Men can have eating disorders too
Wearing a faded T-shirt, dusty trousers and yellow Hard Yakka boots, it's unlikely anybody would ever pick Ryan* as a recovered anorexic. The reason the 28-year-old tradesman says people never picked him as having an eating disorder is because he's a bloke.
The common misconception is that eating disorders only affect females - think young teenage girls or drastically thin models walking down the catwalk during fashion shows. Ryan hates this stereotype.
"To me, eating disorders don't have gender or sexuality. But it's seen as a girl thing - and if it's not a girl thing you're gay," Ryan says.
Figures suggest that around 20 per cent of people with anorexia nervosa are male, 8-11 per cent of those suffering bulimia nervosa are men, as are 50 per cent of binge eating disorder sufferers.
There is no single or specific cause for eating disorders - including gender. Perfectionism, bullying, dieting, trauma and childhood obesity are known risk factors. Research suggests that genetic and psychological vulnerabilities load the gun and socio-cultural influences pull the trigger.
For Ryan, it isn't easy to say exactly when his battle with an eating disorder began.
He was always athletic and remained so after leaving high school and joining the family business as a building apprentice. It was around this time Ryan began to take more notice of the way he looked and how people commented on his appearance. Ostensible compliments on his fit physique began slowly stoking an increasing obsession with fitness. Once one level of fitness was reached, he would set the bar higher and higher. He gave up his favourite sport, basketball, because it didn't push him hard enough.
His strenuous exercise regime soon became harder to keep up with - especially while working as an apprentice full-time. In order to compensate, Ryan's focus shifted to what he would eat. Or what he didn't.
Organisations such as The Butterfly Foundation say that the number of males suffering an eating disorder are probably much higher than reported due to taboos around the illness, especially involving men.
"We find it very difficult to identify a male suffering from or who is recovered from an eating disorder," says Sarah Spence of the Butterfly Foundation.
"There is quite a stigma around males suffering from an eating disorder that we tend to have many females that are prepared to come out and speak, but little to no males," she says.
Ryan agrees. "During this whole time I was very secretive ... It's a very deceitful illness. It's almost like you know you're doing the wrong thing, so you've got to hide that behaviour."
Because Ryan was fit, he was able to cope under the very extreme pressures he was putting his body under. It was months before family and friends discovered that something was wrong. He was always happy and social. And of course, he was a male. A male who was very much into his fitness - who would have guessed?
But Ryan's obsession then began to catch up with him.
After eliminating the "bad" foods and surviving on just five specific foods (such as carrots and broccoli), his body became severely malnourished.
"Even at my worst I did not see myself as thin. And I look back now and look at photos and I wonder how I survived. I knew that when I was at my worst, I wasn't fit any more, but I was happy at the fact that I wasn't overweight," Ryan says.
But his body could only hold on for so long. Struggling to get out of bed, he was falling asleep while driving. His mother told him he looked anorexic. Then he fell off a ladder at work - forcing him to visit his GP, who would become Ryan's saviour.
After a medical examination, Ryan was told his white blood-cell count had plummeted and his liver, lungs and heart were at risk of failing. His heart rate was so low that the doctor thought the medical equipment was broken. If he hadn't visited his GP, he was told he may have been dead within a week.
The decision to seek help is the start of a long and difficult process, one compounded by the lack of facilities available for recovery.
Australian psychiatrist Patrick McGorry, along with a panel of health experts and the Butterfly Foundation, released a report titled Paying the Price in late 2012. The report outlines the dire need for more treatment facilities and awareness within the public health system.
"I think our mental health care is quite shocking considering we are such a wealthy country," Professor McGorry says.
Ryan says the dedicated care given to him by his family GP allowed him to overcome his illness.
He says that admitting to an eating disorder - a "women's illness" - can be the hardest part for men.
"All the stereotypes were running through my head - it was humiliating at a point you don't want to admit it to others," Ryan says.
He has recently begun opening up by volunteering with Eating Disorders Victoria to support other males seeking recovery.
"Back in my darkest times I would have loved to have seen another guy in my situation," he says.
"Humility and isolation should not have to be part of the illness because of an outdated societal opinion."
For advice or help phone EDANZ: Eating Disorders Association of New Zealand on 0880 2 EDANZ
*Not his real name
Sydney Morning Herald