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Keeping Pace with the Growing Problem of Male Eating Disorders
Abstract
Men can and do develop eating disorders, and the prevalence of extreme dieting and purging has increased faster among men than women. As well as anorexia nervosa, bulimia nervosa and binge-eating disorder, men are affected by muscle dysmorphia and other muscularity-orientated eating issues. D espite a public perception to the contrary, men can and do develop eating disorders. Studies have shown that males may account for approximately 25% of cases of anorexia nervosa and bulimia nervosa and 33% of binge-eating disorders (US data), and 25% of early-onset eating disorders in pre-adolescent children (Australian data). 1,2 Alarmingly, these figures are set to rise. Data from a cross-sectional survey of 3000 adults in Australia conducted in 1998 and again in 2008 showed that the prevalence of extreme dieting and purging increased faster among the men than the women. 3 The prevalence of strict dieting or fasting, purging and binging more than doubled among men in Australia between 1995 and 2005. 4 Stated plainly, the problem of eating disorders in males is going to get worse before it gets better. The spectrum of male body image concerns Complicating matters even further is that current prevalence figures might tell only half of the story. Most men do not desire the thin and skinny body coveted by most women. A study of undergraduates in the USA has shown that the ideal male body is similar to that of most competitive swimmers: broad-shouldered with a muscular chest, well-developed arms, big biceps, a V-shaped torso and a set of six-pack abs. 5
... 9 Current trends suggest that body image-and eatingrelated problems among males living in Australia are likely to grow. 10 In light of the recent attention on body dissatisfaction as a public health problem and the evidence for increasing incidence of body dissatisfaction among males, this study aimed to further the emerging field of sex differences in the correlates of body dissatisfaction. To this end, we aimed to examine sex differences in the relationships between body dissatisfaction and physicaland mental health-related QoL, and between body dissatisfaction and psychological distress. ...
Background:
Body dissatisfaction is associated with impairment in women's quality of life (QoL). To date, research has not examined the relationship between body dissatisfaction and men's QoL, or sex differences in this relationship.
Methods:
A community sample of 966 males and 1,031 females living in Australia provided information about their body dissatisfaction, mental health and physical health-related QoL, and eating disorder symptoms. Data were analysed using three hierarchical multiple regressions and interactions between body dissatisfaction and sex were examined.
Results:
For both sexes, increasing levels of body dissatisfaction were associated with poorer mental and physical health-related QoL and greater psychological distress. The adverse associations between body dissatisfaction and mental health-related QoL, and between body dissatisfaction and psychological distress, were more pronounced for males.
Conclusion:
High levels of body dissatisfaction may threaten the psychological and physical wellbeing of both men and women. Body dissatisfaction appears to be a public health problem, distinct from the eating disorders and other adverse psychological phenomena for which body dissatisfaction is commonly discussed as a risk factor. Males, historically understudied and underrepresented in body image research, warrant increased empirical attention.
The perception that eating disorders occur predominantly in young white upper-class women has been challenged. This study examined temporal differences to the demographic correlates of eating disorder behaviors over a 10-year period.
Data from cross-sectional general population surveys in 1998 (n = 3010) and 2008 (n = 3034) were collected on demographics (sex, age, income, residency), current eating disorder behaviors (binge eating, extreme dieting, purging), and health-related quality of life (SF-36).
Below-median annual household income was associated with increased prevalence rates from 1998 to 2008 in binge eating, extreme dieting, and purging. Male sex was associated with increased prevalence rates in extreme dieting and purging. Age over 45 years was associated with increased prevalence rates in purging. In 2008 versus 1998, binge eating was associated with greater mental health-related quality of life impairment in males but not females; and greater physical health-related quality of life impairment in regional but not metropolitan areas. Extreme dieting was also associated with greater physical health-related quality of life impairment in 2008 versus 1998 in the lower but not the higher socioeconomic sector.
