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 34 études publiées entre 2009 et 2014 ont été analysées. Les résultats rapportent une fréquence des troubles alimentaires comprise entre 2,7 et 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.

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.

The results of studies using self-assessments which define the risk thresholds showed a frequency of eating disorders between 2.7 and 13.3% (Hilbert and Tuschen-Caffier, 2004; Gadalla, 2009; Paulson and Rutledge, 2014) [12Hilbert A., Tuschen-Caffier B. Body image interventions in cognitive behavioural therapy of binge-eating disorder: a component analysis Behav Res Ther 2004 ;  42 : 1325-1339 [cross-ref]

Cliquez ici pour aller à la section Références, 13Gadalla T.M. Eating disorders in men: a community-based study Int J Men Health 2009 ;  8 (1) : 78-81

Cliquez ici pour aller à la section Références, 14Paulson L.R., Rutledge P.C. Effects of perfectionism and exercise on disordered eating in college students Eat Behav 2014 ;  15 : 116-119 [cross-ref]

Cliquez ici pour aller à la section Références]. 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) [17Valls M, Callahan S, Rousseau A, Chabrol H. Troubles du comportement alimentaire et symptomatologie dépressive : étude épidémiologique chez les jeunes hommes. Encephale. http://dx.doi.org/10.1016/j.encep.2013.05.003 [in press].

Cliquez ici pour aller à la section Références]. However, few studies indicated the frequency of eating disorders 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 dissatisfaction 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 compensatory (three times greater risk) dimensions of physical exercise were taken into consideration, regardless of sex (Sanftner, 2011) [25Sanftner J.L. Quality of life in relation to psychosocial risk variables for eating disorders in women and men Eat Behav 2011 ;  12 : 136-142

Cliquez ici pour aller à la section Références]. 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) [28Dakanalis A., Timko C.A., Clerici M., Zanetti M.A., Riva G. Comprehensive examination of the trans-diagnostic cognitive behavioral model of eating disorders in males Eat Behav 2014 ;  15 : 63-67

Cliquez ici pour aller à la section Références]. 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 (focusing to details) which could be associated to inappropriate behavior aimed at increasing muscle (Brennan et al., 2011) [22Brennan D.J., Crath R., Hart T.A., Gadalla T., Gillis L. Body dissatisfaction and disordered eating among men who have sex with men in Canada Int J Men Health 2011 ;  10 (3) : 253-268 [cross-ref]

Cliquez ici pour aller à la section Références]. Sociocultural factors such as adherence to masculine stereotypes which are associated with a pursuit of weight loss (Baillie and Copeland, 2013) [31Baillie L.E., Copeland A.L. Disordered eating and body image in Chinese and Caucasian students in the United States Eat Behav 2013 ;  14 : 314-319

Cliquez ici pour aller à la section Références], and interpersonal difficulties associated with bulimic behavior (Lavander and Anderson, 2010) [27Lavander J.M., Anderson D.A. Contribution of emotion regulation difficulties to disordered eating and body dissatisfaction in college men Int J Eat Disord 2010 ;  43 (4) : 352-357

Cliquez ici pour aller à la section Références] were also important. Particular importance was given to sexual orientation. The homosexual population 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) [35Carper T.L.M., Negy C., Tantleff-Dunn S. Relations among media influence, body image, eating concerns, and sexual orientation in men: a preliminary investigation Body Image 2010 ;  7 : 301-309 [cross-ref]

Cliquez ici pour aller à la section Références, 38Dakanalis A., Di Mattei V.E., Bagliacca E.P., Prunas A., Sarno L., Riva G., et al. Disordered eating behaviors among Italian men: objectifying media and sexual orientation differences Eat Disord 2012 ;  20 (5) : 356-367 [cross-ref]

Cliquez ici pour aller à la section Références, 39Ålgars M., Santtila P., Sandnabba N.K. Conflicted gender identity, body dissatisfaction, and disordered eating in adult men and women Sex Roles 2010 ;  63 : 118-125

Cliquez ici pour aller à la section Références]. 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) [17Valls M, Callahan S, Rousseau A, Chabrol H. Troubles du comportement alimentaire et symptomatologie dépressive : étude épidémiologique chez les jeunes hommes. Encephale. http://dx.doi.org/10.1016/j.encep.2013.05.003 [in press].

Cliquez ici pour aller à la section Références, 21Griffiths S., Angus D., Murray S.B., Touyz S. Unique associations between young adult men's emotional functioning and their body dissatisfaction and disordered eating Body Image 2014 ;  11 (2) : 175-178 [cross-ref]

Cliquez ici pour aller à la section Références]. Finally, although there were studies focusing on possible treatments of male eating disorders, only one evaluated the efficiency 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) [10Fernández-Aranda F., Krug I., Jiménez-Murcia S., Granero R., Núñez A., Penelo E., et al. Male eating disorders and therapy: a controlled pilot study with one year follow-up J Behav Ther Exp Psychiatry 2009 ;  40 : 479-486

Cliquez ici pour aller à la section Références].

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, difficulties 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.