Masculinity and femininity in the divergence of male body image concerns

Exploring risk factors of drive for muscularity and muscle dysmorphia in male adolescents from a resource-limited setting in Burkina Faso

In low-income countries, Muscle Dysmorphia (MD) has only been investigated in adult south African amateur-bodybuilders. To date, there is no epidemic study about MD or its cardinal symptom "drive for muscularity" (DFM) and its impact on young men's lives in African low-income settings. We analyzed a population-representative cross-sectional study of 838 adolescent males aged 12-20 in the rural northwestern Burkina Faso. Participants were assessed for MD with the research criteria of Pope and its cardinal symptom DFM based on the DFM scale (DMS). Since DFM has not been studied in a comparable sample so far, all possible influencing variables were examined exploratively in a linear regression model. Many respondents were underweight (41.5%) and few overweight (1.3%). No-one met standard clinical MD criteria. While 60.1% of 837 wished to be more muscular, only 8.7% of 824 desired a lower body-fat percentage. Regression analysis revealed that higher DMS scores were associated with greater internalization of the muscular body ideal, going to school, living in a rural area, older age, and a history of having faced sexual harassment or assault, but not with media exposure. Our results show that levels of DMS in Burkinabe adolescents were elevated. Risk factors for DFM in environmental circumstances where undernutrition and poverty are common are discussed.

'The day you start lifting is the day you become forever small': Bodybuilders explain muscle dysmorphia

Muscle dysmorphia (MD) is a pathological preoccupation with muscularity characterised by negative body image, compulsive behaviours, and obsessive thoughts. Since its first identification academics have suggested that it is caused by sociocultural factors. Despite this there has been very little research exploring the role of sociocultural factors in the development and maintenance of MD, and no research that examines MD from within its cultural context. Instead the medical model of MD has dominated understanding. This model presents professionals as the experts on this disorder, and sufferers as pathological individuals in need of expert treatment. This renders cultural context largely irrelevant to understandings of MD. In this paper we present a different kind of expertise with regards MD. We describe the expertise of those most likely to suffer from MD, and upon whom medical descriptions of MD are based: bodybuilders. Specifically, we describe how bodybuilders explain MD (their definition, theory of aetiology and experience of MD, as well as their suggested management strategies), and compare these explanations to the dominant medical model. Through a consideration of the expertise of bodybuilders we break the tunnel vision of medicine, and suggest ways we can move beyond our current under-developed understanding of MD. This paper examines MD from within its cultural context, and in so doing it lays the foundation for a sociocultural explanatory model of MD. If we are to significantly reduce the harms of this disorder we cannot rely solely on treating the few individuals who present to clinicians. Rather we must develop ways to help sufferers to manage their disorder, and to prevent the development of this disorder among those at risk in the first place. To do this we must understand the sociocultural dimensions of MD, and collaborate with bodybuilding communities.

Conformity to masculine norms, interoceptive dysfunction, and changes in muscle dysmorphia symptoms

Muscle dysmorphia (MD) is a psychiatric illness characterized by preoccupation and compulsive behaviors to increase muscle size/definition. Despite its severity, few risk factors/mechanisms for MD have been identified. Conformity to masculine norms may be a MD risk factor. Furthermore, interoceptive dysfunction may facilitate MD. symptoms, as well as underlie relationships between conformity to masculine norms and MD symptoms. However, research has yet to test the mediating role of interoceptive dysfunction for said relationships. The current study tested if interoceptive dysfunction underlies relationships between conformity to masculine norms and MD symptoms among 269 US men who completed three surveys separated by one month that contained measures of focal constructs. Our sample was majority White, heterosexual, and non-Hispanic. A three-wave autoregressive mediation model was tested in which conformity to masculine norms predicted interoceptive dysfunction, which then predicted MD symptoms. Results indicated that conformity to specific masculine norms predicted both interoceptive dysfunction and MD symptoms over time. Furthermore, our hypothesized mediation pathways were not discovered. Conformity to masculine norms appears to be a risk factor for MD symptoms and interoceptive dysfunction. If clinicians can reduce rigid adherence to masculine stereotypes, this may increase connection with one's body and reduce subsequent MD symptoms.

