This article was downloaded by: [Michigan State University]

On: 03 January 2015, At: 20:17

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered
office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Eating Disorders: The Journal of

Treatment & Prevention
Publication details, including instructions for authors and
subscription information:
http://www.tandfonline.com/loi/uedi20

A Clinical Comparison of Men and Women

on the Eating Disorder Inventory-3
(EDI-3) and the Eating Disorder
Assessment for Men (EDAM)
a b
Stevie Chariese Stanford & Raymond Lemberg
a
Copper Canyon Academy , Rimrock , Arizona , USA
b
Eating Disorder Program , Prescott House , Prescott , Arizona , USA
Published online: 17 Sep 2012.

To cite this article: Stevie Chariese Stanford & Raymond Lemberg (2012) A Clinical Comparison
of Men and Women on the Eating Disorder Inventory-3 (EDI-3) and the Eating Disorder Assessment
for Men (EDAM), Eating Disorders: The Journal of Treatment & Prevention, 20:5, 379-394, DOI:
10.1080/10640266.2012.715516

To link to this article: http://dx.doi.org/10.1080/10640266.2012.715516

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the
“Content”) contained in the publications on our platform. However, Taylor & Francis,
our agents, and our licensors make no representations or warranties whatsoever as to
the accuracy, completeness, or suitability for any purpose of the Content. Any opinions
and views expressed in this publication are the opinions and views of the authors,
and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content
should not be relied upon and should be independently verified with primary sources
of information. Taylor and Francis shall not be liable for any losses, actions, claims,
proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or
howsoever caused arising directly or indirectly in connection with, in relation to or arising
out of the use of the Content.

This article may be used for research, teaching, and private study purposes. Any
substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,
systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
 Conditions of access and use can be found at http://www.tandfonline.com/page/terms-
and-conditions
Downloaded by [Michigan State University] at 20:17 03 January 2015
 Eating Disorders, 20:379–394, 2012
Copyright © Taylor & Francis Group, LLC
ISSN: 1064-0266 print/1532-530X online
DOI: 10.1080/10640266.2012.715516

A Clinical Comparison of Men and Women

on the Eating Disorder Inventory-3 (EDI-3)
and the Eating Disorder Assessment
for Men (EDAM)

STEVIE CHARIESE STANFORD

Downloaded by [Michigan State University] at 20:17 03 January 2015

Copper Canyon Academy, Rimrock, Arizona, USA

RAYMOND LEMBERG
Eating Disorder Program, Prescott House, Prescott, Arizona, USA

This study focused on the most commonly used eating disorder

assessment tool, the Eating Disorder Inventory-3 (EDI-3), and the
preliminary Eating Disorder Assessment for Men (EDAM). These
assessment tools were examined to investigate predictability in
males and the extent they differentiated between men and women.
Specific scales of the EDI-3 and total scores for each instrument
were assessed using a sample of 108 males and females from res-
idential treatment facilities. Overall, the EDI-3 scales were shown
to be significantly different between genders on a MANOVA, with
men scoring significantly lower in body dissatisfaction, drive for
thinness, and bulimia. Both instruments showed the ability to pre-
dict eating disorders when using a logistical regression analysis.
Results support the hypothesis that eating disorders are significantly
different in men and women, providing evidence that there is a
need to develop a valid and reliable eating disorder assessment
tool specifically for men.

INTRODUCTION

Eating disorders have long been assumed to occur primarily in women. Until
recently, one of the most frequently cited statistics was that men comprised
approximately 5% to 10% of the anorexic population and an estimated 10%

Address correspondence to Stevie Chariese Stanford, Copper Canyon Academy,

P.O. Box 230, Rimrock, AZ 86335, USA. E-mail: Stevie_stanford@yahoo.com

379
 380 S. C. Stanford and R. Lemberg

to 15% of the bulimic population (Boerner, Spillane, Andersen, & Smith,

2004). Due to this, the majority of eating disorder assessment tools have
been developed and validated for females. However, recently, a Harvard
study was published by Hudson et al., showing that 25% of all eating dis-
order cases are now men (Hudson, Hiripi, Pope, & Kessler, 2007). With the
prevalence rate of men diagnosed with eating disorders on the rise, from
10% to 25% of all cases in the last decade, it is essential that more empirical
research focus on this specific population to ensure proper assessment and
diagnosis.
The National Association of Anorexia Nervosa and Associated Disorders
reported that approximately one million men suffer from eating disorders.
Reports have indicated that this number may be an underestimation, due
Downloaded by [Michigan State University] at 20:17 03 January 2015

to non-inclusive and inappropriate diagnostic criteria in the DSM-IV-TR

(Wonderlich et al., 2009). One important reason men with eating disorders
may be under-diagnosed is that almost all assessment instruments used to
detect eating disorders were developed for women. Eating disorder symp-
toms present very differently in males and females, namely the construct
of body dissatisfaction and the symptoms associated with compensatory
methods of bulimia.
This study focused on the Eating Disorder Inventory-3 (EDI-3), an
instrument developed and validated for females, and the Eating Disorder
Assessment for Men (EDAM), a male specific eating disorder assessment.
This study examined predictability and significant differences in genders on
each measure. The goal of the study was to determine the utility of the
EDI-3 on detecting eating disorder symptoms in men and to investigate the
necessity of developing a gender specific instrument such as the EDAM.

