Dear Therapist:

Is an eating disorder something that primarily is an issue for women/girls? I am concerned about my teenage son’s eating habits. I try and get him to eat more but he doesn't want to. When is there a cause for concern and how can I get him to eat more?

Response:

Treatment centers and resources for eating disorders do seem to cater more to women than to men. This may be due to various factors. Traditionally, social culture has placed more emphasis on women’s appearance than on men’s. Perhaps partly because of this—as well as for other reasons—women may have typically been more concerned about their body image than have men. This becomes self-perpetuating. If women buy into the idea that their self-worth or success is dependent on their looks, they can feel the need to do whatever it takes to achieve their concept of beauty. This, in turn, adds to the societal perception that women’s looks are more important than men’s.

Although eating disorders have likely existed for men for many years, this may not have been very prevalent. Additionally, these disorders in men may have been underreported. Generally speaking, men have been less willing to acknowledge issues related to mental health. Just as women may have been more apt to link their sense of self to body image, men may have been more likely to define themselves based on their perceptions of strength and toughness. Mental health issues were viewed by many as character flaws—especially for men.

Thankfully, these preconceived notions are being increasingly challenged. This is slowly leading to a decrease in the taboos related to mental health in general, and specifically for men. Issues related to body image—and therefore eating disorders like anorexia and bulimia—however, appear to be lagging. This is probably one of the reasons for a continued gender disparity in the treatment of eating disorders.

Proper treatment for eating disorders related to body image will include a strong component of therapy for underlying causes. From the external perspective of someone who has never experienced an eating disorder, the problem may not seem complex. The person is not eating, so we need to get them to eat. The person has no appetite, but they need to eat anyway. However, for the person with the disorder, it typically goes much deeper than this. Their unconscious impulse that tells them not to eat is much stronger than logic. Despite anything that they are told (or tell themselves), eating is anathema.  

There are many signs and symptoms that can relate to an eating disorder. Perhaps the most obvious are those that directly result from undereating. Obsession with food, weight loss, fatigue, dizziness, insomnia, heart problems, and abdominal pain are some of these symptoms. There are less obvious symptoms, however, that may seem unrelated. Preoccupation with body parts, change in mood, irritability, and social withdrawal are some symptoms that may be related to an eating disorder.

The consequences of the lack of proper nourishment can be severe. Serious health issues can result. Depression, anxiety, suicidal thoughts or behaviors, and social, educational or work problems are common. Those afflicted tend to hide signs of their eating disorders. They may make excuses for their low calorie intake. They may lie about their eating habits, wear loose clothing, or minimize the severity of their symptoms and behaviors.

There can be other causes for lack of eating. People who are depressed or anxious often lose their appetites. There are also physical diseases and illnesses that can lead to appetite loss.  It can be difficult to recognize when someone is not eating due to an eating disorder and when their lack of eating may be due to something else. If you are concerned, it is important to have your son see a professional who has experience with eating disorders. A proper assessment should give you—and him—more clarity.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317