Gender Differences in Binge Eating Disorder

Background: Adolescence represents a period of increased vulnerability to eating disorders −including binge eating disorder (BED)− with females more likely to be diagnosed with BED than males. It is not well understood whether male adolescents have lower prevalence of binge eating than females or whether diagnostic disparities result primarily from males being less likely to report distress related to problematic eating. The latter possibility is relevant, as several symptoms required for the BED diagnosis include self-reported distress and contain emotion-related vocabulary that males may be less likely to endorse (e.g., embarrassed, guilty, upset, depressed, afraid, worried). The present study examined gender differences in prevalence of BED, binge eating behavior (BEB) without BED diagnosis, and endorsement of five BED symptoms with emotion-related vocabulary in adolescents.

Methods: This study utilized data from the National Comorbidity Survey – Adolescent Supplement (NCS-A), a nationally representative sample of 10,123 U.S. adolescents aged 13 to 18 years. Complex survey weights were applied prior to analyses. Adjusted prevalence ratios were calculated to assess gender differences in lifetime prevalence of BED (n=164) and BEB without BED diagnosis (n=368). Adjusted odds ratios were calculated to assess gender differences in endorsing five BED symptoms with emotion-related vocabulary. Age, race, and adolescents’ years of education were controlled for all analyses. 

Results: Adolescent girls displayed 2.81 times higher BED prevalence than boys (95% confidence interval: 1.59, 4.96), whereas no gender differences in prevalence of BEB without the BED diagnosis were found. Adolescent girls showed significantly higher odds of endorsing all five symptoms of BED that contained emotion-related vocabulary than boys.

Discussion: The results suggest that gender differences in BED diagnosis are due to adolescent boys’ lower endorsement of distress-related BED symptoms, rather than lower prevalence of binge eating. The fact that adolescent boys are equally likely to binge eat as their female counterparts but are less likely to be diagnosed with BED suggests they are at greater risk for going without treatment, with negative implications for their future physical and mental health. Future work should consider how to best assess and treat problematic eating in boys.