Clinical features of muscle dysmorphia among males with body dysmorphic disorder

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.     

Body checking and avoidance and the core features of eating disorders among obese men and women seeking bariatric surgery

This study examined two aspects of body checking and avoidance, and their relations to the core psychopathology of eating disorders (EDs), in severely obese men and women seeking bariatric surgery. A consecutive series of 260 (44 male and 216 female) gastric bypass candidates were administered measures to assess body checking and avoidance, binge eating, restraint, and overevaluation of weight and shape. The majority of patients reported regularly pinching areas of their body to check for fatness and avoided wearing clothing that made them particularly aware of their body. Significant associations were observed between checking and restraint, and between avoidance and binge eating. Both checking and avoidance behaviors were significantly associated with overevaluation of weight and shape. The positive associations between each of the two behaviors (body checking and avoidance) with overevaluation of weight/shape remained significant even after controlling for the effects of avoidance on body checking and vice versa. Stepwise multiple regression analyses revealed that binge eating, body checking, and avoidance behaviors made significant unique contributions and jointly accounted for 22-25% of the variance in overevaluation of weight and shape, respectively. This study documents the presence of eating disorder psychopathology among severely obese patients seeking bariatric surgery. The findings support the view that body checking and avoidance behaviors are manifestations of overevaluation of weight and shape and disordered eating.     

Is body checking in the eating disorders more closely related to diagnosis or to symptom presentation?

Body checking behaviours and cognitions are seen as underlying the core pathology of eating disorders-the over-evaluation of eating, shape and weight. While it has been demonstrated that levels of behaviours and cognitions differentiate eating-disordered women from non-eating-disordered women, little is known with regard to how these findings relate to diagnostic group. This study aimed to determine whether body checking cognitions and behaviours are best understood with regard to diagnostic category or symptom presentation. Eighty-four eating-disordered women (with diagnoses of anorexia nervosa, bulimia nervosa, binge eating disorder or other Eating Disorders Not Otherwise Specified) completed measures of body checking behaviours and cognitions and eating psychopathology. Results showed that different aspects of body checking were more closely associated with diagnosis and with symptom presentation. Anorexia nervosa and binge-eating-disorder patients had particularly low levels of body checking behaviours and some related cognitions. However, the belief that body checking allows one to be accurate in knowing one's weight was associated with binging and vomiting behaviours, rather than diagnosis. Future directions for research include understanding the links between body checking phenomena and neurological features. Clinical implications are discussed.     

A comparison of eating, exercise, shape, and weight related symptomatology in males with muscle dysmorphia and anorexia nervosa

In the context of the lack of nosological clarity surrounding muscle dysmorphia, this paper aims to compare the symptomatic profile of muscle dysmorphia and anorexia nervosa in males whilst using measures sensitive to indexing male body image concerns. Twenty-one male muscle dysmorphia patients, 24 male anorexia nervosa patients, and 15 male gym-using controls completed the Eating Disorder Examination-Questionnaire, the Muscle Dysmorphia Disorder Inventory, the Compulsive Exercise Test, and a measure of appearance-enhancing substance use. Men with muscle dysmorphia and anorexia nervosa demonstrated widespread symptomatic similarities spanning the domains of disturbed body image, disordered eating, and exercise behaviour, whilst differences were consistent with the opposing physiques pursued in each condition. Furthermore, correlational analyses revealed significant associations between scores on muscle dysmorphia and eating disorder measures. The present findings provide moderate support for the notion that muscle dysmorphia may be nosologically similar to anorexia nervosa.     

Body checking and avoidance among behavioral weight-loss participants

The present study examined the psychological and weight-related correlates of body checking and avoidance behaviors in individuals who have lost weight through obesity treatment. Among 185 individuals in behavioral weight-control treatment, the prevalence of body checking and avoidance behavior was assessed, as well as the relationship of checking and avoidance to attitudinal disturbances, weight loss, and perception of struggling in treatment. Checking and avoidance were frequent, and they correlated significantly with higher overvaluation of shape and weight, lower self-esteem, greater body dissatisfaction, higher fear of fat, and the perception of greater struggling in weight-loss treatment. Checking was inversely correlated with the percentage weight lost in treatment and BMI lost but not related to pre-treatment or current BMI. Thus, body checking and avoidance behaviors were associated with psychological disturbances and poorer treatment outcome.     

