Anorexia nervosa in male adolescents: body image, eating attitudes and
Araceli Gila, Ph.D., Josefina Castro, M.D.*, José Cesena, Ph.D., and Josep Toro, M.D.
Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic Universitari of Barcelona, Barcelona, Spain
Manuscript received October 16, 2003; manuscript accepted February 6, 2004
Abstract Purpose: To evaluate body image and its relationship with psychological and behavioral traits
associated with anorexia nervosa in male patients.
Methods: Thirty male adolescents with anorexia nervosa (AN) were compared with 421 male
adolescents from the general population. Body image was evaluated with the Subjective Body
Dimensions Apparatus. Eating attitudes were evaluated by the Eating Attitudes Test in its 26-item
version (EAT-26). In 19 AN patients and 200 boys from the comparison group, the Eating Disorders
Inventory (EDI) was also administered.
Results: AN patients had higher mean scores in the EAT-26 and the Body Dissatisfaction scale on
the EDI, but not on the other EDI scales. Both groups overestimated all parts of their bodies but AN
patients presented a greater overestimation of shoulders (p ? .007), hips (p ? .01) and thighs (p ?
.019). Correlations in the anorexic group were high and negative between body overestimation and
body mass index and also high but positive between overestimation and the EAT and the Drive for
Thinness scale on the EDI. Overestimation did not correlate significantly with other EDI scales.
Conclusions: Male patients with anorexia nervosa overestimate some parts of their bodies more
often than controls; this overestimation is related to body mass index, abnormal eating attitudes and
drive for thinness, but not to other psychological traits evaluated by the EDI. © 2005 Society for
Adolescent Medicine. All rights reserved.
Anorexia nervosa; Male adolescents; Body image; Psychological traits; Spain
Body image distortion in anorexia nervosa (AN) patients
is a controversial characteristic . Even though the normal
population may overestimate their body size [2,3] and desire
to be thinner , it is generally accepted that females with
AN present greater body image distortion than the normal
population, especially in our sociocultural environment
[5,6]. Nevertheless, researchers disagree about the specific
disturbance underlying this disorder. Several authors have
concluded that body image disturbance in AN patients is not
a “perception” disorder of a particular dimension, but a
distortion that reflects patients’ ideas, internal images, cog-
nitions or emotions related to their own body [7–9]. It seems
that the distortions reflect, for instance, which parts of the
body have cognitive and emotional importance to the pa-
tient, rather than a real alteration in the image of the body as
a whole. The methods used to evaluate body image distor-
tion can be divided into two main groups : methods that
determine subjects’ views of the size of specific parts of
their body, and methods that give the estimation of the body
as a whole, which is then adjusted by the subject. Patients’
estimations of specific parts of the body provide important
data because the differences between their perceptions and
the actual measurements will highlight the sites that are of
particular concern to them.
Several studies have analyzed body image in boys in the
general population. Some have used questionnaires or in-
terviews to evaluate body dissatisfaction [11–13] and in
general have found that some boys in the general population
are dissatisfied and worried not only if they are fat but also
*Address correspondence to: Dr. Josefina Castro, Department of Child
and Adolescent Psychiatry and Psychology, Hospital Clínic Universitari,
Barcelona, Sabino de Arana 1, Barcelona 08028, Spain.
E-mail address: firstname.lastname@example.org
Journal of Adolescent Health 36 (2005) 221–226
1054-139X/05/$ – see front matter © 2005 Society for Adolescent Medicine. All rights reserved.
an issue that needs to be addressed during treatment. Nev-
ertheless, this overestimation does not seem to be related to
the same psychological aspects in males and in females.
Further studies with male patients are needed to analyze
their specific psychological traits to improve treatment pro-
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