In detail

Male anorexia and its sociocultural stigmas

Male anorexia and its sociocultural stigmas

The sexual difference upon which gender is constructed has a double movement: as a kind of cultural filter with which we interpret the world and also as a kind of armor with which we constrict our life" Marta Lamas

Content

  • 1 What is Anorexia Nervosa
  • 2 Neurobiological and sociocultural level of male anorexia nervosa
  • 3 Sociocultural influence and its stigmas: Male repression and anorexia
  • 4 Psychodynamic development of CT in childhood and adolescence
  • 5 School violence and anorexia nervosa
  • 6 Prevention of suicide and male anorexia nervosa
  • 7 Treatment for male anorexia nervosa
  • 8 Links

What is Anorexia Nervosa

The eating disorders (eating disorders) are serious psychiatric diseases that are life-threatening of the affected person, how many people “battle” in their lives against a disorder of eating behavior? It is estimated that approximately 70 million people have a problem of this type. The DSM-V frames anorexia nervosa within disorders food and food intake, along with rumination disorder, food intake avoidance / restriction disorder, pica, bulimia nervosa, binge eating disorder, as well as other unspecified eating disorders.

Within this category the anorexia nervosa (AN), which is characterized by the refusal to maintain body weight at normal minimum values, an intense fear of gaining weight, those who suffer from it show a lot of resistance to eating or retaining what they eat. As the pathology progresses, a syndromic complex can develop in which the extravagant dietary self-limitations stand out., they can try to exclude foods with high caloric content from their diet, although most end up with excessively restrictive diets in terms of energy intake in relation to their needs according to age, sex, the course of development and their Physical Health.

Despite the progressive loss of weight, which "they can try to hide," their fear and anguish to gain weight does not diminish; unlike other psychopathological and physical alterations that appear as a consequence of the growing malnutrition, with its pernicious effects on health; people with anorexia nervosa they may have irreversible organic damage due to the severity of malnutrition, especially when they are in childhood and adolescence.

Imagine that you have spent days without eating well and that you are presented with a delicious dish in front of you, now it appears, that for some reason, even if you are “starving"You can't eat the succulent and aromatic food that you have in front of you, while you watch everyone else eat, how would you feel? There is a popular belief that people who have anorexia "don't make them hungry," that there is an "absence of appetite." Is not always that way:

I don't want to eat, even though I'm hungry and when I do, I hate myself" Male adolescent patient with AN.

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There are two subtypes of AN: the restrictive and the compulsive / purgative subtype. Some patients with male anorexia nervosa exercise excessively for fear of being obese, some of them may have the belief that taking certain nutritional supplements and vitamins can also cause them to gain weight.

Darren Cutinha, a psychiatrist at the Royal Free Hospital in London, said: "It is very difficult to suffer from an eating disorder, but for a boy it can be doubly difficult." The frequency of this pathology would be 0.20 per 100,000 inhabitants. There is a sex ratio in terms of AN: 1 man for every 10 women who suffer from it, which has been increasing for the past twenty years.

Symptoms of eating disorders and clinical case reports are beginning at an earlier age, both in male and female sex, according to research by Favaro et al. (2009). In males it usually occurs partial or atypical forms, which can make diagnosis difficult, allowing the disease to progressUnfortunately, when the symptoms of male anorexia in men are easily detectable, it is almost always because the condition has caused great damage to the subject.

Neurobiological and sociocultural level of male anorexia nervosa

Neurobiological level: regulation of intake

The dual neural model It concerns the beginning of the meal as maintenance of the intake and its completion. Morley points out that we have two central intake control systems: a dopamine opioid at the service of the selection of foods rich in fat and appetizing, and a second system for the selection of carbohydrates.

Generally when a person is hungry, they are driven to eat, while an individual with AN tries to resist the appetite, because an abnormal brain response to the appetite signals is manifested.

