Brian Pollack, LCSW, CEDS-C
Brian is the Founder and Clinical Director of Hilltop Behavioral Health, a boutique eating disorder specialty practice in Summit, NJ. He is one of the few male master’s-level Certified Eating Disorder Specialists in the country, with expertise in FBT, male clients, athletes, and muscle dysmorphia. He hosts the Minding Men podcast and serves as an adjunct professor at Yeshiva University.
Learn more about Brian →
Brian Pollack, LCSW, CEDS-C
Brian is the Founder and Clinical Director of Hilltop Behavioral Health, a boutique eating disorder specialty practice in Summit, NJ. He is one of the few male master’s-level Certified Eating Disorder Specialists in the country, with expertise in FBT, male clients, athletes, and muscle dysmorphia. He hosts the Minding Men podcast and serves as an adjunct professor at Yeshiva University.
Learn more about Brian →Despite misconceptions that eating disorders predominantly affect women, the National Eating Disorders Association has stated that 33% individuals who struggle with an eating disorder are men. People assigned the female gender at birth have faced tremendous pressures associated with achieving and maintaining unrealistic and frankly unhealthy body shape ideals for some time, no thanks to the growing pervasiveness of mass media that glorifies being ultra-thin as a societally accepted ‘normal weight’. Men are affected by all this as well
A recent study reported that around 10 million teenage boys and men in the United States are affected by eating disorders spanning bulimia nervosa, anorexia, and binge-eating disorder, to name a few. However, due in part to cultural bias and the double-edged stigma sword whereby men who struggle with eating disorders are said to have a feminine disease or one that’s attributed to stereotypes men may feel uncomfortable discussing, the under-diagnosis of eating disorders is somewhat endemic in nature in people of any age, regardless of sexual orientation.
We’re going to try and address this rather complex issue by shining a light on the most common eating disorder behaviours in men that contribute to the rising mental health conditions experienced by men and their family members.
What are eating disorders?
We’re sure you’ve heard the terms ‘anorexia’ and ‘bulimia’ flung around carelessly when growing up, but do you actually know the signs of an eating disorder in males are and what it means to suffer these conditions?
To keep it simple, picture your own eating habits. Do you overeat when stressed? Do you feel like you want to throw up when feeling anxious? Do you frequently pass by your mirror, glance at yourself, and then, for no reason, feel somewhat conscious about your wrongly perceived negative body image? For most of us, the answer to all of the above is yes.
Well for some men, the norm means that all of these feelings are significantly heightened. Certain masculine body ideals, such as having a physique equivalent to that of Mr Olympia, can encourage unhealthy behaviors that encourage overeating or even the use of steroids.
When “Working On Yourself” Becomes Something Else
There’s a newer version of this pressure that I’m seeing more of in my practice, and it usually doesn’t come in looking like an eating disorder at first. It comes in looking like discipline.
Online, it’s called looksmaxxing. The term covers everything from skincare and sleep habits to jawline exercises, supplement stacks, and in its more extreme corners, unsupervised hormone use and dangerous physical practices young men are trying on themselves. It’s framed as self-improvement, and on the surface, some of it is. But I want to name something plainly: when the goal shifts from feeling good in your body to hitting a number, a ratio, a score, that’s not fitness anymore. That’s the beginning of a clinical pattern with a name.
It’s called muscle dysmorphia, sometimes referred to as bigorexia. It’s a real, diagnosable condition, and it’s one of the areas I specialize in. The core feature isn’t vanity. It’s a distortion. A man with muscle dysmorphia can be objectively fit, even muscular by any outside measure, and still see himself as small, soft, unfinished. That distortion drives behavior the same way any eating disorder does: obsessive tracking, rigid food rules, compulsive exercise he can’t skip even when injured, and in some cases, steroid or peptide use that carries real medical risk.
What makes this particular moment different is how normal it’s been made to look. A generation of teenage boys and young men are being shown that constant self-measurement is just what self-improvement looks like now. Some of it is harmless. Some of it isn’t. The line between the two isn’t about which habits someone has. It’s about what happens underneath them, whether the mirror has started running the show.
If you’re a parent and something about this section sounds familiar, that’s worth paying attention to, not panicking over. And if you’re a man reading this and recognizing yourself, I want you to know this isn’t a discipline problem you haven’t solved yet. It’s a treatable condition, and it’s one I see men move through every day.
A Few Signs Worth Noticing
This isn’t a checklist for diagnosis. It’s a starting point for a conversation.
- Mirror-checking or photo-taking that’s frequent, ritualized, or seems to drive his mood
- Rigid rules around food or supplements that don’t bend, even for social situations
- Exercise that continues through injury, illness, or exhaustion, or visible distress when a workout is missed
- Comparing himself constantly to influencers, “before and after” content, or rating scales he’s found online
- Secrecy around supplements, hormones, or products he’s using
- A shift from “I want to feel strong” to “I’m not big enough yet,” no matter how his body actually looks
If several of these feel familiar, the next step isn’t a lecture. It’s a conversation, and if needed, an evaluation from someone who treats this specifically.
Likewise, other sport-specific body goals, such as maintaining a particular weight for a competitive division may lead to extreme dieting, which can be equally as dangerous as overeating.