Eating Disorder Inventory-3: Is it Appropriate for Detecting

Eating Disorders in Males?
The EDI-3 is one of the most widely used instruments in detecting eating
disorders. Reliability and validity of the EDI on measuring eating disorders
in women has been supported time and time again. However, there has
been limited and contradictory research on the EDI and its utility with men.
Spillane, Boerner, Andersen, and Smith, (2004) found “29 studies to date
applying the EDI-2 to men, even though there are no studies investigating
its psychometric properties in men” (p. 85). Studies done by Keel et al.
(2007) and Olivardia et al. (1995) found the EDI to be valid when used to
detect eating disorders in men. However, a study by Rather and Rampold
(1994) showed that the EDI was not valid when used with men. Each of
the above studies stated lower reliability in men than women. Other studies
comparing men and women on the EDI or EDI-2 have often reported sex
differences in mean scores. Significant difference may be because the items
are more likely to be endorsed by women since the instrument was designed
 Comparison of Men and Women on the EDI-3 and EDAM 381

for female issues. Most concluded that men have lower mean scores than
women on the three primary eating disorder risk scales: Bulimia, Drive for
Thinness, and Body Dissatisfaction (Gupta, Schork, & Dhaliwal, 1993; Oates-
Johnson & DeCourville, 1999). These three subscales are a focus of this
study, as existing research shows females scoring much higher than males
on these three problematic scales.
Differences between men and women are seen in the constructs of
body dissatisfaction. Andersen, Cohn, and Holbrook (2000) criticize the use
of the EDI, suggesting that men may not relate when they are asked typical
questions such as “I think my thighs are too large” or “I like the shape of my
buttocks.” Additional items that may not apply to men are “I am preoccupied
with a desire to be thinner” and “Other people think that I am too thin,” since
Downloaded by [Michigan State University] at 20:17 03 January 2015

many males with eating disorders often do not strive to be “thin” as much
as “muscular.” Evidence shows that males generally wish to change their
bodies from the waist up, while females usually dislike their bodies from
the waist down (Andersen, 1999). Weltzin et al. (2005) found that men were
less likely than women to engage in typical compensatory behaviors such as
vomiting and more likely to engage in activities such as excessive exercise
to control their body weight. They also found that men were less likely
to restrict food intake and more likely to binge eat than women (Weltzin
et al., 2005). Considering these critical differences between genders, it is
necessary to ensure that items claiming to measure drive for thinness, body
dissatisfaction, and bulimia are in fact capturing these constructs.
To date, no research has been done on the comparability of the EDI-
3 between men and women. In a report written in 2006 on the EDI-3,
Edward Cumella stated that “the EDI-3’s primary deficit involves a lack of
information about its utility and application with men in both a clinical and
nonclinical population” (2006, p. 117). To date, various male measures detect
body checking, muscle appearance satisfaction, and drive for muscularity.
However, not one measure is designed specifically to detect eating disorders
in males.

The Eating Disorder Assessment for Men: Is a Male Specific

Assessment Necessary?
The EDAM is a preliminary assessment tool devised to detect eating disorder
symptoms specific to males. It contains items specific to men such as male
specific body issues, a more comprehensive measure of symptoms of binge
eating, and detection of Muscle Dysmorphic symptoms. Muscle Dysmorphia
is characterized by an unrealistic perception of the body, combined with
an excessive pursuit of muscularity (Olivardia et al., 2000). This instrument
was developed in part to address some of the shortcomings of the EDI;
particularly issues related to body dissatisfaction, drive for thinness, and
symptoms of bulimia. Throughout a comprehensive literature search and a
 382 S. C. Stanford and R. Lemberg

content validity evaluation with eating disorder experts, five main areas of
assessment for men were established: weight concerns, food issues, exer-
cise issues, body image/appearance concerns, and disordered eating. It is
proposed that the EDAM is a more inclusive instrument for assessing eating
disorders in males.
In comparing the EDI-3 and the EDAM, this study attempted to exam-
ine gender differences and predictability for the instruments. Results were
mixed. While the EDI-3 (EDRC) score was able to correctly predict eat-
ing disorders in men and significantly differentiate between males and
females, results from an examination of the subscales of the EDI-3 differed.
Results from the Body Dissatisfaction scale were particularly interesting;
it was unable to correctly predict eating disorders in men, indicating that
Downloaded by [Michigan State University] at 20:17 03 January 2015

the items were not capturing the construct of body dissatisfaction in men.
Furthermore, it was shown that women with eating disorders scored signif-
icantly higher than men. Results from analysis of the EDAM demonstrated
an ability to correctly predict eating disorders in men and was also able
to show significant differences on items measuring presentation, symptoms,
and drives behind eating disorders. Findings support the hypothesis that
the presentation of eating disorders are significantly different in men and
women, providing evidence that there is a need to develop a valid and
reliable eating disorder assessment tool specifically for men.