Body image importance and body dissatisfaction among indigenous Australian adolescents

Despite their elevated risk of health problems and a propensity to be more overweight or underweight relative to the other members of the Australian population, there has been no previous investigation of body image concerns among Indigenous Australians. In this study we investigated the level of body image importance and body image dissatisfaction among 19 rural Indigenous adolescents (7 males, 12 females) and 28 urban Indigenous adolescents (15 males and 13 females). Our hypotheses that there would be gender differences in body image importance and body image satisfaction were not generally supported. However, males placed more importance on muscle size and strength than females, and rural participants placed more importance on weight than urban participants. Comparison to existing data obtained from Caucasian adolescents suggested that Indigenous youth may be less concerned and dissatisfied with body weight and shape. These results are discussed in relation to findings from studies of non-Indigenous adolescents, and Indigenous health issues. The limitations of the current study and the need for further studies are also discussed.     

An experimental analysis of body checking

The relationship between repeated body checking and its impact on body size estimation and body dissatisfaction is of interest for two reasons. First, it has importance in theoretical accounts of the maintenance of eating disorders and, second, body checking is targeted in cognitive-behavioural treatment. The aim of this study was to determine the impact of manipulating body checking on body size estimation and body dissatisfaction. Sixty women were randomly assigned either to repeatedly scrutinize their bodies in a critical way in the mirror ("high body checking") or to refrain from body checking but to examine the whole of their bodies in a neutral way ("low body checking"). Body dissatisfaction, feelings of fatness and the strength of a particular self-critical thought increased immediately after the manipulation among those in the high body checking condition. Feelings of fatness decreased among those in the low body checking condition. These changes were short-lived. The manipulation did not effect estimations of body size or the discrepancy between estimations of body size and desired body size. The implications of these findings for understanding the influence of body checking on the maintenance of body dissatisfaction are considered.     

Consequences of Repeated Critical Versus Neutral Body Checking in Women With High Shape or Weight Concern

Body checking is a repeated behavior conducted in an attempt to gain information about one’s shape, weight, size, or body composition. Body checking is associated with negative behavioral, emotional, and cognitive outcomes and may maintain body dissatisfaction and eating disorders. The precise function and consequences of body checking remain less well understood. Specifically, immediate and delayed impacts of repeated critical body checking (CBC) have not been determined. The current study randomly assigned 142 young women with high shape/weight concern to daily 10-min CBC, neutral body checking (NBC), or a non-body critical checking (NBCC) comparison condition, examining their immediate and delayed (one-week follow-up) effects on body satisfaction, self-esteem, and negative affect. Multilevel modeling and follow-up planned comparisons found that compared to NBCC, CBC participants’ body satisfaction and self-esteem immediately decreased, but negative affect improved from baseline to follow-up. Compared to CBC, NBC participants’ self-esteem and negative affect improved immediately, and their self-esteem improved over time compared to NBCC. Over time, all participants’ state body satisfaction improved, regardless of condition. Our findings suggest a 10-min CBC session may function differently than typical (harmful) in vivo body checking. However, reasons for this difference are unclear. Additional research is needed to distinguish (harmful) in vivo body checking from CBC procedures such as this and other mirror exposure interventions. Research is needed to examine the effects of varying CBC duration and instructions during body exposure to further clarify mechanisms of change during body exposures.     

Muscularity concerns among men: development of attitudinal and perceptual measures

The current study reports the development and psychometrics of a figure rating scale with leanness and muscularity dimensions and a 13-item questionnaire assessing symptoms associated with muscle dysmorphia (MD). Three separate samples of men and women completed the muscle dysmorphic disorder inventory (MDDI), the bodybuilder image grid (BIG) or both to measure 1-week test–retest reliability, internal consistency, convergent and divergent validity and valid placement of BIG figures along interval scales of body fat and lean muscle mass. The MDDI and MDDI subscales (drive for size, appearance intolerance, and functional impairment) had good reliability, internal consistency, convergent and divergent validity. The BIG had good to excellent test–retest reliability, good convergent and divergent validity and validity as an interval scale. Implications for characterizing body image disturbance in men and benefits and limitations of the measures are discussed.     

Overconcern with weight and shape is not the same as body dissatisfaction: evidence from a prospective study of pre-adolescent boys and girls

Overconcern with weight and shape and body dissatisfaction have both emerged as significant predictors of disordered eating. However, it is unclear how these constructs relate to each other, and if each has different antecedents and consequences. This study aimed to identify prospective predictors of each construct and to determine their relative importance in predicting dietary restraint and binge eating. Eight- to 13-year-old boys and girls (N = 259) were assessed at baseline and one-year follow-up, using a range of measures that included the Child Eating Disorder Examination. Psychosocial variables predicted overconcern with weight and shape whilst objective weight predicted body dissatisfaction. Body dissatisfaction and weight and shape concern predicted restraint, and weight and shape concern and restraint predicted binge eating. Findings provide support for the theoretical differences between body dissatisfaction and overconcern with weight and shape, and highlight the importance of focusing on specific body image variables.     

