351
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Eik-Nes TT, Austin SB, Blashill AJ, Murray SB, Calzo JP. Prospective health associations of drive for muscularity in young adult males. Int J Eat Disord 2018; 51:1185-1193. [PMID: 30260492 DOI: 10.1002/eat.22943] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/20/2018] [Accepted: 07/22/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of the study was to estimate prospective associations of drive for muscularity measured in 2013 and related health outcomes (depressive symptoms, overeating, binge eating, purging, binge drinking, and use of muscle-building products [e.g., creatine and steroids]) measured in 2014. METHOD The data come from a U.S. national large prospective cohort study, the Growing Up Today Study (GUTS) and included 2,460 males aged 18-32 years. Muscularity concerns were assessed with The Drive for Muscularity Scale (item responses ranging from 1 = Never to 6 = Always), which measures the degree of the respondents' preoccupation with increasing their muscularity. RESULTS Gay and bisexual males presented with higher drive for muscularity compared to heterosexual males (β = 0.30, 95% CI = 0.17, 0.43, p < .0001). Prospective analysis using generalized estimating equations indicated that each unit increase in drive for muscularity was associated with increased odds of exhibiting significant depressive symptoms (OR = 1.23, 95% CI = 1.05-1.44, p = .01), binge drinking (OR = 1.21, 95% CI = 1.02-1.45, p = .03), dieting (OR = 1.17, 95% CI = 1.01, 1.35, p = .04), and use of muscle-building products (OR = 4.49, 95% CI = 3.74, 5.40, p < .0001). DISCUSSION The drive for muscularity appears to be relatively prevalent across adolescence and early adulthood in males and is associated with broad and substantial health consequences. Muscularity-oriented concerns should be carefully considered when assessing and treating males with body image dissatisfaction.
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Affiliation(s)
- Trine Tetlie Eik-Nes
- Faculty of Medicine and Health Sciences, Department of Mental Health, Norwegian University for Science and Technology, Trondheim, Norway.,Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University for Science and Technology, Trondheim, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Trøndelag, Norway
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,The Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Aaron J Blashill
- Department of Psychology, San Diego State University, San Diego, California.,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, California
| | - Jerel P Calzo
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Division of Health Promotion & Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, California.,Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
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352
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Reas DL, Rø Ø. Time trends in healthcare-detected incidence of anorexia nervosa and bulimia nervosa in the Norwegian National Patient Register (2010-2016). Int J Eat Disord 2018; 51:1144-1152. [PMID: 30265747 DOI: 10.1002/eat.22949] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/04/2018] [Accepted: 08/05/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Few studies have investigated temporal trends in the incidence of eating disorders (EDs). This study investigated time trends in the age- and sex-specific incidence of healthcare-detected anorexia nervosa (AN) and bulimia nervosa (BN) from 2010 to 2016. METHODS Data were retrieved from the Norwegian National Patient Register as defined by the International Classification of Diseases (ICD-10): narrowly defined AN (F50.0), broadly defined AN (F50.0 + 50.1), narrowly defined BN (F50.2), and broadly defined BN (F50.2 + 50.3). The average annual percent changes (AAPCs) in incidence rates (IRs) were examined by Joinpoint regression analyses. RESULTS The overall (i.e., both genders, ages 10-49) rates of AN were stable across the 7-year period, with IRs ranging from 18.8 to 20.4 per 100,000 for narrowly defined AN and 33.2 to 39.5 per 100,000 for broadly defined AN, whereas overall rates of BN declined. Age- and gender-stratification revealed a significant average annual increase in AN (narrow and broad) among 10- to 14-year-old girls. The incidence of broadly defined AN also increased significantly among females aged 15-19 years between 2010 and 2012, before leveling off. Nearly universal declines in the incidence of narrowly and broadly defined BN among females occurred. IRs among males were stable and comparatively low, with no significant trends toward increasing or decreasing rates of AN or BN over time. DISCUSSION Although register-based studies provide an underestimate of the true incidence and may not accurately reflect population-level changes in true ED occurrence, this study extends our knowledge regarding trends in the detected incidence of EDs into the second decade of the 21st century.
