Though predominantly a female problem, anorexia nervosa is not exclusively a female one because men do suffer from the condition as well. Yet, some wonder if there are subtle gender biases which prevent the condition from being recognized in men. Further, the public image of the condition as an overwhelmingly female problem may prevent men who are affected from seeking out and getting much needed help. The slant of diagnostic criteria used by clinicians checking for anorexia may inadvertently establish a gender bias unfavorable to men. Many already worry that too many cases of anorexia go undiagnosed. How unfortunate if men are at greater risk for flying under the diagnostic radar. According the diagnostic and statistical manual of mental health (DSM-IV), the guide used by mental health professionals to establish a diagnosis, there are four distinct criteria which indicate anorexia. Those criteria are:
- Inappropriate body weight compared to height and age
- Extreme fear or anxiety about weight gain
- An unhealthy view of ones personal body image
- Missing three successive menstrual cycles after the onset of puberty; also known as amenorrhea.
Obviously, criteria number four pertains only to females. While there is a notation elsewhere that men with an eating disorder may experience irregular gonadotropin function, the emphasis on female considerations has been seen by some as an example of gender bias. Another possible instance of gender bias may be the way in which we view male versus female attitudes toward exercise. Excessive exercising and a preoccupation with body image are telltale signs of an eating disorder, yet we may assess them differently between the sexes. Some have suggested that it is culturally acceptable for men to spend hours in the gym building and toning whereas similar behavior in women would be judged as excessive. Since the behavior and attitude are part of the diagnostic grid, the question arises as to whether the double standard is evidence of gender bias. Finally, the fact that anorexia is regularly presented as a condition which affects girls may cause boys and men to hold back from seeking medical help. For those men who do undergo treatment, the vast majority will be placed in facilities largely populated by women. Even if their individual counseling focuses on male issues, the group settings will be overwhelmingly female. It is true that the disease affects mostly women, but it remains to be seen how many cases are escaping detection due to gender bias and shame. Some in the field are suggesting a correlating set of criteria which address male symptoms. Men, for example, often continue to experience low testosterone even after they regain a healthier body weight. Why this is so remains a mystery. Meanwhile, treatment of eating disorders among both men and women continues to make positive strides and it is hopeful that any gaps, including gender gaps, are not far from being filled.