Body image and tobacco cessation: relationships with weight concerns and intention to resume tobacco use

Concern about weight gain after tobacco cessation is a potential barrier to quitting tobacco. Few studies, however, have examined the role of body image in cessation-related weight concerns and anticipated relapse. This study investigated relationships between current body image dissatisfaction, anticipated body image dissatisfaction (discrepancy between anticipated post-cessation body shape and desired body shape), cessation-related weight concerns, and intention to resume tobacco with weight gain. Body image dissatisfaction was significantly related to cessation-related weight concerns. Participants who reported current dissatisfaction with their body image were 2.6 times more likely to intend to resume tobacco use with cessation-related weight gain than those with no body image dissatisfaction. Individuals with anticipated body image dissatisfaction were 3.4 times more likely to intend to resume tobacco compared to individuals with no anticipated body image dissatisfaction. Women and normal weight individuals with anticipated body image dissatisfaction appear to be at particularly high risk for intending to relapse. Results suggest that tobacco cessation interventions may need to target concerns about body image as well as weight gain.     

A Cross-Cultural Exploration: Body Image in Older Black and White Women in the Workplace

This study investigated body image attitudes in a non-clinical sample of black and white older professional women in the workplace in South Africa. Participants were 125 professional women (white woman n=76 and black women n = 49). They completed the shortened version of the Body Shape Questionnaire (BSQ) (Cooper, Taylor, Cooper & Fairburn, 1987). The BSQ is a self-report instrument that measures weight and shape concerns. One-way analysis of variance (ANOVA) and t-tests for independent samples were used to determine the univariate relationships between variables. Following this, a two-way analysis of Variance (ANOVA) was conducted to explore the interaction between ethnicity and BMI. The results indicate that Body Mass Index (BMI) and ethnicity are significantly and independently related to the body shape image. Women with higher BMI scores tended to have more concern about their bodies. Black women with higher BMI scores had more concerns than their white colleagues.     

Relationships between dissatisfaction with specific body characteristics and the Sociocultural Attitudes Toward Appearance Questionnaire-3 and Objectified Body Consciousness Scale

Body dissatisfaction was studied in 123 predominately European-American college women. Desired changes in body characteristics were associated with scores on the Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ-3) and the Objectified Body Consciousness Scale (OBCS). All SATAQ-3 measures were associated with desired changes in bust size and height, but were not related to desired upper body size. In contrast, the OBCS Surveillance and Body Shame Scales were related to desired upper body size, but were not related to desired bust size or height. As hypothesized, the SATAQ-3 Pressure and Internalization-General Scales and the OBCS Surveillance and Body Shame Scales were related to desired weight and lower body size. Results indicate body dissatisfaction is a complex construct and different aspects of this construct are related to different dispositional measures. Results also indicate that the OBCS is a more narrowly focused measure than the SATAQ-3.     

Development of the Muscle Appearance Satisfaction Scale: a self-report measure for the assessment of muscle dysmorphia symptoms

Muscle dysmorphia has recently been described as a variant of body dysmorphic disorder that involves an intense preoccupation with one's perceived lack of muscle size. Currently, no assessment measures specific to the cognitive, affective, and behavioral dimensions of the construct of muscle dysmorphia have been published. To address this need, the authors developed the Muscle Appearance Satisfaction Scale (MASS), a brief 19-item self-report measure for the assessment of muscle dysmorphia symptoms. Psychometric evaluation of the MASS across two samples of male weight lifting participants (total N = 372) revealed a stable five-factor structure. An evaluation of factor content resulted in the following factor labels: Bodybuilding Dependence, Muscle Checking, Substance Use, Injury, and Muscle Satisfaction. Internal consistency, test-retest reliability, and construct validity were established with the MASS total score and its subscales. The authors believe the MASS will be a useful measure for research and applied work relating to muscle dysmorphia.     

Sociocultural influences on adolescent boys' body image and body change strategies

Society provides messages about how people should ideally look and previous research has indicated these messages, both the actual messages provided and the perception of the message, influence body image. Research into male body image has shown males are concerned with having a lean and muscular body and as such, may want to decrease fat and increase their muscles. This paper explored the influence of a range of messages from parents, peers, and the media on a number of different measures of 362 adolescent boys’ body image and body change strategies. Specifically, messages about shape, food, exercise, losing weight and increasing muscles were explored in relation to satisfaction with weight and muscles, and the use of strategies to decrease weight and increase muscles. The findings indicated that parental messages were the strongest influence on body image and that parents, the media, and to a lesser extent messages from male friends were the strongest predictors of body change strategies.     

