9 Eating Disorder Treatment: A Person-Centered Approach for Men – Gracie Milders

The assumption that perpetuates current treatment programs of eating disorders is largely based on the contingency of women. Eating disorders in men are often overlooked or underrepresented due to the prevailing belief of problematic eating behaviors as a women’s issue. Bunnell (2016) suggests, prior to presenting his study on emotional transference within treatment, “Gender is an important factor in conferring risk for development of an ED; being female clearly increases that risk” (p. 99). Due to the inherent nature of eating disorders being difficult to treat, treatment strategies aim to meet a certain set of patient objectives based on the majority of those inflicted: women. This premise of the eating disorder experience as exclusive to women by clinicians contributes to the effectiveness and engagement of treatment with men, or the lack thereof. Due to the preponderance of females in this area, the basis of eating disorder epidemiology has its core in the women’s experience. The general medical conception suggests identification of eating disorders based on the diagnostic criteria of amenorrhea; a symptom held solely by women. This female-based identification is perpetuated by the characterization of low BMI and the preoccupation of thinness (Harvey & Robinson, 2003, p. 300). This criterion maintains the clear deficiency in the treatment of men.  Biases about the role of gender provide for the shortage of clinical programs designed to treat men. However, there are many more men being diagnosed with eating disorders than previously suspected; Bunnell (2016) tenders nearly a quarter of those diagnosed identify as male. Through the following paper a person-centered approach will be illuminated to express the way in which gender influences the expression and treatment of eating disorders. The nuances of gender socialization, with close attention to the psychopathology of men enhances treatment receptivity.

Men have routinely been misrepresented in the eating disorder standard because of the criteria and belief that they are not victims. This stigma of shame that surrounds men seeking help is a direct precursor of their underdiagnosis, creating an apparent blind spot in the treatment process. As stated, current examinations have been normed on the female population. However, new trends of masculinities overarching role in the male eating disorder occurrence highlights a framework for how gender role conflict must be addressed in identification and treatment for the entirety of this illness. Conformity to societal masculine gender socialization is the direct cause of male body dissatisfaction and, in turn transpires as disordered eating. The central themes for men with these inflictions are the fear of softness and lack of muscle. Therefore, muscularity is the very way the masculine identity is achieved (Bunnell, 2016, pp. 99-101). This transparence of behaviors through the male motivation of the V-shaped ideal becomes the problematic means of achieving this muscular look. Harvey and Robinson (2003) point to the pursuit of the “perfect” male body image lying in contradictory gender role expectations. The innate strive for muscularity comes from the societal expectation of denying womanliness, which perpetuates opposing conceptualizations of masculinity and femineity.

Subsequently, it is important to review the understanding of body dysmorphia’s inherent role in the muscle-bound image, and further how that defines the eating disorder experience in men. Affirmed in the research of “Eating Disorders in Men: Current Considerations” muscle dysmorphia is the key proponent defining male dissatisfaction “Men tend to have an increased difference between the level of muscularity that they perceive themselves to have and the level where they would ideally like to be” (Harvey & Robinson, 2003, p. 299). Rather than a preoccupation with thinness, men often express their weight as acceptable. This is in a direct contrast to the women’s core belief of being overweight, and as a result strive to be thinner through disordered behaviors. Due to this, the new approach of recognizing eating disorders in men is to first look at signs of body dysmorphia. Therefore, it is more meaningful to evaluate body percent fat, rather than just strictly assessing on body weight. It is only after the recognition of emasculation and the role of control associated with male eating disorders, that meaningful treatment can be constructed based on the unique factor gender plays.

Gender informed interventions for group treatment to increase the individual awareness of challenges imposed by the societal concepts of masculinity and femineity serve to enrich the mutuality of the eating disorder experience. This guidance creates a space that fulfills the two main proponents in making treatment successful for men: an environment that feels welcoming and the assurance of not being shamed. Eating disorders characteristically are isolating; they emerge and maintain a disconnect from oneself and others. Value comes from the outside in by displacing emotions and conflict onto food and body to resolve them. By altering internal and external image this creates disconnect from the value of outside relationships. By establishing a person-centered approach through same-gender therapy, clinicians develop a group treatment unique to offer relational opportunities to decrease these disconnects (Thapliyal et al., 2020, pp. 542-543). In turn, the discourse mandatory in reestablishing mutual connections to navigate negative behavior and reach recovery has been negotiated.

Acknowledging the symptoms unique to the experiences of men will support the translation into treatment centered in delivery that provides success on gender lines. Male-oriented care, such as single gender group therapy, eliminates the minimization and invalidation of treatment as asserted in Thapliyal’s (2020) exploratory study “For Roger, being in a group that included men ameliorated a sense of isolation and provided a supportive context for him to engage in the therapeutic work in his treatment plan” (p. 540).  Men already present a risk for denying emotion as prescribed by the tradition of gender socialization. In response, a group of mixed gender should contain at least two men to facilitate mutual support in learning to provide connections. Through addressing underlying gender oppressions, “Men argued for the importance of feeling accepted by others in the ED experience for themselves and also for others who are struggling with similar problems” the shame of masculine discourse that positions those seeking help as weak is reframed (Thapliyal et al., 2020, p. 542). The stigma that challenges men’s identities in recognizing their ED experience is reduced through highlighting the difficulties as a shared experience rather than one from within. Redefining masculinity in the treatment setting to be more empathetic benefits therapeutic experience in the male willingness to recognize emotion.

