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Watters S, Higgins A. Muscle dysmorphia: an under-recognised aspect of body dissatisfaction in men. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:584-588. [PMID: 38900653 DOI: 10.12968/bjon.2023.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Although men and women both experience eating disorders such as anorexia nervosa and bulimia nervosa, there are differences in the way their eating disorder may present. Body dissatisfaction or body dysmorphia in men may be more related to a drive for muscularity as opposed to thinness. Muscle dysmorphic disorder (also known as muscle dysmorphia) is a form or subtype of body dysmorphia that is characterised by an extreme desire for muscularity and a preoccupation with the idea that one's physique is too small or not sufficiently muscular. It is more common in men than women and is associated with body image distortion, excessive exercise routines, muscularity-orientated disordered eating and the use of appearance- and performance-enhancing drugs such as anabolic androgenic steroids. Risk factors for muscle dysmorphic disorder include social pressure (including to conform to gender stereotypes) and low self-esteem. The condition has negative psychological, physical, relational and financial effects. Nurses can play a role in health promotion as well as in the assessment, care and referral of men with muscle dysmorphic disorder.
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Affiliation(s)
- Sarah Watters
- Registered Psychiatric Nurse, and Master's Student in Applied Social Research, School of Social Work and Social Policy Trinity College Dublin
| | - Agnes Higgins
- Professor in Mental Health, School of Nursing and Midwifery, Trinity College Dublin
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2
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He J, Cui S, Cui T, Barnhart WR, Han J, Xu Y, Nagata JM. Exploring the associations between muscularity teasing and eating and body image disturbances in Chinese men and women. Body Image 2024; 49:101697. [PMID: 38460293 DOI: 10.1016/j.bodyim.2024.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
This study described muscularity teasing in both men and women and explored its associations with eating and body image disturbances in adults from China. A total of 900 Chinese adults (50% women) were recruited online. Correlation and regression analyses were conducted to examine the relationships between muscularity teasing and a battery of measures on eating and body image disturbances. Gender differences in the associations were examined. Men reported more muscularity teasing than women (31.6% men vs. 15.6% women; χ2(1,N = 900) = 31.99, p < .001). Muscularity teasing was significantly and positively correlated with all measures in both men and women. Muscularity teasing explained significant, unique variance in all measures for men and women, except for body fat dissatisfaction in women, beyond covariates (i.e., age, body mass index, and weight teasing). The relationships between muscularity teasing and eating and body image disturbances were generally stronger in men than women. Findings further suggest that muscularity teasing is an important factor related to eating and body image disturbances in men and women, but muscularity teasing might be more detrimental to men's eating behaviors and body image. Future research is needed to further explore the directionality and mechanisms of the links between muscularity teasing and eating and body image disturbances.
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Affiliation(s)
- Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China.
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Tianxiang Cui
- Department of Psychology, University of Macau, Taipa, Macau, China
| | - Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Jiayi Han
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Yinuo Xu
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Jason M Nagata
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA
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Zhang J, Cui S, Xu Y, Cui T, Barnhart WR, Ji F, Nagata JM, He J. Introducing Diagnostic Classification Modeling as an Unsupervised Method for Screening Probable Eating Disorders. Assessment 2024:10731911241247483. [PMID: 38676565 DOI: 10.1177/10731911241247483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Screening for eating disorders (EDs) is an essential part of the prevention and intervention of EDs. Traditional screening methods mostly rely on predefined cutoff scores which have limitations of generalizability and may produce biased results when the cutoff scores are used in populations where the instruments or cutoff scores have not been validated. Compared to the traditional cutoff score approach, the diagnostic classification modeling (DCM) approach can provide psychometric and classification information simultaneously and has been used for diagnosing mental disorders. In the present study, we introduce DCM as an innovative and alternative approach to screening individuals at risk of EDs. To illustrate the practical utility of DCM, we provide two examples: one involving the application of DCM to examine probable ED status from the 12-item Short form of the Eating Disorder Examination-Questionnaire (EDE-QS) to screen probable thinness-oriented EDs and the Muscularity-Oriented Eating Test (MOET) to screen probable muscularity-oriented EDs.