Body dissatisfaction and body change behaviors in Chile: the role of sociocultural factors

With interest in body image and body change behaviors growing around the world, there has been surprisingly little research conducted in Latin America on these issues. In order to gain some understanding of them in this context, this study investigated body image and body change behaviors, and the sociocultural factors that may influence them, among 337 Chilean adolescents aged 12–18 years. Participants completed a questionnaire that assessed BMI, body dissatisfaction, strategies to lose weight and strategies to increase muscle bulk. In addition, perceived pressure from family, peers, and the media to change body shape was evaluated. Results were partially consistent with those reported in Western nations. Girls were found to report greater body dissatisfaction than boys, but no difference was found between males and females in perceived pressure from adults in the family or from older siblings/cousins to lose weight. However, girls experienced higher levels of perceived pressure to lose weight from the media than boys, and boys reported greater perceived pressure from peers to lose weight than girls, and more pressure than girls from all sources to increase muscle bulk. These findings are discussed in relation to research conducted in other contexts, and it is concluded that findings from other locations may not be applied universally.     

Body ideals in women after viewing images of typical and healthy weight models

Viewing thin models, pervasive in popular culture, is correlated with body dissatisfaction and anxiety in women. Whether or not the same is true when viewing healthy weight models is unknown. In this study we tested whether viewing healthy weight models increases the ideal female body size. Body image, anxiety, happiness and depression were measured in 44 female participants following viewing of images of thin or healthy weight models (within-subject separated by two weeks). We found that after viewing images of healthy weight models, women's body ideals (as measured by a participant-adjusted virtual model) were significantly larger than when the same women viewed images of very thin models. This effect was greatest in those women with the highest levels of baseline anxiety (as measured by the Hospital Anxiety and Depression Scale). These results suggest that viewing healthy weight models results in more healthy body ideals than those typically promoted through media.     

A naturalistic study of fat talk and its behavioral and affective consequences

Fat talk is a style of verbal expression among young women involving negative self-statements, complaints about physical appearance, and weight management. This research used ecological momentary assessment to examine the impact of naturalistic fat talk experiences on body dissatisfaction, body checking, negative affect, and disordered eating behaviors. We examined trait self-objectification as a moderator. Sixty-five female college students completed a baseline questionnaire and responded to questions when randomly prompted by palm pilot devices for five days. Results indicated fat talk is common and associated with greater body dissatisfaction, body checking, negative affect, and disordered eating behaviors. Fat talk participation was associated with greater body checking than overhearing fat talk. Greater trait self-objectification was associated with greater body dissatisfaction and body checking following fat talk. These results suggest that fat talk negatively impacts the cognitions, affect, and behavior of young women and has increased negative effects for women higher in self-objectification.     

Casting weight goal as a function of weight status among a representative population-based sample of adolescents

This paper pursues two objectives: (1) to estimate proportions of adolescents with a weight goal that matched and mismatched weight status, and (2) to identify correlates of a mismatched weight goal. Data were from a representative population-based sample of adolescents (n = 2346, 51% female; 91.5% complete data). Results showed that 69% of adolescents had a weight goal that matched weight status whereas 31% had a weight goal that mismatched weight status. Body dissatisfaction was a significant predictor of having a mismatched weight goal for both sexes while elevated psychological distress was a predictor among girls. Being body dissatisfied mediated the association between psychological distress and having a mismatched weight goal among girls. Casting weight goal as a function of weight status may allow for a better understanding of overall weight management strategies.     

Body dissatisfaction,engagement in body change behaviors and sociocultural influences on body image among Chinese adolescents

Body dissatisfaction and body image disorders are becoming increasingly prevalent in developing non-Western countries such as China, but there is a lack of research examining the sociocultural factors that in other contexts have been associated with these problems. The current study investigated body dissatisfaction, engagement in body change behaviors, and sociocultural pressures on body image, and the relationships between these variables among 517 adolescent males (N = 219) and females (N = 298) in China. Females reported greater body dissatisfaction than males, and males reported using strategies to increase their muscle bulk more often than females. Males reported pressure from a variety of sociocultural sources to increase their muscles or weight, while females reported pressure from the media to lose weight. For males body dissatisfaction was predicted by pressure from peers to increase their muscle bulk, while for females pressure to lose weight from peers, adult relatives, and the media was likely to increase body dissatisfaction. Pressure from the media and adult relatives was also predictive of body change behaviors in both males and females. The findings are discussed in relation to previous research in both Western and non-Western contexts.