Masculinity, Femininity and Male Body Image: A Recipe for Future Research

'My sexual desires, everything, my normal life just stops'; a qualitative study of male sexual health in inflammatory bowel disease

AIM

To describe and interpret the sexual health experiences of men with IBD.

DESIGN

Interpretive qualitative study.

METHODS

In-depth, semi-structured interviews were conducted with 22 men with a diagnosis of Inflammatory Bowel Disease. Interviews were digitally audio-recorded and transcribed verbatim. Data were analysed using constant comparative, thematic analysis.

RESULTS

Three themes were identified from interview data: (1) the disease shapes intimate connections, (2) the disease thwarts sexual experiences and (3) the disease disrupts male gender norms. Men reported that active disease lowered libido and could change pre-, inter- and post-coital sexual practices. All participants noted that health professionals did not initiate the discussion of sexual health and well-being needs in the outpatient hospital setting. Men who engaged in receptive anal sex reported a lack of disease-specific guidance and understanding from professionals.

CONCLUSION

Inflammatory bowel disease can negatively impact the sexual well-being, gender identity and activities of men. Further research is required to identify the care preferences of men with IBD and clarify the barriers and facilitators to sexual health assessment so that nurses may better support the health needs of this population.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

This study highlights the need for sexual health and well-being support that is specific to disease and gender in IBD. There is a paucity of information and guidance for men with peri-anal disease and proctitis who engage in receptive anal sex, which requires urgent attention.

REPORTING METHOD

Reporting follows the COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

A patient and public involvement group informed the development of the study design. The group reviewed public facing documents and interview guides. One member of the group provided comments on the identified themes.

A Qualitative Model of Weight Cycling

Weight cycling is a likely consequence of striving to lose weight after internalizing body image ideals, making upward social comparisons, and experiencing weight stigma. Despite weight cycling's potential physical and psychological consequences, the interplay of weight cycling, social pressures, and experienced and internalized stigma have not been qualitatively explored. Thus, through in-depth interviews of 36 weight-cycling adults, this study sought to understand how people negotiate weight cycling. Interviews informed the development of a qualitative model of weight cycling, which was derived from a theory-neutral inductive analysis. The model's stages included entering the cycle, undergoing the cycle, and challenging the cycle. Participants were triggered to enter the cycle due to weight stigma caused by social pressures. Within the cycle, interviewees internalized weight stigma and engaged in disordered weight management behaviors. Some participants challenged the cycle by becoming more self-aware and mitigating their toxic dieting behaviors. However, it was very difficult, if not impossible, for many to fully exit weight cycling and the restraints of previous weight management thinking and patterns. Our investigation underscores the seriousness of weight cycling and suggests ways to combat weight cycling on both macro and individual levels. It may also be useful to consider weight cycling as disordered eating in hopes of shifting society's dangerous focus on rapid weight loss.

Does body positivity work for men as it does for women? The impact of idealized body and body positive imagery on body satisfaction, drive for thinness, and drive for muscularity

Exposure to body-positive imagery plays a positive role in women's body image. However, literature has not examined if this is the case for men too. In this study (N = 207), we examined the impact of idealized body and body-positive imagery on both men's and women's body satisfaction and body image concerns. Participants were asked to report their positive and negative mood, body satisfaction, drive for thinness, and drive for muscularity before and after being exposed to either control (landscapes and animals), idealized body, or body-positive imagery. Results showed that women were overall more dissatisfied with their bodies and reported a stronger negative mood and a higher drive for thinness than men. Men, instead, reported a higher drive for muscularity. Exposure to idealized body imagery decreased positive mood and body satisfaction in both men and women. In contrast, exposure to body-positive imagery increased body satisfaction and decreased the drive for thinness in both men and women. Drive for muscularity was not affected by the type of imagery. The findings show that idealized body and body-positive imagery have similar effects on men and women and showcase the importance of considering the effects of body-positivity content for both genders.

