We all know that the general public thinks of anorexia nervosa as a “female disease,” but is the American Psychological Association’s diagnostic criteria to blame for this misconception?
Let’s delve into the issue of gender bias in diagnosis of anorexia nervosa.
What is Anorexia Nervosa (AN)?
According to the DSM-IV-TR, the Four Criteria for Diagnosing Anorexia Nervosa Are as Follows (APA, 2000):
- Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85 percent of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85 percent of that expected).
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
- Amenorrhea (i.e. the absence of at least three consecutive menstrual cycles).
Gender Bias in the Diagnosis of Anorexia Nervosa
The fourth criterion (amenorrhea) is only possible to diagnose in females; however, there is no equivalent criterion for males. This automatically predisposes clinicians to overlook the possibility of anorexia nervosa in males.
Even more concerning is that the DSM-IV-TR is the main source that insurance companies use for deciding medical coverage. It is hard enough for males to seek treatment due to the stigma of anorexia being a “female disease.” Many males feel shame or embarrassment about openly admitting they struggle with eating disorder issues, especially when the psychological and medical communities add to the anorexia gender bias with a female-oriented diagnostic criterion.
Male Anorexia Nervosa Statistics
According to the National Eating Disorders Association, approximately one million males suffer from anorexia nervosa in the United States. However, this statistic is probably outdated and underreported due to the high proportion of silent male sufferers.
The National Eating Disorders Association also reports that only ten percent of males with anorexia nervosa actually seek treatment. This is a startling low figure, because anorexia nervosa left untreated has many dangerous consequences.
Dangers and Consequences of Male Anorexia Nervosa
According to the National Eating Disorders Association, these are some major health consequences of anorexia nervosa (NEDA.org).
Health Problems Related to Anorexia Nervosa Include:
- Slow heart rate
- Low blood pressure
- Heart failure
- Reduction of bone density leading to osteoporosis
- Muscle loss and weakness
- Severe dehydration
- Kidney failure
- Fainting, fatigue, and overall weakness
- Dry hair and skin
- Hair loss
- Growth of lanugo (a fur-like layer of hair in an effort to keep the body warm)
Anorexia nervosa has the highest mortality rate of any mental disorder, which is why it is important to seek treatment. Males are at an increased risk for death, because they are less likely to receive proper diagnosis and treatment.
Male Anorexia Treatment Issues
In the rare case that a male does decide to seek help for anorexia, he will find that there are a lot fewer treatment options for him due to his gender. It is a cold, hard fact that the majority of eating disorder residential treatment centers only accept females. This needs to be changed, because the consequences of starvation do not discriminate by gender. Males with anorexia nervosa need medical and psychological attention just as much as females with the disorder need it.
Fighting Gender Bias in the Diagnosis of Anorexia Nervosa
The United States was founded on people coming together to make their grievances known and fighting for their rights. American history shows that many issues can be overcome if enough people fight for them. This may sound extreme, but we, the people, must take matters into our own hands and show the psychological and medical communities that male anorexia nervosa is a serious issue. We must stop this gender bias and stigma, so that the medical community cannot claim ignorance.