Are Our Teenage Boys Suffering from a Silent Epidemic?

eating disorders males boys

Girls aren’t the only ones who struggle with eating disorders. (photo credit:

Many of those with eating disorders suffer in silence, afraid, ashamed, and unable to ask for help.   The National Association for Anorexia and Associated Disorders (ANAD) estimates that only 1 out of every 10 people with an eating disorder ever receive treatment which is more than tragic when you consider the dangers these disorders create.  And new research indicates that there may be more people with eating disorders suffering in silence than previous estimates indicated because the problem is affecting males more often than believed.

The study was conducted by a team of researchers from different medical institutions and was published in the JAMA Pediatrics journal.  The intent of the study was to determine if males who experienced disordered eating were more likely to experience other problems like depression and obesity over time.  The study ran from 1999 to 2011 and involved more than 5,000 teenage males from all over the country.

What the research team found may result in a broadening of how we think about disordered eating and the classification of different kinds of eating disorders that are more specific to males.   The current classifications which include Anorexia Nervosa, Bulimia, Binge Eating Disorder (BED), and Eating Disorder Not Otherwise Specified (EDNOS) are seen in both men and women, but are more likely to be seen in women whose primary concern is often thinness.  Because teenage males have different concerns about their body than teenage girls, males may exhibit different kinds of disordered behavior which is neither classified nor diagnosed.

It also showed that almost 20% of teenage males are extremely concerned about their body and that these teens are more likely than their peers to engage in dangerous behavior including the use of alcohol, drugs, and supplements.    Most experts agree that about 1 in every 10 people with an eating disorder is male but according to the study’s lead author, Alison Field, this ratio is likely much smaller because the current criteria for diagnosis center on symptoms displayed by women which are proving to be different than those experienced by men.

One of the primary differences between males and females with disordered eating highlighted in the study results is what each gender is trying to achieve.  For women, it is generally thinness which leads to disorders like Anorexia Nervosa which causes people to stop eating and Bulimia which results in a cycle of extreme overeating followed by purging.  For males, the focus is more on masculinity, on building musculature which leads to different behaviors.  For example, almost 8% of the study’s 16-22 year old participants admitted to using some form of supplement, growth hormone, or steroid in an effort to attain the desired result.  Field points out that this type of behavior may be the equivalent to the binging and purging seen in women who have bulimia.

The signs and symptoms of eating disorders in males are the same as those in females at this time, which means many males will remain undiagnosed.   Perhaps one of the most positive outcomes of this new study will be a change in how we think about disordered eating and men.


Eating Disorders and Depression

eating disorders depression

Do you know the connection between eating disorders and depression? (photo credit:

Although it isn’t clear exactly how eating disorders, like anorexia nervosa or bulimia, and depression are related, they often seem to go hand in hand.  While there is some scientific evidence that depression may increase the risk of developing an eating disorder, there is also evidence that the reverse can be true, that have an eating disorder can increase the risk of developing depression.

This link with depression seems to be apparent with the three primary eating disorders to varying degrees. With anorexia, in some circumstances the physiological changes resulting from the disorder can lead to depression.  In others, the underlying cause of the eating disorder may be depression and anxiety.   In those with binge eating disorder, the disorder itself can cause feelings of guilt and shame that impact self-esteem and can contribute to or worsen existing depression.

The signs of depression in people with eating disorders are the same as the signs for anyone with this condition including:

  • All encompassing feelings of sadness, hopelessness, and/or unhappiness
  • Losing interest in activities
  • Irritability
  • Quick temper
  • Difficulties sleeping
  • Changes to sleeping patterns or habit
  • Loss of appetite
  • Changes in eating habits
  • Suicidal thoughts or tendencies

Mental health providers use the same diagnostic tools for determining if someone with an eating disorder has depression as they would for any patient.  But when it comes to treating the two co-existing conditions, some challenges present themselves.

In order to be effective, a treatment approach for people that have an eating disorder and depression must address both disorders in order to be successful.  This is one of the reasons it is so important for people who are suffering from both to get both disorders diagnosed.  If treatment focuses solely on the eating disorder or solely on the depression, progress and remission are unlikely in most cases.

