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Body Image Final Paper


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Body Image Final Paper

  1. 1. Taylor Hartman Hartman Dr. Barnes SC 493 8 May, 2015 1 Men’s Perceptions of Body Image, Body Satisfaction, and Eating Disorders: The Influences of Identity Introduction Presently, there is a rise in the amount of new instances of body image dissatisfaction uncovered throughout literature reviews, monographs, and academic journals conducted by researchers. Eating disorders and body image troubles were once perceived as “woman’s only” disorders, dating back to cases of the first publication of eating issues recorded by Richard Morton, in 1694 (Cohn & Lemberg, 2013). As early as 1960, clinicians at St. George’s Hospital in London began studies incorporating large samples of men with eating disorders. This research peaked in the late 1980s, continuing into the 1990s, due to an increased amount of emphasis placed on men from the media to be more muscular, and conscientious of their appearance. According to a recent meta-analysis, Strumia, Emilia, Malvina, & Tatiana (2011) assessed the population of the United States and estimated that between 5% and 10% of all eating disorder cases occurred in males. Currently, there is an even larger amount of undiagnosed men suffering from body image troubles and eating disorders, especially since the stigma attached to the illness itself is very persistent. Furthermore, stereotypes that include body image issues only pertaining to woman, as well as men being raised to be manly and not worry about their weight, may decrease and deter these men with body image and eating disorders away from diagnosis and treatment (Strother, Lemberg, Stanford, & Turberville, 2012). Presently, the primary focus of research on men with body image distortions and eating disorders is the study of the individual characteristics surrounding the nature of their illnesses, the prevalence of their mental and
  2. 2. Hartman 2 physical health, weight competitiveness, and ideal body image, which are linked to the culture of media. Literature Review Body Image and Eating Disorders There is no one “face” of what body image troubles look like. It may manifest itself in men of all shapes, sizes, colors, and origins. According to recent research, the National Eating Disorder Association estimates that 10 million men will at one point suffer from disordered eating in their lives (Wade, Keski-Rahkonen, & Hudson, 2011). Nowadays, not only is there a growing amount of research that describes the identities of men suffering from eating disorders, the amount of treatment facilities that treat these illnesses have about doubled since 2000, resulting in a 34% increase in newly established centers for recovery, stability and wellness (Cohn, 2013). This increase may demonstrate that professionals, clinicians, and researchers are adapting and catering to the need for the treatment and research of eating disorders and body image complications in men. Similarly, rates of recorded body dissatisfaction among men have increased from 10% to 43% over the past 30 years (Goldfield, Blouin, & Woodside, 2006; O’Dea & Abraham, 2002), which are relatively similar to the rates of approximately 50% found among North American women (Garner, 1997). In addition, a research team who studied samples of college-aged males discovered that 95% of their participants had experienced some level of body image dissatisfaction (Mishkind, Rodin, Silberstein, and Striegel-Moore, 1986). This statistic emphasizes the ever-growing number of males who are affected by body image troubles. As of 2013, the Diagnostic and Statistical Manual of Mental Disorders describes the new subtypes of the debilitating feeding and eating disorders, which now consist of anorexia nervosa,