METHOD
Participants
One hundred and eight clinical subjects (78 men and 30 female) served
participated in this study. Participants were current clients at residential
treatment facilities that ranged from 90-day treatment centers to long-term
residential treatment centers where clients stay up to 1 year. Clients were
receiving treatment for eating disorders and addictions such as chemical
dependency, sexual addiction, and gambling addiction. The total number of
participants (male and female) diagnosed with an eating disorder was 66
(with an additional 45 males without eating disorders for comparison).

Measures
DEMOGRAPHIC QUESTIONNAIRE
Participants were asked to complete a demographic questionnaire, provid-
ing basic demographic information about themselves. The questionnaire
addressed participants’ gender, age, race, level of education, relationship
status, sexual orientation, history of childhood abuse, weight history, and
previous treatment history (for eating disorders and other co-occurring
addictions).
 Comparison of Men and Women on the EDI-3 and EDAM 383

EATING DISORDER INSTRUMENT-3 (EDI-3)

The EDI-3 is comprised of 91 items. It contains three primary subscales,
measuring Drive for Thinness, Bulimia, and Body Dissatisfaction. These
three subscales compose the Eating Disorder Risk Composite (EDRC)
score. Nine additional scales include Low Self-Esteem, Personal Alienation,
Interpersonal Insecurity, Interpersonal Alienation, Interoceptive Deficits,
Emotional Dysregulation, Perfectionism, Asceticism, and Maturity Fears.
Items are scored using a 6-choice format: always, usually, often, sometimes,
rarely, or never. The primary use of the EDI-3 is a clinical evaluation of symp-
tomology associated with eating disorders (Garner, 2004). It is standardized
and can be hand-scored or computer-scored. The EDI-3 takes approximately
30 minutes to complete (Garner, 2004).
Downloaded by [Michigan State University] at 20:17 03 January 2015

EATING DISORDER ASSESSMENT FOR MALES (EDAM)

Through a comprehensive literature review and discussion with experts
in the field, the development team identified five main concerns pertain-
ing to men with eating disorders: Food issues, Weight Concerns, Exercise
Issues, Body Image/Appearance Concerns, and Disordered Eating Habits.
The development team devised 95 items, approximately 15 to 25 in each
section, to assess eating disorder symptoms specific to men. This prelimi-
nary version was then reviewed by authoritative experts on eating disorders
in men. Each expert reviewed each item for quality, content, relevance, and
clarity. Ratings included a three-point ordinal rating scale on each item: 1 =
unacceptable, 2 = fair, and 3 = good. Experts were asked to provide feed-
back and suggestions on the instrument. An analysis of the responses was
conducted and items were deleted, added, or revised. Items on the EDAM
were scored on a 5-point Likert scale: 0 = never, 1 = rarely, 2 = some-
times, 3 = usually, and 4 = always. The EDAM was then comprised of
50 items and took approximately 20 minutes to complete. Reliability statis-
tics showed that the EDAM has a Cronbach’s alpha of .91, indicating that
the items on the EDAM are consistently measuring the construct of eating
disorders in men.

Procedure
Participants were introduced to the study as an investigation of gender,
health and eating habits. Each participant was a volunteer randomly selected
from client populations in residential treatment facilities. The demographic
questionnaire and eating disorder instruments were distributed to each par-
ticipant in an all-inclusive packet. The preliminary version of the EDAM was
entitled “The Health, Fitness and Eating Habit Survey” with the purpose of
eliminating bias from a “male specific” instrument. The completion of the
contents of the packet was administered by a staff member at each facility.
 384 S. C. Stanford and R. Lemberg

This was done in person, in the form of paper and pencil administration.
Informed consent was also obtained from each client. Participants were
debriefed with their primary therapists following completion of the study.

Data Analysis
LOGISTICAL REGRESSION
Logistical regression allows one to predict a discrete outcome, such as
group membership, from a set of variables that may be continuous, discrete,
dichotomous, or a mix (Tabachnick & Fidell, 2000). In this study, the discrete
outcome variable was diagnosis of an eating disorder or no diagnosis of an
eating disorder. The predictor variables used were the EDI-3 Eating Disorder
Downloaded by [Michigan State University] at 20:17 03 January 2015

Risk Composite score, the three subscales of the EDI-3, and the EDAM total
score. This study examined to what extent each of these instruments and
subscales predict diagnosis of an eating disorder in men.

ANALYSIS OF VARIANCE AND MULTIVARIATE ANALYSIS OF VARIANCE

The causal comparative research method used was an analysis of variance
(ANOVA) and Multivariate analysis of variance (MANOVA). ANOVA was used
to look at the independent variable of gender (male/female) and the depen-
dent variable was looking at the EDRC scores on the EDI-3 and the total
scores on the EDAM. The statistical technique of MANOVA was used to
examine the extent that the independent variable gender (male/female) dif-
fers on the three primary eating disorder risk scales of the EDI-3: Drive for
Thinness, Bulimia, and Body Dissatisfaction.

