Unveiling Challenges and Strategies: Eating Disorders in Men - A Comprehensive Essay

Introduction

Eating disorders are a common mental health problem that is often underdiagnosed in men. The disorder is always undertreated and misunderstood in men as is more commonly managed in females. The skewed distribution of the disorder to the female gender is attributed to the poor health-seeking behavior in men and the lack of admittance by men of any psychological issues. Moreover, society's view of the disorders as feminine leads to overlooking of symptoms by the males and in males. Eating disorders affect the health of an individual physically, psychologically, and emotionally and lead to adverse physiological and health effects. These adverse effects in males are usually catalyzed by the late diagnosis (Sweeting et al., 2015).

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The American Psychiatric Association describes eating disorders for diagnosis to be classified as anorexia nervosa, binge eating disorder, bulimia nervosa, and single eating disorders symptoms (Sweeting et al., 2015). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–IV) also added restrictive/ avoidant eating disorders as part of the diagnosis (Sagha et al., 2019).

Strother et al. (2012) point out that males suffering from eating disorders and body image issues face immense societal stigma leading to challenges in accessing healthcare. Additionally, the number of evidence-based research and guidelines for eating disorders in males are few as more resources are dedicated to formulating treatment paradigms for females. According to multiple studies as cited in Strother et al. (2012), males account for 10% of all anorexia and bulimia nervosa eating disorders. However, a different study found that males account for approximately 25% of all bulimia and anorexia nervosa cases. The National Institute of Health estimated that as of 2008 1 million males were struggling with eating disorders which could have been an underestimation.

According to Sagha et al. (2019), it is projected that approximately 1o million males will suffer from eating disorders at some point in their lives in the United States. In the United Kingdom, it is estimated that 1 in every 4 individuals diagnosed with eating disorders are male. This paper will seek to provide an in-depth understanding of eating disorders in males and their relevance in nursing practice. Several gaps in research and practice exist on this topic as cited in Sagha et al. (2019). These range from the detection of eating disorder symptoms in males, to the stereotypes that exist about the disorders, and the social stigma. Besides, the management of psychological trauma and internal conflict flowing stigma and strategies to encourage early diagnosis requires further understanding. Promoting efficiencies in the diagnosis and management of eating disorders in males is key to effective nursing care.

Nursing management for male eating disorders

Part of the initial contact for persons with eating disorders is the nursing care team and thus this initial interaction is usually a basis for the development of a strong basis for recovery. In most cases, males with eating disorders often don’t realize that they may not have the disorder. Breaking the myths and stereotypes assists in processing patients with eating disorders. Eating disorder symptoms are not always characterized by emaciation and may have non-specific symptoms. Besides, most male patients are not ready for any treatment interventions and feel they don’t require any assistance and this may give misleading information. (Buekers et al., 2015).

The National Institute for Health and Care Excellence (NICE) Guidelines (2017) provide the assessment history information for the diagnosis of eating habits in males. These include existing unusually low or high body mass index for the patient's age, having a history of rapid weight loss over a short time, and engaging in restrictive feeding habits that are worrying to the patient or their family members or caretakers. Besides, reported history from caretakers about changes in feeding behavior, avoidance behavior in social activities involving food, and the existence of other mental health disorders also assist in diagnosis. The patient may also present with poor management of other diseases that require dieting such as diabetes, a disproportional relationship of weight or shape to unrelated factors, and the presence of endocrine and gastrointestinal disturbances. The assessment signs for eating disorders are the presence of physical signs of malnutrition such as dizziness, palpitations, pallor, and poor circulation.