Body Image Among Sexual and Gender Minorities: An Intersectional Analysis

Body image is consequential for overall well-being and has a complex relation to gender. Sexual and gender minority (SGM) individuals develop body image amid intersecting systems of oppression, such as sexism, cisnormativity, heteronormativity, and gender binary pressures. This study used an intersectionality framework to examine how various aspects of gender identification (cis/trans, binary/nonbinary, woman/man identification) related to body image differences among SGM individuals. We also assessed whether identification with conventionally masculine and feminine personality traits predicted body image. We used one-way and two-way ANOVAs and linear regressions to analyze two indicators of body image (body appreciation and drive for muscularity) in a sample of 643 SGM individuals (148 sexual minority (SM) cis women, 171 trans women, 121 SM cis men, 43 trans men, 160 nonbinary individuals). Results implicated cisnormativity as an influential and hierarchical force for body image, although woman/man and binary/nonbinary identification also played roles in group differences. With a few exceptions, masculine but not feminine trait identification significantly predicted body appreciation and drive for muscularity, indicating a complicated association with overall body image. These findings underscore the value of an intersectional lens for analyzing how broad social forces may manifest in individual-level body image for SGM individuals.

Beyond Gender: Interoceptive Sensibility as a Key Predictor of Body Image Disturbances

Body image disturbance (BID) involves negative attitudes towards shape and weight and is associated with lower levels of interoceptive sensibility (IS) (the subjective perceptions of internal bodily states). This association is considered a risk factor for developing eating disorders (EDs) and is linked to altered sensorimotor representations of the body (i.e., body schema). BIDs manifest across genders and are currently understudied in men. This study investigated gender-related differences in BID and its relationship to the body schema and IS. Data were collected from 86 men and 86 women. BID was assessed using questionnaires measuring self-objectification, state, and trait body dissatisfaction. IS was measured via the MAIA-2. The body schema was indexed via an embodied mental rotation task. Results showed that women reported higher BID than men across all scales. Gender differences in sub-components of interoceptive sensibility were found. Overall, both gender and interoceptive sensibility predicted BID. However, interoceptive sensibility exhibited its own unique association with BID beyond the influence of gender. BID, IS and gender were not significant predictors of performance in the body schema task. Therefore, while gender predicts differences in BID and interoceptive sensibility, there was no evidence of gender-related differences in body schema.

Intercultural insights on the impact of different non-idealized models on men's body image and advertising perceptions

This experiment with 363 Irish and Flemish men aged 19 to 30 years (M = 23.56, SD = 2.36) investigated exposure to different male model ads (i.e. muscular, slim, plus-size, overall diversity, and no models) on well-being (i.e. body image, low body fat and muscularity attitudes, self-objectification, and self-esteem) and advertising outcomes (i.e. ad attitudes, brand attitudes, and purchase intent). Moderation effects of country and masculinity (i.e. dominance, winning) were investigated. The diversity condition generated more positive effects for low body fat attitudes than the muscular, slim, and no model conditions. Yet, no differences appeared for this outcome between the diversity and plus-size condition. No effects for the other well-being and advertising variables were found. Moderation analyses revealed higher purchase intent in the slim condition for men high in dominance. No effects were found for country and winning. Findings suggest that non-idealized models have protective effects for some men.

The Liver King Lie: Misrepresentation, justification, and public health implications

It is well-established that performance and image enhancing drugs (PIEDs) are effective in increasing muscle mass and strength. PIEDs are unique in that, while harm may result from use, there is little evidence of widespread individual or social harm comparable with other illicit substances. However, given the rapid growth of the online health and fitness industry, the digital consumption of hardcore fitness content represents a space ripe for indirect harms. A poignant example of this trend among the digital health and fitness community is the contestation around 'fake natty' users, who falsely claim to not use PIEDs. The non-disclosure of use has the potential to give individuals who are not enhanced the false impression that they too can achieve a bodily ideal which is similar, potentially resulting in psychological distress and risky behaviours. In this commentary, we discuss this harmful phenomenon using the case study of the fitness influencer Brian Johnson, more commonly known as Liver King. Employing a psycho-criminological lens, we use Social Identity Theories to understand the 'Primal' identity, before unpacking Johnson's disavowal of his PIED consumption through Sykes and Matza's (1957) techniques of neutralization. We conclude with an overview of the harms surrounding fake natural influencers and cognitive dissonance, before attempting to map a path towards emic harm reduction in collaboration with the digital fitness community.

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.

Body appreciation and appearance evaluation in individuals with obesity compared to individuals with normal-weight: findings from a representative German population sample

PURPOSE

Body image has been identified as an important factor in mental health in individuals with obesity. Previous studies have focused on negative body image and research of positive body image-particularly in obesity-is still in its infancy. The current study explored the positive body image facet body appreciation and the negative facet appearance evaluation in different BMI groups as well as men and women.

METHODS

A total of 1003 participants of the general German public above the age of 18 years completed measures on body appreciation and appearance evaluation.