RESULTS
Predictability of EDI-3
EDI-3 EATING DISORDER RISK COMPOSITE (EDRC) SCORE
A binary logistical regression was conducted to investigate whether the
Eating Disorder Risk Composite (EDRC) score of the EDI-3 could discrimi-
nate between men with eating disorders and men without eating disorders.
The omnibus test of model coefficients demonstrated that the EDRC could
significantly predict an eating disorder in men, X 2 = 48.01, df = 1, N = 48,
p < .001. The model predicts that 88.5% of the men were correctly cat-
egorized, suggesting the EDRC has the ability to predict eating disorders
in men when compared to men without eating disorders. The Drive for
Thinness scale and the Bulimia scale were both significant, while the Body
Dissatisfaction scale was not found to be significant in discriminating the dif-
ference between men and women with eating disorders. Results are shown
in Table 1.
 Comparison of Men and Women on the EDI-3 and EDAM 385

TABLE 1 Logistical Regression Predicting Extent to Which Men Are Diagnosed With Eating
Disorders Based on Their EDRC Total, EDI-3 Subscales, and EDAM Total Scores

Variable B SE Odds ratio p

EDRC total .26 .06 1.29 <.001

EDI-3 subscales
DT .19 .08 1.20 .013
B .27 4.55 1.31 .033
BD −.03 .18 .97 .673
EDAM total .09 .02 1.09 <.001
Note. DT = Drive for Thinness, B = Bulimia, BD = Body Dissatisfaction, EDRC = Eating Disorder Risk
Composite, EDAM = Eating Disorder Assessment for Men.

Predictability of EDAM
Downloaded by [Michigan State University] at 20:17 03 January 2015

EATING DISORDER ASSESSMENT FOR MEN TOTAL SCORE

A binary logistical regression was used to investigate whether the EDAM
total score was able to discriminate between men with and without eating
disorders. The omnibus test of model coefficients resulted in χ 2 = 36.026,
df = 1, N = 78, p < .001. The model significantly predicts 82.1% of the time
the EDAM total score correctly predicted diagnosis of an eating disorder in
men. Overall, the EDAM was successful at predicting eating disorder diag-
nosis in males when compared to males without eating disorders. Logistical
regression results are shown in Table 1.

Gender Differences
EDI-3 EATING DISORDER RISK COMPOSITE (EDRC) SCORE
A between subjects one way analysis of variance was run to determine
if there was a significant difference between men and women with eat-
ing disorders on the EDRC score. The Levene’s test of homogeneity of
variance indicated that the error variance across groups was equal at the
p < .05 alpha level. The ANOVA revealed a significant difference on the
EDRC score between men (M = 36.70, SD = 10.14) and women (M = 45.53,
SD = 9.78) at a F(1,62) = 12.35, p = .001, Partial eta-squared = .17. This
difference is significant, therefore, significantly differentiating between men
and women with eating disorders.

EDI-3 DRIVE FOR THINNESS SCALE

The MANOVA revealed a significant difference between men and women
with eating disorders on the Drive for Thinness scale of the EDI-3 at the
.05 alpha level. For the Drive for Thinness scale, F(1, 62) = 9.57, p = .003,
Partial eta-squared = .14. These results show that approximately 14% of
the variability in the Drive for Thinness scale can be attributed to the gender
 386 S. C. Stanford and R. Lemberg

of the person with the eating disorder. For men (M = 35.03, S = 9.88),
and for women (M = 43.17, SD = 11.00). Results show that women scored
significantly higher than men on the Drive for Thinness scale.

EDI-3 BULIMIA SCALE

The MANOVA did not reveal a significant difference between men and
women with eating disorders on the Bulimia scale with a p = .228, greater
than the .05 alpha level. For the Bulimia scale, F(1, 62) = 1.49, Partial
eta-squared = .02. These results show that approximately 2% of the vari-
ability in the Bulimia scale can be attributed to gender. For men (M = 37.73,
SD = 9.33), and for women (M = 47.33, S = 8.66). Results show that women
Downloaded by [Michigan State University] at 20:17 03 January 2015

and men did not score significantly different on the Bulimia scale.

EDI-3 BODY DISSATISFACTION SCALE

The MANOVA revealed a significant difference between men and women
with eating disorders on the body dissatisfaction scale of the EDI-3 at the
.05 alpha level. The Bulimia scale showed a F(1, 62) = 17.84, p < .001,
Partial eta-squared = .23. These results show that approximately 23% of
the variability in the body dissatisfaction subscale can be attributed to the
gender of the person with the eating disorder. Results show that women
scored significantly higher than men on the body dissatisfaction subscale.
See Table 2 for results of the MANOVA.

EATING DISORDER ASSESSMENT FOR MEN TOTAL SCORE

A between subjects one way analysis of variance was run to determine if
there was a significant difference between men and women with eating
disorders on the Eating Disorder Assessment for Men (EDAM). The Levene’s
test of homogeneity of variance indicated that the error variance across

TABLE 2 MANOVA of EDI-3 Subscales by Gender

Source DV SS df MS F p

Gender DT 1040.29 1 1040.29 9.56 .003

B 120.29 1 120.29 1.49 .228
BD 1450.06 1 1450.06 17.85 <.001
Error DT 6635.14 61 108.77
B 4941.37 61 81.01
BD 4959.21 61 81.29
Total DT 103031.00 63
B 158291.00 63
BD 119143.00 63
Note. DT = Drive for Thinness, B = Bulimia, BD = Body Dissatisfaction.
 Comparison of Men and Women on the EDI-3 and EDAM 387

groups was equal at the p < .05 alpha level. The ANOVA revealed a sig-
nificant difference on the EDAM total score between men (M = 70.64,
S = 19.84) and women (M = 83.87, SD = 21.05) at an F(1, 62) = 6.59,
p = .013, Partial eta-squared = .10. Results show that men and women
scored significantly different on the EDAM total score.