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Affiliation(s)
- Deborah Lynn Reas
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
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353
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Roberts SR, Ciao AC, Czopp AM. The influence of gender on the evaluation of anorexia nervosa. Int J Eat Disord 2018; 51:1162-1167. [PMID: 30189122 DOI: 10.1002/eat.22917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/07/2022]
Abstract
A stereotype exists that anorexia nervosa (AN) is a "female" disorder. As a result, men with AN may face harsher stigmatization from their peers or go undiagnosed. The shifting standards model provides a framework to explore how gender stereotypes impact perceptions of AN. Participants (N = 438) were given a vignette of a person with symptoms of AN labeled as either male or female. Assessments were experimentally manipulated according to the shifting standards perspective: participants were asked if they were concerned (or convinced) that the target had AN and then indicated the severity of behavioral symptoms (calorie reduction, pounds lost per week, and hours of exercise) needed to make them concerned (or convinced) of AN. Participants were more likely to state that the male target had AN compared to the female target (p = .036) whereas women were more likely to believe an individual had AN than men, regardless of the target gender (p < .001). In addition, men required that the male target have more severe symptoms to assign an AN diagnosis than women (p = .005). In general, severity ratings for symptoms were quite high, indicating a normalization of unhealthy weight loss practices. These results confirm that gender affects the perception of AN, though they do not conform to expectations within the shifting standards model. Instead, they suggest that a male target is more readily identified as having AN than a female target with AN when exhibiting identical symptoms.
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Affiliation(s)
| | - Anna C Ciao
- Western Washington University, Bellingham, Washington
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354
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Nagata JM, Garber AK, Tabler JL, Murray SB, Bibbins-Domingo K. Differential Risk Factors for Unhealthy Weight Control Behaviors by Sex and Weight Status Among U.S. Adolescents. J Adolesc Health 2018; 63:335-341. [PMID: 30236999 PMCID: PMC6152843 DOI: 10.1016/j.jadohealth.2018.03.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/09/2018] [Accepted: 03/21/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine if previously reported risk factors for the development of unhealthy weight control behaviors differ by sex and weight status using a nationally representative longitudinal sample of adolescents followed through young adulthood. METHODS We used nationally representative longitudinal cohort data collected from baseline (11-18 years old, 1994-1995, Wave I) and seven-year follow-up (18-24 years old, 2001-2002, Wave III) of the National Longitudinal Study of Adolescent to Adult Health (Add Health). We examined potential risk factors (adverse childhood events and adolescent family, school, body image, and mental health factors) for the development of unhealthy weight control behaviors including vomiting, fasting/skipping meals, or laxative/diuretic use to lose weight at seven-year follow-up in young adulthood. RESULTS Of the 14,322 included subjects, 11% reported unhealthy weight control behavior at follow-up in young adulthood, with the highest proportion (23.7%) among overweight/obese females and the lowest proportion (3.7%) among underweight/normal weight males. All adolescent family factors were significantly associated with unhealthy weight control behaviors in underweight/normal weight females, whereas none were significantly associated in overweight/obese males. Similar trends were noted for adverse childhood events, and adolescent school and community factors. Adolescent self-perception of being overweight was associated with young adult unhealthy weight control behaviors among all subgroups. CONCLUSIONS Risk factors for unhealthy weight control behaviors may differ based on sex and weight status. Screening, prevention, and treatment interventions for unhealthy weight control behaviors in adolescents and young adults may need to be tailored based on sex and weight status.
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Affiliation(s)
- Jason M. Nagata
- Division of Adolescent and Young Adult Medicine, University of California, San Francisco, San Francisco, CA
| | - Andrea K. Garber
- Division of Adolescent and Young Adult Medicine, University of California, San Francisco, San Francisco, CA
| | - Jennifer L. Tabler
- Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, TX
| | - Stuart B. Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA,Department of Medicine, University of California, San Francisco, San Francisco, CA
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355
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Zayas LV, Wang SB, Coniglio K, Becker K, Murray HB, Klosterman E, Kay B, Bean P, Weltzin T, Franko DL, Eddy KT, Thomas JJ. Gender differences in eating disorder psychopathology across DSM-5 severity categories of anorexia nervosa and bulimia nervosa. Int J Eat Disord 2018; 51:1098-1102. [PMID: 30193008 PMCID: PMC7192048 DOI: 10.1002/eat.22941] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study examined whether patterns of eating-disorder (ED) psychopathology differed by gender across DSM-5 severity specifiers in anorexia nervosa (AN) and bulimia nervosa (BN). METHOD We tested whether ED psychopathology differed across DSM-5 severity specifiers among 532 adults (76% female) in a residential treatment center with AN or BN. We hypothesized that severity of ED psychopathology would increase in tandem with increasing severity classifications for both males and females with AN and BN. RESULTS Among females with BN, DSM-5 severity categories were significantly associated with increasing ED psychopathology, including Eating Disorder Examination-Questionnaire dietary restraint, eating concern, shape concern, and weight concern; and Eating Disorder Inventory drive for thinness and bulimia. ED psychopathology did not differ across DSM-5 severity levels for males with BN. For both males and females with AN, there were no differences in ED psychopathology across severity levels. DISCUSSION Results demonstrate that DSM-5 severity specifiers may function differently for males versus females with BN. Taken together, data suggest DSM-5 severity specifiers may not adequately capture severity, as intended, for males with BN and all with AN. Future research should evaluate additional clinical validators of DSM-5 severity categories (e.g., chronicity, treatment non-response), and consider alternate classification schemes.
