COMPARING AND CONTRASTING BULIMIA NERVOSA IN MALES TO BULIMIA NERVOSA IN FEMALES

Transcription

1 1 2 3 COMPARING AND CONTRASTING BULIMIA NERVOSA IN MALES TO BULIMIA NERVOSA IN FEMALES Abstract: Bulimia nervosa is an eating disorder characterized by binging, the act of ingesting excessive amounts of calories in a short amount of time, and then purging, the act of getting rid of the calories recently eaten, mostly by self-induced vomiting, abusing laxatives, or excessive exercise. Bulimia affects both genders, although the symptoms of each gender may differ. Men have been shown to be more concerned with perfectionism and are more likely to abuse excessive exercise to purge after binging, while women are more concerned with overall thinness and may vomit intentionally or abuse laxatives to purge. Women are also more likely to seek out treatment and to receive treatment for bulimia nervosa, while men are not as likely to seek out or to receive treatment. Similar types of treatment, such as cognitive-behavior therapy and family therapies, were shown to be beneficial for both sexes.

2 INTRODUCTION Rates of eating disorders have increased over the past 50 years. 1 As these rates continue to rise, more awareness is being raised for eating disorder symptoms and treatment options. Despite the increased public awareness of these disorders, very little awareness is raised about male eating disorders. Many people still consider eating disorders such as anorexia nervosa and bulimia nervosa a women s disease. However, approximately 10% of individuals seeking professional treatment for eating disorders and disordered eating are male. 1 That statistic does not include the number of males who refuse to seek treatment or who may not realize that they have eating disorder tendencies. Studies have shown that men are less likely to seek and receive treatment for eating disorders, because of the bias that eating disorders are women s diseases. 2 Males are more likely to be diagnosed with bulimia nervosa, a disorder that is characterized by binging and purging: the act of eating an immense amount of calories over a short period of time and then immediately trying to get rid of the food eaten primarily through vomiting or using laxatives. 2 This review will explore the gender differences apparent in bulimia nervosa. This paper will specifically look at differences in symptoms, in rationale, and in treatment. METHODS Journal articles were found using databases such as PubMed (Medline), and the Web of Science (ISI). Search terms such as adolescent males, bulimia, and treatment options were used. Journal articles were chosen in order of their relevance to the subject and in order of the depth of their research. Research articles were primarily chosen. Other websites and books with general information on the diagnosis of bulimia nervosa and general statistics on bulimia nervosa were also used. 10 research articles will be cited and used in this paper. These papers show the similarities and differences in symptoms and treatment, and will be used to compare bulimia nervosa in adolescent males and in adolescent females. Treatment options for males and females with bulimia will also be discussed. RESULTS/DISCUSSION Male and Female eating disorder diagnostic criteria are the same. Patients must exhibit symptoms of binging and purging at least twice a week for at least three months. Within these diagnostic criteria, there are many clinical similarities that have been found between males and females who have been diagnosed with bulimia nervosa. Age of onset is similar in both genders, as are weight control methods. 3 Through a case-control study conducted at the University of Barcelona in Spain, differences in males and females with bulimia nervosa were analyzed. This study analyzed various psychological and nutritional inventories. It also required subjects meet with a psychiatrist. Results showed that while the age of onset is similar in both genders, the age of onset in males was higher than it was in females. This study also showed that males are more likely to exercise compulsively, females are more likely to abuse laxatives, and both genders exhibit induced vomiting. 3 Males who completed statistical analyses about eating disorders, such as Eating Disorder Inventories, males had higher rates of excessive and compulsive exercise and higher scores on