The differential effects of state and trait masculinity and femininity on body satisfaction among sexual minority men

Masculine men are more likely to idealise being tall, muscular, and lean. Feminine men, on the other hand, are more likely to idealise leanness. At the trait level, masculinity and femininity have been linked with an unhealthy striving for these idealised traits and body dissatisfaction. However, it is unclear how feeling masculine or feminine in the moment might be associated with body satisfaction. Is feeling masculine and/or feminine associated with a boost in body satisfaction? In the first large-scale experience sampling study of masculinity and femininity (n_observations=25,133; N_participants=530), we find that state masculinity and femininity, but not trait, are associated with increased body satisfaction among sexual minority men. We also find a gender congruence effect whereby the positive associations between state masculinity/femininity on body satisfaction are more pronounced when these feelings align with trait levels of masculinity/femininity. Exploratory analyses revealed a moderating effect of eating disorder history. The associations between masculinity and femininity on body satisfaction were amplified for people who had been diagnosed with an eating disorder. This study presents the first evidence that the links between masculinity and femininity and body satisfaction can be delineated based on whether they are measured as traits or states.

Where Sex Meets Gender: How Sex and Gender Come Together to Cause Sex Differences in Mental Illness

Sex differences are prevalent in multiple mental disorders. Internalizing disorders are more commonly diagnosed in women, whereas externalizing and neurodevelopmental disorders are more often diagnosed in men. Significant sex/gender differences are reported in prevalence, symptom profile, age of onset, comorbidities, functional impairment, prognosis, as well as in responses to various treatments. In this conceptual article, we discuss theories and empirical studies of sex- and gender-related influences in mental health, by focusing on three examples: autism spectrum disorder (ASD), acknowledged as a disorder whose roots are mainly biological; eating disorders, whose origins are considered to be mainly psychosocial, and posttraumatic stress disorder (PTSD), an environmentally caused disorder with both psychosocial and biological underpinnings. We examine the ways in which sex differences emerge, from conception through adulthood. We also examine how gender dichotomies in exposures, expectations, role assumptions, and cultural traditions impact the expression of our three selected mental illnesses. We are especially interested in how sex-based influences and gender-based influences interact with one another to affect mental illness. We suggest that sex and gender are multi-faceted and complex phenomena that result in variations, not only between men and women, but also within each sex and gender through alterations in genes, hormone levels, self-perceptions, trauma experiences, and interpersonal relationships. Finally, we propose a conceptual diatheses-stress model, depicting how sex and gender come together to result in multiple sex/gender differences across mental disorders. In our model, we categorize diatheses into several categories: biological, intrapersonal, interpersonal, and environmental. These diatheses interact with exposure to stressors, ranging from relatively minor to traumatic, which allows for the sometimes bidirectional influences of acute and long-term stress responses. Sex and gender are discussed at every level of the model, thereby providing a framework for understanding and predicting sex/gender differences in expression, prevalence and treatment response of mental disorders. We encourage more research into this important field of study.

The Operationalisation of Sex and Gender in Quantitative Health-Related Research: A Scoping Review

Current trends in quantitative health research have highlighted the inadequacy of the usual operationalisation of sex and gender, resulting in a growing demand for more nuanced options. This scoping review provides an overview of recent instruments for the operationalisation of sex and gender in health-related research beyond a concept of mutually exclusive binary categories as male or masculine vs. female or feminine. Our search in three databases (Medline, Scopus and Web of Science) returned 9935 matches, of which 170 were included. From these, we identified 77 different instruments. The number and variety of instruments measuring sex and/or gender in quantitative health-related research increased over time. Most of these instruments were developed with a US-American student population. The majority of instruments focused on the assessment of gender based on a binary understanding, while sex or combinations of sex and gender were less frequently measured. Different populations may require the application of different instruments, and various research questions may ask for different dimensions of sex and gender to be studied. Despite the clear interest in the development of novel sex and/or gender instruments, future research needs to focus on new ways of operationalisation that account for their variability and multiple dimensions.

Conformity to masculine norms, masculine discrepancy stress, and changes in muscle dysmorphia symptoms

Muscle dysmorphia (MD) is a severe psychiatric illness; however, little is known regarding risk factors for MD development. Conformity to masculine norms may represent a risk factor for MD, but research has yet to establish temporal ordering for these relationships. Masculine discrepancy stress (distress at not amounting to masculine stereotypes) could represent a mechanism underlying these relationships. Therefore, the current study examined longitudinal relationships between conformity to masculine norms, masculine discrepancy stress, and MD symptoms. Participants were 272 men displaying elevated MD symptoms who completed self-report questionnaires at three timepoints. An autoregressive cross-lagged mediation model was specified to examine relationships between conformity to masculine norms and MD symptoms and test if masculine discrepancy stress mediated these relationships. Masculine discrepancy stress did not mediate relationships between masculine norms and MD symptoms. However, MD symptoms predicted increased masculine discrepancy stress, and conformity to masculine norms was related to MD symptoms. MD symptoms were both a predictor and outcome of masculine norms, and signs for relationships differed on the masculine norm endorsed. Conformity to masculine norms may represent a risk factor and outcome for MD symptoms. If clinicians provide clients with tools to reduce rigid adherence to masculine identities, this may prevent MD symptom development.