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Affiliation(s)
- Lazaro V. Zayas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Shirley B. Wang
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Kathryn Coniglio
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychology, Rutgers University, Piscataway, New Jersey,Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | - Kendra Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Helen B. Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychology, Rutgers University, Piscataway, New Jersey,Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | - Eric Klosterman
- Eating Disorder Center, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Brian Kay
- Eating Disorder Center, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Pamela Bean
- Eating Disorder Center, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Theodore Weltzin
- Eating Disorder Center, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Debra L. Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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356
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Limbers CA, Cohen LA, Gray BA. Eating disorders in adolescent and young adult males: prevalence, diagnosis, and treatment strategies. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2018; 9:111-116. [PMID: 30127650 PMCID: PMC6091251 DOI: 10.2147/ahmt.s147480] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Males have largely been underrepresented in the eating disorder (ED) peer-reviewed literature. The current review paper examines prevalence rates, ED symptom presentation, and assessment and treatment strategies relevant to adolescent and young adult males. Adolescent and young adult males often report a greater desire to be bigger and more muscular compared to their female counterparts. Due to concerns that contemporary ED assessment tools are over reliant on items that evaluate stereotypically feminine indicators of ED pathology, male-specific ED measures, such as the Eating Disorder Assessment for Men, have been developed. Further validation work is necessary to establish the psychometric properties of these male-specific measures, particularly in adolescent male populations. Attention to a heightened prevalence of comorbid substance abuse disorders and the role that competitive sports play in perpetuating ED pathology are two factors that have been identified as important in the treatment of adolescent and young adult males with EDs.
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Affiliation(s)
- Christine A Limbers
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA,
| | - L Adelyn Cohen
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA,
| | - Bethany A Gray
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA,
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357
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Abstract
OBJECTIVES Despite traditional views of eating disorders as a female illness, there is a growing body of evidence that the incidence rate of eating disorders in men is rising. Research suggests that these men may experience unique symptoms and difficulties, however, it is unclear how these unique needs may impact treatment. The aim of this study was to explore clinicians' views on whether men have gender-specific treatment needs, and how far these needs require treatment adaptations. DESIGN Qualitative interview study using framework analysis to explore the experiences of clinicians working with men with eating disorders. SETTING Outpatient National Health Service eating disorder service in London. PARTICIPANTS Ten clinicians from a variety of clinical backgrounds participated in the study. RESULTS The following three themes emerged: male-specific issues identified by clinicians, treatment approaches used for this population and the importance of creating a male-friendly environment. Male-specific issues identified by participants included an increased focus on muscularity and difficulty expressing or discussing emotion. Clinicians also suggested that men may be more likely to adopt a performance-based approach to. This was linked by clinicians to the impact of cultural perceptions of masculinity on their patients. Clinicians in this study felt that these individual needs could be met by adapting existing approaches within a supportive, male-friendly environment. However, there was not consensus over specific adaptations, including identifying risk, the need for male-only groups, or whether male patients needed access to male clinicians. CONCLUSIONS Although men do present with specific treatment needs, these can typically be met within the framework of typical treatment approaches by experienced clinicians in an environment sensitive to the presence of men in an otherwise female-dominated space. However, there are a lack of explicit guidelines for this process, and areas such as male-only treatment spaces require further research.
