Behind him, the walls are the color of tofu and thick blinds, which block out the darkness of a nighttime sky, hang crookedly. The young man is well-groomed, his narrow shoulders neatly contained within a pressed shirt highlighting the color of his eyes. “I didn’t really know where to go or what to do, to be honest,” he tells an off-camera interviewer. A new study conducted by researchers in the UK finds that eating disorders are not only increasingly common among young men, but unlike women, they are slower to recognize symptoms and so, too, slower to seek help.

“I thought I made it up myself,” another young man says during his interview. “You know, something that only I did, you know, I never thought in a million years this was something that lots of people did, and deliberately did to cause damage to themselves.”

To understand how men recognize symptoms of an eating disorder (ED) and decide to seek help, the researchers launched a general study examining 39 separate experiences of having an ED. As part of their analysis, the researchers interviewed 10 men across the UK, all between the ages of 16 and 25, all suffering from anorexia nervosa, bulimia nervosa, and other disorders. “The widespread perception of EDs as uniquely or predominantly a female problem led to an initial failure by young men to recognise their behaviours as symptoms of an ED,” wrote the researchers. For this reason, many men only begin to seek help once their illness has matured and their behaviors and symptoms are already entrenched.

Why do these men fail to identify the symptoms of their illness? The researchers believe the main reason for this is the widespread perception of EDs as uniquely or predominantly a female problem. Worse, this perception may not exist only with the general community but also among medical professors, who in some cases consistently fail to provide gender-appropriate information and resources for men. A recent French study, for instance, found that a significant proportion of men with eating disorders also have moderate to severe symptoms of depression. These same men also demonstrated what the researchers referred to as inappropriate compensatory behaviors, including excessive exercising and fasting.

“I can't obviously say oh [um] it's harder for men, but there's different experiences for men because, you know, ‘No I don't get ill, I'm a man,'" another participant tells a researchers during the UK study. “You know, ‘I don't get ill, don't need treatment, I don't have emotions.’ Blah, blah, blah. Things like that.”

In an American study conducted under the auspices of the University of Illinois, researchers tried to identify which factors in adolescence predicted pathological eating behaviors in young adulthood, when for many signs of their ED bloom. (According to the National Eating Disorder Association, the rate of eating disorders among college students is anywhere from 10 to 20 percent of women and four to 10 percent of men.) Unsurprisingly, the researchers discovered that dieting, depression, and body image distortion in the early years predicted dieting or extreme weight loss behaviors later in life. Among the gender differences observed, the researchers found that early depression was a significantly stronger predictor of a later ED diagnosis in men than women. In the words of a participant in the British study, “I think people knew something was wrong. I think since talking to some of my friends … they knew I was depressed. They didn't know that I had an eating disorder because I don't think any of us knew anything about eating disorders really.” Meanwhile, another participant described tensions within his family that stopped short of an appropriate intervention, stating, “Dad would get angry if I hadn't had my breakfast. But it was never associated with any kind of eating disorder, ever, it was just, ‘Stop being silly.'"

Unlike young women with an ED, young men with an ED encounter an overwhelmingly hollow sound, in many cases a complete lack of response from their families, friends, teachers, and medical professionals. (For women, on the other hand, even the hint of anorexia, true or not, might propel health providers to take drastic action.) Simply, then, the researchers conclude, “Men with EDs are underdiagnosed, undertreated and under-researched.” Their main hope is to raise awareness so that young men, like young women, can receive early treatment when showing the earliest signs of behaviors that can ruin their lives.

Source: Raisanen U, Hunt K. The role of gendered constructions of eating disorders in delayed help-seeking in men: a qualitative interview study. BMJ. 2014.