Month: July 2013

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While eating disorders are typically associated with young women, you may be surprised to learn that a growing number of individuals with eating disorders today are young men.

Prevalence of Eating Disorders in Males

Approximately 10% of individuals seeking treatment for eating disorders are male, although a larger number fails to seek treatment.  The National Eating Disorders Association estimates that about 10 million U.S. males  will suffer from an eating disorder at some point in their lives – about one third of the total of 30 million individuals facing this illness.

While males are more reluctant to seek treatment, the number getting help is growing.  One recent estimate: the number of males hospitalized for an eating disorder has risen more than 50% over the past decade. This increase may be due to greater willingness to report a problem, but may also represent a larger number of males who develop eating disorders.

Types of Eating Disorders in Males

Boys and men suffer from the same types of eating disorders as females, as well as one type less common in girls or women.  Disorders include:

  • Binge eating disorder.  Characterized by episodes of compulsive or “binge” eating, this disorder is the most common type of eating disorder among males.
  • Bulimia nervosa.  Characterized by binge eating, followed by one or more purging methods (vomiting, laxatives, excessive exercise, etc.), this disorder represents an attempt to avoid weight gain after over-eating.
  • Anorexia nervosa.  Characterized by a refusal to maintain normal body weight and an intense fear of gaining weight, along with severe body image distortion, this disorder causes individuals to literally starve themselves.
  • Muscle dysmorphia.  Characterized by an extreme desire to become more muscular, this disorder is primarily associated with males.  Some individuals with this disorder want to “bulk up” to gain body mass, while others try to lose weight to reduce their percentage of body fat vs. muscle.  Excessive steroid use is often associated with this disorder.

Treatment Issues for Males

Many treatment issues are similar for all individuals, regardless of gender, such as problems with body image and self-esteem or a need to exert control in one’s life, albeit in a dysfunctional manner.

However, males may also face special issues in treatment, such as:

  • Increased stigma.  Because eating disorders are so closely associated with young women, males may be subject to ridicule by their peers, or may fear discovery of their problem.  Such factors decrease the likelihood of males seeking treatment.
  • Severity of the disorder.  Because young men are less comfortable seeking treatment and less likely to be identified by others as having a problem, their cases may be particularly severe by the time they do finally seek help.
  • Issues with sexuality.  Approximately 42% of males with eating disorders also identify themselves as being gay.  Does the emphasis on physical fitness and lean musculature in parts of the gay culture and media make young gay men more vulnerable to the development of eating disorders? Mental health professionals aren’t certain, but must be prepared to address issues of sexuality with young male patients.

Treatment can as beneficial for males as females, once they seek help in a program that is sensitive to their specific needs.  Common treatments include medication, such as antidepressants, and psychotherapy – often cognitive or behavioral therapies. Treatment is frequently most effective with peers in a group setting, with the level of treatment needed based upon the severity of the condition.

Early identification of eating disorders in males is the key to the best recovery.

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Patients with obsessive-compulsive disorder (OCD) frequently experience problems with disturbing, intrusive thoughts, as well as overwhelming impulses to perform ritualistic behaviors that reduce the anxiety associated with such thoughts. Traditional psychotherapy has not been found to be helpful for most individuals with OCD.  However, one modern form of treatment is particularly successful in overcoming symptoms of the disorder.

The nature of cognitive-behavioral therapy

OCD patients typically become distressed about negative thoughts or obsessions, because they see them as warnings of potentially dangerous events. Cognitive –behavioral therapy (CBT) helps patients identify such unrealistic thoughts and reinterpret them, thereby reducing anxiety.  Fewer anxious thoughts lead to decreased compulsive behavior.

How does CBT work?  Treatment focuses on helping patients examine the relationship between their feelings, thoughts, and behaviors. Using a collaborative and structured approach, therapists guide patients to explore and expose themselves to their fears and anxieties in a controlled and safe environment.  The beliefs surrounding those fears are also identified, challenged, and ultimately changed.

Patients learn to recognize their worries as being obsessions and to see their rituals as compulsions. Treatment includes a variety of structured techniques and strategies.

Homework

Working on assignments between therapy sessions is an important part of the treatment process.  Patients are usually asked to keep a journal or “thought record” of their obsessions, in which they write down each one when it occurs, as well as their interpretation of its meaning.  The therapist reviews the journal with the patient and helps challenge any unrealistic beliefs or “magical thinking” that surrounds the obsessive thoughts.

Behavioral Experiments

Once a patient understands the relationships between thoughts and behaviors, therapy may progress to the use of behavioral “experiments,” in which the patient practices what has been learned.  An individual who believes that touching a doorknob three times will prevent her house from burning down may be asked by her therapist to touch it only once, then leave the house.  She will then see that nothing catastrophic happens.