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Affiliation(s)
- Emma Kinnaird
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Caroline Norton
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Arts and Sciences, Ilia State University, Tbilisi, Georgia
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358
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Nagata JM, Garber AK, Tabler J, Murray SB, Vittinghoff E, Bibbins-Domingo K. Disordered eating behaviors and cardiometabolic risk among young adults with overweight or obesity. Int J Eat Disord 2018; 51:931-941. [PMID: 30030944 PMCID: PMC6230303 DOI: 10.1002/eat.22927] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/05/2018] [Accepted: 06/18/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine if unhealthy weight control behaviors or binge-eating behaviors among young adults with overweight/obesity are associated with body mass index (BMI) change and cardiometabolic risk at 7-year follow-up. METHODS We used longitudinal cohort data from 5,552 young adults with overweight/obesity at baseline (18-24 years) with 7-year follow-up (24-32 years) from the National Longitudinal Study of Adolescent to Adult Health. Baseline predictors were: (a) unhealthy weight control behaviors such as vomiting, fasting, skipping meals, or laxative/diuretic use to lose weight; or (b) binge-eating behaviors. Participants reporting either unhealthy weight control behaviors or binge-eating behaviors were considered to engage in any disordered eating behavior (DEB). Outcomes at 7-year follow-up were BMI change, incident diabetes, incident hypertension, and incident hyperlipidemia. RESULTS Young adults with overweight/obesity reporting unhealthy weight control behaviors at baseline had higher BMI and weight at 7-year follow-up than those without unhealthy weight control behaviors. In regression models adjusting for baseline BMI, race/ethnicity, age, and education, unhealthy weight control behaviors were associated with greater change in BMI in both sexes and binge-eating behavior at baseline was associated with greater odds of incident hyperlipidemia (odds ratio 1.90, 95% CI 1.29-2.79) at 7-year follow-up in males. CONCLUSIONS The higher risk for increased BMI (in both males and females) and incident hyperlipidemia (in males) over time in young adults with overweight/obesity who engage in DEBs underscores the need to screen for DEBs in this population and provide referrals and tailored interventions as appropriate.
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Affiliation(s)
- Jason M. Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Andrea K. Garber
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Jennifer Tabler
- Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, TX
| | - Stuart B. Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA,Department of Medicine, University of California, San Francisco, San Francisco, CA
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359
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Compte EJ, Murray SB, Sepúlveda AR, Schweiger S, Bressan M, Torrente F. What position do you play? Eating disorder pathology among rugby players, and the understudied role of player position. Int J Eat Disord 2018; 51:1015-1019. [PMID: 30070382 DOI: 10.1002/eat.22933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/03/2018] [Accepted: 07/08/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Male athletes appear to be at high risk for Eating Disorders (ED), given sport-related pressures. Although in some sports weight loss confers a competitive advantage, men also participate in sports where a large body is considered to enhance performance. In rugby a heavier body has been associated with sports success, however, physical demands vary given the position in the field (forward or back). We aimed to investigate whether ED pathology varied as a function of player position. METHOD A cross-sectional study was conducted among 203 rugby players (Mage = 21.78, SD = 3.54) in order assess associations between elevated eating pathology given the players' position, and with ED mediating mechanisms (physical comparison and exercise dependence). RESULTS 8.9% (95% CI: 4.9, 12.8) of the participants presented elevated eating pathology. Players' position, physical comparison and exercise dependence were associated with elevated eating pathology. Forwards tended to endorse binge eating more frequently, and showed higher levels of eating concerns. DISCUSSION Our findings suggest that ED symptoms differ as a function of player position, and that elevated eating pathology in rugby players is associated with appearance comparison and exercise dependence. Despite the possible implications for prevention and treatment efforts, the clinical validity of the current findings must be confirmed with further research.
