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Anabolic–Androgenic Steroids
Published in Frank A. Barile, Barile’s Clinical Toxicology, 2019
Individuals who have experienced physical or sexual abuse state that the reasons for abusing steroids are to increase muscle size for self-protection. Some adolescents abuse steroids as part of a pattern of high-risk behaviors. Furthermore, muscle dysmorphia is a behavioral syndrome characterized by a distorted, unrealistic self-image. Men and women with the condition use steroids in an attempt to overcome their perception of inadequate physical appearance.
Eating Disorders in Males
Published in Jonna Fries, Veronica Sullivan, Eating Disorders in Special Populations, 2017
Helen B. Murray, Adelaide S. Robb
Previously called “reverse anorexia,” muscle dysmorphia is a specifier for body dysmorphic disorder. Muscle dysmorphia is characterized by preoccupations about increasing musculature and body mass as well as severe body image distortion (Grieve 2007; Ranzenhofer et al. 2012; Griffiths et al. 2014). Men experiencing muscle dysmorphia may obsessively exercise and lift weights, take weight gain supplements, restrict carbohydrates, and eat high-protein diets, yet no matter how fit, they never feel that they are adequately muscular. Frequent mirror-checking and social comparison to the “ideal” male body are often symptoms as well. However, a separate diagnosis of body dysmorphic disorder with muscle dysmorphia cannot be made if the muscle dysmorphia symptoms are primarily linked to the eating disorder symptoms (Mayo and George 2014). A study using vignettes about AN and muscle dysmorphia with male and female college students examined the perception and stigma around eating disorders (Griffiths et al. 2014). A large effect of character diagnosis on masculinity was observed, such that characters with AN were perceived as less masculine than characters with muscle dysmorphia, and this effect was more pronounced among male participants. A second study examined over 700 male and female university students using the Eating Attitudes Test (EAT) to asses risk for eating disorders and the Bodybuilder Image Grid (BIG) to assess body dissatisfaction and perceptual attractiveness (Mayo and George 2014). The study found 28% of the males were at risk based on their EAT scores which showed a positive correlation between the EAT scores and fat dissatisfaction and a negative correlation between the EAT scores and muscle dissatisfaction (muscle dissatisfaction indicated the person wanted smaller muscle mass). The males chose a significantly leaner and more muscular body as attractive compared to the female students’ perception of an ideal male figure (Mayo and George 2014).
Weightlifting
Published in Ira Glick, Danielle Kamis, Todd Stull, The ISSP Manual of Sports Psychiatry, 2018
Ian Steele, Harrison Pope, Gen Kanayama
Muscle dysmorphia is a type of body dysmorphic disorder in which individuals believe that they are “small” or not as muscular as they should be, even though they are often quite muscular. Individuals with muscle dysmorphia display excessive focus on their physiques, rigidity around dieting and exercising, and impairment of social/personal/occupational responsibilities. Muscle dysmorphia was recently acknowledged as an official psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) in 2013 (American Psychiatric Association, 2013). Studies have suggested that weightlifters in general show a higher incidence of muscle dysmorphia than comparison individuals (non-exercisers, fitness exercisers, football players), with a lifetime prevalence of the disorder ranging from 16–44% in various samples (Cafri, Olivardia, & Thompson, 2008; Hildebrandt, Schlundt, Langenbucher, & Chung, 2006; Pickett, Lewis, & Cash, 2005). Studies focusing specifically on bodybuilders have reported a prevalence of muscle dysmorphia as low as 8% or as high as 56% (Hitzeroth, Wessels, Zungu-Dirwayi, Oosthuizen, & Stein, 2001; Pope et al., 1993).Weightlifters with muscle dysmorphia have also been found to have an elevated incidence of other psychiatric conditions. For example, individuals with muscle dysmorphia, most of whom engage in weightlifting, often report symptoms of disordered eating. Studies comparing individuals with muscle dysmorphia against comparison participants have shown that the former group was more likely to have a history of a diagnosable eating disorder (bulimia nervosa, binge-eating disorder, anorexia nervosa) and/or a higher rate of bulimic behaviors (vomiting, laxative abuse) (Brooks, Taylor, Hardy, & Lass, 2000; Hildebrandt et al., 2006; Olivardia, Pope, & Hudson, 2000; Pasman & Thompson, 1988; Pope, Pope, Menard, Fay, Olivardia, & Phillips, 2005). In one study, Pope and colleagues evaluated 32 women who were competitive bodybuilders with features of muscle dysmorphia. Of these women, 15 (47%) reported a past history of an eating disorder (of this group, 20% had anorexia nervosa, 60% had bulimia nervosa, and 20% had a history of both disorders) (Pope, Gruber, Choi, Olivardia, & Phillips, 1997). Other studies have shown that muscle dysmorphia was associated with high rates of AAS use (up to 50% of cases) or other substance use disorders (up to 85% of cases) (Pope et al., 1997; Pope, Pope, Menard, et al., 2005). Individuals with a diagnosis of muscle dysmorphia have been shown to display an increased likelihood of a mood disorder (depression, anxiety) and increased risk of suicide attempts (Cafri et al., 2008; Pope, Pope, Menard, et al., 2005). One study also noted a high comorbidity of muscle dysmorphia with other forms of body dysmorphic disorder (e.g., body dysmorphia surrounding the appearance of hair or skin [Pope, Pope, Menard, et al., 2005]).
