Sex‐dependent clinical presentation, body image, and endocrine status in long‐term remitted anorexia nervosa

Objective Although anorexia nervosa (AN) in males has recently gained attention, knowledge of its psychological and physiological outcomes is still scarce. We explore sex‐specific characteristics of long‐term remitted AN with respect to residual eating disorder (ED) psychopathology, body image, and endocrinology. Method We recruited 33 patients with AN in remission for at least 18 months (24 women, 9 men) and 36 matched healthy controls (HCs). Eating disorder psychopathology and body image ideals were assessed via clinical interviews, questionnaires, and an interactive 3D body morphing tool. Plasma levels of leptin, free triiodothyronine, cortisol, and sex hormones were quantified. Univariate models controlled for age and weight were used to test for the effects of diagnosis and sex. Results Both patient groups showed residual ED psychopathology but normal weight and hormone levels relative to HCs. Male remitted patients demonstrated significantly stronger muscularity‐focused body image ideals, evident in interviews, self‐reports, and behavioural data, than both female patients and HCs. Conclusions Sex‐specific body image characteristics in patients with remitted AN point towards the need to adjust test instruments and diagnostic criteria to male‐specific psychopathology. In the future, sufficiently powered studies should evaluate the risk of men with AN developing muscle dysmorphia in the long term. Highlights Sex‐specific residual symptoms have been identified in long‐term remitted anorexia nervosa (AN) patients, particularly regarding body image disturbance. The drive for muscularity (DMS) in male remitted patients suggest a possible risk of transition from male AN to muscle dysmorphic disorder. Sex‐specific criteria, especially muscle‐oriented behaviour, need to be included in the description of diagnoses and symptoms in male patients.