DISCUSSION

To ensure proper diagnosis and to facilitate more efficacious treatment of

men, the present study examined the EDI-3 and the preliminary Eating
Disorder Assessment for Men (EDAM) - to determine the extent to which the
instruments predicted eating disorders in males and to evaluate the extent
Downloaded by [Michigan State University] at 20:17 03 January 2015

they differentiated between men and women with eating disorders.

Eating Disorder Inventory-3

EATING DISORDER RISK COMPOSITE SCORE (EDRC)
The EDI-3 Eating Disorder Risk Composite (EDRC) score measures the extent
of risk for an eating disorder. The results indicate that the EDRC signifi-
cantly predicted the presence or lack of eating disorders among males. Prior
research suggested that the EDI was not valid when used to detect eating
disorders in men (Rathner & Rumpold, 1994). However, this study provides
evidence to the contrary. When comparing groups of men with and with-
out eating disorders, the EDRC accurately predicted which men had eating
disorder diagnoses.
This study also investigated whether the EDRC score could differentiate
between males and females diagnosed with an eating disorder. It revealed
that females with eating disorders (M = 45.53) scored significantly higher
on the EDRC than males with eating disorders (M = 36.70). This aligns
with previous research showing that women with disordered eating scored
significantly higher than men with disordered eating on each of the EDI
scales (Nevonen & Broberg, 2001). These results suggest that the EDRC does
not capture eating disorder symptoms in males as accurately as it does in
females. Although women scored significantly higher than men, in this study,
the EDRC accurately predicted eating disorders in men when compared to a
group of men without eating disorders. The EDRC score could be considered
an effective tool for determining eating disorders in men, if it were kept in
mind that the male scores may be lower than if the instrument were designed
to measure male specific eating disorder symptoms.

EDI-3 Eating Disorder Risk Subscales

The three main subscales of the EDI-3 make up the Eating Disorder Risk
Composite (EDRC) score described above. These scales were developed
 388 S. C. Stanford and R. Lemberg

to identify a risk area by measuring the constructs of drive for thinness,

bulimia, or body dissatisfaction. Each subscale measures the symptoms and
characteristics pertaining to these risk factors.

DRIVE FOR THINNESS

The Drive for Thinness subscale identifies the construct that has been
described as the “cardinal feature” of eating disorders. According to Garner
(2004), the drive for thinness has been considered an essential criterion for
diagnosis of an eating disorder. The items of the Drive for Thinness scale
assess an extreme desire to be thinner, concern with dieting, preoccupation
with weight, and an intense fear of gaining weight (Garner, 2004). Research
Downloaded by [Michigan State University] at 20:17 03 January 2015

has shown that males are less likely than females to have a drive for thinness
and are more likely to strive for lean muscularity (McCreary & Sasse, 2000).
Examining the Drive for Thinness scale alone determined that females scored
significantly higher (M = 43.17) than males (M = 35.03). This suggests that
females with eating disorders have a more pronounced desire to be thin.
As mentioned previously, research shows that males desire a lean muscular
physique, often reporting a desire to increase muscularity rather than to lose
weight (Grieve, Wann, Henson, & Ford, 2006). They often desire a larger,
bulkier appearance. For instance, Pope et al. (2000) stated that college-aged
men desire to gain an average of 28 pounds of muscle mass to have an “ideal
physique.” This would account for a significantly lower score in the area of
drive for thinness. Scores on this subscale suggest that men have more of
a desire to be muscular, rather than a drive for thinness that is consistent
among females with eating disorders.
Some men, however, do have a desire to be thin. In such cases, males
may score lower because males would not endorse some of the items on
this scale. For example, a male with a desire to be thinner may respond to
“I would like to lose fat around my midsection” rather than the current items
that state “I am terrified about gaining weight.” Men who actually have a
drive to be thin may not score significantly because they do not endorse
items that were made to measure this construct in females. The Drive for
Thinness subscale correctly predicted eating disorder diagnoses in males,
compared to males without eating disorders. However, when comparing
males and females with eating disorders, females scored higher on Drive for
Thinness, suggesting that this subscale focuses on symptoms that are more
suitable for women.