  3. 3. Hartman 3 bulimia nervosa, binge eating disorder, and otherwise specified feeding and eating disorders, which took over the previous eating disorder, not otherwise specified (American Psychological Association, 2013). Hudson, Hiripi, Harrison, Pope, & Kessler, (2007) incorporated prevalence rates of DSM-IV anorexia nervosa, bulimia nervosa, and binge eating disorder in several American and Canadian studies: 0.9%, 1.5% and 3.5% among women, and 0.3%, 0.5% and 2.0% among men respectively. According to the previous estimates, rates of females suffering from each disorder appears to be more common, whereas males are a low, yet growing demographic that may require further research for more precise data. Body image dissatisfaction has also made its way into mainstream society for men. More entrenched with their own perceptions of their bodies, men who have a preoccupation or a drive to be thin or muscular may develop negative self-images (Barlett, Vowels, & Saucier, 2008). Due to this preoccupation, Barlett et al. (2008) found that men reported taking pills, going on diets, abusing muscle-enhancing drugs – like steroids – and engaging in excessive exercise, and even having cosmetic surgery, because of their negative perceptions of their bodies. These are some examples of how research and treatment have become more sophisticated through new research publications and knowledge of the eating disorder illnesses. Two types of foundational theories have been used in body image and eating disorder research: social comparison theory (Festinger, 1954) and cultivation theory (Gerbner, 1969). Social comparison theory utilizes the idea that people make self-appraisals by evaluating themselves relative to others. Examples of this would generally include any person who admits to comparing themselves in superior or inferior status to someone else, and thus believes that they are better or worse depending on their perception of themselves. Another theory that is used in eating behavior and body image perception studies is cultivation theory. Gerbner (1969)
  4. 4. Hartman 4 hypothesized that people often internalize messages broadcasted by the media. These messages can have a significant effect on an individuals’ standards and realization of one’s own self in relation to others. For example, the more an individual is exposed to mass media, he is more likely to internalize and compare himself to body image ideals and see them as realistic standards. There is also one type of body image disorder that includes body dysmorphic disorder (BDD), which entails dissatisfaction with body image, distinct distress with body type and feelings of negative sensation associated with a marked preoccupation with weight. (APA, 2013). In addition, body dysmorphic disorder may be the problem when an individual obsesses over a physical feature, which he or she believes, incorrectly, is deformed or ugly (Smolak & Murnen, 2002). One specific form of this disorder, muscle dysmorphia, is pertinent to men. Muscle dysmorphia is characterized by the persistent feeling of being small, despite being above average weight and/or heavily muscular (Harvey & Robinson, 2003). This disorder has been described as the opposite of anorexia nervosa; individuals suffering from muscle dysmorphia exercise compulsively, and often use steroids or other supplements. Another subcategory of body dissatisfaction includes body surveillance, or body checking. This category of behavior simply includes checking ones own body, comparing oneself to others, and most importantly, involves a person’s value of aesthetics over body function (Marino-Carper, Negy, & Tantleff-Dunn, 2010). In mental health, there may be underlying issues and multiple reasons for a certain pathology of behavior. For example, eating disorders and body image issues in males are usually attached to one or more mental disorders, which refers to a term called comorbidity. Several studies found that upon assessment, anxiety and depression were the most common comorbid disorders in their sample with eating disorders in their sample of men with eating disorders
  5. 5. Hartman 5 (Cohn & Lemberg, 2014; Carlat, Carmago & Herzog, 1997; Strumia et al. 2011; Woodside et al. 2001). Furthermore, anxiety disorders accounted for 67% of comorbid disorders, followed by 30.7% of patients who were suffering from depression. (Cohn & Lemberg). In addition to this statistic, a similar study found that 55% of men within the research sample were also depressed, or in a depressed state (Strumia et al. 2011). Furthermore, 17% had a substance abuse disorder, 24% suffered from a type of personality disorder, and 14% had an alcohol dependence disorder (Strumia et al. 2011). Moreover, in a study conducted by Woodside, Garfinkel, Lin, Kaplan, Goldbloom, & Kennedy (2001), the researchers identified an association between psychiatric diagnoses (major depression, social anxiety, social phobia and simple phobia) and disordered eating symptomatology. These findings showed an increase in eating pathologies that were linked to multiple forms of anxiety, sadness and other phobias, and obsessions. Symptoms of eating disorders and body image