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A brief overview of some challenges still present in the area Eating Disorders in males may introduce the Topical Collection devoted to this field.
Eating disorders (EDs) have long been considered female gender-bound disorders. This view, persistent over time, has led to a significant underestimation of EDs in males. As a result, they have not been adequately studied.
The first description of a case of “phthisis nervosa” in a man, with starvation and undernutrition related to a psychiatric disorder, is due to Sir Richard Morton (1637–1698), an English physician who, in 1689, described the 16-year-old son of a church minister suffering from “nervous consumption” [1].
Since then, however, research studies have focused mainly on the female gender, and the various editions of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM) have followed this perspective, making the study of male EDs more difficult.
In DSM-IV, diagnostic criteria were mostly tailored for the female gender. The introduction of the amenorrhea criterion has made it difficult to find a corresponding criterion in males (i.e., a low level of testosterone or decrease in the sexual drive) and downgraded many cases of male Anorexia Nervosa (AN) under the umbrella term Eating Disorders not otherwise specified (EDNOS) [2].
A substantial revision has resulted in more sex-neutral and more inclusive diagnostic criteria in DSM-5. In particular, the amenorrhea criterion has been removed, and the evaluation of significantly low body weight has become more flexible and is left to the appraisal of the clinician.
However, it remains uncertain the diagnosis of some atypical AN cases (women and men), normal-weight or overweight with severe anorexic features [3,4,5].
Many other difficulties persist in the study of male EDs leading to conflicting results or opinions. A short list of those is as follows:
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The small clinical samples and their heterogeneity [6].
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In the general population studies, instruments and designs are really different and poorly comparable [7].
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The frequent use of diagnostic tools (e.g., tests, questionnaires) tailored for females.
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The accurate prevalence and incidence of EDs in males are still questionable.
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The diagnostic delay linked to the stereotype of the EDs as a female disorder that has always caused difficulty in identifying male EDs.
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The inadequate training of the therapists and discomfort of male patients to turn to services oriented mainly toward the women [8, 9].
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Body Mass Index (BMI) as the primary diagnostic tool in AN to assess the severity of the clinical picture: in fact, BMI has revealed its great inadequacy in male AN, and this has stimulated the study of broader reference scores.
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The muscle ideal and the thin ideal sometimes coexist and take turns.
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Not only anorexia nervosa, bulimia nervosa, and binge eating disorder but also many other disordered eating behaviors (e.g., purging disorder, orthorexia nervosa, drunkorexia, food addiction) should be explored in men [10,11,12,13].
References
Morton R (1689) Phthisiologia seu Exercitationes de Phthisi. Tribus Libris Comprehensae London Smith, London
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Valente S, Di Girolamo G, Forlani M, Biondini A, Scudellari P, De Ronchi D, Atti AR (2017) Sex-specific issues in eating disorders: a clinical and psychopathological investigation. Eat Weight Disord 22(4):707–715. https://doi.org/10.1007/s40519-017-0432-7
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Manzato, E. Eating disorders and disordered eating behaviors in males: a challenging topic. Eat Weight Disord 24, 651–652 (2019). https://doi.org/10.1007/s40519-019-00711-x
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DOI: https://doi.org/10.1007/s40519-019-00711-x