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Affiliation(s)
| | - Shuqi Cui
- The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Yinuo Xu
- The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | | | | | - Feng Ji
- University of Toronto, Ontario, Canada
| | - Jason M Nagata
- University of California, San Francisco, California, USA
| | - Jinbo He
- The Chinese University of Hong Kong, Shenzhen, Guangdong, China
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4
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Ip K, Kusyk N, Stephen ID, Brooks KR. Did you skip leg day? The neural mechanisms of muscle perception for body parts. Cortex 2024; 171:75-89. [PMID: 37980724 DOI: 10.1016/j.cortex.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 11/21/2023]
Abstract
While the neural mechanisms underpinning the perception of muscularity are poorly understood, recent progress has been made using the psychophysical technique of visual adaptation. Prolonged visual exposure to high (low) muscularity bodies causes subsequently viewed bodies to appear less (more) muscular, revealing a recalibration of the neural populations encoding muscularity. Here, we use visual adaptation to further elucidate the tuning properties of the neural processes underpinning muscle perception for the upper and lower halves of the body. Participants manipulated the apparent muscularity of upper and lower bodies until they appeared 'normal', prior to and following exposure to a series of top/bottom halves of bodies that were either high or low in muscularity. In Experiment 1, participants were adapted to isolated own-gender body halves from one of four conditions; increased (muscularity) upper (body half), increased lower, decreased upper, or decreased lower. Despite the presence of muscle aftereffects when the body halves the participants viewed and manipulated were congruent, there was only weak evidence of muscle aftereffect transfer between the upper and lower halves of the body. Aftereffects were significantly weaker when body halves were incongruent, implying minimal overlap in the neural mechanisms encoding muscularity for body half. Experiment 2 examined the generalisability of Experiment 1's findings in a more ecologically valid context using whole-body stimuli, producing a similar pattern of results as Experiment 1, but with no evidence of cross-adaptation. Taken together, the findings are most consistent with muscle-encoding neural populations that are body-half selective. As visual adaptation has been implicated in cases of body size and shape misperception, the present study furthers our current understanding of how these perceptual inaccuracies, particularly those involving muscularity, are developed, maintained, and may potentially be treated.
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Affiliation(s)
- Keefe Ip
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Nicole Kusyk
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Ian D Stephen
- NTU Psychology, Nottingham Trent University, Nottingham, England, UK
| | - Kevin R Brooks
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia; Perception and Action Research Centre (PARC), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, NSW, Australia
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5
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Mueller VM, Forrer F, Meyer AH, Munsch S. Psychological correlates of body dissatisfaction in Swiss youth over a one-year study-period. Front Psychol 2024; 14:1269364. [PMID: 38259526 PMCID: PMC10802120 DOI: 10.3389/fpsyg.2023.1269364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction It is well known that young individuals often report pronounced negative perceptions and attitudes towards their own body or intense fear of being not muscular enough. There is much less data available, however, on the role of psychological mechanisms on these perceptions and attitudes, such as emotion regulation difficulties, correlates of alexithymia, and appearance-related rejection sensitivity. Methods We therefore set out to assess associations between these psychological mechanisms, and body image as well as muscle dysmorphic symptoms. Our sample was recruited as part of a larger-scale study aiming at assessing correlates of mental health (with a focus on eating disorder symptoms) in German speaking Switzerland. The first wave (T1), starting in April 2021, included 605 participants (80% female, 19.6 ± 2.5 years) who completed the online-questionnaire and were reassessed in a second wave (T2), one year later. Results Results indicated that at both waves, emotion regulation difficulties [DERS-SF] and appearance-based rejection sensitivity [ARS-D] were both positively cross-sectionally associated with body dissatisfaction [BSQ-8C] and muscle dysmorphic symptoms [MDDI] at the first assessment time-point and one year later at follow-up assessment. Moreover, alexithymia [TAS-20] was positively cross-sectionally associated with muscle dysmorphic symptoms at both waves. We further observed high absolute and relative level stabilities for all variables involved across the one-year study period. Discussion/Conclusion Even though the effects for some associations were rather small, our findings underline the relevance of such mechanisms in the development of body dissatisfaction and to a lesser extent of muscle dysmorphia symptoms over the period of one year. Additional research is necessary to replicate these findings in other youth samples.
