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Under Diagnosis: Eating Disorders and Teenage Boys

Eating Disorders (EDs) are not the same as having a bad body image or wanting to be thin. They are biologically-based illnesses related to brain functioning, which puts some teens at risk for engaging in life-threatening behaviors, including restricting intake, binging, purging, using laxative and diet pills, or over-exercising to a point of physical harm.

Teens cannot “just eat” or “just stop” these behaviors; they need intensive treatment and medical care to overcome them.

ED’s are often misunderstood as a girl’s disease, resulting in under diagnosis for boys. Family, friends, coaches, and even medical and education professionals are less likely to identify boys as having an ED. They may not question ED behaviors for boys and may even see some behaviors, such as compulsive exercise, as desirable. In the cases where EDs are identified, many boys will resist the diagnosis and treatment of the ED, as they do not want to be seen as having a girl’s disease. Thus, the mislabeling of ED’s as exclusively female can be both sad and damaging to teenage boys.

Though these barriers to diagnosis lead to unclear and underestimated statistics, the current literature suggests that at least 25% of individuals diagnosed with an ED are male. Statistics also show that Bulimia Nervosa is three times as common as Anorexia. The most common constellation of symptoms for males are restricted eating, binging, and compulsive exercise.

Eating disorders are linked to vulnerabilities based on genetics and biology, but environment triggers and gender can determine how they present. As a result, there is not one face of what an eating disorder looks like, so it’s important to consult with an expert.

Fortunately, the scientific understanding and treatment of EDs is better than it has ever been. With the advent of Family Based Treatment (FBT), teens now have a very positive outlook for recovery, with rates greater than 60%. FBT combines expert care and the love and support of parents to effectively treat teenagers in the home environment. With good medical care, FBT therapy, psychiatric care and a support system for parents and child, the prognosis for boys and girls with EDs is now hopeful and positive.

Mark Warren, MD, MPH, FAED, Medical Director, Cleveland Center for Eating Disorders

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