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Affiliation(s)
- Emilio J Compte
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina.,DBT-Eating Disorders Team, Fundación Foro, Buenos Aires, Argentina
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Ana R Sepúlveda
- Department of Biological and health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Sofia Schweiger
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Michelle Bressan
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Fernando Torrente
- Laboratory of Psychopathology Research, Institute of Cognitive and Translational Neuroscience (INCyT), Buenos Aires, Argentina
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360
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Nagata JM, Garber AK, Tabler JL, Murray SB, Bibbins-Domingo K. Prevalence and Correlates of Disordered Eating Behaviors Among Young Adults with Overweight or Obesity. J Gen Intern Med 2018; 33:1337-1343. [PMID: 29948810 PMCID: PMC6082209 DOI: 10.1007/s11606-018-4465-z] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/26/2018] [Accepted: 04/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clinical and community samples indicate that eating disorders (EDs) and disordered eating behaviors (DEBs) may co-occur among adolescents and young adults at a weight status classified as overweight or obese. OBJECTIVE To determine the prevalence of EDs and DEBs among young adults at a weight status classified as overweight or obese using a nationally representative sample and to characterize differences in prevalence by sex, race/ethnicity, sexual orientation, and socioeconomic status. DESIGN Cross-sectional nationally representative data collected from Wave III of the National Longitudinal Study of Adolescent to Adult Health (Add Health). PARTICIPANTS Young adults ages 18-24 years old. MAIN MEASURES ED diagnosis and DEBs (self-reported binge eating or unhealthy weight control behaviors including vomiting, fasting/skipping meals, or laxative/diuretic use to lose weight). Covariates: age, sex, race/ethnicity, sexual orientation, weight status, and education. KEY RESULTS Of the 14,322 young adults in the sample, 48.6% were at a weight status classified as overweight or obese. Compared to young adults at a weight status classified as underweight or normal weight, those at a weight status classified as overweight or obese reported a higher rate of DEBs (29.3 vs 15.8% in females, 15.4 vs 7.5% in males). Logistic regression analyses demonstrated that odds of engaging in DEBs were 2.32 (95% confidence interval 2.05-2.61) times higher for females compared to males; 1.66 (1.23-2.24) times higher for Asian/Pacific Islander compared to White; 1.62 (1.16-2.26) times higher for homosexual or bisexual compared to heterosexual; 1.26 (1.09-1.44) times higher for high school or less versus more than high school education; and 2.45 (2.16-2.79) times higher for obesity compared to normal weight, adjusting for all covariates. CONCLUSIONS The high prevalence of DEBs particularly in young adults at a weight status classified as overweight or obese underscores the need for screening, referrals, and tailored interventions for DEBs in this population.
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Affiliation(s)
- Jason M Nagata
- Division of Adolescent and Young Adult Medicine, , University of California, San Francisco, CA, USA.
| | - Andrea K Garber
- Division of Adolescent and Young Adult Medicine, , University of California, San Francisco, CA, USA
| | - Jennifer L Tabler
- Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Stuart B Murray
- Department of Psychiatry, University of Californias, San Francisco, CA, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
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361
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Voderholzer U, Hessler JB, Naab S, Fichter M, Graetz A, Greetfeld M, Heuser J, Schlegl S. Are there differences between men and women in outcome of intensive inpatient treatment for anorexia nervosa? An analysis of routine data. EUROPEAN EATING DISORDERS REVIEW 2018; 27:59-66. [PMID: 30028060 DOI: 10.1002/erv.2624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 06/06/2018] [Accepted: 06/17/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) in men is rare and understudied. We compared admission characteristics and response to specialized inpatient treatment between men and women with AN. METHOD One hundred sixteen consecutive male patients with AN were matched to 116 female patients. Patients completed the self-rating Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-S) at admission and discharge. Differences at admission and in treatment response were examined with independent samples t-tests and ANOVA for repeated measures, respectively. RESULTS Men had lower body mass index (BMI)-percentiles (Cohen's d = -0.55), higher levels of weight suppression (d = 0.65), and higher scores in the SIAB-S general psychopathology and social integration scale (d = 0.47) at admission. There were no differences in response to treatment except for changes in BMI-percentile (F = 4.49, p = 0.035). CONCLUSIONS There were more similarities than differences between genders in AN. Because this similarity might be confounded with traditionally "feminine" conceptualizations of AN, further studies of male AN are needed.
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Affiliation(s)
- Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Germany
| | | | | | - Manfred Fichter
- Schoen Clinic Roseneck, Prien, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Germany
| | | | | | | | - Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Germany
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362
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Murray SB, Griffiths S, Nagata JM. Community-Based Eating Disorder Research in Males: A Call to Action. J Adolesc Health 2018; 62:649-650. [PMID: 29784111 DOI: 10.1016/j.jadohealth.2018.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 02/26/2018] [Accepted: 03/06/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, California.