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Affiliation(s)
- Verena M. Mueller
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Felicitas Forrer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Andrea H. Meyer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
- Department of Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Basel, Switzerland
| | - Simone Munsch
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
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Ganson KT, Pang N, Testa A, Nagata JM. Muscle dysmorphia symptomatology is prospectively associated with suicidal thoughts, suicidal behaviors, and non-suicidal self-injury among a sample of Canadian adolescents and young adults. Suicide Life Threat Behav 2023; 53:1076-1085. [PMID: 37855328 DOI: 10.1111/sltb.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Limited, primarily cross-sectional research has identified associations between muscle dysmorphia and suicidal thoughts suicidal behaviors, and non-suicidal self-injury (NSSI). This study aimed to investigate the associations between muscle dysmorphia and suicidal thoughts, suicidal behaviors, and NSSI prospectively over a 1-year period among a large, diverse sample of Canadian adolescents and young adults. METHODS Data from wave one (2021) and wave two (2022) of the Canadian Study of Adolescent Health Behaviors were analyzed (N = 912). Multiple modified Poisson regression analyses were used to determine the associations between muscle dysmorphia symptomatology at wave one and three items of suicidal thoughts and behaviors and one item of NSSI at wave two. Unadjusted models and adjusted models were estimated. RESULTS Total muscle dysmorphia symptomatology and symptoms of Appearance Intolerance were prospectively associated with suicidal ideation and suicide planning at 12-month follow-up. These findings were significant across unadjusted and adjusted models. CONCLUSIONS Findings from this study expand prior research and underscore the clinical complexity of muscle dysmorphia. Future research should investigate mechanisms explaining the association between muscle dysmorphia and suicide and develop interventions to prevent suicide among people with muscle dysmorphia.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Nelson Pang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, California, USA
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Underwood M, Olivardia R. 'The day you start lifting is the day you become forever small': Bodybuilders explain muscle dysmorphia. Health (London) 2023; 27:998-1018. [PMID: 35473410 DOI: 10.1177/13634593221093494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Ortiz SN, Grunewald W, Forrest LN, Smith A. Testing the longitudinal relationship between muscle dysmorphia symptoms and suicidality: A network analysis investigation. Body Image 2023; 46:372-382. [PMID: 37481936 DOI: 10.1016/j.bodyim.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 06/29/2023] [Accepted: 07/13/2023] [Indexed: 07/25/2023]
Abstract
Research on suicidality in muscle dysmorphia is limited despite the high rates of suicidal thoughts and behaviors in related disorders. This study employed network analysis to examine the longitudinal relationships between muscle dysmorphia symptoms, as well as the relations between MD symptoms and suicide risk factors. Fifty individuals (Mage = 30.6 years, 63 % male) meeting criteria for muscle dysmorphia received four daily surveys for three weeks. Multi-level vector autoregression analysis was used to estimate associations between muscle dysmorphia- and suicide-related thoughts, emotions, and behaviors. The most central nodes in the muscle dysmorphia networks related to assessing muscle size, dieting, using muscle-building supplements, experiencing body dissatisfaction, seeking reassurance, and avoiding others due to concerns about appearance. In the comorbidity networks, the most central suicide-related factors were feelings of burdensomeness, feeling disgusted, and dwelling on the past. Our findings indicated that various intrusive thoughts (body dissatisfaction, dieting), compulsions (seeking reassurance, body checking, supplement use), and beliefs (burden to others, disgust with oneself) predicted future engagement in muscle dysmorphia and suicide-related symptomology. Targeting intrusive thoughts and compulsions, as well as feelings of disgust and burdensomeness, may reduce the severity of these conditions.