Androgen abuse among gay and bisexual men

PURPOSE OF REVIEW

Androgen abuse is more prevalent among gay and bisexual (i.e. sexual minority) men than heterosexual men. We review recent research about androgen abuse in sexual minority men and provide relevant social, cultural, and historical contexts.

RECENT FINDINGS

Androgen abuse among sexual minority men is shaped by the intersections of sexuality, desirability, masculinity, and race. Muscular male bodies are desired and - in erotic settings especially - prized as literal embodiments of masculinity. Racist stereotypes unjustly diminish the desirability and masculinity of sexual minority men who belong to racial minorities, especially those who are Asian or Black, and the higher rates of androgen abuse among these racial minorities may reflect a compensatory motivation for these diminishments. The historical context for sexual minority men - decades of subjugation alongside stereotypes of masculinity-compromising effeminacy - further complicate the intersections of sexuality with androgen abuse. Harm minimization efforts led by empathetic endocrinologists stand the best chance of achieving positive outcomes for sexual minority men who use androgens.

SUMMARY

More dedicated research on androgen abuse among sexual minority men is needed as this population requires thoughtfully designed research that is incorporative - at a minimum - of the complexities of sexuality, desirability, masculinity, and race.

Disparities in disordered eating between gender minority and cisgender adolescents

OBJECTIVE

Adolescence is a developmental period of increased risk for disordered eating. Gender minority adolescents (GMAs), or those whose gender identity does not align with their sex assigned at birth, may experience body image concerns related to unique gender-related stressors. GMAs may use disordered eating to affirm a feminine, masculine, or nonbinary gender identity. However, little is known about differences in disordered eating between GMAs and cisgender adolescents. Therefore, this study had two primary goals: (a) to compare disordered eating between GMAs and cisgender adolescents by examining the role of gender identity and sex assigned at birth; and (b) within GMAs, to examine associations between gender identity congruence and disordered eating.

METHOD

A large U.S. sample of GMAs and cisgender adolescents (n = 1,191 GMAs; 919 cisgender; M_age = 15.93 years) reported their disordered eating on an anonymous online survey.

RESULTS

A MANOVA revealed a significant interaction between gender identity and sex assigned at birth. Follow-up ANOVAs demonstrated that purging, caloric restriction, excessive exercise, and muscle building differed as a function of gender identity and sex assigned at birth. Among GMAs, a multiple multivariate regression model demonstrated that disordered eating was lower among participants who reported greater gender identity congruence.

DISCUSSION

GMAs should not be considered a homogenous group, as differences in gender identity may lead to the internalization of different appearance ideals and disparate eating disorder symptomatology. Results suggest that clinicians working with GMAs consider the unique body image concerns that could accompany a specific gender identity.

Practitioner eating disorder detection: The influence of health mindset, thin-ideal internalization, orthorexia and gender role

AIMS

The current study sought to determine what factors inhibited psychologists, naturopaths and fitness instructors from detecting an eating disorder (ED), and the discipline differences across these factors.

METHODS

Participants of the online study were 115 health practitioners who consisted of 35 psychologists, 50 naturopathic and 30 fitness practitioners. A vignette describing a female experiencing a sub-threshold bulimic variant without purging was presented alongside ED mental health literacy items such as assessing one's ability to detect a problem. Additional items examined factors that may inhibit detection, including practitioners' level of: thin-ideal internalization, orthorexia, health or fitness mindset (a newly developed scale measuring health and fitness obsessiveness) and gender role identity.

RESULTS

A significant number of naturopaths and fitness instructors (20% and 33.3%, respectively) were found to have elevated orthorexia scores. Similarly, psychologists had the greatest tendency to internalize the thin-ideal (M = 3.60), which was comparable to levels seen in recent research for 20- to 21-year-old females with EDs. The two largest factors inhibiting ED detection were the strength of a health mindset and gender role identity. Practitioners who had higher health mindset scores or who associated with gender identities higher in masculinity traits (ie, either androgynous or masculine gender roles) were more likely to miss detecting an ED.

CONCLUSIONS

While many present ED studies focus upon assessing and changing client cognitions, this study emphasizes the need for further research regarding training interventions to address practitioner cognitions and gender role biases, which may in turn improve ED detection.

