Clinical presentation of eating disorders in young males at a tertiary setting

Abstract

BackgroundYoung males with eating disorders are a neglected study population in eating disorders. The aim of this study was to provide knowledge about the clinical presentation of eating disorders in young males.MethodsThe data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project (N ~ 1000), a prospective, ongoing registry comprising consecutive paediatric (<18 years) tertiary eating disorder referrals. Young males with DSM-5 eating disorders (n = 53) were compared with young females with eating disorders (n = 704).ResultsThere was no significant difference in the prevalence of diagnosis of bulimia nervosa (2 % vs 11 %, p = 0.26) among sexes. Males had comparable duration of illness (9 months; p = 0.28) and a significantly earlier age of onset (M = 12 years; p <0.001). Shape concern (2.39 vs 3.57, p <0.001) and weight concern (1.97 vs 3.09, p <0.001) were lower in males, and body mass index z score (−1.61 vs −1.42, p = 0.29) and medical compromise (odds ratio [OR] = 0.64, 95 % CI: 0.36, 1.12) were comparable. Males had a two-folder higher odds of being diagnosed with unspecified feeding or eating disorders (40 % vs 22 % for females, p = 0.004). Driven exercise to control weight and shape was common and comparable in prevalence among males and females (51 % vs 47 %, p = 0.79) and males were less likely to present with self-induced vomiting (OR = 0.23, 95 % CI: 0.09, 0.59).ConclusionBoys with eating disorders are an understudied group with similarities and differences in clinical presentation from girls with eating disorders. Parents and physicians are encouraged to consider changes in weight, disturbed vital signs, and driven, frequent exercise for the purposes of controlling weight or shape, as possible signs of eating disorders among male children. Diagnostic classification, assessment instruments, conceptualisation, and treatment methods need to be refined to improve application to young males.

Eating disorders—Related hospitalizations in Portugal: A nationwide study from 2000 to 2014

“…The majority of EDs affect mainly females, with few studies examining clinical presentation among males (Shu et al, 2015). Peak onset age of EDs is 19-20 years in AN and 16-20 years in BN (Horney, Stice, & Rohde, 2015).…”

Eating disorders in biological males: clinical presentation and consideration of sex differences in a pediatric sample

“…Several studies suggest no sex differences in admission age (e.g., [ 15 , 20 – 25 ]), while one study with an adolescent sample reported females were older than males [ 26 ]. Adult males have been reported to have a later age of onset [ 16 , 27 ], whereas studies with adolescent samples report a younger age of onset in males [ 26 , 28 ]. Across studies, some conflicting findings between the pediatric and adult literature have therefore emerged with respect to age at admission and age of onset.…”

“…Across studies, some conflicting findings between the pediatric and adult literature have therefore emerged with respect to age at admission and age of onset. With the exception of the two studies on sex differences in adolescents [ 26 , 28 ] all studies were conducted prior to the publication of the 5th edition of the Diagnostic and Statistical Manual (DSM-5) [ 29 ] and therefore do not consider sex or age-related differences in the prevalence of avoidant/restrictive food intake disorder (ARFID). Some of the inconsistencies across the literature can potentially be attributed to low power due to small sample sizes; however, there are a growing number of large studies (sample sizes greater than 50 males; (e.g., [ 20 – 23 , 26 , 28 ]).…”

“…Further discrepancies in the literature arise when considering eating disorder diagnostic presentation. Some researchers have reported no sex differences in eating disorder diagnostic categories [ 22 , 24 ], while others have reported that males are less likely than are females to present with a diagnosis of AN or BN or more likely to present with an atypical or other eating disorder (e.g., [ 26 , 28 ]). Children and adolescents who were diagnosed with ARFID were also more likely to be male in comparison to those diagnosed with AN or BN [ 30 ].…”

Short‐Term Treatment Outcomes and Dropout Risk in Men and Women with Eating Disorders

“…Regarding personality traits, several studies have revealed lower levels of harm avoidance, reward dependence, cooperativeness and higher scores in novelty seeking in men with ED than women with the same disorder (Fernández-Aranda et al, 2004;Núñez-Navarro et al, 2012;Woodside et al, 2004). Men with ED also show less concern about weight and body concerns (Núñez-Navarro et al, 2012;Shingleton, Thompson-Brenner, Thompson, Pratt, & Franko, 2015;Shu et al, 2015), as well as greater general psychopathology (Weltzin et al, 2005). However, these characteristics may be reflective of sociocultural gender differences, as these differential patterns are similar to those described between men and women in healthy, non-ED populations (Fernández-Aranda & Jiménez-Murcia, 2014;Núñez-Navarro et al, 2012).…”