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Eating Disorders in Men: An Interview With Dr. Roberto Olivardia

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Dr. Roberto Olivardia is a clinical instructor of psychology at Harvard Medical School and assistant psychologist at McLean Hospital in Belmont, Mass. He maintains a private psychotherapy practice in Arlington, Mass., where he specializes in the treatment of body dysmorphic disorder (BDD), attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and compulsive skin-picking. He also specializes in the treatment of eating disorders in boys and men. Dr. Olivardia is a co-author of The Adonis Complex, a book which details the various manifestations of body image problems in men, including eating disorders, BDD, steroid use, and cosmetic surgery.

What inspired you to specialize in eating disorders in men?

When I was an undergraduate at Tufts University, I took a seminar in eating disorders class. For my paper, I wrote about men and realized there was a scarcity in the scientific literature. I knew guys with eating disorders, none of whom sought treatment due to shame. I felt it was important to fill that gap of knowledge.

What are the differences in eating disorders in men versus eating disorders in women?

For the most part, they are similar, but there are differences. Men with eating disorders tend to have a history of being overweight, or being the "chubby" kid. This is not the case typically for women with eating disorders. Men with anorexia are also more likely to carry an OCD diagnosis more often than women with anorexia. Bulimic men are less likely to use laxatives or diuretics and are more likely to use exercise as a method of purging, along with vomiting. I have also seen many men with eating disorders who also use anabolic steroids to cut fat and gain muscle.

Men with eating disorders have much shame around their eating disorder, feeling as if they are less masculine because of it. This results in men being less likely to ever seek treatment, or even tell anyone about their eating disorder.

Are men more likely to experience anorexia than bulimia, vice versa, or are they at equal risk?

Males with eating disorders are more likely going to fall in the categories of bulimia nervosa and binge eating disorder. This is not to say that men cannot have anorexia nervosa, but it is far less common than the other two eating disorders among men.

Have you seen an increase in eating disorders amongst men? If so, to what factors do you attribute this?

Eating disorders among males have dramatically increased since the 1980s. We live in a culture where media imagery is just as directed toward young men as it is toward young women. Walk into an Abercrombie and Fitch store, and you will know exactly what I am talking about. Fitness is also more important these days than it was 40 years ago, since obesity rates have also skyrocketed. We are also a more visual culture, starting with MTV in the 1980s to YouTube today. Therefore, many men are responding to the demands to look a certain way.

What are men's risk factors for developing an eating disorder?

Men who transition into puberty on the later side, as well as boys that find puberty and its demands (biologically, socially or sexually) overwhelming, are at higher risk for developing an eating disorder.

Personality characteristics such as perfectionism, high achievement orientation, and impulsivity are risk factors. Certain athletes are at risk, including wrestlers, dancers, and jockeys. Low self-esteem and assertiveness issues are common in men with eating disorders. Depression, OCD, and ADHD are also risk factors for eating disorders.

Is there a specific treatment modality or treatment center for eating disorders in men?

Eating disorders are complex and require a comprehensive treatment plan. Ideally, you want to create a treatment team composed of a psychologist, psychiatrist, family/couples therapist, nutritionist, and primary care physician. A combination of cognitive-behavioral and psychodynamic therapies are most effective. There are treatment centers that work with men. However, many eating disorder facilities do not accept males, leaving boys and men with less options.

What message would you like to send out to men who may be experiencing an eating disorder?

I want boys and men with eating disorders to know that they are truly not alone. There are millions of males who struggle silently with their body image. It is nothing to be ashamed of. Also, treatment works.

Do not let eating disorders destroy you. Get help from an eating disorder specialist, preferably one that has treated males before.

What resources are available for locating an eating disorder specialist?

Academy for Eating Disorders: Find a Professional web tool

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If you're struggling with an eating disorder, call the National Eating Disorders helpline at 1-800-931-2237.

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