Projecting "perfection" and introjecting destruction

The dominant intellectual tendency works on the social construction of the body: from the way in which new cultural meanings are granted to various bodily aspects to political reformulations that, based on how gender and ethnicity, culture and religion are controlled, control and regulate bodies differentially. Marta Lamas

Every day we are bombarded with audiovisual stimuli, which can have a negative impact on health. Today, there is a lot of social pressure to maintain and project a certain image, one aspect that they have emphasized is the weight, This has increased with the use of social networks. Beauty is something subjective, so some say that "beauty is in who sees it", advertising and marketing, have tried to "sell" the idea of ​​what should be the standards of beauty to follow, many of them , go against even characteristic features of the person.

What is considered collectively as a beautiful body has changed through history, culture and individuals.”.

However, considering that obesity is recognized as one of the most prevalent disorders in the general population, the question of selling the idea that: "only a slender body is beautiful" is somewhat Machiavellian, well is outside of what was predetermined by genetics, that is, there are people whose body structure is small, medium or large.

Therefore a person with "wide bones" as they say, whose body structure is large, its features are thick and genetically predisposed to be obese, for example, would not fit the ideal of beauty that advertising tries to sell, but it seems that it is precisely what this is all about !, because many racial and ethnic groups would be outside this standard of beauty, but within the group of potential consumers.

Since less acceptance of the morphology itself may be more consumption of products and services, to try to conform to a "universal standard of beauty". So who imposes the canons of beauty on us? Will it be the big transnational companies that try to have a greater consumption of their products, regardless of whether to "close those sales and increase those figures" they have to compromise people's health?

Advertising meets its objective, since much of society is under pressure about its body image and what they try to project to others.

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Sociocultural influence and its stigmas: Male repression and anorexia

Specialists from the National Center for Eating Disorders of the United Kingdom (NCFED) said: "It is very difficult to know how many men suffered from an eating disorder at any given time." In the case of the male AN, many times it is detected when it is too late, until they collapse, have serious organic damage or when they die of starvation, in the midst of terrible suffering, generally lived between shadows and silence, many of them tend to be isolated people because of their personality traits and their suffering, so the disease progresses bloody and furtive, especially among men who suffer from it.

"There is increasing pressure on men by magazines with celebrities and male models that have the ideal body image" Leanne Thorndyke, Beat Eating Disorders Organization.

Men and women have different ideals of beauty; Progressively there has been an increase in publicity with famous men, models of men's and sporting goods brands. Precisely they represent high-risk groups to develop the disorder, as well as among dancers and in other professions and trades in which great body care is required to project a certain image.

Is a generally covert pathologyHowever, it is more common to be present and diagnosed among women, coupled with the fact that amenorrhea can be an important fact in the diagnosis, physical wear tends to be more visible and quantifiable among females. This condition is even more hidden among the male population, partly because in many cultures there is a strong repression towards men, in terms of the expression of emotions, their sexuality and their own needs.

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In the literature, in terms of this condition, adolescents are generally emphasized. In the journal Annales Médicos-Psychologiques (2017), French specialists reported on the increase in cases of male anorexia in adults, they pointed out that the statistics of male AN are probably below reality due to the difficulties of diagnosis and ignorance of this pathology in children, both by doctors and the environment in which they operate.

AN tends to worsen in the case of men due to repression and sociocultural factors, may present a state of wasting, which implies pathological thinning, as well as important metabolic abnormalities. Some men with AN, are so worried about their body image, that they perform sports intensely, despite eating a poor diet and insufficient for their age, height and activities they perform.

The Exaggeration in self-assessment is a very common feature in patients with male anorexia nervosa, so that physical and emotional wear and tear can become really exhausting for them, because they "live in hunger", are too demanding and try to maintain a slender image and some even to high levels of performance, which can result in the Chronic Fatigue Syndrome.

As well as the amenorrhea in women it can be an important fact within the diagnosis, in men, the decrease in bone mineral density: osteopenia, may be an indicator of a severe state of malnutrition and represents a risk factor for a bone fracture. Unfortunately, when there is osteopenia in men, AN has advanced to greater stages, since, in them, physical wear may be less apparent than in women, thus complicating the timely diagnosis and at the same time overshadowing your health prognosis.

