Eating disorders in men aged midlife and beyond

Eating disorders are serious psychiatric illnesses which can occur across the lifespan. Men aged midlife and beyond are vulnerable to stigma, shame, and stereotypes portraying eating disorders as afflictions of youth and female gender. Historically, men have been neglected in the field of eating disorders owing to traditional and female-centric approaches to conceptualization and classification. In this literature review, we identified 16 case reports of eating disorders in males ranging from the age of 40 to 81 years. The majority of cases reported an earlier onset in life, followed by a variable course of illness with periods of relapse interspersed with remission. Diagnostic crossover or symptom fluctuation was common. High rates of comorbid depression were found, and several cases described a history of weight cycling and premorbid obesity. Precipitating factors included stressors which disproportionately occur in later life, including loss due to death or divorce, changes in financial or housing situation, and medical issues. Very little is known regarding the prevalence of eating disorders in older men, with initial population estimates ranging from 0.02% to 1.6%. Rates of subthreshold eating disordered behavior are higher and appear to be increasing among older individuals and males in the community. Recent revisions in the DSM-5 will likely increase the broader applicability of diagnostic criteria for eating disorders, stimulating improved recognition of diverse presentations occurring across the lifespan for both genders. Eating disorders should be included in the differential diagnosis of unexplained weight gain or weight loss irrespective of age or gender. Multi-site studies are needed for adequate sampling and to allow larger empirical investigations regarding how to improve clinical practices in screening and assessment, as well the provision of differential care for older men suffering from an eating disorder.