Findings suggest the ‘democratization’ of disordered eating, with greatest levels of associated impairment being within marginalized demographic sectors. Implications include the need for broader intervention programs and recruitment of demographically representative samples in eating disorder research.
Despite there being effective clinical treatments for a range of mental health issues (U.S. Department of Health and Human Services, 1999, Mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services), men have a particularly low rate of help-seeking from mental health professionals (U.S. Department of Health and Human Services, 2002, The NHSDA report: Serious mental illness among adults. Rockville, MD: National Institute of Mental Health). A variety of contextual factors may be associated with why men are resistant to professional help-seeking (Addis, M. E., & Mahalik, J. R., 2003, Men, masculinity, and the contexts of help-seeking, American Psychologist, 58, 5–14). The current project recruited a diverse community sample and used two observational rating measures to assess men’s verbal reactions to common mental health labels (“anxiety” and “depression”), different forms of help-seeking (medication, psychotherapy, friends and family, and “other forms of help-seeking”), and different sources of help-seeking advice (romantic partner, doctor, and psychotherapist) within the context of a clinical-style interview. The findings indicated that men prefer talk-therapy with a psychotherapist compared to other forms of professional help-seeking and that many men, particularly those who adhere to hegemonic masculine norms, are more resistant to taking medication. Men were also found to react more positively to seeking professional treatment at the suggestion of a psychotherapist compared with a medical doctor or romantic partner. Finally, the study confirmed previous self-report findings that adherence to masculine norms is negatively associated with men’s willingness to seek professional help. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
Gender role norms may play a crucial role in the male experience of eating disorders. The masculinity hypothesis proposes that conformity to masculine gender roles including dominance, confidence, sexual success, and physical and emotional self-control places men at risk for muscularity-oriented body dissatisfaction and disordered eating. However, despite some empirical support for this hypothesis, several gaps in the literature remain. The present study was the first to use multidimensional instruments of gender role conformity to investigate whether masculinity and femininity are associated with male body dissatisfaction and disordered eating. Participants were 246 young heterosexual men who com- pleted an online survey that asked questions about muscle dissatisfaction, body fat dissatisfaction, thinness- and muscularity-oriented disordered eating. Results from 4 simultaneous multiple regressions showed that increased conformity to masculine norms predicted greater muscle dissatisfaction and muscularity-oriented disordered eating, but not body fat dissatisfaction or thinness-oriented disor- dered eating. Conformity to feminine norms predicted greater muscle dissatisfaction, thinness- and muscularity-oriented disordered eating. The results provide support for the masculinity hypothesis and extend it to include muscularity-oriented disordered eating. Furthermore, the results suggest that the femininity hypothesis, which proposes that feminine norm endorsement is a risk factor for body dissatisfaction and disordered eating in women, may also generalize to men. Clinicians should consider integrating gendered perspectives into treatments for men with eating disorders. Future research into the mechanisms through which gender role conformity influences body image and eating outcomes in males is necessary.
To understand how young men recognise eating disorder (ED) symptoms and decide to seek help, and to examine their experiences of initial contacts with primary care.
A qualitative interview study.
Men from across the UK were interviewed as part of a study of 39 young men's and women's experiences of having an ED.
10 men aged 16-25 years with various EDs including anorexia nervosa and bulimia nervosa.
The widespread perception of EDs as uniquely or predominantly a female problem led to an initial failure by young men to recognise their behaviours as symptoms of an ED. Many presented late in their illness trajectory when ED behaviours and symptoms were entrenched, and some felt that opportunities to recognise their illness had been missed because of others' lack of awareness of EDs in men. In addition, the men discussed the lack of gender-appropriate information and resources for men with EDs as an additional impediment to making sense of their experiences, and some felt that health and other professionals had been slow to recognise their symptoms because they were men.