'Big boys don't cry': Examining the indirect pathway of masculinity discrepancy stress and muscle dysmorphia symptomatology through dimensions of emotion dysregulation

Prevailing conceptualizations of muscle dysmorphia (MD) have highlighted the role of adherence to stereotypical ideals of masculinity. In addition, the endorsement of masculine norms has been associated with dysfunctional emotional regulation, itself a correlate of body image psychopathology. Building on this, the present study sought to investigate the indirect relationship between masculinity discrepancy stress (i.e., distress related to one's perceived discrepancy in masculinity) and MD symptomatology via different facets of emotion dysregulation among adult men. A sample of 391 university and community men aged 18-50 years completed an online survey measuring the aforementioned constructs. A test of parallel indirect pathways revealed that emotion dysregulation, as a unitary construct, accounted for a substantial proportion (29.3 %) of the total association between masculinity discrepancy stress and MD symptomatology. Further, a significant unique indirect pathway was found through the specific emotion dysregulation facet of lack of access to adaptive emotion regulation strategies. Together, these findings suggest that emotion dysregulation is a particularly important construct to consider in understanding the relationship between perceived discrepancies in masculinity and MD symptomatology.

Who's the 'bigger' man? Parsing the relationships between masculinity and men's muscularity dissatisfaction

Muscularity dissatisfaction is documented to be a pervasive phenomenon among men. While previous studies have examined theoretically relevant predictors of muscularity dissatisfaction, such as adherence to traditional masculine norms, to the best of our knowledge we are not aware of empirical research that has assessed how perceived discrepancies in one's level of masculinity may also be associated with these concerns. Therefore, the objective of this study was to determine whether perceived deficits in masculinity bear predictive utility over and above adherence to traditional masculine norms in the context of muscularity dissatisfaction. An online survey that included measures assessing the aforementioned constructs was completed by 390 university and community adult men. A hierarchical regression analysis showed that while adherence to masculine norms was associated with increased muscularity dissatisfaction, masculine role discrepancy (and attendant stress) were particularly strong predictors of muscularity dissatisfaction. Our findings make a novel contribution to the male body image literature by demonstrating the relative importance of perceived discrepancies in masculinity, and related stress, in the context of muscularity dissatisfaction. Pending replication in relevant clinical samples using prospective designs, this study provides preliminary evidence that masculine role discrepancies may be promising targets to help allay muscularity concerns among men.

Conformity to masculine norms and symptom severity among men diagnosed with muscle dysmorphia vs. body dysmorphic disorder

Body dysmorphic disorder (BDD) is associated with severe comorbidity and impairment. Muscle dysmorphia (MD) is a subtype of BDD which has rarely been assessed outside of undergraduate student samples. Further, there are limited data comparing MD to other psychiatric disorders, including BDD. Thus, the aim of the current study is to explore differences in symptom severity and conformity to masculine norms in men diagnosed with BDD or MD. Men from the greater Boston, Massachusetts area completed a one-time assessment, which included clinician-based structured interviews and self-report questionnaires assessing MD symptom severity, BDD symptom severity, and conformity to traditional masculine norms. The sample was N = 30 men (MD: n = 15; BDD: n = 15). Statistically significant medium to large effects emerged with the MD group experiencing greater MD and BDD symptom severity, and positive attitudes towards the use of violence to solve problems. Although not reaching statistical significance, additional medium-to-large effects also emerged with the MD group reporting greater emotional restriction/suppression, heterosexual self-presentation, and desired sexual promiscuity compared to the BDD group. Findings suggest that men diagnosed with MD may experience greater MD/BDD symptom severity and endorsement of some components of 'traditional' masculine norms, compared to men diagnosed with BDD. Results may suggest that addressing some forms of rigid masculine norms (e.g., use of violence) in therapy could be useful in treating MD; however, additional research comparing clinical samples of men with MD and BDD are needed to guide the nosology, assessment, and treatment of MD.

Gender Norms and Weight Control Behaviors in U.S. Adolescents: A Prospective Cohort Study (1994-2002)

PURPOSE

The aim of this article was to determine the relationship between gender norms and weight control behaviors in U.S. adolescents.

METHODS

We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health (N = 9,861), at baseline in 1994-1995 (ages 11-18 years, Wave I), 1-year follow-up (ages 12-19 years, Wave II), and 7-year follow-up (ages 18-26 years, Wave III). The primary exposure variable was a measure of one's gender normativity based on the degree to which males and females behave in ways that are similar to the behaviors of their same-gender peers. The outcome variable was an individual's weight control attempts (trying to lose or gain weight) and behaviors (dieting, fasting/skipping meals, vomiting, or weight-loss pills/laxatives/diuretics to lose weight or ate different/more foods than usual or taking supplements to gain weight).