An intersectional investigation of Asian American men’s muscularity-oriented disordered eating: Associations with gendered racism and masculine norms
Published in Eating Disorders, 2022
Thomas P. Le, Benjamin T. Bradshaw, M Pease, Linda Kuo
A couple of studies have examined the extent to which conformity to masculine norms is associated with MODE. One study found that within a sample of 246 heterosexual men, increased conformity to masculine norms overall was associated with greater MODE and muscle dissatisfaction, but not thinness-oriented disordered eating or body fat dissatisfaction (Griffiths et al., 2015). Another study found that within a sample of men that included men with muscle dysmorphia, anorexia nervosa, and a control group, all of the conformity to masculine norm subscales aside from playboy were associated with muscle dysmorphia symptomatology, and men with clinically significant muscle dysmorphia reported greater overall conformity to masculine norms than those with anorexia nervosa and the control group (Murray et al., 2013). However, these studies included samples that were either predominantly white (Griffiths et al., 2015) or did not report race and ethnicity (Murray et al., 2013), limiting the extent to which these findings can generalize to men of color, including Asian American men.
Hearing vs. engaging in negative body talk: an examination of adult men
Published in Eating Disorders, 2019
Linda Lin, Mark Flynn, Ashley Roberge
Although body image concerns are often regarded as an issue that primarily affects women, research indicates body dissatisfaction is a significant concern for men as well (Fiske, Fallon, Blissmer, & Redding, 2014; Murray et al., 2017). Whereas women’s body concerns tend to focus on weight, men’s body concerns generally focus on muscularity and leanness (Talbot, Smith, Cass, & Griffiths, 2018). One epidemiological study of adult men in the United States found 28% of men were dissatisfied with their bodies (Fallon, Harris, & Johnson, 2014). Another epidemiological study of Australian adults found that 39% of the people reporting at least one feature of an eating disorder were men (Mitchison, Mond, Slewa-Younan, & Hay, 2013). In addition, there is an increasing number of men presenting with symptoms of muscle dysmorphia, a subtype of body dysmorphic disorder characterized by the preoccupation with not being muscular enough (Davey & Bishop, 2006; Murren & Karazia, 2017).
Why do men stigmatize individuals with eating disorders more than women? Experimental evidence that sex differences in conformity to gender norms, not biological sex, drive eating disorders’ stigmatization
Published in Eating Disorders, 2019
Investigating the stigmatization of anorexia nervosa and muscle dysmorphia, Griffiths and \colleagues (2014) similarly revealed gendered perceptions of these disorders. It is important to note that, although muscle dysmorphia is not currently classified as an eating disorder, its conceptual similarities with anorexia nervosa—for example, its characteristic eating and exercise-related behaviours—have led to a push for its reclassification on the eating disorder spectrum (Murray, Rieger, Touyz, & De la Garza García, 2010; Murray & Touyz, 2013). Among the stigmatizing attitudes and beliefs examined by Griffiths and colleagues, the largest difference between anorexia nervosa and muscle dysmorphia was their perceived masculinity. Specifically, those with anorexia nervosa were perceived as considerably less masculine than those with muscle dysmorphia. A corresponding effect for perceived femininity was not evident. In contrast with Boysen and colleagues (2014), Griffiths and colleagues discovered an opposite effect of perceived masculinity on the stigmatization of these diagnoses, such that anorexia nervosa (the lesser-masculine diagnosis) was stigmatized more than muscle dysmorphia. These discrepancies in the effects of perceived masculinity on stigma may be attributable to the different diagnoses investigated by the respective studies, given that the nature of stigma varies across diagnoses (Crisp et al., 2000; Roehrig & McLean, 2010). Overall, these studies evidence the gendered nature of eating disorders and its effects on their stigmatization.