Eating disorders: Not just the girls | Annabel Cuff

Annabel Cuff, Research Support Officer II, Faculty for Social Wellbeing

Eating disorders (EDs) are psychological disturbances that seriously endanger sufferers’ health and have hugely adverse effects on their psycho-social functioning.

Although most of the negative effects of EDs can be reversed, especially if the illness is caught early, these disorders greatly impact the life of sufferers and are more widespread than we would like to acknowledge.

The most commonly-known EDs are Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. More recently Avoidant/Restrictive Food Intake Disorder has also become increasingly recognized and prevalent.

However, there are also sub-clinical and a-typical manifestations of these EDs that may be more common in the general population and less recognizable, as there is not the whole range of symptoms of a full-blown ED.

Until quite recently it was commonplace to view EDs as mainly affecting young females, particularly those coming from the middle and upper classes.

Research however has shown us that they are far more widespread and do not distinguish by race, religion or ethnicity, much less gender or socio-economic background.

EDs devastate the lives of males, middle-aged women, LGBT+ persons and ethnic minorities, as well as younger women, although the latter remain the most at-risk population. What the other demographics have in common however, is that they are less likely to get diagnosed, tests designed to pick up eating disorders are not devised with these alternative sufferers in mind, and because of this EDs are often overlooked in these populations.

The recognition that males make up about a quarter of eating disorder patients has led to increased study of how these disorders manifest in males.

It has become recognised that males often over-exercise rather than restrict eating, that the main aim is to gain muscularity rather than slim down, although both are body-image issues. Since much of the research of EDs is about how they manifest in women, the ways in which male pathways differ from female ED pathways are not fully recognised and bear further investigation.

Likewise, as EDs were historically seem as primary relating to young females, the ways in which EDs manifest and develop in older women and even older men are not fully known.

It is thought that transitional life-phases such as menopause are times of vulnerability, similar to puberty. Since little is known about EDs in older persons, this may hinder recognition and treatment, allowing the disorder to take greater hold, making the effects more severe.

Similarly, little is known and very little research done about EDs in ethnic minorities and members of the LGBT+ community, yet we know that they are also prevalent in these communities.

With atypical demographics, there are issues of delayed recognition, the shame and stigma surrounding EDs are even more pronounced in these communities, and there is a lack of support aimed specifically at these communities, so treatment and healing are delay and suffers may to plough on either oblivious to their disorder, or unaware of how to reach out for help.

In 2020 the Faculty for Social Wellbeing, together with Dar Kenn għal Saħħtek,  undertook a nationally-representative study to examine the prevalence of eating disorders in young people in Malta aged 10-16.

The findings were surprising, in that although the study revealed that the majority of young people do not have an eating disorder, it was discovered that for this age group, the number of affected males nearly equals that of females.

This study was important as it raised awareness and hopefully recognition of eating disorders in young males as well as females. It was a step in acknowledging the difficulties faced by our communities and using empirical evidence to take steps towards putting in place the necessary infrastructure.

We would like to see more studies about EDs in all sorts of manifestations, so that persons suffering from these disorders can seek and find the help they need.