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Affiliation(s)
- Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, OH, USA; Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
| | | | | | - April Smith
- Department of Psychology, Auburn University, Auburn, AL, USA
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Mitchison D, Wang SB, Wade T, Haynos AF, Bussey K, Trompeter N, Lonergan A, MNeuroPsych JT, Hay P. Development of transdiagnostic clinical risk prediction models for 12-month onset and course of eating disorders among adolescents in the community. Int J Eat Disord 2023; 56:1406-1416. [PMID: 37052452 PMCID: PMC10404110 DOI: 10.1002/eat.23951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/26/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To develop and internally validate risk prediction models for adolescent onset and persistence of eating disorders. METHODS N = 963 Australian adolescents (11-19 years) in the EveryBODY Study cohort completed online surveys in 2018 and 2019. Models were built to predict 12-month risk of (1) onset, and (2) persistence of a DSM-5 eating disorder. RESULTS Onset Model. Of the n = 687 adolescents without an eating disorder at baseline, 16.9% were identified with an eating disorder after 12 months. The prediction model was based on evidence-based risk factors for eating disorder onset available within the dataset (sex, body mass index percentile, strict weight loss dieting, history of bullying, psychological distress, weight/shape concerns). This model showed fair discriminative performance (mean AUC = .75). The most important factors were psychological distress, weight and shape concerns, and female sex. Diagnostic Persistence Model. Of the n = 276 adolescents with an eating disorder at baseline, 74.6% were identified as continuing to meet criteria for an eating disorder after 12 months. The prediction model for diagnostic persistence was based on available evidence-based risk factors for eating disorder persistence (purging, distress, social impairment). This model showed poor discriminative performance (mean AUC = .65). The most important factors were psychological distress and self-induced vomiting for weight control. DISCUSSION We found preliminary evidence for the utility of a parsimonious model for 12-month onset of an eating disorder among adolescents in the community. Future research should include additional evidence-based risk factors and validate models beyond the original sample. PUBLIC SIGNIFICANCE This study demonstrated the feasibility of developing parsimonious and accurate models for the prediction of future onset of an eating disorder among adolescents. The most important predictors in this model included psychological distress and weight and shape concerns. This study has laid the ground work for future research to build and test more accurate prediction models in diverse samples, prior to translation into a clinical tool for use in real world settings to aid decisions about referral to early intervention.
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Affiliation(s)
- Deborah Mitchison
- Eating Disorder and Body Image Network, Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Shirley B. Wang
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Tracey Wade
- Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
| | - Ann F. Haynos
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kay Bussey
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Nora Trompeter
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Alexandra Lonergan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Jack Tame MNeuroPsych
- Eating Disorder and Body Image Network, Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Phillipa Hay
- Eating Disorder and Body Image Network, Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Mental Health Services, South West Sydney Local Health District, Campbelltown, Australia
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D'Anna G, Lucherini Angeletti L, Benvenuti F, Melani G, Ferroli M, Poli F, Villano RG, Ricca V, Rotella F. The association between sport type and eating/body image concerns in high school students: a cross-sectional observational study. Eat Weight Disord 2023; 28:43. [PMID: 37195394 DOI: 10.1007/s40519-023-01570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE Disordered eating and body image concerns are increasingly common among adolescents, possibly representing the underpinning of eating disorders (EDs). This cross-sectional observational study aimed at investigating the relationship between various patterns of sports involvement or inactivity, and the abovementioned psychopathological dimensions. METHODS All adolescents attending their 3rd-5th Italian grade in a single high school reported their sociodemographic and anthropometric data, their weekly sports involvement, and filled the Eating Disorders Examination Questionnaire 6.0 (EDE-Q), the Body Uneasiness Test, and the Muscle Dysmorphia Disorder Inventory (for boys). Comparisons were performed considering sex, weekly hours of activity, and different sports type (none, individual, or team sports). RESULTS Of 744 enrolled students, 522 (70.2%) completed the survey. Girls showed higher underweight rates, preference for inactivity or individual sports, and higher psychometric scores compared to boys. Among girls, no differences were found based on time spent exercising or sports type. Inactive boys displayed worse weight- and shape-based psychopathology, higher body uneasiness, and higher appearance intolerance compared to those who devoted more time to exercise. Among boys, individual and team sports were associated with lower EDE-Q scores compared to inactivity, whereas body uneasiness and appearance intolerance were lower only in team sports. CONCLUSIONS The study confirms the presence of remarkable sex differences in eating and body concerns of adolescents. Among boys, sports involvement is tied to lower ED psychopathology, and preference for team sports may be associated with reduced concerns. Wider longitudinal studies on will clarify the direction and specificity of these findings. LEVEL OF EVIDENCE Level V-Cross-sectional observational study.