BULIMIA
The study investigated how males and females compared in symptoms of
bulimia. As noted previously, males and females differ in their symptoms of
bulimia. Males tend to exercise more as a compensatory method; females
 Comparison of Men and Women on the EDI-3 and EDAM 389

tend to use laxatives and purge more than males do (Button, Aldridge, &
Palmer, 2008; Weltzin et al., 2005). Statistical analysis showed that in per-
sons with eating disorders, male scores (M = 48.00) were not significantly
different from females (M = 50.77). This finding was particularly interesting
because most research cited that males and females differed significantly in
their symptoms of bulimia. Upon further examination, it appears that males
and females responded similarly to items on the bulimia scale because of
wording such as “I stuff myself with food,” and “I have gone on eating
binges where I felt that I could not stop” (Garner, 2004). Most items on
the Bulimia scale related to the issues of binge eating. Only one item on the
bulimia scale referred to the compensatory method of vomiting. The Bulimia
scale measures binge eating issues, which do not differ among males and
Downloaded by [Michigan State University] at 20:17 03 January 2015

females. Therefore, their scores were similar for eating disorders in general,
which, for many of the men in this study, actually reflected a diagnosis
of binge eating disorder. Interesting, this result indicated that the Bulimia
scale on the EDI-3 may in fact, adequately measures binge eating symptoms
in men.

BODY DISSATISFACTION
According to the EDI-3 manual, the Body Dissatisfaction subscale is designed
to assess discontentment with the overall body shape and size or regions that
are of extraordinary concern to those who have eating disorders (Garner,
2004). However, the items on the Body Dissatisfaction subscale of the EDI-
3 were developed to measure body dissatisfaction for women; therefore,
it was necessary to determine if this subscale could predict body dissatis-
faction in males. Results from logistical regression analysis showed that the
Body Dissatisfaction subscale alone could not significantly predict diagnosis
of an eating disorder diagnosis for males. The regression equation indicated
the probability of correctly categorizing a diagnosis of an eating disorder
decreases by a multiplicative factor of .973 as the Body Dissatisfaction score
increases. Essentially, this subscale indicated that the more body dissatis-
faction a male has, the less likely he is to have an eating disorder. This
is counterintuitive, clearly indicating that the Body Dissatisfaction subscale,
developed for women, does not discriminate between men with and men
without eating disorders.
In a statistical analysis of males and females with eating disorders, a
between subjects MANOVA found that, in the area of body dissatisfaction,
males scored significantly lower (M = 37.73) than females (M = 47.33). This
result indicates that men with eating disorders have lower body dissatisfac-
tion. This contradicts studies that have shown that body dissatisfaction in
men is increasing: in some areas, it equals body dissatisfaction in females
(Ricciardelli & McCabe, 2001). These findings once again suggest that the
symptoms of body dissatisfaction in women are different, and this subscale
 390 S. C. Stanford and R. Lemberg

results in significantly lower scores for men. To assume that men have less
body dissatisfaction than women is a mistake. Olivardia et al. (2004) showed
that American men exhibited substantial levels of body dissatisfaction: most
prefer to gain muscle mass and lose fat. Therefore, if the Body Dissatisfaction
scale were actually measuring symptoms of body dissatisfaction in males,
the scores would mostly likely reflect this. It is likely that the items on the
Body Dissatisfaction scale are not capturing the construct of body dissatis-
faction in males as they are for females. Items in this subscale, such as “I
think my buttocks are too large,” and “I think my hips are too big,” are not
typical concerns that men would endorse when describing discontent with
their bodies. When studying males, Park and Read (1997) found the two
main concerns were: to “have larger arms” and “to have a ‘V’ shaped body.”
Downloaded by [Michigan State University] at 20:17 03 January 2015

If items measuring body dissatisfaction were more directed towards males’

bodily concerns, the men with eating disorders in this study might have
scored higher in body dissatisfaction. Once again, the differences between
men and women, are likely due to the inability of this scale to adequately
capture body dissatisfaction as it presents in males.

Eating Disorder Assessment for Men (EDAM)

The EDAM was designed to measure eating disorder symptoms, body
dissatisfaction, weight concerns, and food and exercise issues specific to
males. As research has shown, males’ eating disorder symptoms differ from
females’: males are more likely to exercise to compensate for overeating,
whereas females are more likely to fast or purge (Streigel-Moore et al.,
2009). Body dissatisfaction presents itself differently for men, who focus
on different body parts and prefer to gain muscle. As shown in this study
and supported by previous research (Oats-Johnson & DeCourville, 1999),
males score significantly lower than females on the EDI-3 scale designed
to measure body dissatisfaction. This study also shows that men have less
desire to lose weight, as demonstrated by their significantly lower scores on
the Drive for Thinness scale. Overall, besides the binge eating characteristics
of the Bulimia scale, the EDI-3 was not precise in detecting specific eating
disorder symptoms in males.
This study tested the EDAM to determine at what level a male without
eating disorders scored on EDAM items and at what point it correctly predicts
actual diagnosis. Results indicated that the EDAM effectively predicts no
diagnosis when a male does not have symptoms indicative of a risk for
eating disorders. Overall, the EDAM was shown to be successful, predicting
the correct diagnostic category in 82.1% of males.
To compare the EDAM total scores for males and females with eating
disorders, the study used a between-subjects MANOVA. Results showed that
males scored significantly lower (M = 70.64) than females (M = 83.87).
This result was unexpected because items on the EDAM were derived from
 Comparison of Men and Women on the EDI-3 and EDAM 391