Redefining an empathetic and connected sense of masculinity acknowledges the toxic role of shame in the male gender-socialization. By teaching the value of vulnerability within connections with others reduces the underlying problem of isolation faced in male treatment. According to Bunnell (2016), “Conventional masculine norms discourage emotionality and relational intimacy” shifting focus to the recognition and reaction of the male’s emotion is critical (p. 103). Providing male to male emotional closeness in a group setting allows men to maintain individuality and masculinity, whilst simultaneously providing in outlet to assist with identification of their shared feelings that perpetuate their disorders. Exploration of gender socializations potential to create shame reactions is key to the recognition of cognition over emotion that is effective in treating men.

The overt bias towards a female-based approach to eating disorders is not a new concept, but rather a phenomenon throughout the medical epidemiology community. Upheld by Bunnell’s (2016) study, “The motivations, beliefs, vulnerabilities, and developmental factors that cause and perpetuate eating disorders in men are often gendered” (p.99). The conformity to one treatment of eating disorders, with set objectives based on the majority occurrence in gender acts as just one feasible example belying the greater theme of gender socializations impact in the medical field. The oversimplification of vulnerabilities that lead to the development of health issues based on gender norms presents in the invisibility of men struggling with these eating disorder illnesses. Construction of treatment based on inherent gender norms is the cornerstone to the bigger problem of discernment of men’s experience with an eating disorder; experiences are minimized if they do not reflect traditional female symptoms. Male symptomology is minimized, in turn merging with the conceptualization of the male experience as non-problematic, reflecting in male experience defined as separate from eating disorder discourse” (Thapliyal et al., 2020, p.537). Clinicians are less familiar with the ways in which masculinity shapes the expression of eating disorders; this is also present in the way clinicians lack to recognize how femineity influences male majority inflictions like heart attacks. Gender affects the psychotherapeutic experience of medical ailments through implicit and explicit biases, but this can be eliminated through the integration of the person-centered approach tendered through this paper.

Regarding treatment, the recognition of symptoms as unique to a person and translating this knowledge into unique treatment delivery provides a capacity for effective treatment for men, in addition to women. By synthesizing the role of gender in treatment processes alongside the uniqueness of the individual establishes the usefulness of program specialization. With person-centered “ED treatment interventions that are tailored and based on men’s personal choices and preferences” the disconnects that fuel eating disorders are approached (Thapliyal et al., 2020, p. 543). The highly diverse nature of the eating disorder community cannot be compromised, therefore an increase in gender-informed approaches is needed. In negating the stigma of the ED as a women’s experience via highlighting the importance of person-centered treatment; an increase in awareness of the development of interventions tailored for men results in greater positive outcomes. Through clinicians formulating the epidemiology of programs based on both genders, the understanding of context in self and mutual connections will promote the identification of disconnects that are rooted in the oppression of gender socialization (Bunnell, 2016, pp. 103-104). Not only allowing for a space for a more empathetic sense of masculinity, but additionally to empower women’s femineity.

Traditional gender socialization contributes to the disconnect of self that leads to the maintenance of eating disorders in both genders; in turn furthering the disparity in treatment of men who account for a larger number of diagnosed than previously thought. Current diagnosis and treatment by clinicians fail to represent the inherent role of gender and ignores male psychopathology. The themes of minimization of symptoms and lack of understanding proliferate the whole community due to the nature of eating disorders. However, the male struggle is exacerbated through the construction of these illnesses as a problem of women, especially with the role of masculinity at play. As eating disorders are highly variable and unique in themselves, specialization in treatment is needed. Through following a person-centered approach, not only will the effectiveness of treatment in men be enhanced, but also lead to gender-informed characterization and identification of treatment protocols. In distinguishing this phenomenon within the male community, by looking at eating disorder criteria, but also looking at the signs of body dysmorphia; treatments effectiveness will increase. Gendered assumptions affect treatment interactions and protocols; internalized views of masculinity and femineity must be challenged following a person-based approach to exemplify treatment receptibility rather than just one of contingency. By first individualizing treatment, and then approaching connections; forms a personal customization in addressing the gender socialization discrediting current programs.

References

Bunnell, D.W. (2016). Gender socialization, countertransference and the treatment of men with eating disorders. Clinical Social Work Journal, 44(1), 99–104. https://doi.org/10.1007/s10615-015-0564-z

Harvey, J. A., & Robinson, J. D. (2003). Eating disorders in men: Current considerations. Journal of Clinical Psychology in Medical Settings, 10(4), 297–306. https://doi.org/10.1023/A:1026357505747

Thapliyal, P., Conti, J., Bandara S.L., & Hay, P. (2020). It exists: An exploratory study of treatment experiences in men with eating disorders. The Australian Psychologist Society, 55(5), 534-545. https://doi.org/10.1111/ap.12455