dissatisfaction may come with an array of risk factors, and physical and mental health complications. For example, weight history is the most important indicator as to whether a child received adequate caloric intake (Andersen, 1999). Explained further, a history of undernourishment and under eating could be a huge risk factor for the development of an eating disorder. In addition, most men lose weight through intense fasting, purging behaviors, laxative abuse, and excessive lifting and running (Harvey, 2003). In a similar study conducted by Andersen and Holman (1997), participation in sports where weight control is needed to improve performance was a risk factor in the development of eating disorders and/or body image dysmorphia. Comorbid psychical and mental symptoms result from males who suffer from anorexia. These symptoms usually include the loss of the hypothalamic-hypopituitarism-hypogonadis, which decreases the sexual drive in men (Harvey, 2003) More visible signs of anorexia and
  6. 6. Hartman 6 starvation include sebum depletion, as well as lanugo, which is the fine baby hair that is marked across the epidermis. Bulimia, on the other hand, manifests itself through more observable signs, such as Russell’s sign, which are scars and or callouses on the hands and fingers due to purging, caused by the raw acidic fluids eating away at the skin (Harvey, 2003). Demographics of Body Image and Eating Disorders Gender More sociologically oriented factors have also been suggested as possible explanations for body dissatisfaction. Several authors, for example, have pointed to the effects that increased exposure to mainstream media (advertising, magazines, newspapers, pornography, and films) attribute to men’s perception of body image ideals (Duggan & McCreary, 2004; Hartoum & Belle, 2004; Harvey & Robinson, 2003; Morgan & Arcelus, 2009; Morrison, Morrison, & Hopkins, 2003). Additionally, the emphasis on sculpted, lean, and muscular bodies can have a negative effect on men’s desire to change their body perceptions and may change their perceptions of other men around these mostly unattainable body ideals (Duggan & McCreary, 2004; Hartoum & Belle, 2004; Harvey & Robinson, 2003; Morgan & Arcelus, 2009; Morrison, Morrison, & Hopkins, 2003). Gender role norms can be generally described as the set of attitudes, behaviors, and thoughts that society holds as representative of the male or female gender (Connell, 1995). In addition, these roles can be crucial to understanding the male experience of eating disorders and body image complications. The existing crossover of negative eating and negative body image can also manifest itself into feminine and masculine behavior. Lakkis, Riciardelli, & Williams (1999) found that men who reported having feminine traits, such as co-dependence and passivity, sought approval from others. Furthermore, the creation of the femininity hypothesis (Lakkis et al. 1999) was
  7. 7. Hartman 7 proposed to argue that conformity to feminine norms may become a risk factor for eating pathology and body dissatisfaction among women (Lakkis et al. 1999; Meyer, Blissett, & Oldfield, 2001). Similarly, it may also been used in relatable cases and studies involving men who do not identify as masculine, and tend to favor more feminine behavior. In addition, Thomas, Ricciardelli, & Williams (2000) found that young boys and young men who reported an endorsement of feminine roles, also reported a greater drive to diet, and were more preoccupied with food intake. Furthermore, body dissatisfied males who endorsed feminine gender roles may be likely oriented towards thinner, rather than larger body ideals, suggesting a link between femininity and thinness-oriented eating disordered symptomatology in males (Meyer, Blissett & Oldfield, 2001). In contrast to the study of body image research and males who strive for thinness, body image researchers have also focused on muscularity concerns. These types of investigations are usually paired with the theory of threatened masculinity, which states that a pursuit of hyper- muscularity is attached to a vulnerability of feeling threatened with respect to masculinity (Mischkind et al., 1986; Pope, Phillips, & Olividari, 2000). Masculinity and muscularity are therefore seen as important, if not, essential components to certain aspects of male confidence. In addition, the masculinity hypothesis, created by Blashill (2011) argues that muscularity-oriented men who are overly fixated with achieving low body fat and high muscle mass may be at risk for body dysmorphic disorder pathology (Griffiths et al. 2015). Furthermore, men who strive for this ideal may be perceived as more inclined to communicate more traditional masculine characteristics more effectively to other males than others (Griffiths et al. 2015). Some research has highlighted the possibility that there exists a significant amount of peer and culturally manifested pressure to conform to the concepts of a specific and idealized