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Affiliation(s)
- Giulio D'Anna
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Lorenzo Lucherini Angeletti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Federica Benvenuti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Giulia Melani
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Marco Ferroli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Francesca Poli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Rita Giulia Villano
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Francesco Rotella
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy.
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Roberts SR, Hay P, Bussey K, Trompeter N, Lonergan A, Mitchison D. Associations among relationship status, gender, and sexual attraction in Australian adolescents' eating pathology. Int J Eat Disord 2023; 56:551-561. [PMID: 36420932 DOI: 10.1002/eat.23861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Engaging in romantic relationships in adolescence may inadvertently increase participation in appearance culture and the risk for eating pathology. Little research has considered this effect, particularly as it relates to adolescents' gender identity and sexual attraction. Therefore, this study examined the associations among relationship status, gender, and sexual attraction in adolescents' eating pathology. METHODS Data from the first wave of the EveryBODY study, a large sample of Australian adolescents aged 11-19 years (n = 3262, Mage = 15.00, 53.80% girls), were used. Participants reported their relationship status and eating pathology (fasting, purging, binge eating, driven exercise, steroid use, and shape/weight concerns) using an online survey. RESULTS Logistic regressions adjusting for age and BMI percentile revealed that romantic relationships were associated with higher adjusted odds (AORs) for reporting clinical frequency/severity threshold of fasting, purging, steroid use, and shape and weight concerns (AORs: 1.34-3.68). Relative to boys, girls had higher adjusted odds of reporting clinical frequency/severity threshold of all eating disorder features (AORs: 1.47-7.40), except for steroid use for muscle gain. Adolescents who reported same-sex attraction, were unsure of their sexual attraction, or did not endorse any sexual attraction had greater adjusted odds of reporting clinical frequency/severity threshold of fasting, purging, and shape and weight concerns (AORs: 1.35-1.83) than those with only other-sex sexual attraction. Interactions among relationship status, gender, and sexual attraction were nonsignificant. CONCLUSIONS Romantic experience emerged as a novel correlate for adolescents' eating pathology. Future research should uncover the contextual factors within relationships that may contribute to this association. PUBLIC SIGNIFICANCE The initiation of romantic relationships is normative during adolescence. However, adolescents' romantic desirability is often determined by their physical appearance, increasing the risk for eating pathology. Among a large sample of Australian adolescents, romantic involvement was associated with greater likelihood of clinical threshold eating pathology for adolescent boys and girls, regardless of sexual attraction. It is urgent to identify the factors within romantic relationships that are associated with eating pathology.