For the most part, however, eating disorders, defined as the persistent disturbance in eating or related unhealthy behaviors that proportionally affect one’s health and well-being, stem from a variety of factors ranging from mental health to physical abuse. Some of the most common eating disorders in men are highlighted below.
Anorexia Nervosa
Around one in four people affected by anorexia nervosa are men. Contrary to the misconceptions of it being a ‘girl’s disease’, the DSM-V classification of anorexia nervosa is not gender specific and specifies that for diagnosis, the following criteria must be met:
- Consuming calories well below recommended limits to lower body weight
- Having a genuine phobia of gaining weight or behaviors that lead to weight gain
- Attributing weight as the primary factor that determines one’s perception in the eyes of others
- Intense fear of gaining weight
Bulima Nervosa
According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V), bulimia nervosa is a condition that causes an individual to engage in repeated episodes of binge eating (consuming large amounts of food in a short period of time), followed by the over-evaluation of their body weight and size.
Consequently, this promotes compulsory behaviors to prevent weight gain. These unhealthy behaviors to lower body weight include excessive exercise, self-induced vomiting, excessive use of laxatives, and fasting.
Binge Eating Disorder
Arguably the most common eating disorder in men is binge eating disorder, with men accounting for around 40% of cases. The struggle with binge-eating disorder relates closely to what’s perceived as the norm for many men, which in turn may mask the unhealthy behaviors from being recognized as symptoms of a mental health condition.
According to the National Eating Disorder Association, the following are symptoms of binge-eating disorder:
- Eating more quickly than normal
- Eating beyond your perceptions of being full
- A sense of loss of control over eating during the episode
- Overindulging in large quantities of food despite not being hungry
- Not eating with people due to the embarrassment of needing to consume a lot of food
- Overwhelming feelings of guilt, shame, and embarrassment that can lead to depression
Body Dysmorphic Disorder
Being preoccupied or distressed by the flaws you perceive in your own body is in itself a mental health condition known as body dysmorphic disorder. Living with body dysmorphic disorder can interfere with various aspects of your life, including your work life, social life, and overall well-being.
Body dysmorphic disorder is one of the least frequently diagnosed mental health conditions in men and is associated with suicidal contemplation, anxiety, and obsessive-compulsive disorder. However, men may often feel like they need to live up to various societal norms that affect different aspects of their bodies which can lead to the acquisition of sometimes-harmful ‘treatment’.
For instance, those who struggle with male pattern baldness may seek out conventional hair-gain methods that may not be approved. Others who live with muscle dysmorphia may turn to the use of steroids to satisfy their craved body image, and many who live in distress because of their height may put themselves through frankly outrageous procedures such as stature lengthening to give themselves a few inches in height.
What are the risk factors for eating disorders in men?
One of the greatest risk factors for eating disorders in all men engulfs each and every single one of us daily – social media. The ideal body often marketed to men as the most socially desired is typically a combination of cloud-like muscles and a six-pack of abs, despite the fact that a ‘chiseled’ physique is largely determined by genetics. The LGBTQ+ community face unique challenges that put them at greater risk for developing eating disorders as well.
Notwithstanding, eating disorders are complex and affect all kinds of people. The risk factors surrounding eating disorders in men don’t lie in a ‘one-size-fits-all’ approach, and instead involve a range of biological, physical, and sociocultural issues:
- Biological: having a close relative that has previously struggled or is struggling with an eating disorder, frequently dieting, and type-1 diabetes are all biological risk factors for eating disorders in men.
- Psychological: those who struggle with other mental health conditions and those who are perfectionists, believing that there is just one right way to do things to maintain unrealistically high standards can lead to eating disorders.
- Socio-cultural: Having limited social contact and facing the struggle with acculturation can lead to loneliness and isolation, both of which play a part in the development of eating disorders. Likewise having been bullied or teased about your weight when growing up and being confounded by the stigma surrounding weight in men can predispose said individuals to eating disorders.
The struggles men with eating disorders face
No thanks to outdated cultural misogyny and the taboo against men having anything ‘wrong’ with them that can be perceived as even remotely feminine, many men who struggle with eating disorders often keep their issues to themselves instead of reaching out for help. However, even when men do find the courage to speak out about their eating disorders, gender bias comes into play which can refrain some healthcare professionals from identifying an unhealthy relationship with food and prescribing appropriate treatment.
Consequently, the challenges in disclosing one’s eating disorder and the lack of visibility of eating disorders in men exacerbate and accentuate their symptoms, leading to a potentially fatal downward mental health spiral. In turn, no one talks about it, so no one learns about it, and so we’re stuck in this loop of unknowing that encircles the lives of many.
At Hilltop Behavioral Health we break the cycle and create a more balanced approach to overall well being. We are the only group practice that specializes in males who struggle and have the track record to prove it. Contact us to finally put an end to all of this.
Breaking the ‘silent fast’
Combined with the lack of knowledge about eating disorders and the uncultured attitude many still have towards this disease, men face a gigantic hurdle to finding the help they need to manage their symptoms. Vitally, it’s important to know that eating disorders are treatable, and that help is available for all men who face the struggles of any eating disorder.
