Clinical picture in comparison to women
The incidence of anorexia nervosa in males is generally agreed upon to be between 5% to 10% of all anorexia nervosa cases. (Crisp & Burns, 1983) Studies show that there tends to be a predominance of the upper social class in cases of eating disorders with almost two thirds of the group from social classes I and II (Sharp, Clark, Dunan, Blackwood, & Shapiro, 1994). High risk subgroups include jockeys, wrestlers, dancers, and entertainers required to lose weight to be successful (Andersen, 1986). Andersen (1986) also suggests that the incidence in male medical students is several times greater than that of the general male population.
The DSM-IV criteria for anorexia nervosa include an intense fear of gaining weight, a distorted self-perception of body image, refusal to maintain normal body weight (less than 85% of expected weight) and three consecutive months of amenorrhea (American Psychiatric Association, 1994). The criterion of amenorrhea has been subject to much criticism for the creation of a gender bias in diagnosis of the disorder. Several suggestions have been proposed to eliminate this gender bias. Russell (as cited in Crisp & Burns, 1983) solves the problem by altering the amenorrhea criterion to "an endocrine disorder which manifests itself clinical in amenorrhea, or in the case of male subjects, a loss of sexual interest and lack of potency. On the other hand, some suggest that the criterion be eliminated completely due to the fact that the illness is no less severe in patients who meet all the diagnostic criteria with the exception of amenorrhea (Andersen & Holman, 1987).
The clinical picture of anorexia nervosa in males has been extensively researched and detailed. (Crisp & Burns, 1983; Sharp et al., 1994). Crisp and Burns (1983) gave a preliminary description of the clinical features found in 36 male patients being studied at St. George's Hospital in London. They note