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Affiliation(s)
- Savannah R Roberts
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Phillipa Hay
- Eating and Body Image Group, Translational Health Research Institute, School of Medicine, Western Sydney University, Australia
| | - Kay Bussey
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Nora Trompeter
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Alexandra Lonergan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Australia
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12
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Ganson KT, Hallward L, Rodgers RF, Testa A, Jackson DB, Nagata JM. Contemporary screen use and symptoms of muscle dysmorphia among a national sample of Canadian adolescents and young adults. Eat Weight Disord 2023; 28:10. [PMID: 36790649 PMCID: PMC9930713 DOI: 10.1007/s40519-023-01550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/02/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE Screen time has been previously linked to body dissatisfaction and eating disorder behaviors. However, less is known about whether use of common forms of screen technology is associated with symptoms of muscle dysmorphia (MD), which was the aim of this study. METHODS Data from the Canadian Study of Adolescent Health Behaviors (N = 2538) were analyzed. Associations between hours of use of six contemporary forms of recreational screen time, as well as total screen time, and symptoms of MD were determined using multiple linear regression models, stratified by gender, and adjusting for potential confounders. RESULTS Among both men and women, greater total screen time and texting were associated with greater symptoms of MD; however, differences emerged across the screen time modalities by gender. Among women, video chatting was most strongly associated with symptoms of MD, while social media use was most strongly associated with symptoms of MD among men. CONCLUSION Findings add to the growing literature documenting the potentially harmful correlates of screen time by including MD symptomatology. Findings have important implications for health care, public health, and policymaking professionals. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada.
| | - Laura Hallward
- School of Kinesiology, Western University, London, ON, Canada
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, MA, USA.,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, Montpellier, France
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
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13
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Merhy G, Moubarak V, Hallit R, Obeid S, Hallit S. The indirect role of orthorexia nervosa and eating attitudes in the association between perfectionism and muscle dysmorphic disorder in Lebanese male University students - results of a pilot study. BMC Psychiatry 2023; 23:55. [PMID: 36670380 PMCID: PMC9854036 DOI: 10.1186/s12888-023-04549-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The literature highly concentrates on disorders related to body image among women but only minimally when it comes to the male population; hence, in order to provide general practitioners, and primary care physicians in general, and psychiatrists in particular, with additional information concerning muscle dysmorphia among male university students in Lebanon, this study seemed essential, and was therefore conducted to (1) identify the prevalence of MDD, and (2) evaluate the indirect effect of eating attitudes in general and orthorexia nervosa in particular, in the association between perfectionism and muscle dysmorphic disorder (MDD) among a sample of male university students. METHODS In this cross-sectional study conducted between September 2021 and May 2022, 396 male university students from multiple universities in Lebanon filled the online Arabic questionnaire. RESULTS The results showed that 26 (6.6%) of the participants had MDD. Orthorexia nervosa and eating attitudes mediated the association between perfectionism and MDD; higher perfectionism was significantly associated with higher ON and more inappropriate eating; higher ON and more inappropriate eating were significantly associated with higher MDD, whereas perfectionism had a significant total direct effect on MDD. The high prevalence of MDD among male university students in Lebanon implies further investigation on the national level in the country. CONCLUSION Awareness campaigns among the university students could be adopted at the national level to increase the level of knowledge on the concepts of obsessive self-destructive perfectionism, orthorexia nervosa and muscle dysmorphia.
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Affiliation(s)
- Georges Merhy
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Verginia Moubarak
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Rabih Hallit
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon ,Infectious Disease Department, Notre Dame des Secours University Hospital Center, Street 93, Byblos, Postal Code 3, Lebanon ,Infectious Disease Department, Bellevue Medical Center, Mansourieh, Lebanon
| | - Sahar Obeid
- grid.411323.60000 0001 2324 5973Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon. .,Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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14
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Galvin J, Evans EH, Talbot CV, Wilson C, Richards G. The associations between autistic traits and disordered eating/drive for muscularity are independent of anxiety and depression in females but not males. PLoS One 2022; 17:e0276249. [PMID: 36251679 PMCID: PMC9576073 DOI: 10.1371/journal.pone.0276249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022] Open
Abstract
Previous research has shown a positive correlation between autistic traits and eating disorder symptoms, and this relationship appears to be independent of co-occurring mental health status. The current study followed a pre-registered analysis plan with the aim to investigate a previously unconsidered factor in the relationship between autistic traits and disorders of eating and body image: the drive for muscularity. Participants (N = 1068) completed the Autism Spectrum Quotient (AQ), Hospital Anxiety and Depression Scale (HADS), Eating Attitudes Test-26 (EAT-26) and Drive for Muscularity Scale (DMS). Positive correlations between AQ and EAT-26 and AQ and DMS were observed. In females, AQ remained significantly correlated with EAT-26 and DMS when controlling for co-occurring anxiety and depression symptoms, but this was not the case in males. These findings demonstrate the moderating role of sex, and the need to consider autistic traits in individuals diagnosed with, or at a heightened risk for, disorders of eating and body image.
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Affiliation(s)
- John Galvin
- Department of Psychology, Birmingham City University, Birmingham, United Kingdom
| | | | | | - Claire Wilson
- School of Education, University of Strathclyde, Glasgow, United Kingdom
| | - Gareth Richards
- Faculty of Medical Sciences, School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
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15
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Sandgren SS, Lavallee D. Intervention Development for People with Muscle Dysmorphia Symptoms: Best Practice and Future Recommendations. JOURNAL OF LOSS & TRAUMA 2022. [DOI: 10.1080/15325024.2022.2119718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Sebastian S. Sandgren
- Department of Education and Sports Science, University of Stavanger, Stavanger, Norway
| | - David Lavallee
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
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16
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The 'not-so-healthy' appearance pursuit? Disentangling unique associations of female drive for toned muscularity with disordered eating and compulsive exercise. Body Image 2022; 42:276-286. [PMID: 35841701 DOI: 10.1016/j.bodyim.2022.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 05/29/2022] [Accepted: 06/04/2022] [Indexed: 12/22/2022]
Abstract
Today, many women are driven to subscribe to a more athletically oriented appearance ideal hallmarked by muscle tone (referred to as athletic- or fit-looking). However, the constellation of unhealthy eating and exercise behaviors that may accompany the pursuit of toned muscularity among women is not yet well characterized. To address this knowledge gap, our study evaluated the associations among the female drive for toned muscularity and both thinness-oriented disordered eating behaviors (e.g., dietary restriction) and muscularity-oriented disordered eating behaviors (e.g., excessive scrutiny of macro-nutrient values of food), as well as dimensions of compulsive exercise. Participants were 388 Australian undergraduate women who completed an online questionnaire including self-report measures of said constructs. Hierarchical regression models were used to determine whether the drive for toned muscularity accounted for unique variance in eating and exercise behaviors after adjusting for theoretically relevant covariates. Results indicated independent relationships between the drive for toned muscularity and several facets of thinness- and muscularity-oriented disordered eating, as well as compulsive exercise (e.g., exercise rigidity). Our findings further contribute to an emerging literature illustrating that women driven to attain a toned appearance may be vulnerable to engaging in a wide range of maladaptive eating and exercise practices.
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17
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Compte EJ, Cattle CJ, Lavender JM, Brown TA, Murray SB, Capriotti MR, Flentje A, Lubensky ME, Obedin-Maliver J, Lunn MR, Nagata JM. Psychometric evaluation of the muscle dysmorphic disorder inventory (MDDI) among gender-expansive people. J Eat Disord 2022; 10:95. [PMID: 35794647 PMCID: PMC9260975 DOI: 10.1186/s40337-022-00618-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Muscle dysmorphia is generally classified as a specific form of body dysmorphic disorder characterized by a pathological drive for muscularity and the preoccupation that one is too small or not sufficiently muscular. The majority of research on the condition has been conducted in cisgender men with a paucity of literature on gender minority people, a population that is at risk for muscle dysmorphia. One of the most widely used measures of muscle dysmorphia symptoms, the Muscle Dysmorphic Disorder Inventory (MDDI), has not been psychometrically validated for use in gender minority samples, the aim of the present study. METHODS We evaluated the psychometric properties of the MDDI in a sample of 1031 gender-expansive individuals (gender minority people whose gender identity differs from that assumed for their sex assigned at birth and is not exclusively binary man or woman) aged 18-74 who were part of The PRIDE Study, a large-scale, U.S., longitudinal cohort study. RESULTS Using a two-step, split-sample exploratory and confirmatory factor analytic approach, we found support for the original three-factor structure of the measure. The subscales showed adequate internal consistency, and convergent validity was supported based on significant associations of the MDDI subscale scores with theoretically related scores on a widely used measure of disordered eating. CONCLUSIONS These findings provided novel support for adequate psychometric properties of the MDDI in a sample of gender-expansive individuals, facilitating the use of this measure in future research on muscle dysmorphia in this understudied and at-risk population.
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Affiliation(s)
- Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Metis Foundation, San Antonio, TX, USA
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Matthew R Capriotti
- Department of Psychology, San José State University, San Jose, CA, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA.
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18
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Nagata JM, Junqueira ACP, Cattle CJ, Carvalho PHBD, Bagolin V, Murray SB, Compte EJ, Braga Costa TM, Almeida SDS, Laus MF. Validation of the Muscle Dysmorphic Disorder Inventory (MDDI) in Brazilian Women. Body Image 2022; 41:58-66. [PMID: 35228104 DOI: 10.1016/j.bodyim.2022.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/30/2022] [Accepted: 02/06/2022] [Indexed: 12/29/2022]
Abstract
Despite high levels of body dissatisfaction and an increasing drive for muscularity among Brazilian women, most of the existing literature on muscle dysmorphia focuses on men and has mainly been conducted in Western and English-speaking regions. As a result, one of the most widely used assessment tools for symptoms of the disorder, the Muscle Dysmorphic Disorder Inventory (MDDI), has not yet been evaluated in Brazilian women-an at-risk population. In the present study, we perform a psychometric evaluation of the Brazilian Portuguese translation of the MDDI in a sample of 515 women. We evaluated the factor structure using a two-step, split-sample exploratory and confirmatory factor analytic approach, which supported the original three-factor structure of the measure. Additionally, we found good internal consistency, convergent validity, and test-retest reliability of the measure. Collectively, these results support the use of the measure in Brazilian women and provide a foundation to expand the literature in this population.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, USA.
| | - Alessandra Costa Pereira Junqueira
- Department of Nutrition, University of Ribeirão Preto, Ribeirão Preto, Brazil; Department of Psychology, University of São Paulo, Ribeirão Preto, Brazil
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, San Francisco, USA
| | - Pedro Henrique Berbert de Carvalho
- NICTA, Body Image and Eating Disorder Research Group, Federal University of Juiz de Fora, Governador Valadares, Brazil; AMBULIM, Eating Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Vitoria Bagolin
- Department of Nutrition, University of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibá˜nez, Santiago, Chile; Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - Telma Maria Braga Costa
- Department of Nutrition, University of Ribeirão Preto, Ribeirão Preto, Brazil; Department of Psychology, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Maria Fernanda Laus
- Department of Nutrition, University of Ribeirão Preto, Ribeirão Preto, Brazil; Department of Psychology, University of São Paulo, Ribeirão Preto, Brazil
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19
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Grunewald W, Kinkel-Ram SS, Smith AR. Conformity to masculine norms, masculine discrepancy stress, and changes in muscle dysmorphia symptoms. Body Image 2022; 40:237-248. [PMID: 35066243 DOI: 10.1016/j.bodyim.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- William Grunewald
- Department of Psychological Sciences, Auburn University, 226 Thach Hall, Auburn, AL 36849, USA.
| | - Shruti S Kinkel-Ram
- Department of Clinical Psychology, Miami University, 90N Patterson Avenue, Oxford, OH 45056, USA.
| | - April R Smith
- Department of Psychological Sciences, Auburn University, 226 Thach Hall, Auburn, AL 36849, USA.
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20
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Prnjak K, Murray SB. The need for precision research on muscle dysmorphia: Special issue call for research on clinically diagnosed samples. Body Image 2021; 39:iii-iv. [PMID: 34452872 DOI: 10.1016/j.bodyim.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Katarina Prnjak
- School of Medicine, Western Sydney University, Sydney, Australia.
| | - Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, United States.
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