Bridging eating disorder and muscle dysmorphia symptoms: The role of fear.

Eating disorder (ED) symptoms correlate with suicidality; yet the strength of these relationships in men is unclear. Muscle dysmorphia (MD) symptoms may reflect a more accurate index of body-related concerns for men, as they better target muscularity concerns typical of men. However, no studies have tested a model in which ED/MD symptoms and suicidality are simultaneously examined. We longitudinally tested whether ED/MD symptoms were related to suicidal ideation among a community sample of men. Men with MD symptoms (N=272) were recruited to complete three surveys over 6 weeks. A random intercepts cross-lagged panel model tested predictive associations between ED/MD symptoms and suicidal ideation, while disaggregating between/within-person variance. ED/MD symptoms were significantly associated with suicidal ideation at the between-subjects level (ED: b=.04; MD: b=.09) and showed significant within-wave covariances with suicidal ideation (ED: b=.02-.04; MD: b=.02-.05). Those who experienced increases in ED symptoms showed increased suicidal ideation at the next wave (b=.32). Those who experienced increases in suicidal ideation showed increases in MD symptoms at the next wave (b=.85). Results highlight ED symptoms as a potential risk factor for suicidal ideation among men. Further, suicidal ideation predicted MD symptoms. ED symptoms may create intra- and interpersonal distress predicting suicidal ideation. Suicidal ideation may lead to muscle-building behaviors to cope with suicidal thoughts. Clinicians should assess for suicidal ideation among men at risk for MD/EDs, and for MD symptoms among those reporting suicidal ideation. Eating disorder (ED) symptoms are related to suicidality, but these relationships are understudied among men. Since men report concerns surrounding muscularity, muscle dysmorphia (MD) may be a better ED index for this population. However, little research has investigated relationships between ED symptoms, MD symptoms, and suicidality among men. This study investigated relationships between ED/MD symptoms and suicidality among 272 men. Results may inform clinical assessment, treatment, and classification of MD.

To test the efficacy of a dissonance-based (DB) intervention in targeting risk factors for eating disorders (EDs) and predisposing factors for muscle dysmorphia (MD) symptoms in body-dissatisfied Brazilian men over 1 year of follow-up and evaluate whether reductions in body-ideal internalization would mediate the intervention's impact on ED and MD symptoms. Participants were randomized to a two-session DB intervention (n=89) or assessment-only control (AOC) (n=91), and completed validated measures assessing body-ideal internalization, body dissatisfaction, ED, and MD symptoms at baseline, post-intervention, 1-month, 6-month, and 1-year follow-ups. The DB condition showed significantly greater reductions in MD symptoms and body dissatisfaction compared with the AOC group over a 1-year follow-up, while significant differences were not observed for body-ideal internalization and ED symptoms. Changes in body-ideal internalization from baseline to 1-month follow-up completely mediated the relationship between condition and the changes observed in both ED and MD symptoms. These results provide further evidence of the efficacy of the tested intervention through 1-year follow-up in reducing body dissatisfaction and MD symptoms, but no such result was observed for body-ideal internalization and EDs. Our findings provide support for theoretical models of eating pathology and MD symptoms in Brazilian men.

The ego-syntonic nature of anorexia nervosa means that sufferers often deny their symptoms or experience them as positive or comforting. Positive beliefs about eating disorder symptoms may contribute to the development and/or maintenance of eating-disordered behaviour. To date, however, research in this field has been confined to women and anorexia nervosa. Given increasing scientific interest in muscle dysmorphia, a potential eating disorder with ego-syntonic qualities, there is a need to extend current research to include men and muscle dysmorphia. The present study examined whether positive beliefs about anorexia nervosa and muscle dysmorphia were associated with more marked eating disorder symptoms and explored sex differences in these associations. Male and female university students (n = 492) read descriptions of a male or female character with clinically significant symptoms of anorexia nervosa or muscle dysmorphia. Participants subsequently answered questions about the characters and completed a measure of disordered eating. Knowledge, personal history and interpersonal familiarity with the conditions were assessed. Results from two simultaneous multiple regressions showed that more positive beliefs about anorexia nervosa and muscle dysmorphia were uniquely associated with more eating disorder symptoms for both male and female participants. Effect sizes for these relationships were medium to large (partial eta-squared = 0.09-0.10). The relationships were not moderated by the sex of the participant, nor the sex of the character. Although preliminary, these findings suggest that, among young men and women, positive beliefs about anorexia nervosa and muscle dysmorphia may contribute to the development and maintenance of these conditions. Some symptoms of muscle dysmorphia may be perceived as ego-syntonic, providing another parallel with anorexia nervosa.

