A recent and first-rate article in the Los Angeles Times does a lot to bring overdue attention to the growing incidence of eating disorders among boys and young men. Los Angeles boys, the piece points out, now have to put up with "pressures long placed on girls, as buff, bare men proliferate in pop culture."
Alarmingly, as I found out when researching a young-adult novel about a 15-year-old boy battling anorexia, the problem reaches far beyond Los Angeles. The National Eating Disorder Association estimates that 30 million people in this country have eating disorders at some point in their lives.
The National Association of Anorexia Nervosa and Associated Disorders estimates that 10 to 15 percent of people with anorexia or bulimia are male, but many experts say this is an undercount, and some say the true figure is more like 30 percent. It's a hidden sub-population, a serious national health crisis.
Even worse, these boys and men are risking their lives. Eating disorders have the highest death rate of any psychological illness, up to 20 percent.
One aspect of this grim situation, mentioned by LA Times writer Emily Alpert, is that many in the medical profession still cling to the idea that anorexia is "a girl's disease." Several families I spoke with said they had to consult five or more different doctors before they got a correct diagnosis.
And the lures are everywhere -- all the billboards and trailers featuring abs and pecs and glutes. Many boys start out wanting to achieve physical perfection and then spiral down into full-blown eating disorders. The universality of the now hyper-idealized male physique was underscored when Superman opened this summer. Henry Cavill, who played Superman, told Total Film magazine that to get ready for the role, he exercised seven hours a day, "pushing my body beyond its normal limits, putting on a lot of muscle mass and just making myself look like Superman."
For Henry Cavill, this was temporary. For a male anorexic, it's all in a day's workout.
I spoke with young men who said they barely woke up in the morning before launching into 300 sit-ups (and did 500 later in the day, and another 300 before bed). If they ate at all, it was trace amounts. They also ran for miles every afternoon after school. If they couldn't go out and run, because the weather was bad or because their parents wouldn't let them leave the house, they ran up and down stairs thousands of times. If they were forbidden to exercise, they did jumping jacks in the shower. They worked out even when beyond exhausted, famished to the point of fainting or in excruciating pain.
But this behavior didn't give them the body they were after. Justin, one of the boys I contacted, rapidly lost 50 pounds when he was 13. His fingertips, nails and lips turned blue; he had sunken eyes and hollow cheeks; and he wore baggy clothes to conceal an emaciated body. With zero body fat left, his body couldn't stay warm and Justin grew strange patches of soft fuzzy hair on his stomach and neck.
Meanwhile, Justin's entire personality changed. His mother remembered the family "walking on eggshells" because of Justin's mood swings and outbursts.
But the most fascinating -- and scary -- discovery I made was learning about "the voice," which, I came to realize, is at the heart of this heartbreaking disorder. The voice, sometimes called "the anorexic voice," is a voice in their heads, a nagging compelling voice that won't shut up and at the deepest level acts as the great enforcer. It's the voice that outlaws eating, orders more exercising than a Marine recruit could endure, punishes any attempts to break free and constantly, viciously insults and ridicules the person with an eating disorder. It's the voice that makes the disease so insidious and deep-seated, steeling boys not to own up to the changes in themselves while making them fiercely resistant to anything that might help them.
Which means it's not just the outside world that's dangerous to vulnerable teenagers -- it's teenagers own inner worlds. They're at the mercy of a cruel dictator no one else can hear. A New York doctor has never forgotten one teenager's explanation of the way the voice operates: "Imagine your favorite patient dies because you did something wrong, and how bad you'd feel. Then multiply that by 10 million. That's how the voice makes you feel when you try to say no to it."
A big part of recovery is silencing or learning to ignore the voice. Which is far from easy. Justin had to be hospitalized and then worked closely with a doctor afterward. Happily, at 25, he is healthy and thriving. Heroically, he beat an eating disorder. Which I'd say makes him more powerful than a locomotive.
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If you're struggling with an eating disorder, call the National Eating Disorder Association hotline at 1-800-931-2237.