Les troubles alimentaires chez les hommes : Une revue de la littérature actuelle

Abstract

Les troubles du comportement alimentaire (TCA) chez les hommes ont souvent été occultés par leur prévalence plus importante chez les femmes. Cependant, la recherche témoigne d’un regain d’intérêt pour cette thématique. L’objectif de cet article est de réaliser une synthèse des différentes études actuelles. Une revue de la littérature a été menée sur les bases de données PsycINFO, MEDLINE et ScienceDirect, et 34études publiées entre 2009et 2014ont été analysées. Les résultats rapportent une fréquence des troubles alimentaires comprise entre 2,7et 13,3%. Les facteurs de risque observés incluent l’insatisfaction corporelle et notamment l’insatisfaction envers la masse graisseuse et la masse musculaire, l’exercice physique compulsif et compensatoire, les difficultés de régulation des émotions, les difficultés de flexibilité cognitive, l’adhésion aux stéréotypes et l’influence des relations interpersonnelles. Une importance particulière est attribuée à l’orientation sexuelle. Une seule étude concerne l’efficacité d’un traitement des patients boulimiques avec des résultats concluant jusqu’à une année post-traitement. Cette revue de la littérature confirme l’existence de facteurs de risque communs aux deux sexes et souligne certaines particularités des TCA chez les hommes. Elle évoque également la nécessité de mener des études sur les traitements.

Aims. — Male eating disorders are often overshadowed by the higher incidence of such disorders in the female population. Over the last 10 years, there has been renewed interest in research on this topic, although few studies of male eating disorders have been carried out in France. The aim of this article is to summarize current research in this field. A literature review was conducted on the databases of PsycINFO, MEDLINE and ScienceDirect. Articles on samples of males suffering from obesity were excluded due to the specific nature of eating disorders in this population. In the case of articles containing samples of men and women, only data linked to the male sample was analyzed wherever possible. The results of 34 studies published between 2009 and 2014 were analyzed. Results. — The results of studies using self-assessments which define the risk thresholds sho- wed a frequency of eating disorders between 2.7 and 13.3% (Hilbert and Tuschen-Caffier, 2004; Gadalla, 2009; Paulson and Rutledge, 2014) [12—14]. The frequency of subclinical disorders, in other words eating problems which do not fit all the diagnostic criteria of eating disorders, was 11.8% (Valls et al., in press) [17]. However, few studies indicated the frequency of eating disor- ders due to the use of self-assessments which do not contain a threshold score. The risk factors observed concerned dissatisfaction with body shape, notably the distinction between dissatis- faction with fat mass and dissatisfaction with muscle mass. However, no study has investigated eating disorders and the associations between dissatisfaction with fat mass and dissatisfaction with muscle mass. Frequent physical exercise was associated with the risk of developing eating disorders. This association was stronger when compulsive (four times greater risk) and compen- satory (three times greater risk) dimensions of physical exercise were taken into consideration, regardless of sex (Sanftner, 2011) [25]. In addition, inappropriate eating behaviors alleviated emotional dysfunction such as difficulties in controlling emotions and intolerance of negative mood. Self-silencing, i.e. the denial or minimization of one’s own emotions to prioritize others’ needs, was a strong predictor of eating disorders in American students (Dakanalis et al., 2014) [28]. Although men suffering from eating disorders have less cognitions associated to the body than women, cognitive behavioral characteristics were highlighted as risk factors, for example weak cognitive flexibility (inability to adapt to change, rigidity) and central coherence (focu- sing to details) which could be associated to inappropriate behavior aimed at increasing muscle (Brennan et al., 2011) [22]. Sociocultural factors such as adherence to masculine stereotypes which are associated with a pursuit of weight loss (Baillie and Copeland, 2013) [31], and inter- personal difficulties associated with bulimic behavior (Lavander and Anderson, 2010) [27] were also important. Particular importance was given to sexual orientation. The homosexual popu- lation had a significantly higher tendency towards the pursuit of weight loss and was more sensitive to media message, to body objectification and to identity conflicts related to sex (Carper et al., 2010; Dakanalis et al., 2012; Ålgars et al., 2010) [35,38,39]. As in the case of women, studies showed an association between high depressive symptomatology and eating disorders (Valls et al., in press; Griffiths et al., 2014) [17,21]. Finally, although there were studies focusing on possible treatments of male eating disorders, only one evaluated the effi- ciency of cognitive behavioral treatment of bulimic patients. The results of this study indicated a reduction in symptoms up to one year following treatment (Fernández-Aranda et al., 2009) [10]. Conclusion. — Although this literature review was not exhaustive, it confirmed the existence of risk factors which are common to both sexes (for example dissatisfaction with weight, difficul- ties in controlling emotions and depression) and underlined certain peculiarities of male eating disorders (for example, distinction between dissatisfaction with fat mass and dissatisfaction with muscle mass). The importance of risk factors associated with the development of eating disorders in the homosexual population was highlighted. This article also evokes the lack of sensitivity and of information in society and amongst health professionals, as well as the need to carry out studies on the different types of treatment for men suffering from eating disorders.