A Wisconsin psychiatrist who actually specializes in the treatment of eating disorders, Holbrook fell victim to anorexia nervosa when he stopped running in 1976 after suffering a knee injury and began obsessing about becoming fat.
So he adopted a strict diet of carrots and cabbage and began walking six hours a day."I was waking up at 2:30 or 3 in the morning and walking for hours on end. I was the champion of denial, and probably sicker than any of my patients," Holbrook remembers.
Holbrook is among the small but growing number of men who suffer from eating disorders, which can range from anorexia nervosa to bulimia nervosa to binge eating. Although there are no reliable statistics on the number of men with eating disorders, anecdotal evidence indicates the problem is increasing, according to experts.
"More and more men with eating disorders have sought help over the past few years," says Jill Pollack, a psychotherapist in private practice in New York City.
"We've seen lots of men step forward with these problems in the past year, perhaps because they're seeking resources and support," adds Judy Teffer, a spokeswoman for the National Association of Anorexia Nervosa and Associated Disorders.
She estimates that of the eight million Americans with eating disorders, one million are now men.
But the mistaken belief that only women or teen-age girls are afflicted by eating disorders still prevails, experts say.
"Historically, women were the targets of the diet industry. But, only in the past few years have men been so aggressively marketed to with weight-loss and bulk-up products," says Leigh Cohn, who co-authored the book Making Weight: Men's Conflicts with Food, Weight, Shape and Appearance with Holbrook.
Says Pollack: "I've counseled wrestlers who feel pressured to 'make the weight' in order to be on their school's team. To my horror, their coaches will give them water pills, tell them to use the steam room, run more, or bulk up to a certain size."
Roadblocks to recovery
Not surprisingly, men with eating disorders are less likely than women to seek treatment because they feel shame or embarrassment.
Compounding the problem is that doctors often don't spot the signs in men.
"I visited the emergency room countless times and no questions were ever asked about my appearance, despite the fact that my skin was orange from eating too many carrots," Holbrook says.
One telltale sign of a man with an eating disorder is an obsessive preoccupation with his body, weight and shape. This is often coupled with certain behaviors such as compulsive over-exercising or abusing products that help "bulk up," says Dr. Angela Guarda, the director of the eating-disorders program at Johns Hopkins University in Baltimore.
Other symptoms include restricting the amounts or types of foods eaten (eating no fat or eating only vegetables, for example); "purging" eaten foods by vomiting or using laxatives or diuretics; relying on diet pills; and losing noticeable weight or fluctuating in size.
Although eating disorders describe an array of problematic behaviors, the three main types that afflict men -- and women -- are:
- Anorexia nervosa, which is often characterized by self-starvation and compulsive exercising.
- Bulimia nervosa, which involves recurring periods of binge eating and purging. Large amounts of food are consumed in a short amount of time, followed by self-induced vomiting, the abuse of laxatives or diuretics, and fasting.
- Binge-eating disorder involves out-of-control or compulsive overeating. Someone with this condition often fluctuates between periods of overeating and dieting.
Men who participate in competitive sports where body shape and size are important -- gymnastics, ice skating, crew, dance and wrestling -- are at increased risk for eating disorders.
Experts say other forces can lead to eating problems in men, including:
- Negative family patterns. Parents who stress fitness or athleticism to an unhealthy degree, or have unrealistic expectations for their children, can often contribute to eating problems.
- Media influence. Magazines and TV commercials increasingly sport photos of lean, muscular, athletic-looking men, increasing the pressure to be trim and fit.
- Traumatic events. Sexual, physical or emotional abuse can also set the stage for eating disorders.
The common thread is that the patient has experienced intense emotional pain and doesn't know how to cope with it in a healthy way. Controlling eating habits, weight or bodily functions often provides a false sense of control, Pollack says.
Fortunately, psychotherapy and support groups can help.
"A huge part of recovery is accepting that you have an eating disorder and talking about it," Holbrook says. "Getting therapy was the best thing that I've done for myself."
What To Do
The first step in dealing with an eating disorder is to speak with a psychotherapist or mental-health professional who specializes in the treatment of these disorders.
Experts also recommend contacting a nutritionist or registered dietitian to help develop healthful eating habits and menu planning. Contact the American Dietetic Association to learn more.
For more information about eating disorders, check out information provided by the National Association of Anorexia Nervosa and Associated Disorders, or the Harvard Eating Disorders Center.