The research team, led by Silvia Tempia Valenta of the University of Bologna together with colleagues in Italy, Belgium, Spain, and the United Kingdom, set out to answer two related questions. First, has men’s access to specialized eating disorder care changed over the past decade? Second, among the men who do reach specialist services, does their psychopathology differ from that of women in ways that standard diagnostic categories fail to capture? To address these questions, the researchers examined consecutive referrals rather than a selective sample, meaning every adult assessed at the center during the study period was included. This consecutive design matters, because it reduces the referral biases that can distort smaller, more selective studies.

Methodologically, the study was unusually comprehensive for a routine clinical cohort. Each patient completed the Eating Disorder Examination Questionnaire, or EDE-Q, a gold-standard self-report measure of core eating disorder psychopathology covering restraint, eating concern, shape concern, and weight concern. Body image disturbance was assessed with the Body Uneasiness Test, whose Global Severity Index captures distress related to body image across multiple domains. Depressive symptoms were measured with the Patient Health Questionnaire-9, anxiety with the State-Trait Anxiety Inventory Form Y, and personality pathology with the Structured Clinical Interview for DSM-5 Personality Disorders, a clinician-administered diagnostic interview rather than a brief screening tool. Diagnoses were assigned according to DSM-5 criteria, encompassing anorexia nervosa in its restrictive and binge-purge subtypes, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, and other specified feeding or eating disorders.

The diagnostic picture that emerged was sharply gendered. Anorexia nervosa and bulimia nervosa were more common among cisgender women, whereas binge eating disorder predominated among cisgender men. This pattern is consistent with a broader clinical literature suggesting that men with eating disorders more often present with loss-of-control overeating and associated weight gain rather than with the restrictive or purging presentations that have historically defined the field. Because binge eating disorder has only been a formal standalone diagnosis since DSM-5, introduced in 2013, its prominence among men in this cohort underscores how diagnostic frameworks themselves can influence who is recognized as ill and who is steered toward specialist treatment.

Beyond diagnosis, the researchers compared symptom burden across genders using standardized scores. Cisgender women reported significantly higher levels of eating disorder psychopathology on the EDE-Q, greater body uneasiness on the Body Uneasiness Test, and higher trait anxiety on the STAI-Y. Depression and personality disorder findings were also examined across the cohort. Importantly, however, the effect sizes for these gender differences were generally small to moderate, quantified using rank-biserial correlations for the non-normally distributed questionnaire data. In practical terms, this means that while women in the sample were, on average, more symptomatic on these measures, the distributions overlapped substantially, and many men showed clinically meaningful levels of distress. A small average difference between groups should not be mistaken for an absence of illness in the higher-scoring group.

The most innovative component of the study was its use of latent profile analysis, a statistical technique that identifies unobserved subgroups of patients who share similar patterns across multiple measured variables. Rather than sorting patients by diagnosis, latent profile analysis sorts them by overall severity and symptom configuration, allowing the researchers to ask whether men and women occupy the same or different positions along a transdiagnostic spectrum of illness. Three profiles emerged: low, moderate, and high severity. Cisgender men were more frequently classified in the moderate-severity profile, whereas cisgender women were overrepresented in the high-severity profile. The identification of these shared profiles across genders supports the authors’ conclusion that eating disorder severity can be meaningfully conceptualized within a common transdiagnostic framework, one that cuts across traditional diagnostic boundaries.

Why does this matter for clinical practice? If men who reach specialist care tend to sit in a moderate-severity band, they may present a clinical picture that screening tools calibrated on female populations underestimate. Instruments such as the EDE-Q were developed and validated largely in samples of women, and items probing drive for thinness or fear of weight gain may fail to capture the muscularity-oriented concerns, excessive exercise, and dietary rigidity that characterize many male presentations. A man with severe binge eating disorder and profound shame about his body may score lower on thinness-oriented items than a woman with anorexia nervosa, even though his overall illness burden is substantial. The transdiagnostic severity profiles identified in this study offer one way around that blind spot, because they assess overall symptom configuration rather than adherence to a stereotypical presentation.

The stability of the male proportion over ten years is arguably the study’s most sobering finding. Between 2014 and 2024, a period spanning major cultural shifts in how male body image is discussed, the share of men accessing the Bologna service remained fixed at roughly eight percent. This stagnation suggests that whatever awareness has grown in public discourse has not translated into more men reaching specialist assessment. The authors are careful to note that their data cannot disentangle the possible explanations: men may be less likely to recognize their symptoms as an eating disorder, primary care providers may be less likely to suspect one, stigma may deter help-seeking, or referral pathways may be less sensitive to male presentations. Each of these barriers operates at a different point in the care pathway, and each would require a different intervention.

There are also important limitations to weigh. The study was conducted at a single specialized center in one Italian city, and referral patterns there may not generalize to other health systems or countries. The cohort included cisgender men and women, and the authors frame their comparisons explicitly in those terms, leaving questions about transgender and gender-diverse patients for future work. Because the design was cross-sectional at the point of assessment, it captures who reaches care rather than who is ill in the community, so the findings speak to access and presentation rather than true prevalence. Effect sizes for many gender differences were small to moderate, and the latent profile analysis, while statistically rigorous in its use of information criteria such as the AIC and BIC to select the number of profiles, remains a model-based description of the data rather than a biological taxonomy.

Even with those caveats, the study delivers a clear and actionable message. Men remain markedly underrepresented in specialized eating disorder care, and the proportion has not budged in a decade. At the same time, the men who do reach services show meaningful psychopathology, with binge eating disorder predominating and a tendency toward moderate rather than high transdiagnostic severity. The shared severity architecture across genders suggests that the same continuum of illness runs through both populations, which means the same evidence-based treatments may be applicable once patients are identified. The challenge, then, is not to invent a separate psychiatry for men, but to build detection and referral systems that recognize how the same illness can wear different clothes. Until screening, training, and public health messaging catch up with that insight, the study’s title question will remain painfully current: men are still being missed.

Subject of Research: Gender differences in eating disorder psychopathology and access to specialized care

Article Title: Are men still being missed in eating disorder care? Gender differences in psychopathology and transdiagnostic severity profiles across a 10-year clinical sample

Article References: Are men still being missed in eating disorder care? Gender differences in psychopathology and transdiagnostic severity profiles across a 10-year clinical sample. (n.d.). https://doi.org/10.1186/s40337-026-01790-9

Image Credits: AI Generated

DOI: 10.1186/s40337-026-01790-9

Keywords: eating disorders, gender differences, male eating disorders, binge eating disorder, anorexia nervosa, bulimia nervosa, latent profile analysis, body image, transdiagnostic, psychopathology, mental health services, help-seeking