The degree of functional disability may indicate the need for supervision and intervention, some patients require treatments outpatient and others are candidates for internment, where, generally, the affectation of this condition for men can also be appreciated, since being a disease that is diagnosed more frequently among women, some of them, tend to feel more isolated and fail to identify with the group. However, given the severity of the consequences of this disease, it is necessary to be admitted to certain phases of the disease, especially in the advanced stages, to prevent the patient from having a fatal outcome.

Many behavioral alterations are established to reinforce the avoidance behavior of food intake, the DSM-V it specifies the need for a manifest behavior of restriction in the diet, taking for granted the cognitive-emotional aspect of the refusal to maintain a normal weight.

Psychodynamic development of CT in childhood and adolescence

A recent study by the University of Oxford and Glasgow, concluded that young men who have an eating disorder They are not receiving the help and support they need, due to the general perception that it is a "women's disease."

Different epidemiological studies have confirmed that at present that male anorexia nervosa continues to occur more frequently in young people of upper-middle socioeconomic class, although the disease is detected with greater presence in all social strata. When it begins in early stages of development, there may be a lack of weight gain compared to what is expected according to your age, which it can have fatal consequences: illness, irreparable organic damage or death.

Research shows that this condition mostly affects young people between 12 and 24 years of age. Therefore, it is essential that parents (or guardians) are aware of the basic needs of their children from early stages of development, which is when self-concept is formed and many personality traits are modeled, people with AN tend to possess a very punitive way of self-evaluation.

Anorexia syndromes are characterized by excessive worry in body image and weight, although obesity is a problem that should be prevented, It is convenient to teach children to eat a healthy diet, balanced and rich in food diversity.

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Anorexia nervosa can have its genesis in childhood and adolescence, although they can also begin in adult life; psychodynamically they can have their origin within the mother-child relationship, children are not born hating their body morphology, it is something that can be developed through the environment in which it develops and its early education, the type of bond with parents can represent a precipitating factor to develop anorexia nervosa, especially when it represents a conflicting object reaction. Helping them build healthy self-esteem can protect them from suffering AN.

Minuchin pointed out that the family model of patients with AN is often characterized by overprotection in certain aspects and neglect in other important elements by parents, the high level of aspirations, rigidity, the eternalization of conflicts , the tendency to involve the child in parental conflicts and in general by a relationship style in which, not recognizing individual boundaries, family members cannot develop a feeling of autonomy, despite the tendency to isolation which is usually also characteristic of the condition.

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A very restrictive, inflexible education model, with high levels of demand towards the child, as well as an excessively permissive paradigm can be very harmful, can serve as a breeding ground for eating disorders such as AN.

Food is a basic human need, So it is imperative that parents are aware of their children's diet in some way, even if they are very busy. The nutrition has an impact on the body and also on the cognitive: thought, language, memory, attention, learning and sensory perception, are necessary processes for the individual to have a good development and functionality.

So it is recommended that parents and those involved in their care, are aware that children and adolescents eat properly, this will help them have a better quality of life and can avoid many problems both physical and cognitive, especially because adolescents represent an age group at risk for AN.

It is recommended that parents be able to control two meals of their children a day" Brigitte Aquin, CT specialist

Specialists at the Sant Joan de Déu maternal and child hospital in Barcelona, ​​said that children should be taught from an early age the importance of following healthy habits, such as establishing regular meal times, distributing food in four or five consumptions a day, avoiding skip meals and not “peck” at different times, and avoid foods that have little nutritional value, as well as limit the consumption of sugars and highly industrialized products.

Garfinkel and Garner have delved into the development of a multifactorial conception, noting that predisposing, triggering and perpetual factors can be identified, there is a sequential interaction of these elements. Next, I will mention some of them, corresponding to this distribution, among these factors the individual ones, which include cognitive alterations, must be distinguished.

