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Examining the Role of Gender in the Development of Eating Disorders

*Please note that the statements in this article are not intended to be the definitive definition of gender and eating disorders. The article cites relevant studies, but should not be construed as medical advice or as a diagnostic tool.

There are numerous myths and misunderstandings about eating disorders like anorexia nervosa, binge eating disorder, and bulimia nervosa. As an example, some people feel these disorders aren’t too serious and are just phases that come and go. Even more prevalent is the most common myth that only adolescent girls develop these disorders. The truth is, eating disorders affect people of all ages and genders.  However, even the most dangerous misunderstandings can have a kernel of truth – while eating disorders don’t only affect teenage girls, they do appear much more frequently in women (both cisgender and trans) than in men.

This is not to discount in anyway the occurrence of eating disorders in boys and men. Although statistically, women are more likely to develop them all genders are susceptible. Eating disorders also vary in how often they affect genders by type; anorexia nervosa and bulimia nervosa affect women much more often than men, whereas the gender split for disorders like binge eating disorder is much less pronounced. Some disorders that affect young children, such as pica, are less likely to display a significant gender split. Lastly and most importantly, because of the stereotype that eating disorders are “women’s disorders”, eating disorders and body dysmorphia are underreported in men. There remains a stigma against discussing these issues for men.

What Factors Influence Eating Disorder Development?

Research shows that one of the biggest reasons why eating disorders in women are so common is that a combination of societal pressures about weight and beauty can change brain activity to the point of developing disordered thoughts and behaviors. Brain patterns are formulated during childhood and adolescence. During this time, a person’s self-esteem and development of self-worth are malleable and subject to influence from peers, family, and even the media.

Eating disorders are considered to be psychiatric disorders, being listed for the most part in the DSM-5. This means there are several biochemical reasons for their development aside from psychosocial factors such as weight bias and media presentations of beauty. A recent study performed at the University of Pennsylvania indicated that while genetic research into the heritability of eating disorders is still in its infancy, many links were established between genetics and eating disorders. Anecdotally, people whose parents had or have an eating disorder are much more likely to develop one themselves.

In the current state of available research, though, it’s clear that girls and women are at higher risk to develop an eating disorder. This makes parents and family members of women, especially adolescents and young adults, should be aware of these risks. For families interested in outpatient eating disorder treatment, understanding the factors which cause women to develop these types of mental health conditions is the first step to treating them successfully.

Why Are Women More Vulnerable to Eating Disorders?

According to the National Eating Disorders Association or NEDA, about two-thirds of the 30 million people who have some form of an eating disorder are female. In particular, the well-known disorders anorexia nervosa and bulimia nervosa are much more likely to develop in women than men, although the occurrence of binge eating disorder is more evenly split between men and women.

One key factor in many eating disorders is body dissatisfaction, which, in extreme forms, can lead people to feel overweight or otherwise “flawed,” despite evidence to the contrary. Body dissatisfaction is quite common in women of all ages.

These studies show that with anorexia nervosa and other eating disorders, individuals tend to overestimate their body size, perceiving themselves as being larger or heavier than they are. While it’s tempting to try to identify a single contributing factor as the culprit behind eating disorders, most experts believe that women are more vulnerable body dysmorphia (skewed self-image) due to a combination of biological, genetic and cultural factors.

Beginning at puberty, females begin to develop unique biological factors. When female biological changes are combined with common cultural factors like premature sexualization and the presentation of a certain body type as a beauty and sexual ideal, many young women become more at risk for developing an eating disorder.

How Social Pressures and the Media Influence Eating Disorders in Women

People of every gender feel pressure to avoid becoming overweight and appear “healthy.” This can stem from the medical community’s emphasis on avoiding obesity – while excess weight can cause health problems, blind focus on BMI as an indicator of overall health has come under considerable controversy in recent years. The HAES (Healthy At Every Size) movement has helped to challenge this perception, focusing on eating well and healthily without focusing on body weight.

Medical concerns aside, society has long equated a woman’s appearance to her value. This is true to some extent for men as well, of course, but in a society where males are expected to be “breadwinners” and women are largely objectified, the risk of being undesirable can affect women’s self-esteem more easily. It should be noted that this in no way implies a conscious choice on the part of women to become “more desirable”. It’s ingrained as a part of society in many cases; the message that women must be attractive and/or thin permeates almost every layer of society.

One of the main ways this has traditionally been perpetrated is through the media. Films, television, magazines and advertising all portray the ideal woman to be thin, and often underweight. The message this sends is one that inextricably links her value to what’s considered most attractive. Since the 19th century, people have been constantly exposed to these images from childhood. In people susceptible to obsessive thought s about weight and eating, they can be triggering

In recent decades, this has been compounded by the rise of social media. These applications, which can bring people together in unprecedented ways, can also reach people, especially impressionable young people, more directly than ever. While traditional media presents a one-way exchange between the consumer and the presenter, social media encourages interaction between them. Adding peer pressure to idealized media portrayals creates of perfect storm of triggering content. Certain subcultures within social media put even more emphasis on weight loss; diet culture, “fitness” accounts, and even accounts that are pro-eating disorder all flourish on social media. The problem has become so apparent that its was raised at the Congressional hearings on Facebook  in 2021.

How Brain Activity Influences Eating Disorders in Women

While it’s true that both men and women are at risk for developing an eating disorder, research continues to show that women are much more likely to deal with feelings surrounding body dissatisfaction. An interesting exploration of this phenomenon in a recent research project examined the brains of 32 people, 16 each male and female, who had no earlier history of an eating disorder. Each person was monitored for brain activity with an MRI while being shown virtual reality images of their bodies as both obese and very thin.

During these MRI scans, researchers found that perception of one’s body has a direct effect on the brain’s activity, especially in the emotional centers which center around self-esteem. This area of the brain, the parietal lobe, is also associated with subjective emotions like fear and anger. The female study subjects showed a higher chance of “owning” or identifying with the obese body type than the male participants. This helped researchers conclude that one of the biggest contributing factors to the development of eating disorders in women, body dissatisfaction, is more common in women than men.

Of course, not everyone who has body dissatisfaction or dysmorphia will develop an eating disorder – but understanding this connection can point eating disorder treatment facilities and other experts towards effective strategies for recovery. With a solid base of understanding of why women are more prone to developing an eating disorder, specialized recovery plans can be designed – and that’s a great sign of hope.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.