  8. 8. Hartman 8 physique that has become normative in mainstream society. These cultural pressures are similar to the “Act Like a Man Box” created by Paul Kivel (1984). Research conducted by Kivel (1984) demonstrated the structure of masculine behavior in society as rampant and ongoing. Furthermore, he theorized that society teaches our boys and men to ignore feelings of love and sadness, and to embrace a life of aggression, responsibility, and toughness (Kivel, 1984). Moreover, masculine behavior is reinforced when men adhere to their roles, which stereotypically includes dominance, confidence, sexual drive, and physical and emotional control (Griffiths, Murray, & Touyz, 2015). In modern American society, this narrow image of masculinity pushes men and boys into becoming fearful and hyper vigilant of every emotion and behavior they exhibit. Eventually, this may cause boys to grow up fearing the possibility of detachment from social groups and settings if their behavior is not aligned to the behaviors discussed in Kivel’s (1984) work. In addition, the inability to assert oneself above these fears can put men at risk for denial of gender conformity. Sexual Orientation and LGBTQ Community Past research recognizes that sexual orientation is important in the study of men with eating disorders because of the link between the LGBTQ community and the “ideal” body weight (Ousley, Cordero, & White, 2008). Currently, an estimated 3% to 5% of men in the United States population are homosexual and it typically increases to 40% or 45% in the eating disorder population of men (Ousley, et al. 2008). In a separate study, researchers studying eating disorder factors and characteristics found that symptoms related to body dysmorphia and eating pathologies increased by 10 times with gay and bisexual men than with heterosexual men (Strong, Williamson, Netemeyer, & Geer, 2000). These rates imply that though the amount of
  9. 9. Hartman 9 men in the eating disorder and/or body image dysmorphia populations remain low, the incidents of homosexual and bisexual men who suffer from those disorders increase dramatically. A group of researchers described how men’s sexual orientation may affect the risk for having an eating disorder and body image issues, which may be due to their social settings and pressures, while others argue body image dissatisfaction and eating disorders may affect one’s sexual orientation or sexual preference and drive for sex (Dakanalis, Zanetti, Riva, Colmega, Volpato, Madeddu, & Clerici, 2013). Dakanalis et al. (2013) article found that in the need to attract other men, LGBTQ men might fixate or alter their body, which becomes a socio-cultural factor in the LGBTQ community. Dakanalis et al. (2013) explained that the excessive concerns of ideal body weight, being slim, or excessive muscularity, is something similarly found in many traditional issues that women with eating disorders face. Another interesting point of this literature has focused on the importance within gay communities for men to present a healthy body as a counterweight to the stigmatizing force of HIV/AIDS (Diaz, 2006; Ramsay, Catalan, & Gazzard, 1992; Varas Diaz, Toro-Alfonso, & Serrano-Garcia, 2005). This heightened anxiety about health concerns in the LGBTQ community has also made its way into the mainstream ideals of healthy body image in the LGBTQ community. Some research has discussed the connections between homophobia and the stereotypical feminine behavior in homosexuality. For instance, researchers have studied the evidence of the overplaying of behavior in males and identifications of gay men, bisexual men, and men who have sex with men (Meyer, et al. 2001; Pope et al, 2000; Russel & Keel, 2002). Moreover, these studies found that some men tend to exaggerate typical stereotypical male behavior in order to compensate for their lack of muscularity, which was self-reported as attached to masculinity and pertinence in social relationships (Meyer, et al. 2001; Pope et al, 2000; Russel & Keel, 2002).
