Christopher R. Skarinka had heard of eating disorders, of course. Every college student had by the early 2000s, when Skarinka started school. But nearly every college kid, like most everyone else, also thought of eating disorders as a female problem. Not a problem for a buff, 6-foot-5-inch guy like himself.
Yet by the time Skarinka graduated from Harvard, in 2007, he was addicted to making himself purge. He wasn’t worried about his weight. He just liked the sense of control that purging gave him.
Looking back now, Skarinka says he was deeply unhappy. He coped with the stress of a high-pressure school and then a higher-pressure investment banking job by exerting control over one of the few things he could control: what he ate.
Eating disorders have long been considered a female problem, but a 2007 Harvard study based on national survey data found that men are one-third as likely as women to have anorexia or bulimia and more than half as likely to have a binge eating disorder. A study this summer of adolescents found even closer rates of bulimia and identical rates of anorexia between teenage boys and girls.
It’s not clear why it’s taken so long to recognize male eating disorders. It may be that men have a harder time acknowledging problems, or that society has been more accepting of men being overweight or of eating big meals. Or perhaps the rates have been rising as popular culture increasingly celebrates perfect male physiques the way it has long lionized women’s figures.
No one has done the research to find out what’s behind male eating disorders, said Ruth Striegel of Wesleyan University, where she is Walter A. Crowell Professor of Social Sciences and professor of psychology. A renowned eating disorder researcher, Striegel published a study last month calling for more men to be included in binge eating disorder research.
Male eating disorders are slightly different from female ones, specialists in the field say.
Instead of aiming to lose weight, many men who purge are athletes trying to make weight in a sport, or to improve their muscle definition, said Dr. Theodore E. Weltzin, medical director of Eating Disorder Services at Rogers Memorial Hospital, a psychiatric health system in Wisconsin. The male route to anorexia is often through compulsive over-exercise.
Like women, men with eating disorders are often overachievers and perfectionists, eager to please others. They may also have conditions such as anxiety disorder, obsessive-compulsive disorder, depression, substance abuse issues, or attention deficit hyperactivity disorder, said Roberto Olivardia, a clinical psychologist in Arlington who has been researching and writing about male eating disorders since 1994.
Men tend to see eating disorders as a threat to their masculinity, he said.
“Almost every male [I’ve seen in my practice] has always brought in gender identity - this idea of how masculine are they and what does it mean that I have an eating disorder,’’ said Olivardia, also a clinical instructor in psychiatry at Harvard Medical School and co-author of the 2000 book “The Adonis Complex,’’ about male body image.
Straight men are just as likely to have eating disorders as gay men, he said, despite the stereotype that gay men are more concerned with their appearance. Gays tend to be more open about their eating disorders, Olivardia said, perhaps because they have already had to conquer one form of sexual stereotyping when going public about being gay.
Men are also less likely to seek treatment than women, perhaps because of the double stigma of having an eating disorder and a problem that’s usually associated with women, he and others said.
On the plus side, men seem to respond just as well to treatment as women. Cognitive behavioral therapy, aimed at helping people manage self-destructive behaviors, has been shown effective against eating disorders, Olivardia and Striegel said.
Unlike fighting drug or alcohol addiction, abstinence from the addictive substance - food — is not an option when recovering from eating disorders.
“You have to learn how to have a healthy, moderate relationship with food,’’ said Johanna S. Kandel, founder of the Alliance for Eating Disorders Awareness in West Palm Beach, Fla. “You have to deal with it three to six times a day for the rest of your life.’’
Tragedy spurred Skarinka’s recovery.
He and his longtime girlfriend broke up. Three weeks later one of his closest friends committed suicide. The double shock shook him out of his self-absorption and forced him to grow up, Skarinka said. His need for control suddenly didn’t seem so important by comparison to his friend’s life-ending depression. He recognized that no matter how much he tried, he couldn’t control things like relationships and other people’s depression, and he began to take control of his destructive behavior.
Though he thought he was totally alone at the time, in many ways Skarinka’s story is typical of men with eating disorders. He was introduced to the idea of throwing up by fellow friends he rowed crew with. Some men threw up to maintain weight; others to reduce stress. Self-induced vomiting can trigger an endorphin release similar to exercise, Olivardia said, giving the rowers an extra edge at the beginning of a race.
But it’s also highly addictive and dangerous, and the edge does not last long. Eating disorders are considered among the most lethal of all psychiatric conditions, with death rates for anorexia hovering between 10 and 20 percent, said Kandel, author of the 2010 book “Life Beyond Your Eating Disorder.’’
Although Skarinka didn’t realize it at the time, his bulimia started to affect his heart. He failed a medical exam and had to stop rowing.
It also damaged his relationships, such as the one with his girlfriend. Harboring a secret can chip away at the trust in a relationship, and by its very nature, an eating disorder becomes an obsession that absorbs time and mental energy.
“It’s an inherently selfish disease,’’ Skarinka said. “You don’t think about the effect on others.’’
Today, Skarinka says he is completely free of his eating disorder, and has no health problems from his 4 1/2 years of bulimia and no lingering problems with food.
“I don’t even think about it at all, which is amazing,’’ said Skarinka, now an associate at a private equity firm in Boston.
Giving up purging also allowed him to build more muscle and strength, said Skarinka, who still rows and works out regularly.
“I’m a much stronger person - physically and psychologically - than I used to be,’’ he said.
Because of a reporting error, a photo caption that ran with a story about male eating disorders incorrectly stated that Christopher R. Skarinka was a member of the Harvard crew team. Skarinka rowed crew with friends, but was never a member of the Harvard Rowing Team.