The current study aimed to (a) determine the rates of symptoms of muscle dysmorphia (MD), body dysmorphic disorder (BDD), and eating disorder; (b) determine the relationships among symptoms of MD, BDD, and eating disorders; and (c) provide a comprehensive comparison of symptoms of MD, BDD, and eating disorders in a nonclinical population of adult male weightlifters in Australia. The participants (N = 648, mean age = 29.5 years, SD = 10.1) participated in an online survey, consisting of Muscle Appearance Satisfaction Scale, the Body Dysmorphic Disorder Questionnaire, and the Eating Attitude Test-26. Results indicated that 110 participants (17%) were at risk of having MD, 69 participants (10.6%) were at risk of having BDD, and 219 participants (33.8%) were at risk of having an eating disorder. Furthermore, 36 participants (5.6%) were found at risk of having both MD and BDD, and 60 participants (9.3%) were at risk of having both MD and an eating disorder. Significant correlations and associations were found between symptoms of MD and BDD, and symptoms of MD and eating disorders. Support was provided for the comorbidity of, and symptomatic similarities between, symptoms of MD and BDD, and symptoms of MD and eating disorders. This may reflect a shared pathogenesis between symptoms of MD, BDD, and eating disorders. Strength and conditioning professionals, exercise scientists, athletic trainers, and personal trainers should be aware that adult males who are working out with weights (i.e., free weights or machines) may be at increased risk of having MD, BDD, and eating disorders.

Despite the high rates of suicidality in body dysmorphic disorder and eating disorders (EDs), research on suicidality in a related disorder, muscle dysmorphia (MD), is essentially nonexistent. Thus, this study tested relations between suicidal thoughts and behaviors and MD and ED symptoms in an online male community sample. A total of 464 males (Mage = 40.3; 85% Caucasian) recruited from Amazon's Mechanical Turk completed measures that evaluated ED symptoms, MD symptoms, current suicidal ideation, and past suicide attempts. Most MD and ED symptoms were correlated with current suicidal ideation and previous suicide attempts. In multivariate regression models, vomiting and appearance intolerance remained significantly related to suicidal ideation, while hard exercise and lower functional impairment were significantly related to prior suicide attempts. Results indicate that appearance dissatisfaction, a core MD criterion, and hard exercise, a common behavioral symptom of MD, are associated with suicidality.

Adolescents and young adults are at heightened risk for eating disorder (ED) and muscle dysmorphia (MD) symptoms; yet, these symptoms and their relationships to harmful behaviors may also vary by gender. Thus, this study examined: 1) the prevalence of attempts to lose, gain, or maintain the same weight across gender identities, 2) purposes of weight change attempts, and 3) relationships between weight change attempts and ED and MD symptoms across cisgender men, women, and transgender and gender expansive (TGE) youth. 940 adolescents and young adults (57.4% cisgender women, 33.8% cisgender men, 8.8% TGE) completed questionnaires about weight change attempts, ED and MD symptoms. Women and TGE individuals attempted to lose weight more often than men, while men attempted to gain weight more often. All genders endorsed weight loss and gain attempts for different purposes. Weight loss attempts related to ED symptoms and appearance intolerance, whereas weight gain attempts related to MD symptoms across genders. In women, all weight change attempts related to greater functional impairment due to exercise. Findings highlight the need for tailored interventions to address desires to change one’s body and underscore the harmful effects of weight change attempts across genders.

