The secret signs of bulimia and anorexia are familiar.
Looking in the mirror and always seeing an unfit, unattractive, fat person -- even when the real reflection isn't. Purging in the restroom after eating dinner with friends. Starving oneself by eating only one meal a day. Thinking constantly about one's body.
But the person in the mirror is not familiar.
It's a man.
His name is Dick. The 32-year old sales associate from Anaheim asked that his last name not be used. None of his family members, friends and co-workers knows that he has been struggling for more than a decade with a distorted body image.
Dick is among a growing number of men _ about 1 million in the United States, by most estimates _ who battle with what is still largely perceived as a woman's mental health condition. The numbers of men with eating disorders may be greater_from 3 million to 5 million, said Roberto Olivardia, clinical psychologist at McLean Hospital in Belmont, Mass. Olivardia is co-author of "The Adonis Complex: The Secret Crisis of Male Body Obsession," (Free Press, $25).
Male eating disorders are underdiagnosed because society lacks awareness of them and men are less likely to admit they have this medical problem and seek help, Olivardia said.
That's changing slowly, he said.
Knowing who might be at risk may help prevent eating disorders from developing, say body-image researchers. Understanding the nature of male body obsession and eating disorders may help men recognize that they have these conditions and seek treatment.
Doctors and psychologists do not know the exact causes of distorted body images and eating disorders in men because research in these areas is in the infancy stages.
But more studies on men and boys are emerging in medical publications such as the International Journal of Eating Disorders Research.
One in six men may have anorexia and bulimia, according to a 1999 study in Psychiatric Annals, by Dr. Arnold E. Andersen, an eating-disorder researcher at University of Iowa.
Andersen classifies at-risk men into four groups:
-- Men in sports and athletic activities who need to control weight for performance. This is the most prevalent group.
-- Men who were overweight or obese and had negative, sometimes traumatic experiences related to their weight.
-- Men whose fathers had ill health, possibly weight-related, or may have died because of it.
-- Men who want to improve their body image. This includes gay and straight men.
Researchers have coined a term for one type of male body obsession: body dysmorphia disorder (BDD). An example is of BDD is muscle dysmorphia, sometimes called "reverse anorexia" or "biggerexia." This disorder occurs when normal-size or big, muscular men think of themselves as thin and scrawny. Some men with muscle dysmorphia may be workout-aholics, or users of steroids or muscle-enhancing supplements.