About one in ten people with an eating disorder such as anorexia or bulimia are male. We still don't know what causes eating disorders. Researchers have suggested that they stem from the pressures of a weight-conscious Western society, family or relationship problems, and physical and neurological changes in susceptible people. It seems likely that several factors are at work.
Identifying symptoms
One of the main problems in eating disorders is 'body image disturbance'. The illnesses cause a person to have a very inaccurate idea of their own shape.
Asked to stand beside a door, for example, a man with anorexia might think he 'blocks out' the whole doorway because he is so overweight; looking at his thin forearm and bony hand, he might think he is covered in unsightly fat. Recent research has suggested that male bodybuilders might have similar kinds of body image disturbance to that experienced by people with anorexia.
There are a few other features of anorexia. To confirm the diagnosis, the patient must mistakenly think they're too heavy, and be dieting to lose weight. People with anorexia usually have a body mass index of less than 17.5. (Use the BBC Health BMI calculator to work out yours.)
Other ways of trying to lose weight include excessive exercise, extreme 'fat-free' diets, making yourself sick after meals, or purging with laxative and diuretic drugs. Some people with diabetes or thyroid problems manipulate their medication to promote weight loss. Although anorexia means ‘loss of appetite', sufferers are often very hungry - and may have a strong interest in watching others eat, or in helping to prepare their food.
Bulimia shares the body image disturbance of anorexia, but sufferers are more likely to be of normal weight, and binge-eating is more of a problem than dieting.
Living with an eating disorder
The consequences are serious. Not only is it difficult to maintain a normal social life, but the illness often causes intense family upset, and it's not easy to remain fit and alert at work. The body's systems have to work hard to adjust to the changed metabolism caused by abnormal diet, and dangerous changes can occur - particularly when people are making themselves vomit.
How to get help
Treatment needs to be long term, and is best carried out by a psychiatrist or psychologist with a special interest in these disorders. Some drugs, such as 'SSRI' antidepressants like fluoxetine (Prozac) can help to regulate eating - particularly binge eating. Cognitive therapy and self-help groups can also be useful.
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