Treatment experiences of males with an eating disorder: a systematic review of qualitative studies

Figures & data

Fig. 1. Flow chart of literature search.

Table 1. Excluded studies identified in the literature search

Author (date)	Reason for exclusions
Aardoom et al. (2013)	All female participants
Adams et al. (2005)	Not a study on ED treatment experience
Algars et al. (2012)	Not a study on ED treatment experience
Bezance and Holliday (2013)	Predominantly female participants
Bjork et al. (2012)	Not a study of ED treatment experience
Clement et al. (2014)	Not a study on ED treatment experience
Cossrow et al. (2001)	Not a study of ED treatment experience
Couchman et al. (2014)	Not a study of ED treatment experience
Dinos et al. (2004)	Predominantly female participants
Graham and Walton (2011)	Not a qualitative study
Green (2013)	Not a qualitative study
Hargreaves and Tiggemann (2006)	Not a study on ED treatment experience
Hay and Cho (2013)	Predominantly female participants
Higginson and Mansell (2008)	All female participants
Juarascio et al. (2013)	All female participants
Karlsson and Nevonen (2012)	All female participants
Lamb et al. (2012)	Not a study of ED treatment experience
Lawrence (2011)	Not a study on ED treatment experience
Linville and Brown (2012)	All female participants
Long et al. (2011)	All female participants
Malson et al. (2004)	Predominantly female participants
Malson et al. (2011)	Predominantly female participants
Morgan and Arcelus (2009)	Not a study on ED treatment experience
Nakamura (2012)	Predominantly female participants
Pettersen et al. (2011)	All female participants
Pretorius et al. (2010)	All female participants
Rahkonen and Tozzi (2005)	Predominantly female participants
Rance et al. (2013)	All female participants
Reid et al. (2008)	Predominantly female participants
Rosenvinge and Klusmeier (2000)	Not a qualitative study
Sabel et al. (2014)	Not a qualitative study
Stice et al. (2011)	All female participants
Striegel et al. (2012)	Not a qualitative study
Tierney (2008)	Predominantly female participants
Timulak et al. (2013)	Not a qualitative study
Trepal et al. (2012)	Not a qualitative study
Vromans and Schweitzer (2010)	Not a study of ED treatment experience
Warren et al. (2013)	Predominantly female participants
Weltzin et al. (2012)	Not a qualitative study

Table 2. Characteristics of included papers

Author (year)	Country setting	Participants N, age, ED features	Study question	Study design and transparency	Rigor of analysis and reporting
Beer and Wren (2012)	UK Specialist services	9, aged 21–42 years, most AN, all with severe and enduring ED	Research question clear and based on systematic review	Interviews, interpretive phenomenological analysis, secondary report of unpublished thesis thus transparency unclear	Quality unclear, design and analytic approach not reported in publication (book chapter)
Dearden and Mulgrew (2013)	Australia ED services	1) representatives of organizations, 2) practitioners, and 3) 5 male clients with ‘ED issues’, 2 with formal diagnosis of AN and BDD aged 22–58 years, long-standing ED issues of 4–19 years	Research question clear and based on systematic review collection	Purposive sampling, followed by snowballing, males were self-selected by invitation form health care organization, general-inductive approach, open-ended written self-report single author thematic analysis	Quality mixed, unclear role of researchers and ethics, analytic approach described, quotes used and triangulation (3 sources), saturation not reported, limitations discussed (small sample and use written survey)
Robinson et al. (2013)	UK Specialist services	8 males, 3 AN/EDNOS AN, 5 BN/EDNOS BN, aged 24–56 years, illness duration 4–34 years, only 1 had inpatient experience of treatment	Research question clear and based on systematic review	Purposive sampling, 8 of 16 invitees, semi-structured interviews with interpretive phenomenological analysis (single author), themes reported were shared by minimum 3 participants and illustrated with quotes	Approach sound, Approved NHS Ethics, researcher roles clear, second author audited transcripts and process, limitations discussed including possible selection bias, saturation not reported
Drummond and Murray (2002)	Australia ABNA	8 males with ED (AN and BN), age unclear	Research question clear and based on systematic review	In-depth qualitative interview, provided for flexibility, respondents could express their feelings, opinions and understanding of a phenomenon in their own terms	Inductive approach, repeated examination of the data to identify common themes in relation to the phenomenon being researched

AN=anorexia nervosa, BDD=body dysmorphic disorder, ABNA=South Australian Anorexia Bulimia Nervosa Association.

Table 3. Themes related to the experience of ED treatment as reported in the primary papers

Beer and Wren (25)	Dearden and Mulgrew (26)	Robinson et al. (27)	Drummond and Murray (28)
1) Experiencing ED as a pursuit of a physical identity characterized by fitness: ‘It's about being fit, it's not about being skinny’. 2) Experiencing emasculation through stigma associated with an ED diagnosis: ‘It can feel like an admission of being less than male’. 3) Experiencing care as a control: ‘I didn't like being pushed around’.	1) Pre-treatment themes: (a) causation: stress and perceived pressure from others; (b) masculinity and influence of sexuality ‘real men do not suffer EDs’; (c) usefulness of diagnosis in prompting help seeking 2) Treatment and recovery: (a) treatment seeking delayed after 3–6 years; (b) motivating factors: physical illness and prompts from concerned others; (c) range of barriers identified including stigma and lack of male services	1) Difficulty seeing self as having ED: (a) difficulty admitting ED; (b) men with ED are ‘invisible’; (c) fear of negative reaction in others; (d) difficulty seeing ED as a problem; (e) links between ED and discomfort with identity 2) Treatment experience important issues were: (a) being understood and cared for; (b) recognition of issues of sex	1) ED is form/expression of competition 2) Fat phobia: males are also preoccupied sense of weight and body size 3) Fitting the image – a flawed sense of masculinity: mental illness not masculine, weak

Table 4. Translation of themes related to male's experiences of treatment for an eating disorder across the four primary studies

Themes	Sub-themes	Paper origin
Delays/impediments in seeking treatment	Shame/stigma Not fitting sociocultural perception – mental illness/ED Ambivalence toward the disorder Lack of knowledge self/others/ and fear subsequent rejection	Dearden and Mulgrew (26) De Beer and Wren (25) Robinson et al. (27) Drummond (28)
Clinical features in males	Different body image concerns – muscularity Homosexuality Other – suppression sexual function	Dearden and Mulgrew (26) De Beer and Wren (25) Robinson et al. (27) Drummond (28)
Treatment services	Feminized services/psycho-education/being a minority in services Treatment too short/professionals lacking time to listen Experiencing care as control	Dearden and Mulgrew (26) De Beer and Wren (25) Robinson et al. (27)
Lack of consensus in views	Relevance of sex	Dearden and Mulgrew (26) Robinson et al. (27)

De Beer ZD, Wren B. Fox JRE, Goss KP. Wiley series in clinical psychology: eating and its disorders. Somerset. 2012; NJ: John Wiley. 427–41.

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Dearden A, Mulgrew KE. Service provision for men with eating issues in Australia: an analysis of organisations’ practitioners’ and men’ experiences. Aust Soc Work. 2013; 66: 590–606.

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Robinson KJ, Mountford VA, Sperlinger DJ. Being men with eating disorders: perspectives of male eating disorder service users. J Health Psychol. 2012; 18: 176–86.

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Drummond MJN. Men, body image, and eating disorders. Int J Mens Health. 2002; 1: 89–103.

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