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California
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363
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Affiliation(s)
- Rebecca L. Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Edwin & Fannie Gray Hall Center for Human Appearance, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Corresponding author: Rebecca L. Pearl, Center for Weight and Eating Disorders, 3535 Market Street, Suite 3026, Philadelphia, PA 19104,
| | - Thomas A. Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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364
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Trompeter N, Bussey K, Hay P, Mond J, Murray SB, Lonergan A, Griffiths S, Pike K, Mitchison D. Fear of Negative Evaluation and Weight/Shape Concerns among Adolescents: The Moderating Effects of Gender and Weight Status. J Youth Adolesc 2018; 47:1398-1408. [DOI: 10.1007/s10964-018-0872-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/16/2018] [Indexed: 11/28/2022]
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365
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The role of trait emotional intelligence in body dissatisfaction and eating disorder symptoms in preadolescents and adolescents. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2017.12.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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366
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Hoffmann S, Warschburger P. Patterns of body image concerns in adolescence and early adulthood: A latent profile analysis. Eat Behav 2018; 29:28-34. [PMID: 29433085 DOI: 10.1016/j.eatbeh.2018.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 12/01/2022]
Abstract
The present study aimed at identifying latent profiles of body image concerns in adolescents and young adults. Subsequently, associations between these profiles and potentially harmful behaviors are examined. Self-report data of 758 male and female adolescents, aged 14 to 22 years, were analyzed. Participants provided demographic and anthropometric data and completed surveys on weight/shape and muscularity concern as well as on disturbed eating behaviors and dysfunctional exercise. Latent profile analyses of weight/shape concern and muscularity concern were performed separately for each gender. The analyses indicated three-class solutions in men and women. In both genders, the inconspicuous class, characterized by small amounts of weight/shape and muscularity concerns, was the largest one (86% in men, 68% in women). Whereas 10% of the men and 23% of the women were assigned to the borderline class, 4% of the men and 8% of the women formed the conspicuous class (marked weight/shape and muscularity concerns). Between genders, the degrees of muscularity concern differed in the borderline and inconspicuous classes, while the degrees of weight/shape concern differed in the inconspicuous class only. The comparable degrees of weight/shape and muscularity concerns in men and women in the affected classes underline the relevance of both aspects in both genders. Classes could be distinguished by harmful behaviors, like restrained eating or emotional exercise, proving the clinical significance of body image concerns.
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Affiliation(s)
- Svenja Hoffmann
- Department of Psychology, University of Potsdam, Karl-Liebknecht-Straße 24/25, 14476 Potsdam, Germany.
| | - Petra Warschburger
- Department of Psychology, University of Potsdam, Karl-Liebknecht-Straße 24/25, 14476 Potsdam, Germany.
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367
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Klimek P, Murray SB, Brown T, Gonzales Iv M, Blashill AJ. Thinness and muscularity internalization: Associations with disordered eating and muscle dysmorphia in men. Int J Eat Disord 2018; 51:352-357. [PMID: 29473192 DOI: 10.1002/eat.22844] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/23/2018] [Accepted: 01/31/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The tripartite influence model of body image identifies internalization of societal body ideals as a risk factor for developing body dissatisfaction, and subsequent disordered eating behavior. In men, internalization of two dimensions of body image ideals, thinness and muscularity, is associated with body dissatisfaction and eating concerns. However, it is unknown how thinness and muscularity internalization interact in predicting muscle dysmorphia and disordered eating in men. METHOD Data were collected online from 180 undergraduate men, with ages ranging from 18 to 33 years (19.6, SD = 2.6). Regression models were used to test the interactive effects of thinness and muscularity internalization on (a) muscle dysmorphia symptoms and (b) disordered eating. Subsequent simple slope analyses probed effects at the mean, and ±1 standard deviation of thinness internalization. RESULTS Muscularity and thinness internalization were independently positively related to muscle dysmorphia symptoms and disordered eating. Additionally, a significant interaction revealed that muscularity internalization was increasingly related to muscle dysmorphia symptoms as thinness internalization decreased. DISCUSSION Men who internalized the muscular ideal had higher levels of muscle dysmorphia when they did not highly internalize the thin ideal. However, greater internalization of both the muscularity and thin ideal independently may be most relevant in the development of disordered eating in men. Future research is needed to explore variability in experiences of muscle dysmorphia compared with disordered eating in males.