Depression and eating disorders are generally treated with anti-depressant medications, cognitive behavioral therapy(CBT), and/or education on healthy eating habits. Those with binge eating disorder may also be treated with an anticonvulsant medication that has proved to be effective at reducing binge episodes.   CBT is a common treatment option for depression but it is also proving to be very beneficial for those with anorexia, bulimia, and binge eating disorder.

The fastest results come when medication is used but a medication only approach carries a higher risk for relapse.  Those who are treated only with CBT are less likely to relapse but it takes time to see results.  However, when used together, these treatment options can help those with these conditions overcome both disorders.

Treating eating disorders with underlying depression is possible but for the greatest chance of success, all mental health conditions including depression, anxiety, etc. must be diagnosed and the treatment plan implemented must be tailored to the individual’s needs.

Strategies for Dealing with an Eating Disorder During the Holidays

eating disorder

Do you know how to navigate dealing with your teen’s eating disorder this holiday season? (photo credit:

The holiday season can be difficult for everyone.  There is so much going on, so many things to do, and so much stress it is a wonder any of us look forward to this time of year at all.  But if you are dealing with an eating disorder, this time of year can be even tougher.  The key to navigating the holiday season without getting knocked off track is to plan ahead and have strategies ready for the most likely stressors and difficult situations.  Here are some strategies you can use to maintain control and make it though the holiday season without having a meltdown.

1.     Plan Ahead for Success

One of the things about this time of year that can prove especially difficult for those with eating disorders is dealing with many events that seem focused on food and lots of people who are not part of their daily routine.  These two things individually or together can be overwhelming and many people struggle not to stray back into old unhealthy habits and thought patterns.  The best way to avoid this is to acknowledge the possibility of it happening and them make a plan of how to handle those feelings in a healthy way.

2.     Do What is Working

Another thing that can make the holidays season so challenging for those with eating disorders is that they buy into the idea that these special days have to be different than other days.  While that may be true in terms of the day’s activities or the people who will be involved in those activities, it doesn’t have to be true for everything.  If you have a meal plan that is working, stick to it.  If you have a routine that is working, stick to it.  The holidays don’t have to be different to be great.  If you need to alter family plans in order to stick to the things that are working for you, explain that to your family and ask them for support.

3.     Use Your Support System

Identify the people in your life that are acting as your everyday support system and work with them to determine how you can ensure support will be available throughout the holidays.  Let go of the idea that support has to be in person.  You can just as easily reach out for help over the phone or through email.  Knowing who is there to help you makes it much more likely that you will be willing to reach out for help when and if the time comes that it is needed.

4.     Know Your Triggers

Although it might seem as though food would be the most likely trigger, this isn’t always the case.  Those with eating disorders may also be triggered by emotional interactions, family members, or situations.  Understanding your triggers ahead of time will enable you to be aware of them if they happen and to know when to ask for help.

5.     Draw Your Boundaries

As part of identifying your triggers, you may realize that there are some situations or people with whom you cannot interact without being triggered.   In these cases, it is ok to set boundaries around who you will see, how you will spend your time, and what you are willing to tolerate.

How Can I Help My Self-harming Teenager?

self harm teenager

Do you know the warning signs that your teen is causing harm to themselves? (photo credit:

There is no question that parents often struggle to understand their teenagers but when it comes to things like cutting and self-harm, many parents are simply at a loss.  Although teenagers of every generation have struggled to deal with the onslaught of emotional, physical, and mental changes that are a part of the teen years, this way of dealing with that overwhelm is not something most parents today did or heard about when they were teens.  This inability to understand or relate to this type of behavior can make it very difficult for parents to provide the support and assistance their teens need in order to learn healthier ways to cope.  The first step toward helping a teen that is participating in self-harm is to understand what this behavior looks like and why it is happening.

Self-harming behavior is categorized as any behavior that results in deliberately inflicted injury on your body.  This can include things like cutting, scratching, hitting, head banging, skin piercing, biting, and intentional burning.  In most cases, teenagers are participating in self-harm as a way to cope with intense emotional distress that they don’t know how to handle.  Most teens who self-harm participate in more than one type of self-injury and most injuries occur on the arms, legs, and other parts of the front of the body.