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Predisposing factorsPrecipitating factorsMaintenance factors
  • Affective disorder
  • Introversion / Instability.
  • Obesity.
  • Medium / high social level.
  • Relatives with affective disorder, addictions or with eating disorders.
  • Maternal obesity. Dominant aesthetic values.
  • Genetic factors.
  • Age 13 - 20 years.
  • Teen body changes.
  • Separations and losses.
  • Spousal breakdown of parents.
  • Sexual contacts (they don't necessarily have to be genitals).
  • Accelerated weight gain
  • Criticisms about the body.
  • Slimming disease
  • Disfiguring trauma.
  • Increase in physical activity.
  • Vital events.
  • Consequences of starvation.
  • Family interaction.
  • Social isolation.
  • Anorexic cognitions.
  • Excessive physical activity
  • Iatrogenies

In patients with restrictive anorexia, other features have been observed such as: a strong need for approval, hyperresponsibility, lack of response to internal needs, as well as the possible neuroendocrine vulnerability. In family factors both structure and dynamics of the same and genetic aspects should be considered.

Along with male anorexia nervosa, many psychiatric clinical conditions such as mood disorders, the presence of depression is frequent; anxiety disorders, sleep, in some cases occurs later than other eating disorders such as bulimia and obesity. Somatomorphic and dysmorphic bodily disorders correlate with male anorexia nervosa.

Many teenagers take excessive risks. Many of them pretend not to be interested in health or medical care. However, almost everyone cares about their health at some time and often has no one to share their concerns with. Assuming excessive risks" Dr. Anthony Costello, WHO Department of Mother, Newborn, Child and Adolescent Health

School violence and anorexia nervosa

The way in which each culture imagines what is specific to each sex, corresponding to the reproductive role of each one, is what leads to the formulation of a certain social order, even in areas of social life where the reproductive does not count. ”Marta Lamas

The age group with the highest risk of suffering from AN includes adolescents, they have great capacities and potential characteristics of their age, so it is recommended that they be motivated and positively involved in terms of their health, WHO considers that Teen health is a priority. The typology of character traits, as well as the predisposing, precipitating and maintenance factors of those suffering from male anorexia nervosa make them at risk of belonging to the vulnerable group victims of violence or the aggressor group.

They can be reached by the appropriate means, strategies and channels, taking advantage of the fact that they are part of a generation where digital technology dominates. There is an increase in violence within the school environment, much of it is directed towards minority groups, such as people with sexual preferences other than social or culturally established, as well as those who have different customs, these aggressions go beyond of the classrooms and educational centers, because now they have more reach through social networks.

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Suicide prevention and male anorexia nervosa

Anorexia nervosa is associated with self-injurious behaviors and is a psychiatric illness that can end in death, especially when its course extends and lasts, as the condition becomes more pathological and complex. Some of these deaths correspond to cases of suicide.

Somatomorphic disorders, those of eating, including mainly anorexia nervosa and bulimia, are associated with suicidal behavior. The risk of suicide increases in physical and chronic diseases.

Some disorders generally associated with male anorexia nervosa are: somatomorphic disorders, such as body dysmorphic, personality disorders, anxiety disorders and obsessive-compulsive disorder, mood disorders, especially depression has also been linked to AN.

It is important to strengthen the bond with the children, and be aware of them to monitor their health in all areas, so that they feel content, loved and heard., to be ready to help them in case they require it and so that it is not too late to help them, since the consequences of this evil can be fatal.

You look back and think: Am I to blame? What did I do wrong?"Father of patient with male AN

Some countries fight hard against the AN, in France, for example, the models that aspire to work in that area must have a medical certificate that accredits their body mass index. Those responsible for the agencies that transgress the law can be sentenced to prison for up to six months and fines of thousands of euros. In Israel, the "Photoshop Law" of 2012 prohibits advertising with extremely thin models and hiring them, coupled with this, uses the design program to retouch and change those details, thus avoiding promoting extremely slender bodies.

A revolution has begun as soon as this, because now we can admire models with large sizes, it is part of the paradigm shift that is slowly trying to abolish that link of the beautiful with the extremely slender, with the participation of all can have greater scope.

Treatment for male anorexia nervosa

There are cases of partial remission, which are exclusively focused on increasing body weight. On the other hand, total remission would mean the total absence of compliance with diagnostic criteria during that indefinite period of time.

