Many people harbor erroneous beliefs about eating and food issues—beliefs that may be encouraged by stereotypes frequently seen in modern media. Some might believe, for example, that eating disorders only develop in women. Others may further limit their incidence to women who are also young, wealthy, and white. Still others may believe them to be a “fake” concern or ploy for attention.

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

Development vs. Diagnosis and Treatment

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

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

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

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

Who, Then, Develops Eating Disorders?

Eating Disorders in Men

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

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

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

Eating Disorders in the LGBTQ+ Community

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

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

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

Eating Disorders in Ethnic Minorities

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

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

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

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

Eating Disorders in Lower Income Groups

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

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

Older Adults and Eating Disorders

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

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

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

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

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

References:

Ackard, D. M., Richter, S., Frisch, M. J., Mangham, D., & Cronemeyer, C. L. (2013). Eating disorder treatment among women forty and older: Increases in prevalence over time and comparisons to young adult patients. Journal of Psychosomatic Research, 74(2), 175-178. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23332534 Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolsecent Health, 57(2), 144-149. Retrieved from http://www.jahonline.org/article/S1054-139X(15)00087-7/abstract Eating disorders affect us all. (n.d.). Retrieved from https://www.nationaleatingdisorders.org/eating-disorders-affect-us-all Eating disorders in LGBT populations. (n.d.). Retrieved from https://www.nationaleatingdisorders.org/eating-disorders-lgbt-populations Eating disorders in women of color: Explanations and implications. (n.d.). Retrieved from https://www.nationaleatingdisorders.org/eating-disorders-women-color-explanations-and-implications Hudson, J., Hiripi, E., Pope, H., & Kessler, R. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348–58. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892232 Sallans, R. (2015, May 27). Gender outside the binary: Eating disorder recovery and my transgender identity. Retrieved from https://www.nationaleatingdisorders.org/blog/gender-outside-the-binary-part1 Sinha, S., & Warfa, N. (2013). Treatment of eating disorders among ethnic minorities in western settings: A systematic review. Psychiatry Danub, 25, 295-299. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23995197 Types & symptoms of eating disorders. (n.d.). Retrieved from https://www.nationaleatingdisorders.org/types-symptoms-eating-disorders Von dem Knesebeck, O., Mnich, E., Daubmann, A., Wegscheider, K., Angermeyer, M. C., Lambert, M., Karow, A., Harter, M., & Kofahl, C. (2013). Socioeconomic status and beliefs about depression, schizophrenia and eating disorders. Social Psychiatry and Psychiatric Epidemiology, 48(5), 775-782. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23052428

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

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