Perhaps it's time someone wrote a song called It's Different for Guys. There have been many murmurs of comfort for women sufferers of everything from sexual abuse to eating disorders. But what about men? The realisation that men, too, can be the victims is coming to us rather more slowly, in spite of the increasing evidence of male alienation, male victims of sexual abuse and male suicide.
Gerard Butcher, psychotherapist and director of the eating disorders recovery programme at St John of God's Hospital in Dublin, has noted a significant increase in the number of males coming forward for treatment of eating disorders. "Our experience of such an increase is part of a worldwide trend - particularly in the United States," says Butcher. Some studies are now suggesting that up to 10 per cent of those with eating disorders are male.
Butcher believes our cultural expectations of men may be a precipitating factor for this increase. "There are more demands on men now, and the old ways of behaving are no longer seen to be appropriate. We have to ask ourselves what we are really expecting from men now."
The cultural backdrop of gaunt male models, well-honed sports stars and other popular icons in music, film and theatre may be encouraging young men (as it has already done for young females) to turn to their bodies as a means of finding personal control in an otherwise chaotic world. Some studies suggest that between 25 and 30 per cent of men with eating disorders are gay. Various reasons have been suggested for this, including the emphasis on slimness and physical attractiveness within gay subculture, and the insecurity caused by negative views of homosexuality. In a recent journal article, British Research into the Increased Vulnerability of Young Gay Men to Eating Disturbance and Body Dissatisfaction, Iain Williamson and Pat Harley suggest that "eating disturbances reflect issues of control for the gay male (as it often does for the post-pubescent female) in terms of his disempowered position in society and/or anxiety about his maturing gay sexuality".
However, cultural icons and norms are only one part of what is a deeply personal and highly secretive illness. Like many other experts in the field, Butcher identifies eating disorders as an expression of some underlying psychological difficulty the individual is experiencing. "For everyone who develops an eating disorder, it is a means of coping, and the most common factor across men and women is low self-esteem. They see losing weight as a means of achieving something that they can't achieve academically, or physically in terms of sports achievements." Coping with puberty and the changes it brings is a huge precipitating factor for some teenagers, regardless of gender. Parents should perhaps be more alert to teenagers who tend towards perfectionism and over-achievement than those who show the usual signs of teenage rebellion. Other more serious problems, such as sexual abuse, can also lie behind an eating disorder. However, Gillian Moore-Groarke, a consultant psychologist based in Cork city, says sexual abuse tends to be more a component of the problem in females than in males.
Male sufferers can find it difficult to admit to their problem, says Moore-Groarke. "It's harder for men to come forward for treatment. Getting to the stage when they can overcome their denial of the problem is the most difficult." However, she believes that when men do come for treatment, they are often well motivated and likely to recover. Tackling difficult and potentially destructive family dynamics is a key element of recovery for all sufferers. "In eating disorders, it is imperative that a family therapy approach is used and that family dynamics, communications boundaries and problems are explored," explains Butcher. "Family listening skills need to be fostered. One problem needs to be focused on at a time and emotions need to be defused." Kay Gavan, senior social worker at the Eating Disorders Unit at the South London and Maudsley Hospital, put forward a new model of working with families at a recent workshop for professionals, held in Dublin. Gavan suggested that because sufferers see the behaviour of others as being judgmental or overpowering and intrusive, it is important to alter these dynamics in a recovery programme.
`Some parents can become overly involved in the illness, resulting in a disempowerment of the patient. By setting boundaries for the involvement of the family, the person with the eating disorder can begin to feel more independent, the sick role is minimised, and other skills are encouraged," she says. Over-critical families also need to be encouraged and informed regarding realistic expectations for progress and recovery.
At present, support groups such as Bodywhys are attended almost exclusively by women.
"We agree that a support group for men could be a good idea if there were enough men who wanted to form a support group," says Bridin McCarthy of Bodywhys. "However, we would never exclude one gender from our support groups."
Butcher points to a preventive model currently in place in Norway. There, a former teacher is employed on a full-time basis to work with teenagers in schools, preparing them for puberty and enhancing their self-esteem. So far, there have been some promising findings, pointing to a decline in eating disorders following such early intervention.
Bodywhys helpline (01-2835126) operates Tuesdays 12.30-2.30 p.m.; Wednesdays 7.30-9.30 p.m.; Thursdays 10 a.m.-noon