Thursday, August 21, 2008

Trek Magazine - Manorexia

This article appeared in the Summer 2007 issue of Trek Magazine (U of British Columbia) -- a compelling explanation of male anorexia. [Thanks to Paul posting at Isabella's Change Therapy for the link.] This is an important and useful article.

This appears at the end, but wanted to move it up to the top.
If you are interested in participating in a research focus group, please contact Jane Harbottle, Research Coordinator, 604.682.2344 ext: 62524. If you’d like to receive more information about treatment through the Eating Disorders Program at St. Paul’s Hospital, go to ¤
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Issue #18: Summer 2007


by Vanessa Clarke

“The bottom line is I am 5' 9" and feel fat, despite weighing only 75 pounds. Just for the record, I am white, American Jewish, and 25 years old. What sets me aside from most other anorexics is that I am male.”

So writes Michael Krasnow in the introduction to his 1996 book, My Life as a Male Anorexic. It describes in frank terms the friendless years he spent consulting specialists, suffering depression, being hospitalized, running away in a bid to starve himself to death, devising intricate tricks to sidestep intervention and feeling guilty about the massive toll wreaked on his family by all this. Despite diagnosis and treatment, Michael Krasnow died the year after his book was published.

Depending on their age, people thinking of eating disorders might recall singer Karen Carpenter, whose death from heart failure associated with anorexia nervosa in the early ’80s brought that disease to mainstream consciousness in the West, or Princess Dianna, whose famous 1993 speech on the subject was made “on very good authority.” (Her own, we guessed.) Or to the fashion industry, with its seeming predilection for size zero female models and heroin chic.

Although the majority of individuals with eating disorders are female, research suggests that males account for an increasing proportion of cases. The idea that disorders like anorexia are female illnesses, however, persists. Another common misperception is that eating disorders are just a product of modern society and its ubiquitous images of unrepresentative beauty and unattainable body-types. But eating disorders aren’t new and neither are eating disorders in males a recent phenomenon. English physician, Richard Morton is generally credited with the first medical description of anorexia nervosa in the late 1600s (although the term itself was not coined until the 1800s). One of Dr. Morton’s first documented cases was that of a 16 year old boy.

Despite these centuries of recorded history, it was only a little over a decade ago that Michael Krasnow wrote: “Although concern about anorexia is growing, there is still a large unawareness, especially about male anorexia, and this is the major purpose of my story: so that other men with this problem will realize they are not alone. My parents and I could not pick up a book and read about male anorexics. For all we knew, I was the only man in the world with anorexia. My parents did not know how to deal with me or even what to think. We had no one to whom we could turn.”

Today, the level of awareness about eating disorders in men has increased, somewhat, with celebrities like Elton John and Dennis Quaid going public with their private battles. But some experts, such as Paul Gallant, mhk’95, feel that current stats on the number of men with eating disorders are probably conservative – in part due to a reluctance in males to come forward – and that current methods for diagnosis and treatment tend be skewed towards women.

Gallant is operations leader for Mental Health Provincial Programs at St. Paul’s Hospital in Vancouver, where he has been based (originally as a recreation therapist) for more than 15 years. Latterly, his attention has been focused on the Eating Disorders program, which he now co-leads. He noticed a gender-based discrepancy in reporting patterns. “I didn’t know why we didn’t see more males at the clinic,” he says. “I expected to see at least one in ten going by the stats. So I decided to look into it further.”

Gallant is now a Human Kinetics PhD candidate at UBC, exploring coping mechanisms and access to treatment in men with eating disorders. His dual role as researcher and leader means he is able to put theory into practice and is conducting a series of focus groups with male subjects who have reported or been diagnosed with an eating disorder. He hopes this will help inform new approaches for identifying males with eating disorders and provide them with the most appropriate treatments. So far, his project has been small scale because so few men have come forward. He is now looking for 20 more men with eating disorders to help him continue his research.

He suspects that common misperceptions play a large part in discouraging men from seeking help. Straight men with an eating disorder might be put off seeking treatment not only because eating disorders are commonly associated with women, but also because there is a perception that if males are susceptible to eating disorders it is because they are gay.

“If you did a study across the country, most people would guess more gay men had eating disorders per capita than straight men,” says Gallant. “But it’s important to stress that the majority of men with eating disorders – about two thirds – are straight. It’s important to explain the statistics and their implications. We want to encourage as many men as possible to disclose and come for treatment and not feel stigmatized.”