Although increasingly common in young men, widespread cultural constructions of EDs as a 'women's illness' mean that men may fail to recognise ED symptoms until disordered behaviours become entrenched and less tractable to intervention. Men also report that such perceptions can affect the reactions of their families and friends, as well as health and educational professionals. Primary care professionals are well placed to challenge inappropriate perceptions of EDs.
Background
Given recent assertions suggesting that gender role endorsement may be relevant in the divergence of male body image concerns, this study examined the self-reported gender role endorsement in opposing dimensional extremes of male body image disorders, namely, muscle dysmorphia and anorexia nervosa. This study further examined the relationship between gender role endorsement and eating disordered and muscle dysmorphia disorder pathology.
Methodology
Participants were 21 male muscle dysmorphia patients, 24 male anorexia nervosa patients, and 30 male gym-using controls from Australia, the United Kingdom, and the United States. All participants completed multidimensional measures of masculinity and femininity, and measures of eating disorder and muscle dysmorphia symptomatology.
Results
Patients with muscle dysmorphia reported significantly elevated adherence to masculine (but not feminine) norms relative to control gym-using men and men with anorexia nervosa, whereas patients with anorexia nervosa exhibited elevated feminine (but not masculine) gender role endorsement relative to control gym-using men and men with muscle dysmorphia.
Conclusions
Masculine and feminine gender role endorsement appear to be associated with the divergence of body image concerns towards muscularity and thinness-oriented ideals respectively.
To examine whether gender differences in primary care consultation rates (1) vary by age and deprivation status and (2) diminish when consultation for reproductive reasons or common underlying morbidities are accounted for.
Cross-sectional study of a cohort of patients registered with general practice.
UK primary care.
Patients (1 869 149 men and 1 916 898 women) registered with 446 eligible practices in 2010.
Primary care consultation rate.
This study analyses routinely collected primary care consultation data. The crude consultation rate was 32% lower in men than women. The magnitude of gender difference varied across the life course, and there was no 'excess' female consulting in early and later life. The greatest gender gap in primary care consultations was seen among those aged between 16 and 60 years. Gender differences in consulting were higher in people from more deprived areas than among those from more affluent areas. Accounting for reproductive-related consultations diminished but did not eradicate the gender gap. However, consultation rates in men and women who had comparable underlying morbidities (as assessed by receipt of medication) were similar; men in receipt of antidepressant medication were only 8% less likely to consult than women in receipt of antidepressant medication (relative risk (RR) 0.916, 95% CI 0.913 to 0.918), and men in receipt of medication to treat cardiovascular disease were just 5% less likely to consult (RR=0.950, 95% CI 0.948 to 0.952) than women receiving similar medication. These small gender differences diminished further, particularly for depression (RR=0.950, 95% CI 0.947 to 0.953), after also taking account of reproductive consultations.
Overall gender differences in consulting are most marked between the ages of 16 and 60 years; these differences are only partially accounted for by consultations for reproductive reasons. Differences in consultation rates between men and women were largely eradicated when comparing men and women in receipt of medication for similar underlying morbidities.
Researchers have recently developed instruments that measure fat-and muscularity-related body image concerns in men so that the full spectrum of male body dissatisfaction can be assessed. However, little research has attempted to identify dimensions of disordered eating as they pertain to the muscular body-ideal. Current conceptualisations of disordered eating are synonymous with body fat, fat loss, weight loss and calorie restriction, all of which characterise the drive for thinness, not the drive for muscularity. Instruments that are sensitive to the full spectrum of disordered eating are needed to enable future investigations into whether muscularity-oriented disordered eating is associated with distress and disability in the same way as thinness-oriented disordered eating.