  10. 10. Hartman 10 Additionally, the theme in their sample of men was geared toward the drive toward masculinity, or included a combination of their gendered behavior and drive to masculinity, which varied along the masculine and feminine spectrum (Meyer et al. 2001). Furthermore, a number of men in their research were found to act as stereotypical heterosexual, masculine males, and relied on their more toned bodies in order to prove their masculinity, despite the orientations of their sexual desire (Russel & Keel, 2002). It is evident that the differences between gender and behavior is distinct and manifests itself in negative stigma (Pope et al. 2000). Other studies such as research conducted by Yager, Landsuerk, Wiesmeier, & Kurtzman (1988) examined college men who had eating disorders and found that many homosexual men had binge eating problems. Furthermore, many reported feeling “fatter” than how others perceived them. The men also used diuretics and felt shameful of their weight and image (Yager et al. 1988). Additionally, these results suggested that binge eating disorders were more prevalent among homosexual men rather than heterosexual men in a given lifetime prevalence (Yager et al. 1988). A further study examined by Yean, Benau, Dakanalis, Hormes, Perone, & Timko (2013) assessed disordered eating, body dissatisfaction, and how they compared with the participant’s sexual orientation. The men within their sample had a greater drive for muscularity than women had. With regards to homosexual men, gay men had reported more body image dissatisfaction, as well as an internal drive for thinness (Yean et al. 2013). In a similar study, bisexual men reported less body shape dissatisfaction then homosexual men (Hunt, Gonsalkorale, & Nosek, 2012). Additionally, body dysmorphic disorder was a precursor to some who had body image dissatisfaction. Further, induced stresses also led men into a drive for muscle gain, thus causing some men to have a physique anxiety. Their findings also noted that self-esteem was a
  11. 11. Hartman 11 determinant on the drive for muscle, and for “ideal”, thin body types. These body type fixations were also self-reported as factors in their sexual orientation and sexual drives, which ultimately became a risk factor for their eating disorder (Hunt et al. 2012). According to a study conducted by Bosley (2011), gay men were more accurate and frequent in checking their bodies than heterosexual men. Furthermore, gay men were found to exercise more than the heterosexual men, according to their studies. Additional findings suggested that gay men felt physical attractiveness was important, and were just as likely to compare and check their bodies as much as women had (Bosley, 2011). These risk factors were linked to their idea that those specific behaviors and ideas were correlated to bulimia symptomology. Overall, the homosexual men were also more likely to discuss their bodies and appearance more than women and heterosexual men (Bosley, 2011). Overall, the anxiety of heightened perceptions about one’s body was a major concern in this sample of homosexual men. In fact, while there is no solid causal relationship currently established, homosexuality in itself is commonly considered to be a risk factor for body image complications and eating disorders in men. Sexual Abuse Victims Sexual abuse is another related topic that is sensitive and related to sexual orientation, eating disorders, and body image. According to a study conducted by Schwartz & Cohn (1996) researchers examined a 1980s statistic in which victims of sexual abuse prevalence was 1 in every 7 men. Because occurrences in males are already underreported, and because there is an association between shame and guilt with eating disorders and sexual orientation, their studies suggested that males who are victims of sexual abuse may develop issues with sexual and/or gender orientation, along with fear of sex itself (Schwartz & Cohn, 1996). To clarify, there was a
  12. 12. Hartman 12 higher occurrence of homosexual men with eating disorders who happened to have been sexually abused (Schwartz et al. 1996). Though this was a finding of the study, it does not imply that all sexually abused men become gay, or develop an eating disorder, but that they are at a higher risk to develop body image complications due to repressed memories and physical abuse (Schwartz et al. 1996). Furthermore, researchers had noted that anorexia was the common struggle for their sample of men with eating disorders who have been traumatized by sexual abuse (Schwartz et al. 1996). Additionally, their research proposed that due to hormonal imbalances in the brain, the chemical imbalances due to anorexia nervosa and the denial of self-acceptance, caused certain men to become asexual, avoiding sexual encounters altogether (Schwartz et al. 1996). Another study conducted by Bosley (2011) was initiated in order to study body image, LGBTQ identities, eating disorders, and sexual abuse. Her research found that bisexual men especially were at higher risk for developing bulimia, rather than anorexia, and had also experienced encounters with sexual abuse as children. Furthermore, the homosexual men were connected to previous sexual abuse, which was a factor in their development of bulimia nervosa. Bosley’s (2011) references to Feldman & Meyer (2007) reinforced the relationship between disordered eating as coping mechanisms for the emotions from childhood abuse. Bosleys’ (2011) analyses did report, however, that further research is required in order to generalize this small field of data. Race, Ethnicity, and Nationality Western culture in the United States is connected with subjecting people to “ideals” by familiarizing people with a set of behavioral guidelines. Furthermore, these might include norms, upbringing, media, schooling, etc. In addition, there may include an assimilation of other cultures, behavior, norms, and beauty into that of those portrayed by mainstream messages