Self- harm often offers an outlet for extreme emotions that cannot be expressed in another way.  It can also be a way to impose control on an otherwise out of control world.  It can be a cry for help or a tool for manipulation.  For some teens, self-harm is calming because it allows for the release of tension or pent up emotions.

Unlike some other mental health conditions, self-harm has no real cause although it can co-exist with other mental health problems like depression and eating disorders.  Although most people who engage in this type of activity are teenagers, people of all ages can use self-injury as a coping strategy for handling intense emotions.  Although there is no specific cause, there are some risk factors that can increase the likelihood that someone will use self-harm as a coping strategy.  Those factors include age as most people who self-harm are teenagers, mental health, and life experiences.  Teens who have been abused or neglected during their childhood or who have experienced a significant loss, like the death of a parent, are more likely than their peers to participate in self-harm.

If you suspect that a teenager in your life is participating in self-harming behavior, don’t wait to get them help.  Start by contacting their medical doctor or a mental health provider to discuss your concerns.  Ask that your teen be evaluated for self-harm and other potential mental health conditions.  Listen to your provider’s advice about next steps for diagnosis, treatment options, and other things you need to do to get your teen the help and support they need.

5 Signs Your Teen is Using Drugs

teens and drugs

Do you know how to tell if your teen is using drugs? (Photo Credit:

If there is one thing that happens in all teens it’s that once in awhile they can be moody and rebellious and it can feel like their personality is shifting from one person to another.  This can make if difficult for parents to see the signs that something is wrong.  But many teenagers who are struggling with mental health issues, eating disorders, or substance abuse problems need their parents to see that they are struggling so that they can get the help they need.

When it comes to the use and abuse of drugs, it is crucial that parents are able to recognize that there is a problem, identify the problem, and get their teen the help they need to get clean and get their lives back on track.

Know when to be worried, what to look for, what questions to ask, and when to step in by reviewing these common signs of teenage drug use and abuse.

1.     New Friends or No Friends

If your teenager suddenly stops hanging out with the people they have always spent time with, it is time to pay attention.  If your teen starts hanging around with a completely new set of friends, it is time to ask questions.  If your teen goes from having lots of friends to spending more time alone, there may be something going on.

2.     Hating School

If your typical A or B student suddenly starts bringing home D’s and F’s or your teen starts complaining about how much they hate school all the time, you should pay attention and try to determine what is going on.  If your teen starts skipping school, dropping out of sports or other activities, or develops a negative attitude towards all things related to school, they may be struggling and need your help.

3.     Privacy!

If your generally laid back teenager suddenly becomes very angry when you put her laundry away, there may be cause for concern.  While many teenagers go through phases of needing additional privacy during these years, anger can be a sign that they are hiding something serious, like drugs.

4.     Secretive

Similar to the adoption of stricter concerns about privacy, when teens start using drugs they can become more secretive about their lives, their whereabouts, who they are talking to, etc.  If your previously open and friendly teenager starts offering ambiguous answers and giving primarily vague responses, it may be time to find out why.

5.     Money

Another change that teenagers often exhibit when they become involved with drugs is an increase in the amount of money they need.  If your teen seems to be borrowing money all the time or keeps asking if there are ways to earn money working around the house, you need to understand why.

All of these signs may indicate a problem with drug use or may be just a normal shift in your teen’s behavior.  The key to knowing when to worry and when to step back is looking for other things in their lives that might be influencing their change in behavior.  For example, a bunch of new friends would be normal for a teen that just joined a new club or started playing a sport.  Watching for the signs, asking lots of questions, and listening to your parental instincts are the best things you can do to keep your kids safe.

Current Research Into Eating Disorders

Here are some quality resources for Eating Disorders. (Photo

Here are some quality resources for Eating Disorders. (Photo

Eating Attitudes and Concerns Research Study

This study is being conducted at Bowling Green State University and seeks to better understand the relationships between eating attitudes and concerns and performance on certain tasks related to vocabulary.  Women ages 18 and up are welcome to participate in the study and participation can be conducted completely online.  The study, which is completely anonymous, is expected to take between 20-40 minutes and volunteers will be entered in a drawing for one of 2 $50 gift cards from  To participate in the study, click here.