This study sought to increase professionals' knowledge of college men's perceptions of ideal body composition and shape by a qualitative design. Based on data obtained from 30 college men, themes and individual differences emerged. Muscularity, leanness, height, and certain body areas were highlighted and their representativeness within the data was presented. Muscularity was found to be multifaceted with 5 components, and men varied in the overall and site-specific body areas that they emphasized. Discussions of how these findings can direct future research (e.g., construction of instruments assessing men's body satisfaction), theory, and practice are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article presents an integrative overview of existing research on anorexia nervosa (AN) in adolescent males. AN is commonly thought of as a female disorder. Even though as much as 25% of the clinical population is male, research on AN in males is limited. Additionally, most conceptualizations of male AN emphasize a single etiological factor and, therefore, produce treatments that fail to address it as a global phenomenon. In contrast, an integrative understanding that incorporates research on the familial, biological, cultural, and psychodynamic elements involved in male AN encourages treatment that comprehensively addresses the disorder.
This article provides a survey of eating disorders in men, highlights the dramatic rise in eating disorders, identifies issues specific to males, and suggests areas for research and intervention. This survey concludes that men with eating disorders are currently under-diagnosed, undertreated, and misunderstood by many clinicians who encounter them. Ongoing research addressing these issues is expected to result in assessment tools and treatment interventions that will advance positive outcomes for men with eating disorders.
To collect nationally representative epidemiological data on early-onset eating disorders (EOEDs) in children.
Prospective, active surveillance using the Australian Paediatric Surveillance Unit with key informant design.
Child health specialists in Australia (July 2002 to June 2005).
Incident cases of EOEDs in children aged 5-13 years.
Disease rates, demographic characteristics, clinical features and complications, hospitalisation, psychological comorbidity, and concordance of clinical features with Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) criteria.
We identified 101 children aged 5-13 years with EOEDs (median age, 12.2 years; range, 5.5-13.9 years), of whom one in four were boys. Most were hospitalised (78%), and the mean duration of hospitalisation was 24.7 days (range, 1-75 days). More than 70% of inpatients were admitted to specialised eating disorder units in paediatric teaching hospitals. Among inpatients, 37% met DSM-IV diagnostic criteria for anorexia nervosa; although 61% had life-threatening complications of malnutrition, only 51% met weight criteria. Psychological symptoms were similar to those in adults with anorexia nervosa: 67% of inpatients met both psychological diagnostic criteria for anorexia nervosa (fear of weight gain/fatness and misperception of body shape). Of 19 postmenarchal girls, 18 had secondary amenorrhoea. Nasogastric feeding was used in 58% of inpatients, and 34% received psychotropic medications.
This is the first prospective national study of EOEDs. It demonstrates the limitations of applying DSM-IV diagnostic criteria for anorexia nervosa to young children; the high proportion of boys affected by EOEDs; and the significant psychological comorbidity and high frequency of hospitalisation associated with EOEDs. Potentially life-threatening medical complications are common at presentation, suggesting possible missed diagnoses and a need for education of health professionals. The study underlines the severity of EOEDs and the need for joint medical and psychiatric specialist management.
Little population-based data exist on the prevalence or correlates of eating disorders.
Prevalence and correlates of eating disorders from the National Comorbidity Replication, a nationally representative face-to-face household survey (n = 9282), conducted in 2001-2003, were assessed using the WHO Composite International Diagnostic Interview.
Lifetime prevalence estimates of DSM-IV anorexia nervosa, bulimia nervosa, and binge eating disorder are .9%, 1.5%, and 3.5% among women, and .3% .5%, and 2.0% among men. Survival analysis based on retrospective age-of-onset reports suggests that risk of bulimia nervosa and binge eating disorder increased with successive birth cohorts. All 3 disorders are significantly comorbid with many other DSM-IV disorders. Lifetime anorexia nervosa is significantly associated with low current weight (body-mass index <18.5), whereas lifetime binge eating disorder is associated with current severe obesity (body-mass index > or =40). Although most respondents with 12-month bulimia nervosa and binge eating disorder report some role impairment (data unavailable for anorexia nervosa since no respondents met criteria for 12-month prevalence), only a minority of cases ever sought treatment.
Eating disorders, although relatively uncommon, represent a public health concern because they are frequently associated with other psychopathology and role impairment, and are frequently under-treated.
