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

Abstract Background Eating disorders (EDs) affect both men and women, yet men account for only a small minority of patients seen in specialized ED services, and little is known about how their psychopathology differs beyond core ED symptoms. We examined temporal trends in men’s access to specialized ED care over a 10-year period and compared diagnostic distribution, psychopathological characteristics, and transdiagnostic severity profiles across genders. Methods We analyzed 863 consecutive adults assessed at a specialized ED center in Bologna, Italy, between 2014 and 2024. Gender differences in diagnostic distribution and psychopathological features were examined using standardized clinical measures (EDE-Q, BUT, PHQ-9, STAI-Y, and SCID-5-PD). Changes over time in the proportion of men accessing specialized ED care were assessed using logistic regression. Latent profile analysis (LPA) was used to identify transdiagnostic severity profiles. Results Throughout the study period, cisgender men accounted for only 7.9% of patients accessing specialized ED care. Diagnostic distribution differed by gender: anorexia nervosa and bulimia nervosa were more common among cisgender women, whereas binge eating disorder predominated among cisgender men. Compared with cisgender men, cisgender women reported higher levels of ED psychopathology, body uneasiness, and trait anxiety, although effect sizes were generally small to moderate. LPA identified three severity profiles (low, moderate, high). Cisgender men were more frequently classified in the moderate-severity profile, whereas cisgender women were overrepresented in the high-severity profile. Conclusion Cisgender men remained markedly underrepresented among patients seeking specialized ED care and were more likely to belong to the moderate-severity profile. At the same time, the identification of shared transdiagnostic severity profiles across genders supports the view that ED severity can be conceptualized within a common transdiagnostic framework.