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Affiliation(s)
- Patrycja Klimek
- Joint Doctoral Program in Clinical Psychology, Department of Psychology, San Diego State University/University of California, San Diego, California
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, California
| | - Tiffany Brown
- Department of Psychiatry, University of California, San Diego, California
| | - Manuel Gonzales Iv
- Department of Psychology, San Diego State University, San Diego, California
| | - Aaron J Blashill
- Joint Doctoral Program in Clinical Psychology, Department of Psychology, San Diego State University/University of California, San Diego, California.,Department of Psychology, San Diego State University, San Diego, California
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368
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Boys, Biceps, and Bradycardia: The Hidden Dangers of Muscularity-Oriented Disordered Eating. J Adolesc Health 2018; 62:352-355. [PMID: 29241987 DOI: 10.1016/j.jadohealth.2017.09.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/19/2017] [Accepted: 09/19/2017] [Indexed: 11/21/2022]
Abstract
The recognition of eating disorders (EDs) in males represents an ongoing challenge for physicians. This challenge is particularly complex in the case of EDs that are oriented toward muscularity, as opposed to thinness, which current diagnostic criteria do not accommodate. Nevertheless, EDs in males, and muscularity-oriented disordered eating (MODE) in particular, are increasingly prevalent and are likely to be encountered in clinical practice. We report the case of a 16-year-old male who presented with medical instability, requiring hospitalization, in the context of MODE. Importantly, this patient did not meet formal diagnostic criteria for a specific ED, and behavioral symptoms were deemed goal oriented in the context of high school wrestling pursuits. This case highlights the challenges of identifying MODE and the medical risks associated therein. Pediatricians are encouraged to screen for MODE in adolescent males reporting body image concerns.
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369
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Anderson LM, Reilly EE, Thomas JJ, Eddy KT, Franko DL, Hormes JM, Anderson DA. Associations among fear, disgust, and eating pathology in undergraduate men and women. Appetite 2018; 125:445-453. [PMID: 29481914 DOI: 10.1016/j.appet.2018.02.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/21/2018] [Accepted: 02/18/2018] [Indexed: 10/18/2022]
Abstract
Fear and disgust are distinct emotions that have been independently linked with EDs and may motivate avoidance behaviors that may be relevant targets for ED interventions (e.g., food rejection). Despite similar motivational function, it is possible that one emotion is more strongly associated with ED symptoms, relative to the other. Given that emerging evidence suggests that disgust-based behavior may be more difficult to change than fear-based behaviors, research is needed to evaluate whether each emotion differentially relates to ED symptoms. Therefore, the current study tested the relative importance of fear and disgust in accounting for variance in ED symptoms. Participants included undergraduate men (n = 127) and women (n = 263) from a university in the northeast US. Participants completed self-report measures assessing demographics, disordered eating attitudes and behaviors, and visual analog scales assessing fear and disgust responses to high-calorie food images, low-calorie food images, and non-food fear and disgust images. Bivariate correlations revealed significant positive associations among fear, disgust, and EDE-Q global symptom scores. Relative weights analysis results yielded relative importance weights that suggested disgust responding to high calorie food images accounts for the greatest total variance in EDE-Q global symptom scores in men, and fear responding to high calorie food images accounts for the greatest total variance in EDE-Q scores in women. Findings provide initial evidence that investigative and clinical efforts should consider fear and disgust as unique facets of negative affect with different patterns of relative importance to ED symptoms in undergraduate men and women.
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Affiliation(s)
- Lisa M Anderson
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA; Department of Psychiatry, University of Minnesota, 2450 Riverside Avenue, F227, Minneapolis, MN, 55454, USA.
| | - Erin E Reilly
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA; Department of Psychiatry, University of California - San Diego, 4510 Executive Drive, Suite 330, San Diego, CA, 92121, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, 2 West, Room 305, Boston, MA, 02215, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, 2 West, Room 305, Boston, MA, 02215, USA
| | - Debra L Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, 2 West, Room 305, Boston, MA, 02215, USA; Department of Applied Psychology, Northeastern University, 110 Churchill Hall, 360 Huntington Ave., Boston, MA, 02115, USA
| | - Julia M Hormes
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
| | - Drew A Anderson
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
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370
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Visual attention mediates the relationship between body satisfaction and susceptibility to the body size adaptation effect. PLoS One 2018; 13:e0189855. [PMID: 29385137 PMCID: PMC5791942 DOI: 10.1371/journal.pone.0189855] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 12/04/2017] [Indexed: 12/16/2022] Open
Abstract
Body size misperception–the belief that one is larger or smaller than reality–affects a large and growing segment of the population. Recently, studies have shown that exposure to extreme body stimuli results in a shift in the point of subjective normality, suggesting that visual adaptation may be a mechanism by which body size misperception occurs. Yet, despite being exposed to a similar set of bodies, some individuals within a given geographical area will develop body size misperception and others will not. The reason for these individual difference is currently unknown. One possible explanation stems from the observation that women with lower levels of body satisfaction have been found to pay more attention to images of thin bodies. However, while attention has been shown to enhance visual adaptation effects in low (e.g. rotational and linear motion) and high level stimuli (e.g., facial gender), it is not known whether this effect exists in visual adaptation to body size. Here, we test the hypothesis that there is an indirect effect of body satisfaction on the direction and magnitude of the body fat adaptation effect, mediated via visual attention (i.e., selectively attending to images of thin over fat bodies or vice versa). Significant mediation effects were found in both men and women, suggesting that observers’ level of body satisfaction may influence selective visual attention to thin or fat bodies, which in turn influences the magnitude and direction of visual adaptation to body size. This may provide a potential mechanism by which some individuals develop body size misperception–a risk factor for eating disorders, compulsive exercise behaviour and steroid abuse–while others do not.