Evidence for an increase in the prevalence of eating disorders is inconsistent. Our aim was to determine change in the population point prevalence of eating disorder behaviors over a 10-year period.
Eating disorder behaviors were assessed in consecutive general population surveys of men and women conducted in 1995 (n = 3001, 72% respondents) and 2005 (n = 3047, 63.1% respondents). Participants were randomly sampled from households in rural and metropolitan South Australia. There was a significant (all p<0.01) and over two-fold increase in the prevalence of binge eating, purging (self-induced vomiting and/or laxative or diuretic misuse) and strict dieting or fasting for weight or shape control among both genders. The most common diagnosis in 2005 was either binge eating disorder or other "eating disorders not otherwise specified" (EDNOS; n = 119, 4.2%).
In this population sample the point prevalence of eating disorder behaviors increased over the past decade. Cases of anorexia nervosa and bulimia nervosa, as currently defined, remain uncommon.
Objective: To investigate the severity and nature of compulsive exercise in males and females with anorexia nervosa (AN). Method: Male (n = 27) and female (n = 24) patients with AN completed measures of compulsive exercise and eating disorder symptomatology. Results: Males reported significantly greater overall compulsive exercise pathology than females. Analysis of subscale scores on the compulsive exercise test showed that males relied significantly more heavily on avoiding negative affect and increasing positive affect, and endorsed more rigid and repetitive exercise habits than females. Discussion: Compulsive exercise appears to be more severe in males with AN relative to females. For males in particular, exercise may function to regulate affect by both reducing negative emotionality and increasing positive emotionality, indicating an important psychological function of exercise beyond the physiological effects of expunging calories. Furthermore, the exercise behaviours endorsed by males were more deeply embedded in rigidity, routine and repetitiveness, which may lead to increased treatment resistance and difficulty achieving an overall relaxation of rigid and repetitive cognition and behaviour. Clinicians treating males with AN should pay special attention to the presence and severity of compulsive exercise, with emphasis on its affect regulatory components.
A growing body of evidence suggests that the prevalence of male body dissatisfaction and muscle dysmorphia is rising. To date, however, there is no published evidence on the efficacy of treatments for muscle dysmorphia. We present the case of a 15-year-old boy who met full diagnostic criteria for muscle dysmorphia, whose symptoms were treated into remission with eating disorder-focused, family-based treatment. The age of this patient fell within the time period in which symptoms of muscle dysmorphia are most likely to develop and this case represents the first published case report of family-based treatment for muscle dysmorphia in this age group. Thus, this case report has important implications for clinicians considering treatment options for presentations of muscle dysmorphia when first presenting in adolescence. Implications for the development of treatment guidelines for muscle dysmorphia and for the diagnostic debate surrounding muscle dysmorphia are also discussed.
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.
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.
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.
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. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013).
Objective
To review the literature for scientific evidence in support of inclusion of Muscle Dysmorphia (MD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).DesignThe criteria proposed by Blashfield, Sprock, and Fuller (1990) were used for determining whether scientific evidence supports the introduction of MD as a new disorder into a disease classification system.Method
Peer-reviewed journal articles were identified by searching databases for articles published (in print and electronically) from 2001 to 2011.ResultsThe search identified 59 journal articles that specifically focused on MD, of which 39 were empirical journal articles. There is ample literature on MD, including a common set of diagnostic criteria and assessment instruments to measure MD. However, questions remain about the diagnostic reliability and validity, including inter-rater reliability, and whether MD represents a disorder that consists of symptoms that frequently co-occur. Also, evidence of syndrome differentiation is lacking. Only two of the five criteria proposed by Blashfield et al. have been met.Conclusion
Literature suggests that MD is associated with several indicators of clinical significance and distinctiveness. However the current review has found significant limitations and gaps in the scientific literature on MD. Possible options regarding the status of MD in the DSM-5 are proposed, including introducing MD as an example of an eating disorder not otherwise specified, retaining MD as a body dysmorphic disorder, introducing MD as a new disorder, or introducing MD as a provisional diagnosis in need of further study.