The adequate and timely detection of anorexia nervosa can make a difference in the course of it, so it would be convenient to protect and banish the collective conception of body perfection as a synonym for slenderness, which has generated so many health problems. Given the social pressure to maintain an image, appropriate food and nutritional education strategies can be established in the different areas where the person operates.

How to know the right weight of a person? As a guide to determine the normal weight of an individual, the body mass index (BMI) should be considered, since the severity criterion is based on this indicator, other factors that are taken into account are the physical constitution and history of previous patient weight. It is necessary to specify the degree and type of activity, to calculate the intake required to have a good functioning.

Using the WHO thinness limits, the continuous from a mild frame a BMI ≥ 17 kg / m2 and in extreme cases a BMI <15 kg / m2 would be established.

“Helping countries move towards universal health coverage through strengthening based on primary care is the best we can do to make sure that no one is left behind,” said Margaret Chan, WHO Director-General until 2017.

If you detect that a friend, family member or yourself, are at risk of anorexia nervosa, do not hesitate to ask for help, If you do not find someone to talk to, you can count on professional psychological support, there you can provide yourself with tools to fight this condition.

Conclusion

Eating disorders of eating behavior (eating disorders) have become a center of interest in research, due to the obvious need to prevent and give therapeutic response to conditions that affect an important sector of the population worldwide, with adolescents being more affected

When there are challenging conflicts within the home, it is necessary to take family psychological therapy so that it does not affect the children when they exist, this conflict can represent a risk factor, as well as precipitating and maintenance in the development of the AN. It is important for the family to develop affective bonds and healthy interactions, where respect is promoted and adequate Food and nutrition education.

Epidemiological studies have shown that anorexia nervosa has a higher incidence than statistics show, as it is a condition that tends to be in the shadows, mainly among men, because There is a greater repression by society in that men can express their emotions, their sexuality and even their discomforts.

Research shows that the age parameter of male anorexia is increasing, as it is occurring in both younger men and adults, so it is a condition that must be well diagnosed and treated, as well as strengthen primary care , health promotion and prevention, since It is a disorder that can have serious consequences and its end can be the death of the person, leaving behind a terrible suffering.

Links

  1. Global Strategy for the Health of Women, Children and Adolescents (2016-2030)
  2. //realitesbiomedicales.blog.lemonde.fr/2017/12/11/quand-lanorexie-mentale-touche-lhomme-adulte/
  3. //www.revmed.ch/RMS/2012/RMS-333/Anorexie-nerveuse-atypique-chez-l-homme.-Particularites-des-troubles-endocrino-sexuels-de-la-dysmorphomanie
  4. //www.who.int/mediacentre/commentaries/investing-in-adolescents/es/
  5. //www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/Estad%C3%ADsticas%20de%20los%20Trastorno%20de%20la%20Conducta%20Alimentaria.pdf
  6. //www.paho.org/mex/index.php?option=com_content&view=article&id=1117:publica-la-oms-el-informe-estadisticas-sanitarias-mundial-2016&Itemid=499
  7. //www.who.int/gho/publications/world_health_statistics/2016/en/
  8. //www.bbc.com/mundo/noticias/2014/04/140409_salud_trastorno_alimenticio_hombres_gtg
  9. //www.revmed.ch/RMS/2012/RMS-333/Anorexie-nerveuse-atypique-chez-l-homme.-Particularites-des-troubles-endocrino-sexuels-de-la-dysmorphomanie
  10. //www.sciencedirect.com/science/article/pii/S0003448717303104

Bibliographic references

  • American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Goldman, Howard, H. (1987).General Psychiatry. Mexico: Modern Manual.
  • Vallejo Ruiloba, J. (1992).Introduction to psychopathology and psychiatry. Mexico: Salvat.
  • Vallejo Ruiloba, J. (Introduction to Psychiatry and psychopathology. Salvat, Barcelona.
  • Lamas, M. Body: Sexual difference and gender. Taurus, Mexico
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