One effective type of behavioral experiment is the use of exposure and ritual prevention.  This technique involves a patient’s prolonged exposure to a distressing situation or object, along with strict prevention of any associated ritualistic behavior.

First the patient is exposed to a situation or cue that stimulates obsessive thoughts. For example, a patient with a germ obsession may find that touching a faucet in a public restroom triggers thoughts of contracting a fatal disease. These thoughts, in turn, lead to compulsive hand washing. During exposure, the patient may actually touch the restroom faucet, while imagining the possible horrible consequences associated with this action.

Following exposure to the triggering obsessive thought, the patient is asked to abstain from performing the behavior believed to prevent the feared consequence; e.g., ritual hand washing. After several exposures, followed by no performance of the compulsive act, the patient realizes that the feared consequence does not occur if the compulsive act is not performed.  More importantly, the patient realizes that distress and anxiety can lesson even without performance of the ritualized behaviors.

Finally, the patient and therapist process the patient’s experience during or after the experiment and discuss how the experience affects the patient’s beliefs and fears.

CBT is generally successful as a short-term therapy, and it has achieved very positive results with a variety of patients.

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Millions of individuals live each day in fear – not of an actual physical threat, but imaginary dangers, remembered trauma, inanimate objects, or something as simple as walking outside their front door.

The most common psychiatric illnesses today are anxiety disorders.  Estimates place the number of affected Americans at up to 40 million. At least 18% of adults and 13% of children suffer from some type of anxiety disorder in a given year.

The Nature of Anxiety Disorders

We all experience brief moments of anxiety during stress.  In order to be considered an actual disorder, anxiety symptoms must be intense and frequent.

Mental health professionals recognize six different types of anxiety disorders:

  • Obsessive-compulsive disorder – continual disturbing thoughts and/or the need to perform ritualistic behaviors;
  • Generalized anxiety disorder – excessive, unrealistic worry or tension without apparent cause;
  • Post-traumatic stress disorder – frightening thoughts and memories after a traumatic event, often with emotional numbing;
  • Social anxiety disorder – overwhelming self-consciousness or phobia about being in social situations;
  • Panic disorder – sudden feelings of terror, often with incapacitating physical symptoms;
  • Specific phobias – intense fears of specific situations or objects.

Excessive fears or feelings of dread are common to all types of anxiety disorders.

Common Symptoms

While clusters of symptoms vary with the type of anxiety disorder, individuals with severe anxiety may experience:

  • Persistent feelings of panic, fear, or dread;
  • Obsessive thoughts;
  • Ritualistic, compulsive behaviors;
  • Flashbacks to traumatic experiences;
  • Feelings of losing control;
  • Frequent nightmares;
    • Intense fears in public situation;
    • Intense fears of certain objects or activities;
    • Physical symptoms such as shortness of breath, heart palpitations, nausea, muscle tension, dizziness, or dry mouth.

Causes and Risk Factors

Many factors may influence the development of an anxiety disorder.  They include genetic tendencies as well as such environmental factors as repeated exposure to stressful events or one major traumatic event. Even certain medications, including antihistamines, oral contraceptives, and insulin, have been found to trigger anxiety.  As with most mental illnesses, anxiety disorders appear to develop from an interaction of many medical, genetic, psychological, and environmental factors.

Anxiety disorders can affect anyone and often occur in conjunction with other physical and mental illnesses. Women are diagnosed with anxiety disorders more frequently than men.  No differences in prevalence have been noted across races or cultures.

Anxiety Treatment

Treatment of anxiety can greatly reduce or eliminate symptoms in most individuals.  Primary treatments for most anxiety disorders include medication and psychotherapy.  Treatment can usually be provided on an outpatient basis, although brief residential or inpatient treatment is sometimes needed, depending upon the individual’s unique needs.

Medications used to treat anxiety disorders include a variety of antidepressants and anti-anxiety drugs.

Cognitive-behavioral therapy is the preferred type of psychotherapy for severe anxiety.  Through therapy, patients learn to recognize unhealthy thought patterns and behaviors associated with their anxiety and to change both faulty thinking patterns and their reactions to “trigger” situations.

In addition to medication and psychotherapy, treatment may include relaxation therapy, changes in diet and lifestyle, and education on the illness for both patients and their families.

While anxiety disorders cannot be prevented, people can often reduce symptoms by limiting caffeine consumption, avoiding over-stimulating medications or supplements, and seeking immediate support or counseling after a traumatic experience.

Through proper treatment and symptom management, millions of individuals affected by anxiety disorders can lead fulfilling lives again.