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Also see Bulimia and Anorexia in males

Fichter et al. (65) defines atypical anorexia nervosa in males as that occurring in males who fulfill some, but not all, criteria of anorexia nervosa and who manifest atypical symptoms or characteristics.

Of four cases of male anorexia nervosa reported by Fichter et al. (65) two atypical male cases with obsessive-compulsive features were noted. One patient had anorexia, bulimic episodes, and obsessive-compulsive behaviors (hand washing rituals). The onset of illness occurred after a driving accident. The second patient, age 28, developed an obsessive-compulsive neurosis after his father's death, with obessive thoughts of aggressiveness and with rituals to undo his evil deeds and thoughts. He starved himself and made several suicide attempts. However, body image disturbances and weight phobic symptoms were not present.

Another patient, with full criteria for anorexia nervosa, had a depressive-apathetic syndrome, secondary conflicts with his homosexual partner which produced labile personality changes, and depressive reactions (65).

In addition to weight loss, another patient developed disturbances in swallowing of psychogenic origin and displayed personality features seen in anorexia nervosa (rigidity, social anxiety, achievement orientations) (65).

Atypical Eating Disorders in Males

Andersen and Mickalide (60) noted that 21 percent of male patients who were referred to Johns Hopkins Eating Disorders Clinic had an eating disturbance with weight loss or abnormal eating patterns in the absence of criteria of DSMIII anorexia nervosa.

One group had a swallowing phobia (fear of choking) with significant weight loss, previously misdiagnosed as anorexia nervosa. An earlier choking episode (often vaguely recalled) and a second, more recent choking episode resulted in a sustained fear of choking associated with severe dietary restrictions of solid food. Blinder (70) noted that this syndrome may be a variant of anorexia occurring in a post traumatic context; he found patients who exhibited similar fears after mouth injury or dental surgery. Choking and aspiration, associated with a rare, chronic ruminatory disorder, may also lead to food restriction (71).

Andersen and Mickalide (60) also noted patients who had a classic panic disorder with an associated preoccupation with fears of public vomiting, leading to food restriction and diminished weight. In contrast, a patient with general anxiety had specific overeating episodes unassociated with the fear of obesity (60).

These atypical eating disorders are differentiated from anorexia nervosa, since full DSMIII criteria for anorexia nervosa re not present, and may be defined as a mild form of anorexia nervosa.


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