Long‐term outcome in males with anorexia nervosa: A prospective, sex‐matched study

Abstract

Objective The objective of this study is to report on the 5.5‐years outcome of anorexia nervosa (AN) in male adolescent inpatients and compare it to the outcome of female adolescent inpatients with AN. Method Diagnostic eating disorder outcome was assessed by the Structured Inventory of Anorexic and Bulimic Syndromes (DSM‐IV) in 20 males and 20 females matched for AN diagnosis, age at treatment, and length of follow‐up. For documentation, follow‐up scores of the Eating Disorder Inventory and the Brief Symptom Inventory are reported. Results Diagnostic outcome did not differ between sexes. Four male and six female participants had AN at follow‐up. One male and four females had crossed to bulimia nervosa, and five males and three females to eating disorder not otherwise specified. Remission was found in 10 males and 7 females. Effect sizes were mostly small. At follow‐up females had higher scores than males with large effect sizes for drive for thinness (Cohen's d = 0.86) and body dissatisfaction (d = 1.07). Discussion Few significant sex differences were found. Additional research involving larger samples of males and a broader range of assessed outcomes (e.g., drive for muscularity) in both sexes is urgently needed.

Clinical Aspects of Anorexia and Bulimia in Men

“…In the AN study, remission after 5.5 years was more frequent in males than in females [4]. Also, males with AN were found to have a shorter duration of ED and a shorter period of inpatient treatment [4].…”

“…Research has demonstrated that the symptoms of EDs among males are as severe as females; hence, it is important for clinicians to implement more screening and education efforts among males who have EDs. In a study assessing the 5.5-year outcome of AN in male versus female adolescent inpatients, it was found that both genders follow a similar course: Both have a similar age at admission, age at ED onset, and duration of illness [4]. Another study showed that the onset of AN in men occurs between the ages of 14-18 years, while bulimia occurs at the late stage of adulthood.…”

Sex-dependent Clinical Presentation, Body Image, and Endocrine Status in Long-term Remitted Anorexia Nervosa

“…The short-term clinical outcome of AN in males was reported to be better than that in females (Coelho et al, 2021). However, the long-term courses were described to be comparable in both sexes, although previous research emphasized the need for a broader range of assessed outcomes in males (e.g., drive for muscularity) (Quadflieg et al, 2022). From research findings that were primarily obtained in female patients with AN (Tomba et al, 2019), even in a long-term recovered state and in the absence of any fulfilled DSM-5 criteria, significant residual eating disorder (ED) psychopathology can also be expected for males (Quadflieg et al, 2022).…”

“…However, the long-term courses were described to be comparable in both sexes, although previous research emphasized the need for a broader range of assessed outcomes in males (e.g., drive for muscularity) (Quadflieg et al, 2022). From research findings that were primarily obtained in female patients with AN (Tomba et al, 2019), even in a long-term recovered state and in the absence of any fulfilled DSM-5 criteria, significant residual eating disorder (ED) psychopathology can also be expected for males (Quadflieg et al, 2022). However, the very limited data on potential specific psychopathological and biological characteristics of long-term outcomes of AN in males remitted from AN requires further evaluation.…”

Sex‐dependent clinical presentation, body image, and endocrine status in long‐term remitted anorexia nervosa

“…The short‐term clinical outcome of AN in males was reported to be better than that in females (Coelho et al., 2021). However, the long‐term courses were described to be comparable in both sexes, although previous research emphasised the need for a broader range of assessed outcomes in males (e.g., DMS) (Quadflieg et al., 2022). From research findings that were primarily obtained in female patients with AN (Tomba et al., 2019), even in a long‐term recovered state and in the absence of any fulfiled DSM‐5 criteria, significant residual eating disorder (ED) psychopathology can also be expected for males (Quadflieg et al., 2022).…”