The Telegraph newspaper had published an article on British actor Christopher Eccleston’s disclosure of his struggles with anorexia Being interviewed for this article got me thinking about writing a post on this often-hidden issue in men. So, here are my thoughts on how it develops and why it is such an important problem to help.
What is anorexia?
In short, anorexia – or to give it it’s full title anorexia nervosa – is an obsessive and distorted repulsion of being big/fat, plus deliberate efforts to eat less than needed for normal functioning, leading to the body entering a starvation state. According to the psychological and psychiatric diagnostic manual, the ICD-10, it is defined as:
A disorder characterized by deliberate weight loss, induced and sustained by the patient. It occurs most commonly in adolescent girls and young women, but adolescent boys and young men may also be affected, as may children approaching puberty and older women up to the menopause. The disorder is associated with a specific psychopathology whereby a dread of fatness and flabbiness of body contour persists as an intrusive overvalued idea, and the patients impose a low weight threshold on themselves. There is usually undernutrition of varying severity with secondary endocrine and metabolic changes and disturbances of bodily function. The symptoms include restricted dietary choice, excessive exercise, induced vomiting and purgation, and use of appetite suppressants and diuretics.
If you would like a more detailed comparison of the ICD-10 and alternative DSM-IV-TR diagnostic criteria for anorexia, have a look at this link https://www.ncbi.nlm.nih.gov/books/NBK49317/
How does anorexia develop?
Anorexia doesn’t just become fully-fledged and established overnight. It takes time to develop within the person and to show it’s to others.
It starts small. It can start with making what appears to be a reasonable or even good decision to look after yourself a bit better. Maybe by tightening up your diet. Cutting-out some ‘crap’ or junk. Maybe by doing some exercise, to getting into better shape. If you exercise, you get a bit of a high, through your body’s endogenous opiates (happy hormones), which feel good.
You are taking control. Feeling better. What’s wrong with that?
Well, nothing – yet.
Then you start to notice good effects. You might lose a bit of weight. So clothes fit a bit differently. You feel more in trim shape. You make better food choices. Your body feels less sluggish. Maybe other people comment on your new discipline, your food choices, your ability to do exercise.
And so, your actions become reinforced.
And there’s nothing wrong with that, right?
However, for some people, these actions get stepped-up a level. More food gets banned, because now these foods are seen as bad, becoming demonised. There is less flexibility about food choices. Rules become less flexible, more extreme.
Exercise too is likely to become stepped-up. Doing more. Going harder. Resting less. Not heeding the body’s warning signs to back-off.
Your body continues to change, these results appear good to you. But as you are under-fuelling your body, your hunger pangs send strong signals to eat.
Other people may comment positively on your progress, your choices, your discipline.
You feel more in control.
Whether you go looking for it or not, there are many sources of reinforcement through the media – magazines, social media, blogs, YouTube, advertisements…
When we break our food rule or skip part of an exercise session, we feel disproportionately bad. So we work-out a way to compensate for this, to make amends. We tighten the screw even more.
Now things have started to become less balance, healthy, good for you. You are becoming more obsessed and fixated on body size, fatness, calorie burn, your food rules, restriction…. Your mood and self-esteem is linked to these things.
Now you are tipping into anorexia.
Why should we take anorexia seriously?
There are several reasons why we should take anorexia seriously. Here are my top three:
It dominates your life and can make your life miserable.
It is unhealthy and can cause long-term damage to your body.
It is a risk to your survival (there is a high risk of death through starvation or suicide)
Can anorexia show differently in men?
For men, anorexia can develop just as in women. However, there is this idea of bigorexia which is more prevalent in boys and men. Bigorexia can be thought of as the opposite of anorexia, where we think that we aren’t big enough and develop a strong need to become bigger, muscularly bigger, to be acceptable. This leads to a focus on muscle-building, gym-going and temptations to take anabolic steroids to be more acceptable. As with anorexia, there is an obsessive focus and self-esteem basis to how one looks and what one does that makes this unhealthy, pathological, dangerous.
Why is anorexia a hidden problem in men?
For men, it can go unnoticed because we just don’t expect it in men. Most of the eating disorders and anorexia focus is about women (where it is more prevalent). In addition, men just don’t tell others about it. We tend to hide our problems from other people – whether this is friends, family, our GP…
Here’s a quick free eating disorder screening assessment:
Do you ever make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone in a three month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?
These 5 questions, known as the SCOFF, are used to identify those who might warrant a more detailed assessment. If you answered “yes” to 2 or more questions, then consider reaching-out for some help.
Further information on eating disorders in the UK can be found through the BEAT charity (www.beateatingdisorders.org.uk/).
If you would like to find out how I can help, then get in touch.
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