MEN, MUSCLES & MASCULINITY: THE GENERAL PRACTITIONER AND THE MALE EXPERIENCE OF BODY DISSATISFACTIONScott Griffiths | Prof. Stephen Touyz | Dr. Stuart Murray | A/Prof Jonathan Mond

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DSM V – “feeding and eating disorders”

› Anorexia nervosa- Restriction of energy

intake relative to requirements leading to significantly low weight

- Intense fear of gaining weight or persistent behaviour that interferes with weight gain

- Self-evaluation unduly influenced by body shape and weight

› Bulimia nervosa- Recurrent episodes of

binge eating

- Recurrent inappropriate compensatory behaviours to preent weight gain, e.g. purging

- Self-evaluation unduly influenced by body shape and weight

› Binge eating disorders- Recurrent episodes of

binge eating

- The binge eating is not associated with recurrent inappropriate compensatory behaviours as in bulimia nervosa

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Prevalence of eating disorders in males

› Men are no longer "immune" to eating disorders- 15-33% of anorexia and bulimia diagnoses (Hoek & Hueken, 2003; Hudson et al.

2007)

- 30-40% of binge eating disorders (Muise et al. 2003)

- 25% of early onset eating disorders (Madden et al. 2009)

- 100% increase in binge eating, purging and strict dieting amongst males from 1995 to 2005 (Hay et al. 2008)

- Rates of disordered eating amongst males are increasing faster than for females (Hay et al. in press)

- Young Australian males rate body image as their most significant concern (Mission Australia, 2007, 2010)

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But what about men trying to become more muscular?

› Like women, men desire a body low in body fat

› Unlike women, men rarely describe their ideal body as "skinny" or "thin"

› The ideal male body combines low body fat with well-developed muscles

› Both components are equally important to male body image (Bergeron & Tylka, 2007)

› Men describe their ideal body as "toned," "cut," "athletic", "ripped," or "jacked"

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Muscle dysmorphia

› "Discovered" in 1993 and named "reverse anorexia" (Pope, Katz & Hudson, 1993)

› Renamed "muscle dysmorphia" in 2001 and classified as a subtype of body dysmorphic disorder

› Criteria- Preoccupation with being lean and muscular

- At least 2 of the following:

- Giving up important activities due to a compulsive need to work out and diet

- Avoiding body exposure/enduring body exposure with intense anxiety and distress

- The preoccupation with body size/musculature causes impairments in important activities

- Continuing to work out, diet or use steroids/PEDs despite knowledge of adverse physical or psychological outcomes

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“Problematic eating attitudes and behaviours motivated by the desire to become more muscular”What makes an eating attitude or behaviour disordered/problematic?

The attitude or behaviour must be1.Rule-driven, or2.Compensatory

Definition of muscularity-oriented disordered eating:

Muscularity-oriented disordered eating

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MUSCULARITY-ORIENTED

DISORDERED EATING

MUSCULARITY-

ORIENTED DISORDERED EATING

Emotion regulation deficits(Griffiths, Angus, Murray, & Touyz, under review in Body Image)

Attentional biases(Griffiths, Angus, Murray, & Touyz, under review in Body Image)

Cognitive deficits(Griffiths, Murray, & Touyz, in press in Body Image)

Thinness-oriented disordered eating

Admiration of muscle dysmorphia (Griffiths, Mond, Murray & Touyz, under review in International Journal of Eating Disorders)

Masculinity(Griffiths, Murray, & Touyz, under review in Psychology of Men & Masculinity)

Associations with muscularity-oriented disordered eating

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Never

Rarely

Someti

mes

Often

Usuall

yAlw

ays

Muscle dissatisfaction (mean scores)

N = 286Mean = 3.14

Often to Always = 20%

Never

Rarely

Someti

mes

Often

Usuall

yAlw

ays

Body fat dissatisfaction (mean scores)

N = 286Mean = 2.87

Often to Always = 18%

Body dissatisfaction in young men

› Men are being exposed to increasingly muscular bodies

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Why are men so bothered by their appearance?

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Why are men so bothered by their appearance?

› Video games feature hypermuscular male bodies (Barlett & Harris, 2008)

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› Advertising on campus at the University of Sydney

Why are men so bothered by their appearance?

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› Messages communicated to young boys

Why are men so bothered by their appearance?

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Why are so few males in treatment?