RESULTS

Significantly lower body appreciation was observed in male participants with obesity compared to normal-weight participants. In women, the BMI groups did not differ significantly in body appreciation. BMI was negatively associated with appearance evaluation in both genders. While men and women did not differ in body appreciation, men reported lower appearance evaluation scores compared to women.

CONCLUSION

The present study is one of few that investigated positive body image in individuals with obesity compared to individuals with normal weight. The findings underscore the potential of body appreciation as a resource in treatment of body image concerns in individuals with obesity. Further implications for future research are discussed.

LEVEL OF EVIDENCE

III, case-control analytic study.

Community norms of the Muscle Dysmorphic Disorder Inventory (MDDI) among gender minority populations

PURPOSE

Representing the pathological extreme pursuit of muscularity, muscle dysmorphia (MD) is characterized by a pervasive belief or fear around insufficient muscularity and an elevated drive for muscularity. Despite evidence of heightened body image-related concerns among gender minority populations, little is known about the degree of MD symptoms among gender minorities, particularly based on Muscle Dysmorphic Disorder Inventory (MDDI) scores. The objective of this study was to assess community norms of the MDDI in gender-expansive people, transgender men, and transgender women.

METHOD

Data from participants in The PRIDE Study, an existing study of health outcomes in sexual and gender minority people, were examined. We calculated means, standard deviations, and percentiles for the MDDI total and subscale scores among gender-expansive people (i.e., those who identify outside of the binary system of man or woman; n = 1023), transgender men (n = 326), and transgender women (n = 177). The Kruskal-Wallis test was used to assess group differences and post hoc Dunn's tests were used to examine pairwise differences.

RESULTS

Transgender men reported the highest mean MDDI total score (30.5 ± 7.5), followed by gender-expansive people (27.2 ± 6.7), then transgender women (24.6 ± 5.7). The differences in total MDDI score were driven largely by the Drive for Size subscale and, to a lesser extent, the Functional Impairment subscale. There were no significant differences in the Appearance Intolerance subscale among the three groups.

CONCLUSIONS

Transgender men reported higher Drive for Size, Functional Impairment, and Total MDDI scores compared to gender-expansive people and transgender women. These norms provide insights into the experience of MD symptoms among gender minorities and can aid researchers and clinicians in the interpretation of MDDI scores among gender minority populations.

Uncovering men's stereotype content (warmth and competence) associated with a representative range of male body size categories

Research indicates that 40 % of men experience weight-related stigmatization. Yet perceptions of body size continue to be understudied in men and the stereotype content of men's weight status remains largely unknown. Grounded in Stereotype Content Model, the research aims to uncover men's stereotype content associated with distinct body sizes. A pilot study tested the methodological design using a representative measure of BMI-specific images among a sample of undergraduate men (N = 80). Study 1 included the BMI-specific images to assess stereotype content among a broad online sample (N = 142) and explored how participant BMI relates to such perceptions. Study 2 included images of real men to increase the ecological validity of our findings (N = 152). We also included empathy and protestant ethics to examine possible interaction effects. Results revealed that normal to overweight men scored highest on warmth and competence, while underweight and obese classes were perceived less favorably and, evidently, stereotype perceptions were increasingly severe with adiposity. Empathy moderated evaluations of warmth toward stigmatized groups, and protestant ethics moderated warmth appraisals for underweight and normal weight targets but did not influence perceptions of competence. Overall, weight stereotype content should be considered when understanding stigma-related experiences in men.

Gender Expression, Peer Victimization, and Disordered Weight-Control Behaviors Among U.S. High School Students

PURPOSE

The purpose of this study is to examine the association between gender expression, peer victimization, and disordered weight-control behaviors (DWCBs) in four population-based samples of U.S. high school students.

METHODS

Analyses include data from 5,488 U.S. high school students from the 2013 Youth Risk Behavior Surveys in four jurisdictions (Broward County, FL; Chicago, IL; Los Angeles, CA; San Diego, CA). Participants were 56% Hispanic/Latino, 21% black/African American, and 14% white. Two items asked about perceived gender expression; responses were classified into three groups: highly gender conforming (e.g., very masculine boys), moderately gender conforming, gender nonconforming (e.g., feminine boys). Sex-stratified multivariable logistic regression models were used to examine the association between gender expression, peer victimization, and DWCBs in previous month (fasting, using diet pills/liquids/powders, and purging [vomiting or using laxatives]), controlling for potential confounders.

