A narrative review of sex differences in eating disorders: Is there a biological basis?
Open accessAbstract
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.Implications There is a biological basis to heightened risk for eating pathology in females, relative to males, as well as unique biological influences within each sex. Findings from this review highlight the importance of studying both sexes and considering sex-specific biological mechanisms that may underlie differential risk for eating pathology.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The sample composition of nine females and one male reflects the widely documented distribution in eating disorders, with an approximate female-to-male ratio of 9:1.
“In line with the existing literature, the composition of the sample in this study-nine females and one male-reflects the widely documented distribution in eating disorders, with an approximate female-to-male ratio of 9:1, as reported in [7], which highlights the marked overrepresentation of females in these disorders.”
From Immersive Virtual Reality in Psychotherapeutic Interventions for Youth with Eating Disorders: A Pilot Study in a Rural Context (2025) · cites this paper as [7]
The Introduction reports that females are at greater risk and that female-to-male prevalence ratios range from approximately 2:1 to 10:1 across eating disorders. This supports female overrepresentation, but not a generally applicable approximate ratio of 9:1 or the inference that a nine-female, one-male sample reflects a typical distribution. No page number is available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 118 · Cited by 142
Research works printed but not linked: 4
- [1]American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5). American Psychiatric Association; 2013.
- [22]Root TL, Ph D, Thornton L, NIH Public Access. 2011; 11(2): 92– 98. doi: 10.1016/j.eatbeh.2009.10.004.Shared · DOI
- [28]Klump KL, Culbert KM, Slane JD, Burt SA, Sisk CL, Nigg JT. The effects of puberty on genetic risk for disordered eating: evidence for a sex differences. Psychol Med. 2012; 42(3): 627– 637. doi: 10.1017/S0033291711001541.The 21854699 PMC3697115 · DOI
- [79]Altabe M, Thompson JK. Menstrual cycle, body image, and eating disturbance. Int J Eat Disord. 1990; 9: 395– 401.
- Authors
- Culbert, K. M., Sisk, C. L., & Klump, K. L.
- Affiliations
- Wayne State University (US)
- Michigan State University (US)
- Corresponding author
- Culbert, Kristen M.
- Venue
- Clinical Therapeutics
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 43
- Issue
- 1
- Pages
- 95-111
- ISSN
- 0149-2918 (ISSN-L)
- PMC
- PMC7902379
- OpenAlex
- W3114095057
- Cited by
- 142
- References
- 118
- Citations by year
- 2026: 26 · 2025: 41 · 2024: 36 · 2023: 23 · 2022: 10 · 2021: 5
- FWCI
- 0.75
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- eating disorders, sex differences, biological basis, puberty, gonadarche, adrenarche, sex hormones, testosterone, estradiol, progesterone, genetic risk, binge eating, body image concern, food cue reactivity
- MeSH terms
- Animals, Feeding and Eating Disorders, Humans, Sex Characteristics, Gonadal Steroid Hormones
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
