Eating disorders and body image issues (such as found in a body dysmorphic disorder) tend to be seen as female-based disorders.
These kinds of disorders, however, are not exclusive to females.
Dr. Marc Aversa describes the basics of normal growth for teenage males.
“Growth and development are two different things. Generally with development we are talking about, for teenage boys, further hair growth and development, in addition with muscle mass and kind of finishing out their length-wise growth,” Aversa said. “Of course when we are talking about [growth] we also have to be mindful that there is the growth development piece of adding body fat, which has been certainly a change from where things were 10 to 20 years ago. It is quite a bit more body fat in addition to what we are seeing in teenage boys and girls.”
Aversa explains the kinds of eating disorders that can affect teens and adults.
“As far as eating disorders, there are different types of eating disorders. We see binge eating disorders, binging and purging which we think of as bulimia, we see anorexia and then beyond that we have just a general idea we call body dysmorphic disorder,” Aversa said. “[This disorder would include] somebody who may not be different enough to meet the criteria for those eating disorders but somebody who is [obsessed] enough about their appearance that it affects their mood or it impacts their comfort in social situations for example.”
The difference between what is relatively normal behavior and what constitutes an eating disorder or body dysmorphic disorder depends on the medical definition of that disorder. Definitions of behavioral disorders can be found in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V).
“Some of that depends on what you call a disorder. There is a manual of psychiatric disorders that is kind of kept to provide some clarity on when you call it a disorder or when you call it just sort of feeling awkward and uncertain about yourself. I think if you just look at the feeling awkward and uncertain about yourself it would be probably rare that any teenager did not have some of those concerns and questions about their body,” Aversa said.
Aversa further explains the differentiation between a disorder and what may be considered normal.
“There is that intense peer comparison that we see in teenagers where they look at ‘how do I compare to that person?’ One of the dimensions that are always going to be a physical appearance and you can always find somebody that looks, in your mind, better than you. That is a big issue in teenagers, especially high school. Generally that is those feelings moderate quite a bit when somebody hits college-age or after high school age,” Aversa said.
Registered dietitian nutritionist Karen Petermeyer from the Eating Center of Washington explains why there tends to be more women seen with eating disorders than men.
“We do see more women with eating disorders and I am inclined to believe that is for multiple reasons; our diagnosis criteria is geared towards women, males are less likely to seek treatment and there are not a lot of options for males in the treatment world. Eating disorders are viewed as a ‘female thing.’ Previously one of the criteria for diagnosis of anorexia nervosa was amenorrhea (not having their monthly period) this automatically excludes any males from the diagnosis. Sadly, eating disorder measures are not gender neutral, which is something to still be worked on,” Petermeyer said. “In most treatment facilities the population is 9:1; females to males. That does not mean that number is true for the amount of males with eating disorders in our country. Current data shows a ratio of eating disorders in adolescents as 3.5:1 (females to males). Most of the eating disorder research is geared towards women.”
Counselor Charissa Walson describes the general idea behind how people develop body dysmorphic disorders.
“Some people get too obsessed with it which can show up as an eating disorder, it usually has to do with a loss of confidence and an emotional state and a lack of ego strength. We usually think of ego as being too big of an ego or there are mean to people and are overcompensating. It actually usually means that they have a small ego, where they do not think very highly of themselves so they are making up for it in other ways,” Wilson said. “It is a slow moving situation basically you start with working out and getting attention or getting healthy feedback. If people get used to you being in shape they are not going to tell you that you look amazing every day, then it becomes ‘How do I get stronger and better and how do I achieve the attention that I was getting before.’”
There is currently no general recommendation as to the amount of time one should spend exercising as Aversa explains.
“You have different organizations that attempt to make recommendations on exercise and we are trying to figure that out. I do not think, in medicine, we have a set ‘here is how much somebody should exercise’ especially for teenagers. There are two questions to that, there is how much should somebody exercise, formal exercise, like somebody going out and playing sports or running or doing vigorous exercise. Generally you could say 30 minutes a day of exercise most days. There is probably a good place to have a minimum but vigorous could include just a good walk,” Aversa said. “I think another question is how much inactive time do people have and these days with video games, TV, telephones, cars, class time, there is a lot of inactive time where somebody just sits and does not move much.”
Even though there is no set maximum amount of time people should spend exercising it is possible to exercise too much, according to Aversa.
“In many cases, you will see people with anorexia who will exercise to the point of such physical stress that their body does not produce normal hormones. It is more recognized in females sometimes stop having periods because their hormones are telling them that they are severely stressed and their hormones cannot be balanced right. We do see too much exercise with some eating disorders,” Aversa said.
Wilson describes what a body dysmorphic disorder is and how it develops in terms of muscle dysmorphia.
“Their emotions are not connected to what their bodies are actually going through. It becomes like a very strong tunnel vision. With muscle building specifically, people do not quite understand that they cannot achieve what they see in other people because we all have different genetics. What guys [tend] to want in their shoulders is to have a strong shoulder bed, which is just genetics,” Wilson said. “You cannot create a bigger shoulder bed…that is just genetics. You can work out you calves all you want but if you do not have a big calf bed, your calves are not going to look bigger. So then it gets frustrating that they are not [working out] hard enough so it becomes more and more of a mental disorder.”
Treatment for eating disorders can involve a team of people with various roles and jobs, according to Petermeyer.
“Eating disorders can be treated by a multidisciplinary team (dietitian, therapist, primary care physician and psychiatrist if needed). At Eating Recovery Center we treat those who need higher levels of care (inpatient, residential, day treatment and intensive outpatient), this is where individuals go to receive more therapeutic and medical support. We work as a collaborative team to individualize care to help disrupt eating disorder behaviors, re-nourish and restore someone so instead of just surviving they are thriving,” Petermeyer said.
While eating disorders are not something that can always be avoided, Petermeyer offers insight as to how one can start recovering from a disorder if it develops.
“Talking with a safe person (family member, friend, counselor, etc) to share thoughts and feelings can be very beneficial. Eating disorders are not a choice, they are a biopsychosocial disorder. We like to say, genes load the gun and life pulls the trigger,” Petermeyer said. “Being supported by community and loved ones who are able to see a shift in personality, temperament and eating behaviors can be helpful in intervening early. Eating disorders thrive in isolation and shame. The sooner you share with someone the quicker the recovery process can be.”