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371
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Dakanalis A, Zanetti MA, Colmegna F, Riva G, Clerici M. Classifying binge eating-disordered adolescents based on severity levels. J Adolesc 2018; 62:47-54. [DOI: 10.1016/j.adolescence.2017.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 10/04/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022]
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372
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Schneider SC, Baillie AJ, Mond J, Turner CM, Hudson JL. The classification of body dysmorphic disorder symptoms in male and female adolescents. J Affect Disord 2018; 225:429-437. [PMID: 28858657 DOI: 10.1016/j.jad.2017.08.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/10/2017] [Accepted: 08/20/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) was categorised in DSM-5 within the newly created 'obsessive-compulsive and related disorders' chapter, however this classification remains subject to debate. Confirmatory factor analysis was used to test competing models of the co-occurrence of symptoms of BDD, obsessive-compulsive disorder, unipolar depression, anxiety, and eating disorders in a community sample of adolescents, and to explore potential sex differences in these models. METHODS Self-report questionnaires assessing disorder symptoms were completed by 3149 Australian adolescents. The fit of correlated factor models was calculated separately in males and females, and measurement invariance testing compared parameters of the best-fitting model between males and females. RESULTS All theoretical models of the classification of BDD had poor fit to the data. Good fit was found for a novel model where BDD symptoms formed a distinct latent factor, correlated with affective disorder and eating disorder latent factors. Metric non-invariance was found between males and females, and the majority of factor loadings differed between males and females. Correlations between some latent factors also differed by sex. LIMITATIONS Only cross-sectional data were collected, and the study did not assess a broad range of DSM-5 defined eating disorder symptoms or other disorders in the DSM-5 obsessive-compulsive and related disorders chapter. CONCLUSIONS This study is the first to statistically evaluate competing models of BDD classification. The findings highlight the unique features of BDD and its associations with affective and eating disorders. Future studies examining the classification of BDD should consider developmental and sex differences in their models.
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Affiliation(s)
- Sophie C Schneider
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Andrew J Baillie
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use, Australia
| | - Jonathan Mond
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Australia; Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia
| | - Cynthia M Turner
- School of Psychology, Australian Catholic University, Brisbane, Australia
| | - Jennifer L Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
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373
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Griffiths S, Murray SB, Medeiros A, Blashill AJ. The tall and the short of it: An investigation of height ideals, height preferences, height dissatisfaction, heightism, and height-related quality of life impairment among sexual minority men. Body Image 2017; 23:146-154. [PMID: 29031097 DOI: 10.1016/j.bodyim.2017.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/16/2022]
Abstract
Human height has attracted empirical interest from a variety of psychological perspectives. However, little research has explored height from the perspective of sexual minority men, inclusive of their height beliefs, height preferences, height dissatisfaction, experiences of heightism, and height-related quality of life impairment. We explored these height variables in 2733 sexual minority men who completed a survey distributed nationwide to Australian and New Zealander users of geosocial-networking smartphone applications. Results showed that men's ideal height (M=182.26cm, SD=5.93cm) was taller than their actual height (M=178.96cm, SD=7.52cm). Shorter and taller men reported negative and positive treatment from others due to their height, respectively, with the cross-over (i.e., neutral) point at approximately 175-176cm. Heightism was reported by 11.0% of men. Height dissatisfaction and heightism were uniquely associated with quality of life impairment; the size of these associations was small.
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Affiliation(s)
- Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia.
| | - Stuart B Murray
- Department of Psychiatry, University of California San Francisco, CA, United States
| | - Aimee Medeiros
- Department of Psychiatry, University of California San Francisco, CA, United States
| | - Aaron J Blashill
- Department of Psychology, San Diego State University, CA, United States; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, CA, United States
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