Brain Activity Study in Women with Bulimia

This study, conducted by researchers at Drexel University, seeks to better understand the differences in brain activity between women with bulimia and those who do not have the condition.  The study is open to right-handed women aged 18-45 who are being treated for binge eating and purging and can visit the research team in Philadelphia.  For more information and to see if you qualify for the study, contact Laura Berner or Alyssa Matteuccicall by phone at (215) 762-1850 or e-mail the research team at

Predictors of Anorexia Nervosa Preoccupation and Ritual Severity

This study is being conducted at Fordham University and seeks to learn more about the risk factors related to Anorexia Nervosa to better inform treatment providers.  In order to participate in the study, volunteers must be between the ages of 12 and 18 and must be currently receiving treatment for anorexia nervosa or have previously been professionally treated for the condition.  To participate, visit the survey here.

Eating Disorders Research Study

This study is being conducted at the Mount Sinai Eating and Weight Disorders Program and seeks to examine the differences in attention patterns, flexibility of thought, and problem solving styles between those with eating disorders and those who do not have these conditions.  Participants can be between the ages of 12 and 60 and will include those with eating disorders and those without.  In order to participate, volunteers will need to be able to visit the centers twice for 3-4 hours each.  For more information, contact Adrianne Flores at the Mount Sinai Eating and Weight Disorders Program at (212) 659- 8724 or

Anorexia Research Study

This study is also being conducted at Mount Sinai and seeks to determine if there is a relationship between the level of sex hormones in adolescents and young adults and the presence of obsessive/compulsive disorders like Anorexia Nervosa.  Participants must be female between the ages of 12 and 22, cannot be diagnosed with Anorexia Nervosa, and must be available for two in-person visits lasting about 2 hours each.  For more information, contact Adrianne Flores at (212)659-8724 or by email at

Family-Based Treatment for Anorexia Study

This study, being conducted at the University of Iowa, seeks to investigate the differing experiences of parents who have participated in family-based treatment programs for Anorexia Nervosa.  The research team is looking for 25 parents who had a child between the ages of 10 and 18 who previously participated in family based treatment.   Participants do not need to be local to the University to participate.  For more information, contact Joanna Wiese a 563-676-2500 or

Signs Someone You Love is Struggling with Anorexia

If you suspect someone you know may suffer from anorexia, check out these warning signs (photo credit:

If you suspect someone you know may suffer from anorexia, check out these warning signs (photo credit:

When a person has anorexia nervosa, they are starving themselves and not providing their body with the basic nutrients and calories needed for survival.  When this happens for an extended period of time, the body takes drastic action to conserve energy and preserve life.  Unfortunately, these defensive mechanisms can have very serious long-term health consequences.   The challenge for parents, teachers, coaches, and teens is to know when someone they care about is in trouble so that help and support can be provided in an effort to avoid these negative consequences.  While the main sign that someone is struggling with anorexia is their appearance, there are other signs that can be seen before the disorder progresses to the point that it is visibly noticeable.

1.     Dramatic Weight Loss

One sign that someone you love may be in trouble would be a dramatic reduction in weight within a relatively short period of time.  Healthy weight loss for those who are overweight is generally considered to be 1-2 pounds per week.  If someone is losing significantly more than that, they may be struggling with anorexia or another eating disorder.

2.     Obsession with Food

Many people with eating disorders exhibit a preoccupation or type of obsession with food.  This can include obsessively weighing everything before it is eaten, fanatically tracking weight, food, calories, fat, or other related information, or going on extreme diets. Other signs of food obsession can also include collecting recipes, watching TV cooking shows, and looking at internet food sites.

3.     Distorted Body Image

It is not uncommon for people with anorexia to have a distorted image of what their body looks like.  This can result in very thin people complaining about being fat or obsessively talking about the need to lose weight no matter how much weight they lose.  While it may seem like a strategy to get attention, in many cases the image the person sees when they look in the mirror does not match the reality.

