Evidence based assessment and eating disorders in men

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At CEBTOhio, we talk a lot about evidence based treatment (it is in our name after all). However, there is an important step before a therapist can begin delivering evidence-based treatment: conducting an evidence based assessment.

In order to know what treatment to apply, we have to identify the condition a client is experiencing. So we ask incoming clients to complete a battery of measures that have been shown to reliably screen for various psychological disorders.

It’s important to keep in mind that, while these measures are the best self-reporting tools we currently have, they do not predict with 100 percent accuracy. In general, when talking about evidence-based practice, we must consider who were the participants that constituted the “evidence” for the evidence-based tools we use.

Limits of evidence based assessment

This is particularly important if the individual seeking treatment belongs to communities that are traditionally underrepresented in the research. In this way, it is crucial that we combine the evidence-based tools we have with critical reflection, humility and individualized assessment of the person sitting in front of us. There could be as many blog posts about this concept as there are people and presenting concerns. This post focuses on one of our areas of clinical specialty – eating disorders – and a group that is traditionally underrepresented in this area: men.

A chapter in the recently published Comprehensive Men’s Mental Health provides an overview of eating/body image disorders and how they present particularly for men. This information is summarized below to guide mental health providers in conducting thoughtful assessment for men with eating concerns.

Evidence based assessment of Anorexia Nervosa in men

Regarding anorexia nervosa (AN), data show that men are generally less concerned with body weight than women, but equally concerned with body shape. Men may also find themselves preoccupied with developing a lean/muscular body rather than the thinness more commonly sought by women.

Men with AN may also struggle with compulsive exercise more often than women. And there is some data to suggest that, for men, exercise can act more as emotion regulation than body size/shape management. Regarding objective measurement, men traditionally score lower in the Eating Disorders Examination-Questionnaire (EDE-Q) – which is one of the diagnostic measures we use in our intake battery) – than women, who made up the majority of the sample on which the measure was normed. It is important to keep this in mind when interpreting scores.

Evidence based assessment of Bulimia Nervosa in men

Regarding bulimia nervosa (BN), men appear to generally consume greater quantities of food during binge episodes, and may eat more high-fat/high-protein foods (e.g., meat) than high-sugar foods (e.g., desserts) than women. Men’s compensatory behavior following a binge is also less likely to be vomiting or laxative abuse, and more likely to be food restriction or excessive exercise. As with men with AN, men with BN traditionally score lower in the EDE-Q.

Finally, of all eating disorders, men are most likely to be afflicted with binge eating disorder (BED). However, due to the recent development of BED as its own formal clinical diagnosis, there is,  as of yet, insufficient research to identify specific characteristics of the illness that might differ by gender.

If you are a man or are treating a man with eating concerns, and you would like additional help with evidence-based treatment for these conditions, please give us a call and we will be happy to help you get connected with professional resources.


About the Author:

Dean Malec, therapist and Director of Training at CEBTOhio, received his Ph.D. in Counseling Psychology from Cleveland State University. He trained in various university counseling settings during his doctoral education and completed his internship at Case Western Reserve University’s Health & Counseling Services. He is currently a postdoctoral fellow at Center for Evidence Based Treatment- Ohio, where he is supporting the development of an adherent DBT skills group exclusively for the young adult/college population.