ObjectiveIn the tripartite influence model, appearance‐ideal internalization is identified as a prominent risk factor for the development of body dissatisfaction and subsequent eating disorder (ED) behaviors. For men, prior research has emphasized the importance of both thin‐ideal internalization and muscular‐ideal internalization in explaining later ED behaviors and muscle dysmorphia (MD) symptoms. Previous research in heterosexual men has shown that the associations between muscular‐ideal internalization and ED or MD symptoms may depend on whether the individual has also internalized the thin ideal. However, this interaction has not been examined in research with sexual minority men (SMM).MethodThe current study collected self‐report data from 452 at risk SMM (i.e., endorsed body dissatisfaction), with ages ranging from 18 to 35 years. Linear regression models were conducted to test the interaction effects between thinness and muscularity internalization on ED symptoms, MD behaviors, and general body dissatisfaction. Simple slopes and the Johnson–Neyman technique were used to investigate significant interaction terms.ResultsThin‐ and muscular‐ideal internalization were positively associated with muscular appearance intolerance and dietary restriction with no significant interaction. Muscular drive for size was highest when both muscularity internalization and thinness internalization were high. Muscular‐ideal internalization was positively associated with both cognitive restraint and general body dissatisfaction, but only at lower levels of thinness internalization.DiscussionGiven the interacting association between thinness and muscularity internalization and aspects of body dissatisfaction, attitudes, and behavior, prevention and intervention programs for EDs and MDs in SMM should seek to dismantle both thinness and muscularity internalization.Public Significance StatementInternalizing—or adopting as one's own—the ideal of a body with low body fat and high muscularity has been shown to lead to muscle dysmorphia and eating disorder symptoms in men. The current study examines whether the combination of thin‐ideal and muscular‐ideal internalization is associated with worse symptoms than either facet alone in sexual minority men. Treatment efforts in sexual minority men should address both types of internalization.

Few prevention programs have been developed and empirically evaluated to address eating disorder (ED) and muscle dysmorphia (MD) symptoms in men. Furthermore, new strategies for the broad implementation of available programs are needed. We investigated the acceptability and efficacy of a dissonance-based (DB) intervention for Brazilian undergraduate men with body dissatisfaction to target risk and protective factors for ED and MD symptoms (the Body Project: More Than Muscles) after an online training for facilitators. Participants were randomized to a two-session DB-intervention (n = 89) or assessment-only control (AOC) (n = 91), and completed validated measures assessing ED and MD risk and protective factors pre-intervention, post-intervention, and at 4- and 24-week follow-up post-intervention. Acceptability ratings were highly favorable. Regarding efficacy, the DB condition demonstrated significantly greater decreases in ED and MD risk factors compared to AOC from pre-intervention to 4-week (p-values <.05, between-condition Cohen's d = 0.35-1.10) and 24-week follow-up (p-values <.05, between-condition Cohen's d = 0.33-0.78). Results at post-intervention were not significant, with the exception that body appreciation showed significantly greater improvements in the DB condition (post-intervention: p < .01, between-condition Cohen's d = 0.40; 4-week: p < .001, between-condition Cohen's d = 0.80; and 24-week follow-up: p < .001, between-condition Cohen's d = 0.58). Results support the acceptability and efficacy of a DB-intervention delivered in-person after an online training for facilitators up to 24-week follow-up in Brazilian men.

This study examined the mediating role of self-oriented and socially prescribed perfectionism in the relationship between sociocultural influences (i.e., media, peer, and teasing) and symptoms of muscle dysmorphia (MD) and eating disorders (ED). A nonclinical sample of males (N = 158, Mage = 26.94, SD = 5.50) completed measures of perfectionism, MD, body dissatisfaction, drive for thinness, and bulimia. Susceptibility to appearance-based messages from the media, their peers, and family was also measured. Analyses confirmed the partial mediating role of self-oriented perfectionism only for drive for thinness. In contrast, socially prescribed perfectionism was found to be a partial mediator between all three sociocultural variables and measures of both MD and ED; except for those between peer influence and body dissatisfaction, and teasing and bulimia symptomatology. These two relationships were fully mediated by socially prescribed perfectionism. Results suggest that vulnerability to MD and ED depend on pre-existing perfectionistic attitudes, particularly that of socially prescribed perfectionism.