4.     Unusual Eating Habits

Some people with anorexia exhibit unusual eating habits.  This can include things like avoiding entire food groups, eating food in a certain order, denying that they are hungry, and excessive chewing.  People who avoid eating any of their meals with other people or who participate in meals but don’t really eat anything are also exhibiting unusual eating habits consistent with anorexia.

5.     Obsessive Exercise

When people with anorexia do allow themselves to take in some food, they can become obsessed with burning off those calories as soon as they eat them.  People who have become obsessive about exercise as part of their anorexia will be rigid in their adherence to their workout routine.  They will exercise regardless of weather, illness, or injury.  The need to rid themselves of the calories they have taken in can be more important than anything else.

6.     Social Withdrawal

Another behavior that many people with eating disorders like anorexia display is social withdrawal.  They may stop participating in activities they previously enjoyed or stop spending time with friends or loved ones.

Anorexia is a serious eating disorder that can lead to long-term health consequences and even death.  If you suspect someone in your life is suffering from anorexia, reach out and get them the support they need.


Related articles


Doorways Now Accepting New Patients in Intensive Outpatient Programs

A Note from Jan, Founder of Doorways:


I am excited to let you know that we are now accepting new patients for our Intensive Outpatient Programs at Doorways!

These programs are highly successful as they offer an intensive, therapeutic approach to meet the individual’s needs.

We are also contracted with Blue Cross Blue Shield and United Behavioral Healthcare for our IOP’s. 

If you know anyone who may benefit from one of our specialty IOP programs listed below or would like to register, please give us a call at (602) 997-2880. We would love to help!


Eating Disorder Resources

National Eating Disorder Resources (photo credit:

National Eating Disorder Resources (photo credit:

Trusted information for parents and teens who are dealing with eating disorders.

General Eating Disorder Resources

  • National Eating Disorders Association (NEDA) – The National Eating Disorders Association (NEDA) is the leading non-profit organization in the United States advocating on behalf of and supporting individuals and families affected by eating disorders. Reaching millions every year, we campaign for prevention, improved access to quality treatment, and increased research funding to better understand and treat eating disorders. We work with partners and volunteers to develop programs and tools to help everyone who seeks assistance.
  • National Association of Anorexia and Related Disorders  – “The National Association of Anorexia Nervosa and Associated Disorders, Inc. is a non-profit (501 c 3) corporation that seeks to prevent and alleviate the problems of eating disorders, especially including anorexia nervosa, bulimia nervosa and binge eating disorder.  ANAD advocates for the development of healthy attitudes, bodies, and behaviors.   ANAD promotes eating disorder awareness, prevention and recovery through supporting, educating, and connecting individuals, families and professionals.”
  • National Institutes of Mental Health, Eating Disorders – Publication of the National Institutes of Mental Health providing an overview of eating disorders and links to other government resources.
  • National Alliance on Mental Illness (NAMI), Eating Disorders – “NAMI is the National Alliance on Mental Illness, the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services, treatment, supports and research and is steadfast in its commitment to raise awareness and build a community for hope for all of those in need.  NAMI is the foundation for hundreds of NAMI State Organizations, NAMI Affiliates and volunteer leaders who work in local communities across the country to raise awareness and provide essential and free education, advocacy and support group programs.”
  • Binge Eating Disorder Association – “Founded in 2008, the Binge Eating Disorder Association (BEDA) is a national organization focused on providing leadership, recognition, prevention, and treatment of BED and associated weight stigma. Through outreach, education and advocacy, BEDA will facilitate increased awareness and proper diagnosis of BED, and promote excellence in care for those who live with, and those who treat, binge eating disorder and its associated conditions. BEDA is committed to promoting cultural acceptance of, and respect for, the natural diversity of sizes, as well as promoting a goal of improved health, which may or may not include weight change.”
  • Finding Balance  – Finding Balance is the world’s largest media-based resource for people seeking balance with food and body image.
  • International Association of Eating Disorders Professionals Foundation (IAEDP) –  recognized for its excellence in providing first-quality education and high-level training standards to an international multidisciplinary group of various healthcare treatment providers and helping professions, who treat the full spectrum of eating disorder problems.


