Bulimia nervosa: Gender and Stigma

Without taking gender into account, people with eating disorders experience extensive stigma (O’Connor et al., 2019), from a discredited social identity to internalized issues with self esteem. Specifically with Bulimia, stigma can stem from the compensatory behaviors that follow periods of binge-eating. When examining gender and Bulimia, stigma only grows as eating disorders are often considered to be a female mental illness and not something that men can also suffer from. Studies have found that stigma around Bulimia nervosa is highest among those who identify as male. In addition to a difference in stigma in regards to Bulimia, different genders have differing patterns in symptoms and dissatisfaction in their body.

In 2003, the National Institute of Mental Health found that females have a five times higher prevalence of Bulimia than males (NIMH, 2017). However, there are a few explanations for this. Eating disorders in males could potentially be under-diagnosed as they may be less likely to “seek medical advice for a condition that is considered a “female mental illness”” (Støving et al., 2011, p. 362). The stigma surrounding men and Bulimia may be too strong to even seek treatment or ask for help. This way of thinking can be highly problematic, as the statistics show that bulimia is not just a “female mental illness” and affects people of all gender identities.

As explained in a previous blog post, Bulimia nervosa is rooted in a deep fear of fatness. In order to achieve their ideal body type, a body devoid fat, people with Bulimia perform compensatory behaviors. Although there is a similar level of body dissatisfaction among both males and females, empirical data has found that for males, both thinness and muscularity are driving factors of Bulimia (Strobel et al., 2019) whereas females strictly want to be thinner. When thinking about Western society, these standards that people with Bulimia place on themselves are in line with what the “perfect” body is in popular culture. One limitation in these claims is that there are few studies that examine Bulimia in non-Western contexts. It is important to think about the Western-centric view of ideal body types that many people in the studies mentioned in this post are holding. While the evidence presented in this blog post focuses mainly on people from the United States, it would be interesting to see how the ideal body type in other cultures influences Bulimia nervosa.

Aside from body dissatisfaction, genders view eating disorders, specifically Bulimia, differently. Men consider Bulimia nervosa to be less serious than women do, as well as are more likely to think that recovery is easier (McLean, 2014). These assumptions directly contribute to the stigma around Bulimia, specifically the stigma that those who identify as male feel when they themselves are suffering from Bulimia nervosa. When thinking that Bulimia is easy to recover from, they diminish the seriousness of the disorder and minimize the lived experience of the disorder. All of this ties back to the idea that eating disorders are female mental illnesses. This type of thinking is dangerous, as it not only eliminates the lived experience of so many people suffering from Bulimia, but can also cause males with Bulimia to feel shame and be less likely to seek treatment.

Overall, Bulimia nervosa is a complex eating disorder that can affect anyone, regardless of age or gender. When examining Bulimia and gender, it is important to take into account the role that stigma plays, from diagnosis to motivation. In order to fight the stigma that those who identify as male feel in particular, we as a society must work to actively normalize that they are not immune to eating disorders and that eating disorders are not a strictly “female” mental illness.

References

McLean, S. A., Paxton, S. J., Massey, R., Hay, P. J., Mond, J. M., & Rodgers, B. (2014). Stigmatizing attitudes and beliefs about bulimia nervosa: Gender, age, education and income variability in a community sample. International Journal of Eating Disorders, 47(4), 353–361.

NIMH » Eating Disorders. (2017, November). https://www.nimh.nih.gov/health/statistics/eating-disorders.shtml#part_155059

O’Connor, C., McNamara, N., O’Hara, L., McNicholas, M., & McNicholas, F. (2019). How do people with eating disorders experience the stigma associated with their condition? A mixed-methods systematic review. Journal of Mental Health, 0(0), 1–16. 

Støving, R. K., Andries, A., Brixen, K., Bilenberg, N., & Hørder, K. (2011). Gender differences in outcome of eating disorders: A retrospective cohort study. Psychiatry Research, 186(2–3), 362–366.Strobel, C., Quadflieg, N., Naab, S., Voderholzer, U., & Fichter, M. M. (2019). Long-term outcomes in treated males with anorexia nervosa and bulimia nervosa—A prospective, gender-matched study. International Journal of Eating Disorders, 52(12), 1353–1364.

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