In a thorough review of literature of eating disorders in men, it is consistently shown that symptom presentation varies greatly by gender. However, almost all eating disorder instruments have been developed and validated on females. These critical differences between men and women in symptom presentation provoke the necessity to develop a male specific eating disorder assessment tool. The development of the EDAM is described, and in a study of 108 clients of residential treatment facilities, results of the preliminary version of the EDAM are shown. Internal consistency reliability is supported and factor analysis loadings are provided. Results from a logistical regression support the EDAM's ability to predict eating disorders in men.
Muscle dysmorphia is a relatively recently identified psychological condition that, since its inception, has been variously conceptualized as an eating disorder and subsequently as a type of body dysmorphic disorder within the somatoform disorders. This review aims to inform and encourage ongoing debate surrounding the diagnostic placement of this disorder.
We present a review and synthesis of the extant literature with a view to informing future decisions regarding the conceptualization of muscle dysmorphia.
The validity of muscle dysmorphia as a clinical entity has been empirically demonstrated. While the condition bears little semblance to somatization as currently conceptualized, the research suggests a strong conceptual similarity with anorexia nervosa. However, future research needs to utilize more appropriate measures of male eating disorder pathology. Muscle dysmorphia is also inclusive of obsessive compulsive features that are typical to those seen in eating disorder presentations.
We suggest that muscle dysmorphia be reanalyzed through the lens of an eating disorder spectrum. Recognition of muscle dysmorphia as an eating disorder may offer more clinical utility in recognizing the male experience of eating disorder pathology and also help reduce the number of current male cases falling into the EDNOS category.
In the course of several ongoing studies, the authors have encountered men and women who display a form of body dysmorphic disorder in which they become pathologically preoccupied with their degree of muscularity. This condition, which the authors have tentatively termed "muscle dysmorphia," may cause severe subjective distress, impaired social and occupational functioning, and abuse of anabolic steroids and other substances. Epidemiologic data suggest that muscle dysmorphia, though rarely recognized, may afflict substantial numbers of Americans. The authors summarize the features of muscle dysmorphia, present several case examples, and offer proposed diagnostic criteria that may be useful for subsequent research.
Muscle dysmorphia is a form of body dysmorphic disorder in which individuals develop a pathological preoccupation with their muscularity.
The authors interviewed 24 men with muscle dysmorphia and 30 normal comparison weightlifters, recruited from gymnasiums in the Boston area, using a battery of demographic, psychiatric, and physical measures.
The men with muscle dysmorphia differed significantly from the normal comparison weightlifters on numerous measures, including body dissatisfaction, eating attitudes, prevalence of anabolic steroid use, and lifetime prevalence of DSM-IV mood, anxiety, and eating disorders. The men with muscle dysmorphia frequently described shame, embarrassment, and impairment of social and occupational functioning in association with their condition. By contrast, normal weightlifters displayed little pathology. Indeed, in an a posteriori analysis, the normal weightlifters proved closely comparable to a group of male college students recruited as a normal comparison group in an earlier study.
Muscle dysmorphia appears to be a valid diagnostic entity, possibly related to a larger group of disorders, and is associated with striking and stereotypical features. Men with muscle dysmorphia differ sharply from normal weightlifters, most of whom display little psychopathology. Further research is necessary to characterize the nosology and potential treatment of this syndrome.
Eating disorders have significantly different rates of incidence in males and females. Although there is ample scientific evidence supporting gender-specific diagnostic criteria, common stereotypes prevent accurate diagnosis of eating disorders in males. This article focuses on areas of practical consequence to physicians and other health professionals, emphasizing topics for which evidence-based studies can direct treatment guidelines for both female and male patients.
This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.
