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 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.

Keywords: ARFID; Anorexia; Diagnosis; Eating disorders; Ethics; Gastroparesis; Individualised treatment; Males; Medical management; Neurodivergence.

Fig. 1

Components of holistic and individualised medical care for eating disorders

Fig. 2

A multi-dimensional approach to integrated and inclusive psychosocial treatment