Reas Deborah L, Stedal Kristin
Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway.
Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway.
Maturitas. 2015 Jun;81(2):248-55. doi: 10.1016/j.maturitas.2015.03.004. Epub 2015 Mar 18.
Eating disorders are serious psychiatric illnesses which can occur across the lifespan. Men aged midlife and beyond are vulnerable to stigma, shame, and stereotypes portraying eating disorders as afflictions of youth and female gender. Historically, men have been neglected in the field of eating disorders owing to traditional and female-centric approaches to conceptualization and classification. In this literature review, we identified 16 case reports of eating disorders in males ranging from the age of 40 to 81 years. The majority of cases reported an earlier onset in life, followed by a variable course of illness with periods of relapse interspersed with remission. Diagnostic crossover or symptom fluctuation was common. High rates of comorbid depression were found, and several cases described a history of weight cycling and premorbid obesity. Precipitating factors included stressors which disproportionately occur in later life, including loss due to death or divorce, changes in financial or housing situation, and medical issues. Very little is known regarding the prevalence of eating disorders in older men, with initial population estimates ranging from 0.02% to 1.6%. Rates of subthreshold eating disordered behavior are higher and appear to be increasing among older individuals and males in the community. Recent revisions in the DSM-5 will likely increase the broader applicability of diagnostic criteria for eating disorders, stimulating improved recognition of diverse presentations occurring across the lifespan for both genders. Eating disorders should be included in the differential diagnosis of unexplained weight gain or weight loss irrespective of age or gender. Multi-site studies are needed for adequate sampling and to allow larger empirical investigations regarding how to improve clinical practices in screening and assessment, as well the provision of differential care for older men suffering from an eating disorder.
饮食失调是严重的精神疾病，可发生于整个生命周期。中年及以上的男性容易受到耻辱感、羞耻感以及将饮食失调描绘为青年女性疾病的刻板印象的影响。从历史上看，由于传统的以女性为中心的概念化和分类方法，饮食失调领域一直忽视男性。在这篇文献综述中，我们确定了16例年龄在40至81岁之间的男性饮食失调病例报告。大多数病例报告发病较早，随后病情呈可变过程，有复发期与缓解期交替出现。诊断交叉或症状波动很常见。发现共病抑郁症的发生率很高，几例病例描述了体重循环史和病前肥胖史。诱发因素包括在晚年不成比例出现的压力源，包括因死亡或离婚导致的损失、财务或住房状况的变化以及医疗问题。关于老年男性饮食失调的患病率知之甚少，初步的人群估计范围为0.02%至1.6%。阈下饮食失调行为的发生率更高，并且在社区中的老年人和男性中似乎在增加。《精神疾病诊断与统计手册》第五版（DSM-5）的最新修订可能会提高饮食失调诊断标准的更广泛适用性，促进对男女在整个生命周期中出现的各种表现的更好识别。无论年龄或性别，饮食失调都应纳入不明原因体重增加或减轻的鉴别诊断中。需要进行多地点研究以进行充分抽样，并允许就如何改善筛查和评估中的临床实践以及为患有饮食失调的老年男性提供差异化护理进行更大规模的实证研究。
