’t prepared themselves, there may be cause for concern.

Also, be aware that weight fluctuation isn’t always an obvious sign that someone is suffering.

“People can be healthy at a wide range of different shapes and sizes and weight loss does not necessarily improve your health,” says Dr. Alexis Conason, a psychologist and author of the chapter “The Influence of Dieting (Hedonic Deprivation) on Food Intake: How it Can Promote Hedonic Overeating and Mindful Eating Interventions” in Hedonic Eating. She’s also the author of the Eating Mindfully blog on Psychology Today.

2. Encourage mindful eating over disordered eating.
Contrasting hedonic starvation (anorexia) with mindful eating, Dr. Conason says, is talking about the difference between illness and wellness.

“Mindful eating is a way to help people nurture their body by eating in ways that are attuned to our internal signals of hunger, fullness and satiety,” she adds. “Understand[ing] what it is that we truly want in a way that is not possible when we are trapped in the dieting mentality.”

3. Seek professional help if you or someone you know does feel trapped.
“As hard as it is to leave your job or school behind, it is absolutely the right decision to seek treatment,” Colin says. “You can always return to work or school, but you can’t get your life back from an eating disorder if you don’t take time away to get help and take care of yourself. You are not less of a man because you struggle with an eating disorder. You’re definitely NOT less of a man for seeking treatment. In the end, being willing to address the tough issues will give you a life you never thought you could have.”

You can reach out to the Eating Recovery Center by visiting their website and scheduling a free consultation here or by dialing 877-789-5758 to talk to a clinician.  

Illustrations: Ben Jervis

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