  13. 13. Hartman 13 within the United States. Cultures of other diverse countries obviously vary in respect to the standard ideals portrayed by their standards. Additionally, there may be a growing need for research in cross-cultural and ethnic relations due to the variety of standards of ideal beauty and body image satisfaction across nationalities, races, and ethnicities. In order to illuminate this previously explained phenomenon, a study conducted by Agliata & Tanteleff-Dunn (2004) found exposure to beauty and fashion magazines were consistently linked with body disturbances for men in western societies. Additionally, they found men exposed to male models possessing the ideal look of their society reported feeling more depressed and dissatisfied with their muscularity and body image than those exposed to neutral advertisements (Agliata & Tanteleff-Dunn, 2004). Warren & Rios (2012) studied young male second-generation Hispanic-American college students still assimilating into American society. The study was designed to assess perceived stress, anxiety, and body image awareness. Participants reported higher levels of anxiety and stress due to the mass media portraying images of the ideal body along with assimilation into the norms associated with male physique and body image (Warren et al. 2012). In addition, higher levels of body image dissatisfaction and body dysmorphia were reported. Furthermore, these also caused some a heightened anxiety to “fit in” through exercising, eating less, and internalizing nervousness and hyper-vigilance about the opinions of others (Warren et al. 2012). This study exemplified how media portrayals and body image issues connected internalized thoughts and pathology in regards to the Hispanic-Latino-American population at the collegiate level (Warren et al. 2012). A related study regarding Hispanic men in the United States focused on body image and eating disorders. De Santis, Layerla, Barroso, Gattamorta, Sanchez, & Prado (2012) reported a link between eating attitudes, behavior, and body image. Results found sexual behaviors
  14. 14. Hartman 14 decreased when negative eating behaviors increased. As the first descriptive cross-sectional study of its kind, it branched out and extended to Hispanic individuals with similar eating disorders. Overall, 13% had a risk for an eating disorder, and since they were homosexual as well, the study decided not to generalize to the overall community. Due to this finding, it is safe to say that not all homosexuals are at a risk for an eating disorder; rather, sexual orientation may be a common trait for those populations who suffer from eating disorders and body image complications. Additionally, due to the upbringing of many Hispanic men, they are raised to be more machismo and masculine, and are expected to engage in risk taking behaviors (Meyer & Champion, 2008). Ryan & Morrison (2012) conducted a study incorporating the Drive for Leanness Scale to measure attitudes toward Irish men and women. This study was used to compare the participants’ perceptions of ideal body weight and body type, considering men and women’s motivating interest was low body fat and muscle mass. Conducted in western Ireland, men and women strove for both leanness and muscle tone. Additionally, men typically reported muscular body images as their ideal body image. Their data also suggested men’s drive for muscularity predicted a variety of muscle dysmorphia symptoms. On the other end of the spectrum, there was lack of data on men’s drive for thinness in this study, and it has yet to be investigated in further detail (Ryan et al. 2012). Generally, the Irish men in this study tended to drive for the more stereotypical male-muscular ideal form of body image, whereas the females strove for more lean, yet thin ideals. Interestingly, both sexes overall sought a more fit and athletic body type (Ryan et al. 2012). Similarly, another study focusing on the behavior of Italian college-aged men examined participant’s self-reported sexual orientation, eating behaviors, and mood (Dakanalis, Mattei,
  15. 15. Hartman 15 Bagliacca, Prunas, Sarno, Riva, & Zanetti, 2012). Using the Body Surveillance and the Body Shame Subscale, they attempted to measure the way participants viewed their own appearance. According to their research, they found no significant pathway from body surveillance to depression, though body surveillance had a direct effect on body shame and an effect on disordered eating (Dakanalis et al. 2012). Their research found heterosexual men exposed to objectifying media led to body checking and body shame, which led to some disordered eating. Depression was also statistically significant in this case, another comorbid diagnosis generally seen in patients with disordered eating and body image dysmorphia (Carlat et al. 1997). More innovative research takes into account an Asian male perspective. A study in Singapore was conducted to determine differences in the features of eating disorders in males. Most of the researchers noted that most men in their sample did not have full-blown diagnoses for an eating disorder or body dysmorphia, but had very debilitating symptoms of eating symptomatology (Tan Shain, Lin Miao Shan, Kuek Shu Chen, Lee Ee & Boon Swee Kim, 2014). Researchers also noted that certain participants alluded to punishing themselves by purging, or excessively exercising after receiving comments about their weight in a negative manner. This pattern of behaviors is similar to research conducted by Smolak et al. (2002), in which their study identified self-punishing behaviors such as food restriction and other substance use as compensatory means to manage their emotional states. Furthermore, these patterns were self- reported as tools of empowerment in which men were able to exercise self-control and possession over what goes in and out of their bodies (Smolak et al. 2002). Overall, it is clear that some Asian males may tend to use guilt and shame as reasons to punish and restrict food intake due to a fixation on weight management.