RESULTS

In logistic regression analyses controlling for potential confounders, a higher baseline individual gender normativity score (higher femininity in females and higher masculinity in males) was associated with weight loss attempts (β = .10; p = .01) and weight loss behaviors (β = .18; p < .001) in girls but was associated with weight gain attempts (β = .18; p < .001) and behaviors (β = .16; p < .001) in boys at 1-year follow-up. Higher individual gender normativity score was protective of weight loss attempts (β = -.15; p < .001) and weight loss behaviors (β = -.17; p < .001) in males but not females at 7-year follow-up. Loess plots provided visualizations of significant relationships.

CONCLUSIONS

Gender norms may reinforce a thinner body ideal for girls but a larger ideal for boys.

Does masculinity moderate the relationship of height with height dissatisfaction? Findings from an Internet forum for short statured men

Research suggests that height is fundamental to Western conceptualisations of masculinity. However, researchers are yet to examine whether individual differences in conformity to Western masculine norms can help to explain why men experience height dissatisfaction. Thus, we investigated conformity to Western masculine norms as a moderator of the relationship between men's height and height dissatisfaction. Men experiencing height dissatisfaction (N = 249) were recruited from an Internet forum that functions as a discussion space for short-statured individuals. Results indicated that shorter men and more masculine men reported greater height dissatisfaction. As hypothesised, we observed a significant interaction between height and masculinity, such that the strength of the relationship of short stature with height dissatisfaction was stronger for more masculine men. Crucially, results from a Johnson-Neyman analysis indicated that it was only for men extremely low in their endorsement of masculine norms (i.e., the 2^nd percentile or lower) that the relationship of height with height dissatisfaction was nonsignificant, suggesting that, in the near-absence of masculine norm conformity, height no longer contributes to male body dissatisfaction. Whilst acknowledging that our findings require further exploration, we propose that conformity to masculine norms may be an influential factor in males' experience of height dissatisfaction.

Direct comparisons of anorexia nervosa and body dysmorphic disorder: A systematic review

Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are serious psychiatric conditions, both of which are associated with a disturbance of body image. The aim of this paper was to review those studies that have directly compared groups of individuals with AN and BDD, to determine similarities and differences in presentation between the two conditions. The literature was searched to September 2018, and studies were included if they were English language, empirical research papers published in peer-reviewed journals, specifically comparing AN and BDD patients. Fifteen relevant studies were identified. The results suggested that individuals with AN and BDD share a number of similarities, including their degree of body dissatisfaction. Differences between the conditions included primary concerns with body shape and weight in AN, and much more diffuse concerns (but predominantly the face) in BDD. The small number of studies, along with the limited replication of results emphasises the need for greater research in this area. However, the studies undertaken to date highlight the high degree of overlap between AN and BDD and suggests that the conditions may represent similar body image disorders. This has implications for the nosological status of AN and BDD.

The moderating effect of gender role on the relationships between gender and attitudes about body and eating in a sample of Italian adolescents

PURPOSE

The differential prevalence of eating disorders in males and females can be explained by the impact of gender-role orientations. Inside the Italian socio-cultural context, gender socialization can be influenced by stereotypical gender beliefs, and this may contribute to the psychological distress of individuals who identify with discrepant gender roles from their biological sex. Our study explored, within the Italian context, the potential moderating effect of masculinity and femininity on the relationships between gender and attitudes about body and eating.

METHODS

Nine hundred and twenty Italian male and female adolescents (M = 427, F = 493; age 14-21 years) completed the Eating Disorder Inventory-2 (EDI-2) and the Bem Sex-Role Inventory (BSRI).

RESULTS

A moderating effect of gender role on the relationship between gender and bulimia, and drive of thinness emerged. Girls with higher levels of masculinity scored higher on bulimia than did their counterparts with lower levels, and boys with higher levels of femininity scored higher on bulimia and on drive for thinness than did their counterparts with lower levels. Data did not reveal a moderating effect of gender role on the relationship between gender and body satisfaction.

CONCLUSIONS

Our data suggest that adolescents who endorsed a gender role that is socially considered discrepant from their biological sex (girls with higher levels of masculinity and boys with higher levels of femininity) are more likely to show higher level of bulimia and drive of thinness. This suggests the need for prevention and treatment programmes for eating disorders that take into account individuals' gender-role orientation and the influence that culturally dominant gender beliefs can exert on it.