RESULTS

Overall, 12% of respondents reported fasting, 6% reported diet pill use, and 5% reported purging, with significantly higher prevalence among gender nonconforming than among gender conforming male students (p < .001). In adjusted models, gender nonconforming male students had greater odds of fasting (odds ratio [95% confidence interval]: 3.0 [2.0-4.7]), diet pill use (6.1 [3.7-9.9]), and purging (7.2 [3.6-14.8]), relative to moderately conforming males. No significant associations were found among female students. Adding peer victimization to models modestly attenuated the association between gender nonconformity and DWCBs for male students.

CONCLUSIONS

In probability samples of U.S. high school students, we observed marked differences by gender expression in DWCBs among male students but not among female students. Gender expression-related stigma should be addressed within clinical and school-based interventions to prevent DWCBs.

The Relationship between Restrained Eating, Body Image, and Dietary Intake among University Students in China: A Cross-Sectional Study

This study aims to explore the association between restrained eating, body image, and dietary intake among Chinese college students. This cross-sectional study included 1301 college students at two universities in Hunan Province. Electronic questionnaires were used to collect information including students’ demographic characteristics, restrained eating, perception of body weight, body satisfaction, and dietary intake. Anthropometric measurements were collected to calculate body mass index (BMI). The prevalence of high restrained eating was 52.8%. Students who were dissatisfied with their bodies or overestimated their body weight showed a higher tendency toward high restrained eating (p < 0.05). Students with high restrained eating tended to eat fruits and eggs more frequently, while the frequency of eating domestic animals and poultry, sugar-sweetened beverages, and fast food were the opposite. Moreover, high restrained eating was a risk factor for low dietary diversity (odds ratio (OR) = 1.384, 95% confidence interval: 1.002~1.912). The high incidence of restrained eating among Chinese college students and its energy-restricted diets that may lead to possible health implications require attention. Further studies are needed to investigate the characteristics of college students’ restrained eating to tailor appropriate interventions for forming positive body images and promoting healthy eating behaviors, thus, improving dietary quality.

Meta-analysis of gender differences in body appreciation

There are a number of studies that have conducted comparisons of body appreciation between males and females. However, findings are largely inconsistent, making it unclear whether there are actual gender differences in body appreciation. With a meta-analytic approach, the current study quantitatively reviewed and synthesized previous findings, published up to May 2019, on gender differences in body appreciation. After searching and screening potential studies in four databases (i.e., PubMed, PsycINFO, Web of Science, and ProQuest Dissertations & Theses Global), we identified 40 relevant articles published from 2008 to 2019. A random-effects model reveals an overall estimate of gender difference in body appreciation of d = 0.27 (95 % CI: 0.21, 0.33; p <  .001); that is, males generally have a higher level of body appreciation than females, with a small effect size. Survey method, type of sample (cohorts), and age were identified as significant moderators that have contributed to the variability in previous findings. Future research and interventions in body appreciation may consider gender differences in their designs.

Status and competitive choice

In this paper, we extend the logic of existing sociological theory on status to explain how status processes can inform selection in competitive choice situations. We argue that in the absence of knowledge about the specific abilities of others and assuming a desire to win, when given the opportunity to "pick their battles," people will draw on overt status differences as a basis for selecting a competitor from a pool of possible competitors. Results from three studies indicate that, as predicted, status differences affect competitor selection, with individuals choosing to compete against those who are relatively lower status based on diffuse characteristics. Moreover, consistent with expectation state theories, results from two studies show that the expectations that people form for their potential competitors based on status differences mediate this relationship. We conclude by discussing the implications of this research.

Gender differences in responses to thin, athletic, and hyper-muscular idealized bodies

Recent evidence suggests that the ideal female body has shifted from an ultra-thin image toward one that is both thin and toned, or muscular. Furthermore, the ideal male body may be more athletic, characterized by moderate muscularity combined with leanness, than bodybuilder-muscular. Thus, we experimentally examined women's (n = 92) and men's (n = 106) cognitive processing style in response to idealized body types, i.e., thin images, athletic images (thin and muscular), or hyper-muscular images (moderately thin and extremely muscular). Results revealed that women in the athletic condition were the most likely to generate negative social comparisons. Women in the thin condition were more likely to generate counter-arguments compared to women in the other two conditions. Men in the hyper-muscular condition were more likely to generate counter-arguments than men in the other two conditions. Further, among women in the thin condition, negative social comparisons were inversely related to body appreciation but positively related to internalization of appearance ideals. Findings confirm that the athletic ideal likely poses problems for women's body image. Both women and men seemed to be able to "talk back" when exposed to their gendered body ideal.