› Men with eating disorders tell us that society believes eating disorders are a "female issue/girl's problem" (Robinson et al. 2012)

› Health professionals may believe that eating disorders are a "female issue" and may not ask the right questions

› Many psychologists will tell you that men with eating disorders are stigmatised more than women with eating disorders, but evidence for this is lacking

› Eating disorders and mental health in general are stigmatised already

› What additional elements of stigmatisation apply to men?

› Studying anorexia nervosa and muscle dysmorphia together is useful

› Anorexia nervosa may be perceived as a “female problem”

› Muscle dysmorphia may be perceived as a “male problem”

Anorexia Nervosa

Muscle DysmorphiaAnorexia Nervosa

Muscle Dysmorphia

1

2

3

4

5 Male partici-pantsFemale partic-ipants

Character diagnosis

Per

ceiv

ed m

ascu

linity

(mea

n)

› Exhibiting thiness-focused versus muscularity-focused psychopathology has a significant effect on how masculine one is perceived

› Size of this effect size is very large (η2 = .23) - The effect is even stronger

amongst male participants

- 3 times larger than the effect of participant sex on masculinity (η2 = .07)

***

= no less or more masculine

Stigmatisation and societal gender role expectations

0

50

100

150

Healthy con-trols

Anorexia ner-vosa

Con

form

ity to

mas

culin

e ro

le (m

ean)

› Men with muscle dysmorphia exhibit greater masculinity than healthy control men

› However, men with anorexia nervosa are just as masculine as healthy controls

Muscle dysmorphia

Masculinity and femininity in men with anorexia and muscle dysmorphia

Anorex

ia Nerv

osa

Muscle

Dys

morphia

0%

25%

50%

75%

100%“How much did you know about __________ before taking this survey?”

Character Diagnosis

Per

cent

age

of re

spon

ses

Never heard of it

Heard of it, but don’t know much about it

I know a lot about it

Knowledge of anorexia vs. muscle dysmorphia

“Do you know anyone who has had a problem like ________”

N = 343Error bars =

95% CIs

n.s. p >.05

Prevalence of thinness- vs. muscularity-focused psychopathology

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Challenge your stereotypes Eating disorders are not a "female" problem Males account for 25-33% of anorexia nervosa diagnoses Males account for ~25% of bulimia nervosa diagnoses Males account for 40-50% of binge eating disorder diagnoses Males probably account for >85% of muscle dysmorphia diagnoses Men with eating disorders are no less masculine than other men

- Even for anorexia nervosa, which may be perceived as the most "female/girlish" of the eating disorders

What can I do?

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Ask questions How important is it to you that you get your ideal physique?

Some guys (particularly young guys and masculine guys) baulk at discussing "body image"

Concept of body image is viewed as feminine, girlish, effeminate

"Physique" is interpreted as more gender-neutral Do you have definite rules about eating? E.g., the types of food you can eat,

when you can eat it, how much you have to eat? What happens if you break those rules? How do you feel when you meet your physique or diet goals? Do you feel

content? Do you immediately re-set your goals? How would you feel if you had a setback? For example, you badly sprained

your wrist during a workout and could not train for two months?

What can I do?

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"Ye shall not judge"- Anorexia and muscle dysmorphia are ego-syntonic

- Good chance they are in your office because of a co-morbid issue that has developed because of / in conjuntion with the eating disorder

- Depression and anxiety are common, but also substance abuse, bipolar disorder, obsessive-compulsive disorder

- If disclosed to you, do not pass strong negative judgements about steroid use

- Steroid use in samples of men with muscle dysmorphia has ranged from 33% to 90%

- Men with muscle dysmorphia who use steroids are not "junkies," they extend the same metitcioulsness over their diet and training to their steroid use

- Attacking the steroids might win you the battle but will cost you the war

What can I do?

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› Breaking down the masculinity / ego-syntonic barrier in that first meeting- Frame your collaboration as trying to relieve negative emotions, not change

behaviour

- "My goal here is not to try and change your diet or your workouts. I hear you when you say that watching what you eat and excerising regularly are positives in your life. What I want for you is to be able to diet and train without the negatives; the guilt you feel when you eat something you shouldn't, the embarassment you feel when you examine your physique in the mirror... Does that sound like something worth working towards?"

- Use whatever terms they use to describe their emotions and be prepared for little emotional insight and intolerance of emotional vulnerability

- Male with muscle dysmorphia, age 27: "It's like I'm working a dumbell 24/7. It's physically right there. Gear [steroids] make it go away, training hard make it go away, but if I stuff up my eating or skip the gym the dumbell is right back there sitting on my head or in my chest and I have to train it away again. I get so frustrated that it's even there. Fucking feelings are wrecking my life."

What can I do?