Sexual orientation disparities in eating disorder symptoms among adolescent boys and girls in the UK

Much of the research on sexual orientation disparities in eating disorder behaviors has been conducted in the USA, Canada, and Australia. Data on the associations of sexual orientation and eating disorder symptoms among adolescents in the UK are lacking. Participants were children from the Avon Longitudinal Study of Parents and Children, a youth cohort born 1991-1992 (n = 5048; 53% female; 12% sexual minority). Sexual orientation was assessed at 16 years. Eating disorder symptoms were assessed at 14 and 16 years. Multivariable regression models (adjusting for BMI, ethnicity, socioeconomic status) examined associations between sexual orientation and (1) odds of past-year purging and binge eating, and (2) mean differences in body dissatisfaction, pressure to increase muscularity (boys only), and Dutch Eating Behavior Questionnaire subscales. At age 14, gay and bisexual boys and mostly heterosexual girls reported greater body dissatisfaction than their same-gender heterosexual peers. All sexual minority boys and mostly heterosexual girls reported greater mean dysfunctional eating behaviors than their same-gender heterosexual peers. At age 16, gay and bisexual boys had 12.5 times the odds of heterosexual boys of binge eating; mostly heterosexual boys had over three times the odds of reporting binge eating. Sexual minority girls had over twice the odds of heterosexual girls of purging and binge eating. By mid-adolescence, sexual minority youth in the UK had elevated risk for eating disorder symptoms, suggesting the need for early prevention efforts.

Cross-sectional associations between gender-linked personality traits and use of weight-loss and muscle-building products among U.S. young adults

This study examined the cross-sectional associations between gender-linked personality traits and use of products for weight loss and muscle building using data from young adults participating in Wave III of the National Longitudinal Study of Adolescent to Adult Health who completed the short-form Bem Sex-Role Inventory (n = 3,343). Among men, a higher score on the masculinity scale was associated with greater odds of diet pill use, legal performance-enhancing substance (PES) use, and illicit PES use, while a higher score on the femininity scale was associated with lower odds of illicit PES use. These findings can inform interventions for men with weight/shape concerns.

Body image satisfaction and weight concerns among a Mediterranean adult population

Background

People tend to underestimate their current weight and overestimate their height minimizing health risk factors. The aim of this study was to assess body weight satisfaction, acceptance of body image, weight concern and dieting habits among a Mediterranean adult population.

Methods

Cross-sectional survey was carried out (2009–2010) in the Balearic Islands, Spain. A random sample (n = 1081) of young (18–35 y.o.) and middle-aged adults (36–55 y.o.) was interviewed and anthropometrically measured.

Results

Women were more dissatisfied being overweight, less dissatisfied being underweight, and more worried about weight gain than men. Middle-aged participants were more dissatisfied with body shape and underestimated body weight than young’s. Employed women defined better current weight than unemployed, but unemployed were more worried about body weight gain. Overweight adults were more likely to underestimate their body weight but were also very worried about weight gain and more likely to report current dieting than their leaner counterparts. Active participants self-reported better body weight and were more satisfied with body image than sedentary.

Conclusions

Most of studied population reported body image dissatisfaction, but half of them are not worried about it. Women were more concerned about their body weight status. Practice of physical activity is a positive factor in self-perception. Holistic strategies are needed to avoid promoting unreal bodies, as well as the acceptance of the real body image.

Sport practice, physical structure, and body image among university students

BACKGROUND

The aim of this study was to estimate body image perception in undergraduate students, and to investigate its associations with weight status, abdominal obesity, muscularity, gender and sport.

METHODS

The sample consisted of 231 Italian students (174 males and 57 females); anthropometric measurements, taken by trained technicians, were: height, weight, arm-circumference, waist and hip circumferences. BMI, WHR and Δ arm-circumference were calculated. Body image was assessed using body silhouette charts. Information about sport (currently practiced sport, starting age, and weekly hours of sport) was acquired with questionnaires.

RESULTS

Females perceived themselves as slightly overweight, while males identified themselves as normal weight. Females had a tendency to desire to be thinner in all weight status categories; in males, normal weight subjects had a tendency to desire to be larger, while overweight wished to be thinner. Sport practice was significantly higher in males. Individuals who were overweight and did less sport were significantly more likely to have higher body dissatisfaction.

CONCLUSIONS

The present study highlights a positive relationship between sport practice, corpulence and body image perception.