a thorough literature review, specifying issues specific to men with eating

disorders. The items were then developed to capture symptoms of eating
disorders unique to males. It is unclear why males scored much lower on
an eating disorder assessment tool designed for males than females did.
It is possible that there was an unexpected confounding variable of
inequality in the sample. The men and women diagnosed with eating dis-
orders may not have had the same severity in symptoms. The majority of
females in this population came from eating disorder treatment centers, indi-
cating that their primary diagnosis was an eating disorder. In addition, the
severity of their eating disorder was such that it would require inpatient treat-
ment. The majority of males in this population were in addiction treatment
facilities that also treat eating disorders. For the majority of the males in the
Downloaded by [Michigan State University] at 20:17 03 January 2015

eating disorder category, an eating disorder was not the primary diagnosis,
indicating that their eating disorder symptoms might not have been as severe
as those for the women, thus producing a lower total score on the EDAM.
Another issue that may have contributed to females attaining higher
scores is the language that was used when describing emotions in the EDAM.
Many of the items used words such as “terrified to gain fat” or “obsessed
with losing weight.” It has been suggested that men respond differently to
verbal expressions related to body size. One study analyzing the personal
ads in the Washington magazine compared the self-descriptions of body
size and shape of those seeking social partners. When women described
themselves as “thin,” statistics showed them to be only 87% of the average
female population weight—13% below average. In contrast, the men who
described themselves as “thin” were 5% above the population for men of
similar body weight by comparison. Men were shown to be more likely to
be at least above average in weight when they call themselves “fat” or “over-
weight,” while women are taught to see themselves as fat from about third
grade (Andersen et al., 2000). Interestingly, Dr. Katherine Halmi, Professor
of Psychiatry at the New York Hospital, Westchester Center, has said, “Even
normal-weight women consider themselves fat, and only very thin women
consider themselves to be normal” (Anderson & DiDomenico, 1992). It sig-
nificant to note that there are numerous favorable expressions to describe
larger men such as buff, monster, or hulk. Yet, there are few similar words
to describe women of larger than average stature (Anderson & DiDomenico,
1992).
This suggests a significant difference in the way in which genders
view themselves when related to body shape and size. They may feel as
if words such as this are too strong and may have endorsed items using
terms such as “worried” or “concerned.” It is also possible that women
may always score higher on an eating disorder instrument due to the soci-
etal concerns and pressure for women to lose weight and attain an ideal
body image. It could be argued that this pressure is higher for women sim-
ply due to sociocultural gender expectations. The results of this analysis
 392 S. C. Stanford and R. Lemberg

provide further evidence that males and females differ significantly in their
symptoms, severity, presentation, and manifestation of eating disorders.

Recommendations for Eating Disorder Assessment Tools for Men

The need for improvements on current eating disorder instrumentation is a
significant clinical implication derived from this study. This study has shown
that the most widely used eating disorder instrument, the EDI-3, does not
capture the construct of drive for thinness or body dissatisfaction in males.
The EDI-3 might indicate that males with eating disorders are not at risk
due to low scores on both subscales. As noted, the construct of drive for
thinness is known to be an essential feature for females with eating disor-
Downloaded by [Michigan State University] at 20:17 03 January 2015

ders. However, it is not the dominant feature for males, who tend to have
a desire for lean muscularity. Such items on the Drive for Thinness scale as
“I am preoccupied by the desire to be thinner,” and “I am terrified of gain-
ing weight” should be replaced by “I am preoccupied by the desire to be
lean and muscular.” A more fitting item would also be “I am concerned with
the thought of gaining fat” because most males seek to gain weight in the
form of muscle, while losing fat. An assessment tool using these alternatives
would be more likely to capture the drive for thinness construct among men
with eating disorders.
The inability of the EDI-3 to capture body dissatisfaction in males with
eating disorders is a critical point. The items on the EDI-3 measuring body
dissatisfaction do not represent body concerns pertinent to males. As noted
earlier, items stating, “I think that my thighs are too large,” or “I think
my hips are too big” measure body concerns specific to women. Again,
males with eating disorders would be more likely to endorse such items
as “I would like bigger arms” or “I think my abdominal muscles need to
be more defined.” Because men have distinctly different body concerns, the
assessment tool should concentrate on the areas of the body and appearance
concerns relevant to men.

CONCLUSIONS

The most critical point to be derived from this study is to prompt development
and utilization of a valid and reliable male-specific eating disorder assessment
tool. Results of this study provide evidence that the most widely used eating
disorder assessment tool, the EDI-3, does not adequately detect symptoms
in males with eating disorders. A main focus of this study was to determine
if EDI-3 was appropriate for measuring eating disorders in men and if
there was a need to develop a male-specific eating disorder instrument;
the results conclusively indicate the necessity to continue development and
attain validity on an a gender specific instrument such at the EDAM.
 Comparison of Men and Women on the EDI-3 and EDAM 393

REFERENCES

Andersen, A. E. (1999). Eating disorders in males: Critical questions. In R. Lemberg