Left without diagnosis and treatment, eating disorders can have alarming consequences. Many people who develop them can also develop very serious physical repercussions, such as osteoporosis, types of arthritis, or internal system failures. At 10-20 per cent, eating disorders have the highest mortality rate of mental illnesses, and although there are no figures on comparative mortality based on gender, men face specific risk factors based on their body types.

“More attention is paid to eating disorders now because of the deaths related to them,” says Gallant. “We don’t know if the mortality rate is higher for men or women, but we do know that men with anorexia, for example, have a tighter timeline in terms of getting treatment. If you’re a male with an eating disorder at a severe level, there’s a finer line between changes in Body Mass Index and when there could be consequences to your health, because men are already leaner.” And because they are naturally leaner, weight loss may be less noticeable in males.

Eating disorders are complex conditions with a variety of causes, and are often accompanied by other conditions such as depression or schizophrenia. “That can make them a lot more complex to treat and difficult to recognize,” says Gallant. Compounding this problem for male sufferers are some of the diagnostic criteria used by physicians. Gallant says these are sometimes geared towards the treatment of females, which could explain why men tend to be overrepresented in the EDNOS diagnostic category (Eating Disorders Not Otherwise Specified). This is a sub-clinical diagnosis meaning that a patient meets most of the criteria for a diagnosis, for example bulimia, but don’t meet the full criteria as laid out in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (which includes a category about menstruation). It depends which criteria a doctor chooses to use. Gallant prefers the slightly different set offered by The World Health Organization. These include a category on endocrine function, for example, which covers erectile dysfunction – a potential consequence of eating disorders in males.

Eating disorders can be the product of many factors, including physiological. “Most people would agree there’s a certain biological predisposition to developing an eating disorder,” says Gallant. There is also a large psychological component. Common childhood experiences of sufferers including bullying at school, a critical adult, or worse forms of abuse. Feelings of guilt often go hand-in-hand with a disorder: “Eating disorders never only affect one person. They affect everyone around that individual,” he says. The traditional stiff-upper-lip stereotype of masculinity might mean men are less open about their emotions. “They are more prone to mask them with alcohol or drugs. Substance abuse probably is higher in men with eating disorders than women,” says Gallant.

Men may also have an easier time covering up their problem behaviour. “There’s some consensus that men may compensate with over-exercising, and may purge less. Men may be able to mask their disorder a little better through sports and athleticism,” says Gallant, who points to the world of professional sport as having a concentration of cases. “Ironically, you’d be surprised at how many people from elite sports suffer from eating disorders. Not a well publicized fact, especially if the athletes are stars. They may actually perform quite well for some time and then crash.” Gallant will be presenting a talk on eating disorders in males to Human Kinetics and Coaching Science faculty at UBC to sensitize them to the danger signs. He feels that an essential part of his team’s job is to raise awareness.

The Eating Disorder Program at St.Paul’s is the provincial leader for treatment and standards, and it has links to other agencies across the province such as Jessie’s Hope and the Eating Disorders Resources Centre. “We broadcast video- and tele-conferences to rural and remote communities where we have representatives. Our partners are interested in developing the expertise to treat men. We may be the provincial centre for excellence, but we also want to offer expertise in other communities helping to identify both males and females with eating disorders and offer help on how to work with them.”

Any man or any women can apply to the treatment program if they’ve first been seen in their own regional or community program. The demand for treatment services outweighs resources and there is a detailed case by case review process based on strict criteria. The in-patient program has a wait list of six months. There are also a number of day programs and a follow-up clinic for medical monitoring.

“We want to build from the ground up,” says Gallant. “We’re sending out a message that we’re open to men and want to learn more about how we can help them. According to the literature, needs and treatment modalities may be quite similar, but we’re trying to find out what it’s like from the male’s perspective and what sort of treatment they might want to access. They will realize they’re not the lone man in a treatment program full of women, as is often the case. As word gets out, we’re hoping enough men will come forward.”


isabella mori said...

thanks for mentioning that! i'm actally going to meet with paul gallant next week, see what else he has to say. am looking forward to blogging about it.

Anonymous said...

Thanks for posting this article and highlighting the ongoing research.Questions or interested persons can contact me directly to discuss males with eating disorders as Jane has moved on to or Thanks Paul Gallant