Muscle Dysmorphia: An Overview of Clinical Features and Treatment Options

An increasing public and empirical focus on male body image indicates that muscularity is a preeminent concern among boys and men. For some, these concerns develop into a complex and disabling psychiatric disorder termedmuscle dysmorphia(MD), the hallmark of which is an intense preoccupation regarding one’s (subjectively) insufficient muscularity. Treatment of MD is critical; however, evidence to inform treatment approaches is sorely lacking. The purpose of this article is twofold. First, we provide an overview of the clinical features of MD, drawing particular attention to the preoccupation, functional impairment and psychiatric comorbidity associated with the disorder. Second, we discuss and recommend potential treatment directions for MD, including techniques that have demonstrated efficacy in the treatment of related disorders, namely, body dysmorphic disorder and eating disorders (and anorexia nervosa in particular). Psychotherapeutic techniques, including cognitive restructuring of deleterious perfectionistic and egosyntonic beliefs, and dialectical behavioral techniques to improve the repertoire of emotion regulation skills available to afflicted individuals, are discussed, in addition to psychopharmacological approaches.

Muscle dysmorphia: current insights

Since 1997, there has been increasing research focusing on muscle dysmorphia, a condition underpinned by people’s beliefs that they have insufficient muscularity, in both the Western and non-Western medical and scientific communities. Much of this empirical interest has surveyed nonclinical samples, and there is limited understanding of people with the condition beyond knowledge about their characteristics. Much of the existing knowledge about people with the condition is unsurprising and inherent in the definition of the disorder, such as dissatisfaction with muscularity and adherence to muscle-building activities. Only recently have investigators started to explore questions beyond these limited tautological findings that may give rise to substantial knowledge advances, such as the examination of masculine and feminine norms. There is limited understanding of additional topics such as etiology, prevalence, nosology, prognosis, and treatment. Further, the evidence is largely based on a small number of unstandardized case reports and descriptive studies (involving small samples), which are largely confined to Western (North American, British, and Australian) males. Although much research has been undertaken since the term “muscle dysmorphia” entered the psychiatric lexicon in 1997, there remains tremendous scope for knowledge advancement. A primary task in the short term is for investigators to examine the extent to which the condition exists among well-defined populations to help determine the justification for research funding relative to other public health issues. A greater variety of research questions and designs may contribute to a broader and more robust knowledge base than currently exists. Future work will help clinicians assist a group of people whose quality of life and health are placed at risk by their muscular preoccupation.

The incidence of eating disorders in a Danish register study: Associations with suicide risk and mortality

Our aim was to characterize the incidence rates and cumulative incidence of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), and examine associations among eating disorder diagnoses, suicide attempts, and mortality. Individuals born in Denmark between 1989 and 2006 were included (N = 966,141, 51.3% male). Eating disorders diagnoses (AN, broad AN, BN, EDNOS) were drawn from the Danish Psychiatric Central Research Register (PCRR) and Danish National Patient Register (NPR). Suicide attempts and deaths were captured in the NPR, the PCRR, and the Danish Civil Registration System (CRS). In females, AN had a peak hazard at approximately age 15 years, BN at 22 years, and EDNOS had an extended peak that spanned 18 years-22 years. Eating disorder diagnoses predicted a significantly higher hazard for death and suicide attempt compared with the referent of individuals with no eating disorders. In males, peak hazard for diagnosis was earlier than in females. The present study represents one of the largest and longest studies of eating disorder incidence and suicide attempts and death in both females and males. Eating disorders are accompanied by increased hazard of suicide attempts and death even in young adults.

What can we learn from the history of male anorexia nervosa?

The eating disorders literature has focussed on females and little is known of the male experience. The overall image this has generated suggests a young woman in conflict with socio-cultural pressures which associate thinness with beauty. Historical studies have examined anorexia nervosa from an entirely female focus while ignoring how diagnostic categories have shaped approaches to the male body. This paper will track the case of the male with anorexia nervosa through changing theories of causation and treatment approaches, from when the condition first emerged in 1873 to the present. In doing so, we gain a valuable new insight into how anorexia nervosa has been historically gendered and the far-reaching implications this has had for diagnosis and treatment of the male sufferer. Similarities between the sexes helped to establish male anorexia as a distinct category. However, this shifted focus away from important differences, which have yet unexplored implications in the assessment, diagnosis and management of disordered eating. Throughout history, there has been constant pressure to give a precise definition to anorexia nervosa, despite being fraught with medical uncertainties. This has resulted in inevitably harmful generalisations rooted in the dominant epidemiology. This paper reveals that anorexia nervosa is a truly global phenomenon which cannot be adequately constructed through exclusive studies of the female. There is consequently a pressing need to address the dearth of research examining eating disorders in males.