(Ed.), Eating disorders: A reference source book (pp. 72–79). Phoenix, AZ: Oryx
Press.
Andersen, A. E., Cohn, L., & Holbrook, T. (2000). Making weight: Healing men’s
conflicts with food, weight and shape. Carlsbad, CA: Gurze Books.
Andersen, A. E., & DiDomenico, L. (1992). Diet vs. shape content of popular male
and female magazines: A dose-response relationship to the incidence of eating
disorders? International Journal of Eating Disorders, 3, 283–287.
Boerner, L. M., Spillane, N. S., Andersen, K. G., & Smith, G. T. (2004). Similarities
and differences between women and men on eating disorder risk factors and
symptom measures. Eating Behaviors, 5, 209–222.
Downloaded by [Michigan State University] at 20:17 03 January 2015

Button, E., Aldridge, S., & Palmer, R. (2008). Males assessed by a specialized
eating disorders service: Patterns over time and comparisons with females.
International Journal Eating Disorders; 41, 758–761.
Cumella, E. J. (2006). Review of the Eating Disorder Inventory-3. Journal of
Personality Assessment, 87, 116–117.
Garner, D. M. (2004). Eating Disorder Inventory-3: Professional manual. Lutz, FL:
Psychological Assessment Resources, Inc.
Grieve, F. G., Wann, D., Henson, C. T., & Ford, P. (2006). Healthy and unhealthy
weight management practices in collegiate men and women. Journal of Sport
Behavior, 29, 229–241.
Gupta, M. A., Schork, N. J., & Dhaliwal, J. S. (1993). Stature, drive for thinness and
body dissatisfaction: A study of males and females from a non-clinical sample.
Canadian Journal of Psychiatry, 38(1), 59–61.
Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2007). The prevalence and
correlates of eating disorders in the National Comorbidity Survey Replication.
Biological Psychiatry, 61, 348–358.
Keel, P., Baxter, M. G., Heatherton, T. F., & Joiner, T. E. (2007). A 20-year longitu-
dinal study of body weight, dieting, and eating disorder symptoms. Journal of
Abnormal Psychology, 116, 422–432.
McCreary, D. R., & Sasse, D. K. (2000). An exploration of the drive for muscularity
in adolescent boys and girls. Journal of American College Health, 48, 297–304.
Nevonen, L., & Broberg, A. G. (2005). A comparison of sequenced individual and
group psychotherapy for eating disorder not otherwise specified. European
Eating Disorders Review, 13, 29–37.
Oates-Johnson, T., & Decourville, N. (1999). Weight preoccupation, personality,
and depression in university students: An interactionist perspective. Journal
of Clinical Psychology, 55, 1157–1166.
Olivardia, R., Pope, H., Borowiecki, J. J., & Cohane, G. (2004). Biceps and body
image: The relationship between muscularity and self-esteem, depression and
eating disorder symptoms. Psychology of Men and Masculinity, 5, 112–120.
Olivardia, R., Pope, H. G., & Hudson, J. I. (2000). Muscle dysmorphia in male
weightlifters: A case control study. American Journal of Psychiatry, 157,
1291–1296.
Olivardia, R., Pope, H. G., Mangweth, B., & Hudson, J. I. (1995). Eating disorders in
college men. American Journal of Psychiatry, 152, 1279–1285.
 394 S. C. Stanford and R. Lemberg

Parks, P. S. M., & Read, M. H. (1997). Adolescent male athletes: Body image, diet,
and exercise. Adolescence, 32, 593–602.
Pope, H. G., Gruber, A., Magweth, B., Bureau, B., deCol, C., Jovent, R., & Hudson,
J. I. (2000). Body image perception among men in three countries. American
Journal of Psychiatry, 157, 1297–1301.
Rathner, G., & Rumpold, G. (1994). Convergent validity of the eating disorder inven-
tory and the anorexia nervosa inventory for self-rating in an Austrian nonclinical
population. Journal of Eating Disorders, 16, 381–393.
Ricciardelli, L. A., & McCabe, M. P. (2001). Dietary restraints and negative affect as
mediators of body dissatisfaction and bulimic behavior in adolescent girls and
boys. Behavior Research and Therapy, 39, 1317–1328.
Spillane, N. S., Boerner, L. M., Andersen, K. G., & Smith, G. T. (2004). Comparability
of the eating disorder inventory-2 between men and women. Assessment, 11,
Downloaded by [Michigan State University] at 20:17 03 January 2015

85–93.
Streigel-Moore, R. H., Rosselli, R., Perrin, N., DeBar, L., Wilson, G. T., & May, A.
(2009). Gender differences in the prevalence of eating disorder symptoms.
International Journal of Eating Disorders, 42, 471–474.
Tabachnick, B. G., & Fidell, L. S. (2000). Using multivariate statistics (4th ed).
Boston, MA: Allyn and Bacon.
Weltzin, T. E., Weisensel, N., Franczyk, D., Burnett, K., Klitz, C., & Bean, P. (2005).
Eating disorders in men: Update. Journal of Men’s Health & Gender, 2, 186–193.
Wonderlich, S. A., Gordon, K. H., Mitchell, J. E., Crosby, R. D., & Engel, S. G.
(2009). Validity and utility of binge eating disorder. International Journal of
Eating Disorders, 42, 687–705.