Most outpatient psychotherapists reported limited knowledge, low confidence, and minimal formal training in treating boys and men with eating disorders and muscle dysmorphia, despite reporting that they treat these patients in clinical practice, according to a recent study in the International Journal of Eating Disorders.
In the survey, 27% of clinicians reported no knowledge of eating disorders in boys and men and 44% reported no knowledge of muscle dysmorphia; similarly, 44% and 54%, respectively, reported no confidence in treating these conditions. Formal training was limited, reported by 14% during undergraduate or graduate education and 26% after undergraduate or graduate education.
The investigators conducted a cross-sectional online survey of 259 licensed outpatient psychotherapists in the US and Canada between March and June 2025. Participants were recruited through professional listservs, social media, targeted advertisements, and direct outreach. Of 430 responses, 259 met eligibility criteria after excluding duplicates, incomplete surveys, and ineligible respondents. Data were collected via Qualtrics and analyzed using descriptive methods.
Participants had a mean age of 40 years and an average of 9.6 years in practice, seeing a mean of 15 patients weekly. Clinicians reported treating a mean of 2 patients with eating disorders per week, including 1 boy or man, and few with muscle dysmorphia in the prior 12 months. Only 12% of clinicians identified as eating disorder specialists. Mean knowledge scores were 1.2 for eating disorders and 0.8 for muscle dysmorphia in boys and men, while confidence scores were 0.9 and 0.7, respectively, on 5-point scales.
Among those who received formal training (n=80), webinars (51%) and conference workshops (48%) were the most common formats. Training was perceived to improve clinical care; however, effectiveness across competencies remained modest, with mean scores ranging from 0.8 for understanding muscle dysmorphia to 1.7 for providing individual psychotherapy.
Training needs were widely reported. Approximately 64% of clinicians cited a need for additional training on symptom presentations and 61% on risk factors specific to boys and men. Around half reported gaps in assessing symptoms (49%), tailoring treatment (50%), addressing barriers (62%), and managing stigma (48%). Fewer prioritized rapport-building (23%) or engagement strategies (34%).
Clinicians identifying as eating disorder specialists reported greater knowledge, confidence, training exposure, and higher patient volumes, but training needs did not differ from nonspecialists.
The authors reported no funding, and Dr. Bunnell disclosed serving as a senior clinical advisor for Eating Recovery Center and Pathlight Mood and Anxiety Centers and receiving royalties for a related publication, while all other authors reported no conflicts of interest.