Body Image Avoidance, Body Dissatisfaction, and Eating Pathology: Is There a Difference Between Male Gym Users and Non-Gym Users?

With research highlighting the increasing prevalence and severity of body image and eating disturbances in males, particularly athletes and regular gymnasium users, the current study examined body image and eating disturbances in a sample of male gym users and non-gym users (N = 180). Based on previous research, it was predicted that male gym users would report greater body image disturbance (e.g., body image avoidance and body dissatisfaction) and eating pathology, compared with non-gym users. Results of the study partially supported hypotheses, revealing body dissatisfaction and eating pathology were significantly increased in male gym users. However, no significant differences were observed in body image avoidance behaviors, though this is likely because of methodological limitations associated with psychometric measures selected. The study provides preliminary evidence that male gym users do experience subclinical eating and body image concerns, with some also experiencing clinically significant symptoms that could be precursors to the later development of an eating disorder. Results of the current study highlight the importance of educating key stakeholders within health and fitness centers, through community-based interventions, to increase awareness regarding male body image and eating disturbances.

Unique associations between young adult men's emotional functioning and their body dissatisfaction and disordered eating

Research on emotional functioning, body dissatisfaction, and disordered eating in males is predominated by studies of negative affect and emotion regulation. Other aspects of emotional functioning, namely emotion recognition and attentional biases toward emotional stimuli, have received little empirical attention. The present study investigated the unique associations between different aspects of men's emotional functioning and their disordered eating attitudes, muscularity dissatisfaction, and body fat dissatisfaction. Results from 132 male undergraduates showed that muscularity dissatisfaction was uniquely associated with both emotion regulation difficulties and an attentional bias toward rejecting faces. Body fat dissatisfaction was not uniquely associated with any aspect of emotional functioning. Disordered eating was uniquely associated with emotion regulation difficulties. Collectively, the results indicate differences in the patterns of associations between men's emotional functioning and their body dissatisfaction and disordered eating.

Young peoples' stigmatizing attitudes and beliefs about anorexia nervosa and muscle dysmorphia

OBJECTIVE

The nature and extent of stigma toward individuals with anorexia nervosa and muscle dysmorphia remains underexplored. This study investigated attitudes and beliefs likely to be conducive to stigmatization of individuals with these conditions.

METHOD

Male and female undergraduate students (n = 361) read one of four vignettes describing a fictional male or female character with anorexia nervosa or muscle dysmorphia, after which they responded to a series of questions addressing potentially stigmatizing attitudes and beliefs toward each character.

RESULTS

Characters with anorexia nervosa were more stigmatized than characters with muscle dysmorphia, female characters were more stigmatized than male characters, and male participants were more stigmatizing than female participants. A large effect of character diagnosis on masculinity was observed, such that characters with anorexia nervosa were perceived as less masculine than characters with muscle dysmorphia, and this effect was more pronounced among male participants. However, no significant corresponding effects were observed for femininity.

DISCUSSION

Females with anorexia nervosa may be particularly susceptible to stigmatization, especially by males. Anorexia nervosa and muscle dysmorphia are perceived as "female" and "male" disorders respectively, in line with societal gender role expectations, and this stigmatization is tied more strongly to perceptions of sufferers' masculinity than femininity.

Eating disorders and anabolic androgenic steroids in males--similarities and differences in self-image and psychiatric symptoms

Background

Body dissatisfaction is common among both females and males. Dissatisfaction with the body is a risk factor both for onset of eating disorders and for abuse of anabolic androgenic steroids (AAS). Few studies have however investigated if there are other similarities in respect to self-image or psychiatric symptoms between clinical samples of eating disordered males and males in treatment for negative effects of AAS use.

Aim

The aim of this study was to compare two clinical samples, one of males with ED and one of males who used AAS, regarding self-image and psychiatric symptoms.

Methods

This study compared males with eating disorders (n = 13) and males who recently stopped AAS use (n = 29) on self-image and psychiatric symptoms, using The Structural Analysis of Social Behavior self-questionnaire and a shortened version of The Symptom Check List.

Results

The eating disorder group reported significantly lower scores for Self-emancipation and Active self-love and higher scores for Self-blame and Self-hate. Both groups reported serious psychiatric symptoms. The common denominator between groups was serious psychiatric symptomatology rather than negative self-image.

Conclusions

The negative self-image profile, especially self-hate, found among males with Eating Disorders may indicate that the studied groups differ in aetiology of the underlying problems. The serious psychiatric symptoms in both groups call staff to pay attention to any thoughts of suicide due to severe depressive symptoms where by specialized psychiatric treatment may be needed.