Tuy nhiên, nó đã được đề cập rằng "quy tắc này là một sự đơn giản hóa và không tổ chức trên cơ sở phương pháp luận. Giữa các nghiên cứu định nghĩa khác nhau về kết quả nghèo, trung cấp và tốt đã được sử dụng, | EATING DISORDERS IN MALES 379 to hold true in the largest male follow-up studies . one-third with good intermediate and poor outcome respectively. Findings in females to date concur largely with this rule. However it has to be mentioned that this rule is an oversimplification and does not hold on methodological grounds. Between studies different definitions of poor intermediate and good outcome have been used and frequently outcome has not been assessed reliably in outcome studies. Mixing male and female eating-disordered patients in a therapy group sometimes may be difficult as men normally are under-represented in these groups and therefore may feel that their typical male problems are not being addressed adequately. In addition some eating-disordered women may feel threatened by or prejudiced towards eating disordered men Andersen 1995 . Contrary to this view Woodside and Kaplan 1994 experienced no difficulties integrating male subjects in their group therapy day treatment programme. There are indications that case identification and referral to specialist services differ between patients with AN and BN. In Carlat et al. s 1997 sample of 135 men with eating disorders bulimic men were significantly older at first treatment and were mostly selfreferred. On the other hand anorexic patients whose disorder is more visible to lay persons and doctors due to low body weight were referred to specialist services earlier referral in the case of AN is frequently initiated by relatives. Usually bulimic patients have more or less normal body weight and handle their symptoms rather secretively. Most likely this is a major reason for the longer delay between onset of illness and referral to treatment. Apparently over the past decade public as well as professional awareness of eating disorders has increased Braun et al. 1999 . Waller and Katzman 1998 recently have examined opinions of therapists concerning the role of the therapist s gender for treatment. However at this .
