Medical management and differential diagnosis of restrictive eating disorders in men: a case study report with co-produced recommendations
Abstract Background Males with eating disorders (EDs) are an underrepresented population whose symptomatology and treatment needs are poorly understood, having been overlooked in clinical research to date. The role of gastrointestinal disorders, such as gastroparesis, in the context of restrictive E...
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BMC
2025-07-01
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| Series: | Journal of Eating Disorders |
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| Online Access: | https://doi.org/10.1186/s40337-025-01250-w |
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| author | James Downs Clive Kelly |
| author_facet | James Downs Clive Kelly |
| author_sort | James Downs |
| collection | DOAJ |
| description | Abstract Background Males with eating disorders (EDs) are an underrepresented population whose symptomatology and treatment needs are poorly understood, having been overlooked in clinical research to date. The role of gastrointestinal disorders, such as gastroparesis, in the context of restrictive EDs is similarly under-explored. Making use of emerging evidence regarding conditions that co-occur with severe EDs to consider potential differential diagnoses in cases of complex and uncertain symptomatology can assist in providing more individualised and empathetic care, preventing avoidable outcomes, including death. Case presentation The case of a male patient with a longstanding history of restrictive eating and diagnosis of anorexia nervosa is presented. After hospital admission, they developed severe complications, including aspiration pneumonia. Despite medical interventions, the patient’s complex presentation and the lack of individualised treatment options contributed to the tragic outcome of death. A postmortem diagnosis revealed gastroparesis, a condition that had gone undetected during his life. Prior to his death, the patient had presented with symptoms overlapping with Avoidant Restrictive Food Intake Disorder (ARFID) and neurodivergence, which are worth considering for how they may have played a role in complicating the clinical picture and making diagnosis and treatment more challenging. Conclusions The case illustrates the value of exploring differential diagnoses when providing individualised and comprehensive treatment for ED patients with diverse symptomatology and identities. Even where diagnoses of co-occurring conditions do not apply, traditional research and knowledge from lived experience show how adopting an integrative stance is valuable for all patients. Specifically, there is an urgent need for improved treatment protocols for males with restrictive EDs, which accommodate co-occurring conditions like gastroparesis and possible differential diagnoses such as ARFID and neurodivergent conditions. Recommendations are given for how providers can implement gender-specific treatment, comprehensive assessments, and a multidisciplinary approach. Co-creating knowledge with patients themselves is central to achieving more empathetic, well-fitting, and effective treatment that appreciates the complexities of overlapping physical and psychological conditions, and ultimately reduces the risk of preventable deaths. |
| format | Article |
| id | doaj-art-d8d6ce3cef774242b06265d49cd6f231 |
| institution | DOAJ |
| issn | 2050-2974 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Eating Disorders |
| spelling | doaj-art-d8d6ce3cef774242b06265d49cd6f2312025-08-20T02:44:13ZengBMCJournal of Eating Disorders2050-29742025-07-0113111410.1186/s40337-025-01250-wMedical management and differential diagnosis of restrictive eating disorders in men: a case study report with co-produced recommendationsJames Downs0Clive Kelly1Person with Lived Experience, Independent Peer ResearcherJames Cook University HospitalAbstract Background Males with eating disorders (EDs) are an underrepresented population whose symptomatology and treatment needs are poorly understood, having been overlooked in clinical research to date. The role of gastrointestinal disorders, such as gastroparesis, in the context of restrictive EDs is similarly under-explored. Making use of emerging evidence regarding conditions that co-occur with severe EDs to consider potential differential diagnoses in cases of complex and uncertain symptomatology can assist in providing more individualised and empathetic care, preventing avoidable outcomes, including death. Case presentation The case of a male patient with a longstanding history of restrictive eating and diagnosis of anorexia nervosa is presented. After hospital admission, they developed severe complications, including aspiration pneumonia. Despite medical interventions, the patient’s complex presentation and the lack of individualised treatment options contributed to the tragic outcome of death. A postmortem diagnosis revealed gastroparesis, a condition that had gone undetected during his life. Prior to his death, the patient had presented with symptoms overlapping with Avoidant Restrictive Food Intake Disorder (ARFID) and neurodivergence, which are worth considering for how they may have played a role in complicating the clinical picture and making diagnosis and treatment more challenging. Conclusions The case illustrates the value of exploring differential diagnoses when providing individualised and comprehensive treatment for ED patients with diverse symptomatology and identities. Even where diagnoses of co-occurring conditions do not apply, traditional research and knowledge from lived experience show how adopting an integrative stance is valuable for all patients. Specifically, there is an urgent need for improved treatment protocols for males with restrictive EDs, which accommodate co-occurring conditions like gastroparesis and possible differential diagnoses such as ARFID and neurodivergent conditions. Recommendations are given for how providers can implement gender-specific treatment, comprehensive assessments, and a multidisciplinary approach. Co-creating knowledge with patients themselves is central to achieving more empathetic, well-fitting, and effective treatment that appreciates the complexities of overlapping physical and psychological conditions, and ultimately reduces the risk of preventable deaths.https://doi.org/10.1186/s40337-025-01250-wEating disordersAnorexiaMalesGastroparesisNeurodivergenceARFID |
| spellingShingle | James Downs Clive Kelly Medical management and differential diagnosis of restrictive eating disorders in men: a case study report with co-produced recommendations Journal of Eating Disorders Eating disorders Anorexia Males Gastroparesis Neurodivergence ARFID |
| title | Medical management and differential diagnosis of restrictive eating disorders in men: a case study report with co-produced recommendations |
| title_full | Medical management and differential diagnosis of restrictive eating disorders in men: a case study report with co-produced recommendations |
| title_fullStr | Medical management and differential diagnosis of restrictive eating disorders in men: a case study report with co-produced recommendations |
| title_full_unstemmed | Medical management and differential diagnosis of restrictive eating disorders in men: a case study report with co-produced recommendations |
| title_short | Medical management and differential diagnosis of restrictive eating disorders in men: a case study report with co-produced recommendations |
| title_sort | medical management and differential diagnosis of restrictive eating disorders in men a case study report with co produced recommendations |
| topic | Eating disorders Anorexia Males Gastroparesis Neurodivergence ARFID |
| url | https://doi.org/10.1186/s40337-025-01250-w |
| work_keys_str_mv | AT jamesdowns medicalmanagementanddifferentialdiagnosisofrestrictiveeatingdisordersinmenacasestudyreportwithcoproducedrecommendations AT clivekelly medicalmanagementanddifferentialdiagnosisofrestrictiveeatingdisordersinmenacasestudyreportwithcoproducedrecommendations |