Anorexia Nervosa

  • Anorexia Nervosa, NEDA – Overview, symptoms, warning signs, health consequences, and statistics.
  • Anorexia Nervosa, Mayo Clinic – Overview, signs, symptoms, treatment, and prognosis information
  • Anorexia Nervosa, ANAD – Overview, signs, and symptoms.
  • Anorexia Nervosa,  – Provides in-depth information on the illness, causes, signs, symptoms, and treatments.

Bulimia Nervosa

  • Bulimia Nervosa, NEDA  – Overview, symptoms, warning signs, health consequences, and statistics.
  • Bulimia Nervosa Fact Sheet, Office on Women’s Health, U.S. Department of Health and Human Services – Overview, profile, causes, prognosis, affect on pregnancy, and ways to help.
  • Bulimia Nervosa, Mayo Clinic  – Overview, signs, symptoms, treatment, and prognosis information
  • Bulimia Nervosa, Medline Plus from the National Institutes of Health – Overview, signs, symptoms, diagnosis, treatment, prognosis, and complications.


Binge Eating Disorder (BED)

  • Binge Eating Disorder, NEDA – Overview, symptoms, warning signs, health consequences, and statistics.
  • Binge Eating Disorder, Mayo Clinic  – Overview, signs, symptoms, treatment, and prognosis information
  • Understanding BED, Binge Eating Disorder Association  – Characteristics, causes, symptoms, complications, treatment, and prognosis


Eating Disorder Not Otherwise Specified (EDNOS)

  • EDNOS, NEDA – Overview, symptoms of anorexia and bulimia, examples of EDNOS.
  • EDNOS, NAMI – Overviews, signs, causes, treatment, and prevention information.

Family Counseling Provides a Foundation

Kids from military families enjoy Teen Wildern...

Even though one person in the family may be struggling with a disorder, the whole family is affected and must work together towards health. (Photo credit: Virginia Guard Public Affairs)

When we first work with a new client, one of our goals is to find the right program to help that person overcome whatever obstacles they are facing.  In many cases, our work with teenagers leads to a recommendation that some form of family counseling be incorporated into the program.  When this recommendation is made, one of the most common questions other family members have is why they need to participate when they are not the one with the problem.  This is completely understandable, especially in circumstances where the client’s problems have already caused hardship or dysfunction within the family.  Siblings and even parents can struggle to understand why they have to disrupt their lives when they are not the one causing or having the problem in the first place.

We find that in families where this happens, where there is ambivalence or animosity towards the client by other family members, family counseling is almost always needed.  To understand why it is so crucial, it helps to understand what family counseling can do for families, even when they are not in crisis.  The simple fact is that all the members in the family are responsible for creating the dynamic within the family and when one of those members is dysfunctional, the family dynamic will most likely be too.  Teens who are victims of abuse, neglect, or trauma may be experiencing symptoms that impact the family.  Mental health conditions and eating disorders may only be experienced by one person, but they effect the whole family.  Regardless of where the dysfunction originates, the family is being affected and in order to repair the dysfunction, the family has to work together.

To illustrate this point, let’s look at a tale of two teenagers.  One is a popular, athletic, friendly senior who is on the wrestling team and appears to be heading toward a bright future.  The other is a nice, pretty, well-liked freshman with perfect grades and a penchant for science.  On the surface, these two teens seem to be well-adjusted and highly functional.  But follow them home and you will find that the senior boy is struggling with an eating disorder.  His obsession with his weight causes strife within the family around meal-times.  He works out for hours each day and suffers from mood swings.  At school, he can put up a front but at home he can’t.  His sister resents him because his obsession and subsequent obsession means he gets more attention from their parents.  His behaviors impact almost every interaction between all the family members.  She is also stressed out underneath because she feels like she has to keep his secret at school and that is very wearing.  Even though he is the one with the eating disorder, everyone in the family is being affected which means everyone needs to participate in order to overcome the current challenges.

Family counseling provides the foundation on which successful recoveries from eating disorders, substance abuse problems, and other dysfunction corrections happen.  Families and individuals are the most successful when the members of the unit pull together to solve their common problems regardless of where those problems are coming from.  This is why it is so critical for all family members to participate when this kind of therapy is recommended as part of a client’s program.