The initial treatment of eating disorders requires a psychological approach. One of the most effective methods is cognitive-behavioral therapy (CBT) which aims at providing treatment for the eating disorder psychopathology rather than providing a diagnosis. This treatment modality is based on the trans-diagnostic theory. This method is based on providing behavior change and involves the assessment of the characteristics of the feeding disorder, preparing the patient to change, providing education, nursing care provider and patient joint formulation of a change formulation for a normal feeding habit, and involving the patient family or caretakers. The second step involves addressing the patients’ overvaluation of weight and body shape, dietary rules, events that result in changes in eating behavior, and the management of other personality, anxiety, and mental health problems. Challenges in effecting this treatment modality include clinical perfectionism, interpersonal differences, and low self-esteem (Murphy et al., 2010).

Murphy et al. (2010) note that before the initiation of cognitive-based therapy, the presence of clinical depression, drugs, and substance abuse, competing commitments, and major events distracting the patients’ lives should be considered. Multiple studies as cited in Costa and Melnik (2016) indicate that CBT is effective in the management of binge eating behavior, bulimia, and anorexia nervosa either alone or in combination with psychotropic medications.

Nursing leadership strategies

The nursing management of patients is guided by medical ethics and existing nursing practice guidelines. These must be adhered to for better patient outcomes and to avoid litigation. The interplay of individual principles, patient expectations, professional care guidelines, policies of the institution, and societal perception influence the delivery of nursing care (Pozgra, 2014). Medical ethics that guide healthcare delivery are autonomy, respect, beneficence, justice, and confidentiality. The care of the patient must be guided by high levels of confidentiality and respect especially considering the psychological effects of the eating disorders on men and the challenges in obtaining history for diagnosis in men (Peel, 2005).

The second leadership strategy for the management of eating disorders is interdisciplinary collaboration. Assessment and intervention strategies for eating disorders in men require collaboration between medical disciplines to achieve a better patient outcome by forming care teams consisting of nurses, psychiatrists, nutritionists, and psychologists. The Collaborative Therapeutic Practice domain of nursing care emphasizes the need for collaboration through the delineation of the boundaries of each profession. Achieving inter-professional collaboration is one of the nursing key competencies. Initiating and maintaining effective interpersonal and inter-professional communications is essential in maintaining an effective interdisciplinary team for achieving better patient outcomes (Reinke & Hammer, 2011).

Another aspect of leadership skill required to be demonstrated in the management of eating disorders in males is communication. Considering the fact that most male patients with eating disorders do not accept that they have a problem, the communication strategy employed plays a major role in dictating outcomes. Effective communication is required in communicating with the patient, other healthcare providers, and the patient's caregivers. Listening skills, a combination of verbal and non-verbal skills, and maintaining eye contact are effective strategies to enable the patient to open up and cues for detecting symptoms. Effective communication promotes behavioral change as it allows the delivery of health messages required for the management of the eating disorder. Communicating with the patient must be in simple language and avoid the use of scientific terms that may not be understood or misinterpreted (Kourkouta & Papathanasiou, 2014).

The nursing care professional must also be able to communicate with the patient's caregivers taking into consideration the principles of confidentiality and privacy. An informed consent must be sought from the patient before sharing any information. Inter-professional communication assists in handing over information for continuity of care for the patient and also receiving feedback. Effective communication requires honesty at all times from all parties, a comfortable environment for any disclosures, and allowance for adequate time (Kourkouta & Papathanasiou, 2014).

References

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Murphy, R., Straebler, S. et al. (2010). Cognitive behavioral therapy for eating disorders. The psychiatric clinics of North America, 33(3), 611 – 627. doi: 10.1016/j.psc.2010.04.004

National Guidelines for Health and Care Excellence, NICE (2017). Eating disorders: recognition and treatment. NICE. www.nice.org.uk/guidance/ng69

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Strother, E., Lemberg, R. et al. (2012). Eating disorders in men: Underdiagnosed, undertreated, and misunderstood. Eating disorders, 20, 346 – 355. DOI: 10.1080/10640266.2012.715512

Sweeting, H. & Walker, L. et al. (2015). Prevalence of eating disorders in males: a review of rates reported in academic research and UK mass media. International journal of men’s health, 14(2). doi:10.3149/jmh.1402.86