To look at him, one would never guess that Jason has an eating problem. At 21, he's a sturdy man with a well-developed body and a California tan.
Yet nine months ago, Jason (not his real name) weighed 130 pounds. A year ago, he weighed 112. That's not bad if you're just over 5 feet tall. But Jason is 6-feet even.
Jason is one of about 20,000 males nationwide who have anorexia nervosa, an eating disorder generally considered a "woman's disease," whose victims resist food to the point of starvation.
Because anorexia is so rare among men--90% to 95% of its victims are women--experts can only speculate on why a man would develop the disease.
Questions concerning sexuality and self-identity seem to be common factors. Some researchers have found that many anorexic men had no sexual experiences during adolescence, while others have lost their interest in sex because severe weight loss causes a decrease in hormones.
While homosexuals are no more susceptible to anorexia than are heterosexuals, researchers say, gay men who suffer from eating disorders do feel the same societal pressures as heterosexual women to stay slim to please a lover or to boost their own self-image.
And, perhaps unlike women, some men see anorexia as a test of their physical strength, a way to prove to themselves that they "can live forever," as one researcher said, or that they are worth something despite neglect or criticism from friends and family.
In Jason's case, severe depression over grades and the difficulty of making friends in college led to his two-year bout with anorexia.
"It was kind of like, 'Yeah, I can endure the pain of not eating anything so that kind of validates me as a person' since my grades didn't show what kind of person I was," he said.
His illness also forced him to question his sexuality: "I just thought, 'Am I a woman?,' and I know I'm not. I'm me and it happened."
Another anorexic, Daryl (not his real name), says he has no doubts about his sexuality--he is heterosexual. However, his interest in sex is very low:
"If there were on (a) table a cookbook and a Playboy, I would read the cookbook."
Daryl, whose father died when he was 13, traces his obsession with food to a lack of affection from his mother. This problem has created a psychological hunger, he said, because a mother is supposed to be "where a baby gets fed from and nourished."
Dr. Joel Yager, director of UCLA's Eating Disorders Clinic, said that almost all of his male anorexic patients have been heterosexual, although his male patients with bulimia, the self-induced vomiting of food, seemed to show a higher rate of homosexuality.
"The gay men who I have seen with bulimia have said to me that having a slim body shape to be an attractive gay is very, very important," said Yager, who added that the "passive partner" in particular strives for a figure that is "boylike or girlish."
More Heterosexual Men
At ESTEEM, a nonprofit eating-disorders clinic in Santa Monica, psychologist Arlene Alexander said that most of the males that come to the clinic are homosexual, though she said she is "seeing a trend" of more heterosexual men at the clinic.
"I would say the similarity between gay men and straight women is that the relationships that they're in are based upon an image, not who they are as a person," said Alexander, who estimated that 15% of the clinic's patients are men. "Gay men are often subject to the same strict standards of physical beauty as straight women are."
Appearance aside, anorexic men may also be seeking a sense of physical immortality, said Dr. Harry Gwirtsman, Yager's colleague at UCLA. He speculated that a man in his 30s may feel a self-imposed pressure to "live forever" through exercise as he feels "age creeping up." Eventually, the man may associate weight loss with good health and will begin dieting, sometimes adopting poor eating habits.
Yager said that several of his male bulimics were former wrestlers or gymnasts who had to battle weight gain. Such men do not see any harm in excessive weight loss because it was acceptable for them to starve for athletic competitions, he said.
Alexander, the executive director of ESTEEM, said she believes anorexics, though obsessed with food, starve themselves to overcome the pain of unfulfilled emotional needs.
For Daryl, his relationship with his mother created such needs.
"I guess I didn't feel like I'd gotten nourished from my mom . . . in another way so I went to the food."
And to the bottle. Toward the end of his third year at USC, Daryl, now 25, compounded his eating disorder with alcoholism.
He would get drunk to "relax his prohibitions" against eating or to numb hunger pains, said Dr. Carole Edelstein, his psychiatrist at UCLA, where he started treatment in 1982.
Before seeking help at UCLA, Daryl dropped out of college to see a psychologist, thinking that with therapy he could "get everything fixed and go back into the world."