Bulimia Nervosa in Men & Boys

But eating disorders, such as bulimia nervosa (BN), anorexia nervosa (AN), and binge eating disorder (BED), are serious mental health conditions that can have life-threatening complications, regardless of who they impact. So, it’s critical to understand how bulimia affects men.

Prevalence of Bulimia Nervosa in Males

Males aren’t immune to developing eating disorders. In fact, eating disorders in general—and bulimia nervosa, specifically—affect men much more often than many people think.

It’s estimated that one in three people with an eating disorder is male, and it is thought that, overall, around 10 million men will struggle with an eating disorder at some time in their lives.²
Of these men, around 30% are thought to struggle with bulimia nervosa.³

Other studies reported men participating in a number of other disordered eating behaviors, including binge eating or purging, fasting, or misusing laxatives to lose body weight.

How Bulimia Nervosa Presents in Men

While bulimia is an individualized condition and can present in any number of different ways in people, some traits tend to manifest in men who struggle with the eating disorder.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), bulimia nervosa is defined as having recurrent episodes of binge eating followed by compensatory behavior, such as self-induced vomiting.⁵

Some findings suggest boys and men with bulimia nervosa express less concern over eating and don’t experience as much loss of control during binge episodes. Others guess these episodes are more likely, in boys and men, to be considered “cheat meals” or part of a diet, especially those focused on gaining muscle.⁴

In general, it’s thought that cisgender men and boys with bulimia fixate on different body types than cisgender women and girls with the condition. Males are thought to generally strive for more “masculine” shapes, which can be lean but are primarily muscular, compared to women, who tend to focus on thinness.⁴

Diagnosing Bulimia Nervosa in Men

One of the primary reasons men and boys may not be commonly thought of as people who struggle with eating disorders is the widespread misdiagnosis and underdiagnosis of this group.

Men and nonbinary individuals struggle with body image issues as much as those who identify as women do. However, the standard questions used to diagnose an eating disorder may not flesh out the different ways these concerns are expressed. For example, a healthcare worker may ask someone if they have a desire to be thinner, and a male struggling with bulimia may be more concerned with gaining muscle.

Much of the current diagnostic framework and historical research on eating disorders is based exclusively on gender constructs for women. It’s estimated that less than 1% of these studies consider the presentation of bulimia nervosa or other eating disorders in men.⁴

Signs of Bulimia Nervosa in Males 

The lack of historical studies and empirical information has also created somewhat of a blind spot when it comes to early diagnosis of bulimia in boys. The understanding of the condition is so undeveloped and biased, based on preconceived beliefs about who suffers from eating disorders, that experts have a difference of opinion on whether the disorder presents earlier or later in males. 

Regardless, there are some signs most experts agree point to the possibility of bulimia in cisgender boys and men, including:³

• Preoccupation with body shape, muscle mass, and body fat 
• Participation in excessive exercise regimes
• Taking part in “cheat” meals, where large amounts of calories are consumed and then “worked” off or purged
• Lowered testosterone levels

Most of the other common signs of bulimia also apply to males with the condition, including rigid eating rituals, discomfort eating around others, depression or anxiety, and low self-esteem.

Treatment Barriers for Males With Bulimia

One reason so many cisgender boys and men may fail to seek help for bulimia is the stigma associated with the condition.

Many people in this group may consider bulimia and other eating disorders to be conditions that only affect women. They may either fail to see the signs, such as self-induced vomiting, body image concerns, or male body obsession, in themselves, or feel too embarrassed to speak up about what they’re experiencing.

Society also tends to hold different expectations around cisgender men and cisgender women. Focusing on building muscle mass or even participating in “cheat meals” may not be as readily seen as disordered behavior in men. In fact, in our fitness-focused society, many behaviors that are clinically diagnosable as eating disorder behaviors are considered “healthy.”

If cisgender men present as “too thin,” they may be the subject of bullying, which can intensify unhelpful thoughts and behaviors and further discourage people from seeking help.

Finding Treatment for Bulimia Nervosa

Bulimia is becoming more commonly recognized in men, and with raised awareness often comes decreased stigma. This can open doors to wider outreach and more effective treatment.

Regardless of who is impacted by the condition, bulimia and other eating disorders are serious mental disorders with significant impacts on emotional, physical, and mental health. 

If left untreated, the condition can even be fatal. That’s why it’s important to seek help from a mental health professional who specializes in eating disorders as early as possible. 

Today, some programs cater specifically to boys and men with bulimia, helping them feel supported and accepted in treatment. 

With the right help, recovery is possible. Seek treatment today.