Muscle dysmorphia - a pathological preoccupation with muscularity - appears to be a form of body dysmorphic disorder (BDD) with a focus on muscularity. However, little is known about muscle dysmorphia in men with BDD, and no study has compared men with BDD who do and do not report muscle dysmorphia. To explore this issue, we reviewed the histories of 63 men with BDD; we compared those rated as having a history of muscle dysmorphia with those who had BDD but not muscle dysmorphia in several domains. The 14 men with muscle dysmorphia resembled the 49 comparison men in demographic features, BDD severity, delusionality, and number of non-muscle-related body parts of concern. However, those with muscle dysmorphia were more likely to have attempted suicide, had poorer quality of life, and had a higher frequency of any substance use disorder and anabolic steroid abuse. Thus, muscle dysmorphia was associated with greater psychopathology.
This study examined the influence of clinical and nonclinical features of case presentation on the diagnosis and treatment of eating disorders in primary care.
Family physicians from a defined region of the UK were provided with two vignettes, characterizing eating disorder presentations in primary care. Case gender, ethnicity, weight status, and diabetes history were experimentally manipulated. Outcome variables included the primary diagnosis and the treatment course selected for each case.
Female cases were more likely to receive an eating disorder diagnosis, even when their symptoms were identical to those of males. Nonclinical demographic variables also influenced treatment decisions. Weight status and physical comorbidity had a limited influence on treatment pathways.
Nonclinical features of case presentations are used when making eating disorder diagnoses and in selecting treatment. Decision-making in primary care does not reflect recommendations from clinical guidance, and this disparity might increase the risk of complications in the care of sub-groups of eating-disordered patients.
A measure of men's attitudes toward their body (MBAS) was developed and evaluated via three independent samples of college men. In Studies 1 and 2, factor analyses determined and cross-validated the MBAS's underlying structure. Three factors emerged from the items: muscularity, low body fat, and height. Studies 1 and 2 provided construct (i.e., convergent, concurrent, and discriminant) validity evidence for the MBAS total scale and subscales; they were related or not related as expected to drive for muscularity, body esteem, internalization of the muscular ideal, pressures for muscularity, pressures for thinness, self-esteem, body comparison, eating disorder symptomatology, and impression management. Study 3 revealed that the MBAS total score and subscale scores were stable over a 2-week period. The internal consistency reliabilities for the total score and subscale scores were high across all three studies. The MBAS should prove useful for researchers and clinicians interested in men's body image assessment.
Muscle dysmorphia has been described as a disorder in which individuals are pathologically preoccupied with their muscularity. This study was designed to further investigate the symptom characteristics and psychiatric conditions associated with the disorder.
Weight lifting males meeting current criteria for muscle dysmorphia (n = 15), past muscle dysmorphia (n = 8), and no history of muscle dysmorphia (n = 28) responded to advertisements placed in gymnasium and nutrition stores. Structured and semistructured interviews were administered, as well as survey measures.
Relative to controls, males with current muscle dysmorphia experienced more aversive symptoms related to the appearance of their bodies, including more often thinking about their muscularity, dissatisfaction with appearance, appearance checking, bodybuilding dependence, and functional impairment. Higher rates of mood and anxiety disorders were found among individuals with a history of muscle dysmorphia relative to individuals with no history of muscle dysmorphia.
The findings suggest that muscle dysmorphia can be distinguished from normal weight lifting on a number of clinical dimensions. Muscle dysmorphia appears to be comorbid with other psychiatric conditions. Limitations of the current study and directions for future research are considered.
Australian Needle and Syringe Program Survey (NSP)
- J Iversen
- L Maher
Iversen J, Maher L. Australian Needle and Syringe Program Survey (NSP)
Variables that influence diagnosis and treatment of the eating disorders within primary care settings: a vignette study
- L Curran
- U Schmidt
- G Waller
Curran L, Schmidt U, Waller G. Variables that influence diagnosis and
treatment of the eating disorders within primary care settings: a vignette study.
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