BackgroundAnabolic-androgenic steroid (AAS) dependence has numerous adverse health consequences, and may be driven in part by body image concerns, primarily muscle dysmorphia. This study aims to further understand and identify potential clinical targets using network analyses of AAS dependence and muscle dysmorphia symptoms in males who used AAS and weightlifting controls.MethodsA sample of 153 men who currently or previously used AAS and 88 weight-lifting controls were recruited through social media and relevant online forums, and via posters and flyers distributed in select gyms in Oslo, Norway. Symptoms of AAS dependence and muscle dysmorphia were assessed using clinical interviews and standardized questionnaires. Severity of muscle dysmorphia symptoms were compared between the groups using independent samples t-tests. The following symptom networks were computed using Gaussian graphical modeling or mixed graphical modeling: (1) AAS dependence symptoms among men with AAS use (2) muscle dysmorphia symptoms among men with AAS use and weight-lifting controls in two separate networks, which were compared using a network comparison test, and (3) AAS dependence and muscle dysmorphia symptoms among men with AAS use.ResultsIn a network of AAS dependence symptoms, continuing use despite physical and mental side effects, using longer than planned, tolerance, and work/life interference were the most central symptoms. When comparing symptom structures of muscle dysmorphia between those who used AAS and controls, the most central symptoms in each group were exercise dependence and size/symmetry concerns, respectively. Men with AAS use demonstrated elevated muscle dysmorphia symptoms compared to controls, indicating that both the severity and structure of symptoms differ between these groups. In a network including both AAS dependence and muscle dysmorphia symptoms, no significant connections between symptom groups were identified.ConclusionsAAS dependence is complex, with correlated somatic and psychological challenges driving the symptom network, indicating that alleviating physical and mental health concerns during both AAS use and cessation is an important clinical target. Muscle dysmorphia symptoms related to taking action (diet, exercise, and supplement use) appear to cluster together more for those who use AAS than those who do not.

Eating disorders (EDs), in women, are one of the most predominant psychiatric problems (Fairburn & Bohn, 2005), whilst in men, EDs and muscularity concerns are becoming increasingly prevalent; thus, highlighting the importance of investigating ED symptoms and body image concerns in both men and women (Kjelsas, Bjornstrom, & Gotestam, 2004). More generally, EDs symptoms impact functioning whether at threshold and non-threshold levels (Lewinsohn, Striegel-Moore, & Seeley, 2000). Therefore, research targeting interpersonal and environmental factors associated with EDs is relevant to understand complex relationships among ED symptoms and their correlates which significantly impact functioning. In Chapter One, this dissertation includes a review of the literature on ED symptoms and muscle dysmorphia; existing research concerning factors that may contribute to the development of ED symptoms is described, focusing on the interpersonal and environmental factors influencing ED symptoms within a social context. Subsequent discussion sections focus on theoretical and empirical literature associated with these factors. expression of ED symptoms within romantic relationships was also appraised. On the basis of the findings from the literature review, a program of research was developed that is reported in three empirical manuscripts. Chapter Two provides a comprehensive overview of the research. first empirical paper (Chapter Three) entitled, Norms for Measures of Eating Disorder Symptoms, Drive for Muscularity and Muscle Dysmorphia for Men utilised an Australian community sample of men (n = 284) to provide normative data for ED symptoms, drive for muscularity and muscle dysmorphia, and compared current findings to prior research. findings indicated similar rates of disordered eating behaviours to those previously reported by university men. findings indicate the usefulness of ED, muscle dysmorphia and drive for muscularity measures, to supply unique information regarding ED symptoms in men. These findings are relevant to Australian researchers and clinicians to assist in the interpretation of EDs, muscle dysmorphia and drive for muscularity measures. second empirical paper (Chapter Four) entitled, The Examination of Eating Disorder in the Context of Relationships within Community and Couple Samples examined associations between romantic relationship status and well-being including ED symptoms, perceived social support, anxious and avoidant partner attachment, sociocultural pressures, mating approaches and mating tactics in a large community sample of men (n = 208) and women (n = 588) and a subsample of couples (n = 80). study found that involvement in a romantic relationship was associated with less ED symptoms, less partner attachment anxiety and avoidance, greater perceived social support, a more committed sexual approach style and more supportive and intimate mating tactics than single status individuals. Within the subsample of couples, partners were similar with regard to their level of perceived social support, global sociosexuality and use of friendship mating tactics. These findings supplement the ED literature and enhance knowledge of human mating behaviour. final empirical paper (Chapter Five) entitled, Romantic Attachment, Social Support, Sexual Approach Style and Sociocultural Influences on Eating Disorder Symptoms utilised a large community sample (n = 671) of women to explore the mediating and predictive pathways of romantic partner attachment, perceived social support, sexual approach styles and the internalisation of the media's portrayal of ideal body standards to ED symptoms within a theoretical model. partner attachment was associated with ED symptoms through the interpersonal factors of perceived social support and a game-playing sexual approach style, as well as, an environmental factor of the internalisation of the media's portrayal of ideal body standards. partner attachment anxiety predicted ED symptoms directly; however, romantic partner attachment avoidance did not predict ED symptoms directly. Taken together, the findings from this program of research provide further support for the interpersonal and environmental factors contributing to ED symptoms and suggest that the attachment and mating approach frameworks have applicability to ED symptoms, thereby providing theoretical advancement in the ED literature and also prompting further empirical research. dissertation concludes by providing an overarching view through a general discussion of the findings associated with the overall program of research. In addition, limitations and strengths of the research are identified and directions for future research are proposed. Lastly, final conclusions are drawn.