3 perfectionism and interpersonal distrust when compared with females. 4-5 Women scored higher within the subsystems of bulimia and drive for thinness. 4-5 From this, it is inferred that the primary drive of bulimia may be thinness for females, but for males, bulimia may come because of a desire for perfection, and males are more likely to achieve that feeling of perfection through obsessive and excessive exercise. Males diagnosed with bulimia have also been shown to have negative self-perceptions of themselves. 6 These negative self-perceptions may cause an increased desire for perfectionism. The negative self-esteem and increased perfectionism may correlate that adolescents think that if they are perfect, then their self-esteem will increase. 6 Goodwin, et al. reports that perfectionism may contribute to the development of compulsive exercising in males. Compulsive exercise has been reported as a risk factor in children for developing bulimia nervosa. 7 To test this, nine schools across Great Britain were screened for bulimia subjects had their BMIs measured, and then completed a Compulsive Exercise Test, Eating Disorder Inventory-2, Child and Adolescent Perfectionism Scale, Spence Child Anxiety Scale, Hospital Anxiety and Depression Scale, and Social Physique Anxiety Scale. Subjects survey results were then analyzed, and it was found that high scores in the drive for thinness were good predictors for females, while for males, self-perfectionism was the best predictor, with 40% of compulsive exercise episodes attributed to self-perfectionsim. 7 Obsessive-compulsiveness was found to be a poor predictor of bulimia nervosa in both males and females. 7 Other patients were surveyed about their nutritional knowledge using seven subscales of eating attitudes. These consisted of how the individuals dealt with food and emotional eating, their concerns about weight gain, their restrictions of food and calories, their desires of not eating, guilt associated with eating, pleasurable feelings related with eating, and their nutrition knowledge and beliefs. 8 To achieve what constituted a passing score on these scales, a greater knowledge of general nutrition was needed instead of knowledge about specific calories or foods. This method was used to ensure that this was a more rigorous study, as many individuals diagnosed with eating disorders have an extensive knowledge of calorie amounts, but not nutrition. These subsystems showed that men with bulimia nervosa had better eating attitudes and greater nutritional knowledge than women with bulimia nervosa. 8 This could be attributed to the fact that women have a higher drive for thinness than men do. The Western mentality of thinness and dieting could contribute to this. Because men do not have as much pressure on them to be thin, they may have better eating attitudes. This also correlates back to earlier studies mentioned which show that males with bulimia nervosa have a higher drive for perfection rather than thinness. A study at the Oregon Research Center found that there were no significant gender differences in binging and purging. Males and females reported binging and purging around the same number of times in the three months before the study was conducted, but also estimated similar calorie amounts that were binged. However, while males are likely to binge and purge as many times as females who are diagnosed with bulimia nervosa, they are statistically less likely to seek treatment or admit wanting to seek treatment for bulimia. 5 This study reports that out of the male participants, only 1% reported receiving treatment for bulimia. 5 One explanation for this is that females reported binging with feelings of no control and guilt, while males did not experience these feelings. 5 This could contribute to males rarely seeking treatment for bulimia. Studies have shown that treatment options such as cognitive-behavior therapy are successful for males and females with bulimia. Cognitive-behavior can significantly decrease purging episodes in individuals with bulimia. 9

4 Family therapy has also been shown to be beneficial in males and females who are in their late teens and early twenties. In instances where cognitive-behavior therapy and family therapies fail, there are many medications that can be prescribed to help relieve the feelings of depression, perfectionism, and failure that can accompany individuals with bulimia nervosa. The primary medications prescribed are various forms of antidepressants. 10 Antidepressants have been shown to be useful, but they are especially useful when combined with other kinds of therapies, such as cognitivebehavior therapy. 10 Prescribed antidepressants can help control binge and purge episodes and reduce these episodes up to 47%. 11 Bulimia affects both genders, but there are many differences in symptoms between individuals of both genders who have been diagnosed with bulimia. Males are more likely to exercise compulsively to purge after binging episodes rather than vomit or abuse laxatives, and are also more concerned with perfectionism rather than being thin. 3-5 Males and females reported binging similar times throughout an extended period of time, and also reported taking in similar amounts of calories during binging episodes. However, males reported fewer feelings of guilt and rarely reported feeling out of control while binging. 8 Both cognitive-behavior therapy and family therapy have been found to be beneficial in both genders. Anti-depressants can also be prescribed in combination with the cognitivebehavior therapy to increase the overall efficacy of both treatments. 9-11

5 REFERENCES 1. National Association for Eating Disorders. Research on males and eating disorders. Available at Accessed February 8, National Association of Anorexia Nervosa and Associated Disorders. Eating disorder statistics. Available at Accessed February 8, Nunez-Navarro A, Aguera Z, Krug I, et al. Do men with eating disorders differ from women in clinics, psychopathology, and personality?. European Eating Disorder Review. 2012;20(1): Joiner TE, Katz J, Heatherton TF. Personality features differentiate late adolescent females and males with chronic bulimia symptoms. International Journal of Eating Disorders. 2000;27(2): Lewinsohn PM, Seeley JR, Moerk KC, Striegel-Moore RH. Gender differences in eating disorder symptoms in young adults. International Journal of Eating Disorders. 2002;32(4): Keel PK, Klump KL, Leon GR, Fulkerson JA. Disordered eating in adolescent males from a school-based sample. International Journal of Eating Disorders. 1998;23(2): Goodwin H, Haycraft E, Willis, AM, Meyer C. Compulsive exercise: The role of personality, psychological morbidity, and disordered eating. International Journal of Eating Disorders. 2011;44(7): Scagliusi FB, Nakagawa KA, Campos RA, et al. Nutritional knowledge, eating attitudes, and chronic dietary restraint among men with eating disorders. Appetite. 2009;53(3): Agras WS, Schneider JA, Arnow B, Raeburn SD, Telch CF. Cognitive-behavioral and response-prevention treatments for bulimia nervosa. Journal of Consulting and Clinical Psychology. 1989;57(2): Wilson TG. Treatment of bulimia nervosa: When CBT fails. Behavior Research and Therapy. 1996;34: Walsh T, Hadigan C, Devlin MJ, Gladis M, Roose SP. Long-term outcome of antidepressant treatment for bulimia nervosa. American Journal of Psychiatry. 1991;148: