The Trials and Tribulations of Being a Man With Anorexia

If you were to scroll through his Instagram, you would think Cathal Larkin was a typical Gen-Z 22-year-old. Vibrant, fashion-forward apparel sits casually against his glowing skin, which no doubt comes as a result of a skincare routine we all wish we could maintain. But, like all young Instagrammers in the digital age, Cathal’s 3-photo-wide window into his life shows its viewer a bite-sized, false persona. The photographs on Cathal’s Instagram account may show his social life, sense of style, and radiant skin, but what they don’t show, is his battle with anorexia.

Cathal, from Templeogue in South Dublin, attributes the origins of his troublesome relationship with food and body image to a childhood spent worrying about his diet as a competitive swimmer and gymnast. The actual onset of his eating disorder came at around age 15. At the time, he was self-harming and had started to use drugs as a coping mechanism for his then undiagnosed borderline personality disorder (BPD).

He was diagnosed with BPD in 2018, and soon after, the anorexia became unabatingly worse. The diagnosis meant that the aforementioned coping methods had to come to a grinding halt as part of his treatment. To soften the blow of this change, Cathal turned to food restrictions as a replacement. For Cathal, food restrictions symbolised control – that is, if he could control his calorie intake and the number on the weighing scales, then that would be one solitary aspect of his life which would remain steady, providing a welcome escape from the turbulence of his day-to-day at the time.

Cathal has spent the past three years in and out of psychiatric hospital as a regular outpatient. His recovery has not been a linear path, with many setbacks and relapses leaving him no choice but to undergo additional care as an inpatient on multiple occasions, usually at the behest of his family.

The arrival of the Covid-19 pandemic in 2020, and the restrictions that came with it, saw Cathal hit rock bottom. By June of that year he was left with no option but to return to inpatient care due to the ever-growing severity of his struggles with anorexia. “When the pandemic hit, there was no escape from my eating disorder. It was constant – everything revolved around it,” he says.

Anorexia, or to go by its full name, anorexia nervosa, has become somewhat of a poster child for eating disorders. It is characterised by severely restrictive eating habits and an array of fears and anxieties concerning body image, weight gain, and control of one’s environment. People with anorexia die at up to 12 times the rate of the general population – the highest mortality rate among all mental illnesses. And that’s only taking into account deaths caused by illness-related complications, the list of which is long. Short-term side effects range from brittle hair to constipation. Long term, the effects of the illness become more severe: osteoporosis, kidney failure, seizures, and an absence of menstruation in female patients, to name a few. If that wasn’t concerning enough, people with anorexia are up to 56 times more likely to die by suicide than the average person.

Anorexia has stereotypes aplenty, as is the case for all mental illnesses. Like a game of Word Association, it doesn’t take much expansive or intellectual thought to conjure up a list of low-hanging misconceptions for each mental illness there is: schizophrenic people are dangerous; people with bipolar disorder are erratic; people living with depression are lazy; anorexia is a women’s issue. A myth for every day of the week. “If you were to ask a random person what an eating disorder looks like,” Cathal says, “the first thing that will come to mind is a teenaged white girl with a thin frame.” It’s of course a stereotype, but admittedly, the effigy of extremely thin, destitute young women didn’t shoot up from the ground. Most anorexia patients are women, and the emergence of the illness into broader public consciousness was dotted with cases and research exclusively concerning female patients. Anorexia was also catapulted into further notoriety after American musician Karen Carpenter died from it in 1983. One can see where the misconception that anorexia is a girls-only club began to raise its head.

Underlying all of the above is the age-old perception of mental illness as a by-product of emotional weakness, an evil twin of femininity, or at the very least, a far-cry from the world of masculine invincibility. Similarly, some might argue that due to its association with physical appearance and weight, anorexia is inherently a female problem, too superficial and inane for any strapping young man to bother himself with. And yet, in spite of sensational celebrity cases, media misrepresentations, or harmful preconceptions that would erase Cathal’s very existence, here he is, speaking to me over Zoom, as a man with anorexia.

According to Cathal, the stereotypes don’t just exist in the mind of the average Joe Soap, but in the treatment room of eating disorder programmes, too. Describing the male-specific care on eating disorder wards in Ireland, Cathal uses the term “very limited”. During his time as an inpatient on a specialist eating disorder ward, he had nowhere to shower or use the toilet, as the bathroom facilities on his ward were only for female patients. He would instead have to trek to a different ward on the other side of the hospital to avail of those luxuries. The female-oriented nature of the care also permeated its way into his time spent as an outpatient, where he would spend the odd group therapy session learning how to cope with losing his period. It’s a major side effect of the illness, so much so that female anorexia patients are not considered to have made a full recovery until their menstrual cycle returns to normal. Yet, in spite of its importance, teaching people who don’t have periods about how to cope with losing them is probably a fruitless endeavour. “It makes no sense to me,” says Cathal, “when I was [in outpatient care], there were three other guys there.”

The three other guys, period therapy and all, were but a drop in the ocean. Last year, 40% of hospital admissions for eating disorders between March and September were men, a “considerably higher” figure than in the years prior, according to research in the Irish Medical Journal. It’s a big jump indeed. The usual estimate for the proportion of eating disorder patients who are male ranges from 10% in anorexia and bulimia, to 50% in binge eating disorders. Most of the men who get treatment – Cathal included – are the lucky ones. Or, to put it plainly: they have the money. Current public treatment options for those living with an eating disorder in Ireland are nigh on inexistent. For at least the past 15 years, there have been just three specialised beds allocated to eating disorder patients in the public health system, despite HSE research projecting almost 190,000 Irish people will experience an eating disorder in their lifetimes.

So what does the typical road to recovery look like for men? Well first and foremost, they must clash with the inner torment of acknowledging that they might be one of those unspoken creatures: a man with an eating disorder. According to Cathal, admitting to yourself that you are sick is one of the very first stumbling blocks one can face, saying “You can be naïve, and think you’re never going to get as bad as the others. ‘That’s never going to be me’.” He continues: “It’s very common for men to think ‘I’m a guy, why am I thinking like this?’”. Once they jump that hurdle, next is actually getting help, and looking at the numbers, the help just isn’t there. However, if they do manage to get into clinical care, whether that be through ample finances or months spent on a waiting list, then come some added thorns-in-the-side: inadequate bathroom services, or perhaps spending precious, expensive therapy sessions discussing the emotional impact of halted menstruation.

So, where do we go from here? How do we make headway against eating disorder stigma? For Cathal, it’s all about education and keeping an open mind. “I saw it with my parents”, he says. In the early stages of Cathal’s eating disorder, his parents struggled to come to grips with what was happening in their only son’s life. It was through educating themselves using resources such as the all-encompassing eating disorder support group Bodywhys, that Cathal’s parents eventually came to a point of understanding that placed him in the best possible environment for recovery.

When it comes to the breaking down of stereotypes, Cathal says we must keep in mind that eating disorders exist on a spectrum of differing forms. “Eating disorders are so diverse. It’s not one set mould,” says Cathal, “It’s important to realise that it’s not just about weight – that is a symptom.” While anorexia is accompanied by an overwhelming fear of gaining weight, most experts agree that the disorder develops as a result of underlying causes. In Cathal’s case, his borderline personality disorder was a major contributing factor in the development of his anorexia. For others, those underlying causes can range from peer pressure to genetic predisposition.

So, if a large part of the stigma lies in our homogeneous perception of what people with eating disorders look like, and we genuinely want to help in the fight against it, then perhaps we should take the aforementioned effigy of destitute young girls and remind ourselves: effigies are meant to be burned.

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