Muscle Dysmorphia (MD) is a severe subtype of body dysmorphic disorder (BDD) that shares symptomatic overlap with eating disorders. Although associations between eating disorders/BDD and suicidality are well documented, research has rarely examined associations between MD symptoms and suicidality, which is concerning given MD is associated with additional suicide risk factors compared with these disorders. Further, existing associations between MD symptoms and suicidality have yet to establish temporal ordering for these relationships. Therefore, the current study investigated longitudinal relationships between MD symptoms and suicidal ideation to establish the direction of the MD-suicidality relationship. Participants were 272 US men displaying sub-clinical MD symptoms who completed self-report measurement at three time points over 6weeks. Longitudinal relationships between MD symptoms and suicidal ideation were examined using a three-wave autoregressive cross-lagged model. Certain MD symptoms were longitudinally predicted by suicidal ideation. Specifically, suicidal ideation longitudinally predicted increased drive for size and appearance intolerance. Results may suggest that individuals engage in MD symptoms potentially to cope with distressing thoughts of suicide. Clinicians should provide clients with comorbid MD and suicidality with appropriate coping tools to manage distress from suicidal thoughts outside of engaging in compulsive exercise characteristic of MD symptoms.

Background and aimsResearch shows inconsistent findings about the link between muscle dysmorphia (MD) and eating disorder (ED) symptomatology. The aim of this study is to synthesize the scientific evidence available on this topic, the researchers conducted a systematic review and meta-analysis.MethodsThe literature search enabled us to identify 39 published articles, which provided 36 independent estimations of the correlation between the two variables.ResultsOur analysis found a positive association between MD and ED symptoms (r+ = .36; 95% CI = 0.30, 0.41). Moderator analyses showed that the type of sample and the tools for assessing MD and ED were statistically associated with the MD–ED effect sizes. The methodological quality of the studies exhibited a positive, statistically significant association with the MD–ED effect sizes.ConclusionsHigher levels of MD were related to greater ED symptomatology, but several study characteristics may moderate the association between the two variables. In this study, we discuss limitations and implications for clinical practice and future research.

Psychosocial factors underlying symptoms of muscle dysmorphia in a non-clinical sample of men

A network analysis of eating disorder symptoms and co-occurring alcohol misuse among heterosexual and sexual minority college women