- The Washington Times - Monday, September 13, 2004

Many celebrity watchers gasped at the sight of a gaunt Mary-Kate Olsen in the weeks before she checked into a clinic to treat an eating disorder this summer.

That sadness reminded fans of singer Karen Carpenter’s 1983 death from the same condition.

No high-profile male figure has admitted to an eating disorder, but that doesn’t mean millions of men aren’t suffering from these potentially deadly disorders.

Some eating-disorder experts estimate that one in every 10 patients is male, despite the lack of notoriety connecting men to the disorders.

Eating disorders break down into two main categories, anorexia nervosa and bulimia nervosa. The former involves self-starvation, while the latter finds the patient binge-eating, then purging.

Dr. Gary Litovitz, medical director of Dominion Hospital in Falls Church, says that for too long, doctors discarded the notion that men could suffer from eating disorders.

“If you see a man who’s underweight or preoccupied with his weight, most people don’t stop to think it’s an eating disorder,” Dr. Litovitz says. “That’s changing.”

Men and women share many similarities regarding eating disorders, he says. The emotional triggers typically differ.

“For men, it’s often an overconcern about health and fitness, particularly if a man had a father who died young of a heart attack. They might become obsessed with their health,” Dr. Litovitz says. “For women, it’s triggered more by appearance concerns or clothes concerns.”

Eating disorders cause a number of health complications, ranging from tooth decay and staining from the purging of stomach acids to muscle loss, fatigue, bone-density reduction and pancreatitis.

Female sufferers find their estrogen levels drop, while a man’s testosterone levels do the same.

More serious cases can lead to heart and gallbladder disease, high blood pressure and slower heart rates.

The more severe cases can prove fatal.

That makes diagnosing and treating the conditions in men all the more important. They aren’t always so eager to seek help, though.

“Men who have it are embarrassed or ashamed. This is a woman’s disease, they think,” Dr. Litovitz says.

New Jersey resident Tom Davis began experiencing bulimia as a college student but didn’t dream it could be a version of what Miss Carpenter had suffered.

Mr. Davis, now 37, recalls how obsessed he was with his waistline during his college days and how that obsession turned into bulimia.

A hard romantic breakup led to some stomach discomfort, which he treated by cutting down drastically on what he ate in hopes of curing it. He continued his running regimen and eventually began throwing up whenever he ate a large or calorie-laden meal.

The 6-foot-2-inch college student weighed 140 pounds at his lightest.

“I lost about 60 pounds in two or three months,” Mr. Davis says.

“People around me were very concerned. I was wondering what was going on [too],” Mr. Davis says, adding that he was sure it wasn’t an eating disorder because he thought men never developed those conditions.

He eventually sought counseling, which led to healthier eating patterns.

Mr. Davis calls his condition “stable” but says that even recently, after a hearty Mexican dinner, a bulimic urge came to him.

Dr. David Herzog, president and founder of the Harvard Eating Disorders Center, says concerns about steroid abuses with athletes — particularly men and their body image — have helped nudge male eating disorders into the public discourse.

Some male patients may be dealing with conflicting thoughts on their sexuality, Dr. Herzog says.

In the homosexual community, “a very thin body image is valued,” he says.

The more pressing issue is that the disorders hit those who feel they don’t fit in with society, Dr. Herzog says.

There’s a core sense of inadequacy, a certain kind of a personality that tends to obsess and feel a loss of control, he says.

Dr. Angela Guarda, director of the Johns Hopkins Eating Disorders Unit in Baltimore, says few people recognized conditions like anorexia in either men or women 20 to 30 years ago.

Times change, and today some place the blame on a culture that increasingly asks men to be as well-groomed and idealized as their female counterparts.

It’s true that aesthetic conditioning doesn’t help matters, but men were suffering from these conditions long before the nation’s current “abs of steel” mind-set, Dr. Guarda says.

Plus, she argues, women have been exposed to perfectly imagined versions of themselves for decades but only about 1 percent develop eating disorders.

The endless search for the ideal diet is a fatter target for blame.

“Dieting is the entryway to most eating disorders. There’s more dieting in the culture right now,” Dr. Guarda says.

The personality traits of eating disorder patients often follow predictable patterns.

“Anorexics are introverted perfectionistic individuals. They did very well in school. … Suddenly they develop this disorder,” Dr. Guarda says.

An eating disorder, if treated properly, can be a manageable part of a person’s overall health.

Some eating-disorder patients relapse, but generally if a person has conquered his or her disorder for more than five years, the chances for such setbacks are slim, she says.

Dr. Guarda estimates about 30 percent of patients recover, while another 30 percent will suffer with it all their lives, elevating their mortality rates.

Barrie Seidman, a clinical social worker and therapist with George Washington University Medical Center, says men with the disorder often have the unhealthy pallor women take on with this condition.

“They tend to have negative reactions to their bodies, mostly from growing up. A lot of them were severely teased,” Ms. Seidman says.

Ms. Seidman says sports with a weight requirement or with a need for slim physiques — such as swimming, wrestling or crew — can foster eating disorders among players and those trying out for a team.

Squaring off against eating disorders isn’t a short-term fix.

“Eating disorders become a way of life,” Ms. Seidman says of her 26 years at the medical center. “I’ve seen people over the longer haul here. … They tend to be in therapy with me for a longer, not shorter, time.”

Alcoholics can put away the bottle. Drug addicts can never look at another pill. Eating-disorder patients face their nemesis three times a day.

Ms. Seidman says patients tell her “there isn’t a day that goes by they don’t think about this. We have to have a relationship to food, but how do you eat in a way that’s good for our body that isn’t obsessive in any one way, shape or form?”

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