Young men's body dissatisfaction: A qualitative analysis of anonymous online accounts

Associated with numerous adverse health outcomes, body dissatisfaction in young men requires close examination. This study explores online accounts relating to male body image, including young men's personal disclosures within one online newspaper article, and posts responding to this topic. Discursively informed thematic analysis indicated that non-disclosure was considered a problematic social expectation by the young men featured in the article. Also, reader posts variously constructed body dissatisfaction as a symptom of adolescence, a lack of self-care and an incapacity to capitalise on compensatory qualities. Our analysis suggests young men may welcome safe opportunities to critically discuss prevailing body image ideals.

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.

'I didn't realise I was such a sausage': men's accounts of whole-body scanning, body image, and expected changes in health-related behaviours

OBJECTIVE

Whole-body scanning is now available in stores to assist buyers in choosing well-fitting clothes. This study was designed to investigate men's accounts of scanning, body image and expectations of behaviour change.

DESIGN

Ten men aged 18-39 years without histories of eating disorders or previous experience of whole-body scanning, took part in semi-structured interviews before and after scanning. Data were analysed using inductive thematic analysis.

RESULTS

Pre-scan, men's body ideals were tall, slender and relatively muscular. Post-scan, seven reported looking shorter, fatter, thinner and/or less symmetrical than they hoped; three were pleasantly surprised by the images. Men were interested in scans as an objective view of their bodies and as a 'wake-up call' to motivate healthy behaviours. Five men intended to change their behaviour as a result of scanning, and repeat scanning was seen as a good way to monitor behavioural changes. Participants suggested that scanning may raise body concerns in other men, though downplayed impacts on their own body image.

CONCLUSION

Whole-body scanning may encourage men to exercise and eat more healthily. However, men became more negative about their bodies as a result of seeing their body scans, so scanning needs to be carried out with supervision and support.

Perceptions of eating disorder diagnoses and body image issues in four male cases in Singapore

BACKGROUND

Despite the increasing number of patients presenting for treatment, little is still known about male eating disorders cases. The current study presents four male eating disorder cases presented to our specialized treatment facility in Singapore.

CASE PRESENTATION

Cases 1, 2 and 3 are homosexual males in their twenties and thirties who presented with anorexia nervosa and bulimia nervosa. Case 4 is a heterosexual male in his twenties diagnosed with binge eating disorder. All four cases expressed body image dissatisfaction, fat phobia and fear of weight gain. Additionally, all of them sought treatment because of comorbid psychiatric conditions or parental wishes. Premorbid obesity and homosexual orientation may be potential risk factors for males in developing eating disorders.

CONCLUSIONS

These findings suggest that more exploration needs to be done for males diagnosed with eating disorders, particularly in the Asian society. A deeper understanding into factors associated with symptom presentation and treatment-seeking behaviors would greatly assist in informing the direction and focus of treatment in the region.

Systematic review of the diagnostic category muscle dysmorphia

OBJECTIVES

(1) To collect, analyze and synthetize the evidence on muscle dysmorphia diagnosis as defined by Pope et al. and (2) To discuss its appropriate nosology and inclusion as a specific category in psychiatric classificatory systems.

METHOD

A systematic search in the MEDLINE, the PsycNET, the LILACS and SciELO databases and in the International Journal of Eating Disorders was conducted looking for articles published between January 1997 and October 2014 and in EMBASE database between January 1997 and August 2013. Only epidemiological and analytical studies were considered for selection. The methodological quality of included studies was assessed according to the Evidence-Based Mental Health and the National Health and Medical Research Council's guidelines. The support for inclusion of muscle dysmorphia in psychiatric classificatory systems was examined against Blashfield et al.'s criteria.

RESULTS

Thirty-four articles were considered eligible out of 5136. Most of the studies were cross-sectional and enrolled small, non-clinical samples. The methodological quality of all selected papers was graded at the lowest hierarchical level due to studies' designs. Forty-one percent of the publications considered the available evidence insufficient to support the inclusion of muscle dysmorphia in any existing category of psychiatric disorders. The current literature does not fulfill Blashfield et al.'s criteria for the inclusion of muscle dysmorphia as a specific entity in psychiatric diagnostic manuals.

CONCLUSION

The current evidence does not ensure the validity, clinical utility, nosological classification and inclusion of muscle dysmorphia as a new disorder in classificatory systems of mental disorders.