A Narrative Review of Sex Differences in Eating Disorders: Is There a Biological Basis?

Purpose: Eating disorders and their core symptoms (eg, binge eating, body weight/shape concerns) disproportionately affect females, and these sex-differentiated effects become prominent during and after puberty. Although psychosocial influences such as heightened sociocultural pressures for thinness in girls and women contribute to this sex imbalance, biological factors could also play an important role. Methods: This narrative review summarizes evidence of biological factors underlying the sex-differentiated prevalence of eating pathology as well as within-sex variability in risk. Findings: There are sex differences in the pubertal emergence of genetic effects on eating pathology (adrenarche in males; gonadarche in females), and at least some genetic contributions to eating pathology seem to vary between the sexes. Furthermore, sex steroid hormones (eg, testosterone, estradiol, progesterone) are leading contributors to differential risk for eating pathology in males and females across the life span. Emerging data suggest that between-sex and within-sex variability in risk might occur via hormone-driven modulation (activation/deactivation) of genetic influences and neural responsiveness to food-related cues. (C) 2020 Elsevier Inc.

Automated summary

Eating disorders and their core symptoms disproportionately affect females, with biological factors and hormonal influences playing important roles in the sex-differentiated prevalence and risk. Genetic effects and sex steroid hormones contribute to variations in eating pathology between males and females, with hormone-driven modulation of genetic influences and neural responsiveness to food-related cues potentially explaining within-sex variability in risk.