  16. 16. Hartman 16 As an illustration, Asian males—including Chinese males in Singapore—are more vulnerable to idealized images of muscular bodies because their true body sizes are usually not as muscular as Caucasian males (Barnett, Keel, & Conoscenti, 2001; Cachelin, Rebeck, Chung, & Pelayo, 2002). As a matter of fact, the majority of the readers in Singapore are Chinese, but models of muscular body images in men’s magazines are predominantly Caucasian (Khoo & Karan, 2007). Barnett et al. (2001) findings support the idea that men idealize and standardize their beauty in men of western cultures. Generally, the comparisons between cultures can be explained through a combination of social comparison theory (Festinger, 1954), and of cultivation theory (Gerbner, 1969) because these instances include cases of comparing cultural media messages from other nations and internalizing them as standard beauty ideals. Education and Age There are few studies examining the influence of age, income, or education among men with eating or body image disorders. However, certain studies such as the one conducted by Keel et al. (2010) focused on the risk of how middle-aged men developed significant problems with eating. Additionally, they tried to explain this phenomenon through healthy weight gain as age progressed, along with what the person at that time considered an ideal body weight. Furthermore, a study conducted by Kimmel & Mahalik (2005) and Siever (1994) suggested a desire to hold onto an ideal body physique was coupled with a desire for youthfulness. Their implications suggested older gay men might compare themselves to younger, fit gay males, subsequently negatively associating their older age with a negative perception of their body image. Still, in regards to education, very little research tackles the social identities of eating disorders and body image. Another study suggested patterns of bulimia are connected with the
  17. 17. Hartman 17 development of young adults, especially students who are in higher education, due to peer pressure and exposure to suggestible audiences and influences (Gravener et al. 2008). Other caveats from these studies included more gender-driven styles of “eating” while attending an undergraduate institution (Gravener et al. 2008). The researchers realized their sample of men labeled eating disorders as either feminine or masculine, depending on the severity of illness. For example, anorexia nervosa was seen as more feminine, because of the ties to a drive for thinness, whereas binge eating disorder was labeled as masculine, due to the extroverted behavior in weight gain (Gravener et al. 2008). Students in higher education were also found to be more susceptible to bulimia nervosa (Kelly-Weeder, 2011). Furthermore, a link was found between binge drinkers and disordered eating. Their results of the study found binge drinkers and disordered eaters were not substantiated as typical of college men or for risk in developing an eating disorder. Measuring And Responding to Body and Eating Disorders Measuring Disorders Due to the fact that eating disorders were only treated as a “female disorder”, the invention and adaptation of tools to assess eating disorders were never recognized as only meant for men until recently. One study specifically admitted to the lack of proper test tools to properly examine, measure, and rate the severities of certain men and their disorders. Darcy & Lin (2012) explained that males dramatically underscored women in these tests that were meant to assess their eating disorder. She described males consistently scored lower than females on most measures even when the severity of the psychopathology was relatively equivalent. Additionally, it was not valid or reliable to use female-oriented tests for severity assessment until norms have been established for the men as well (Darcy et al. 2012). Without the correct tools to test people
  18. 18. Hartman 18 and to collect data, articles written without these crucial tools become null and meaningless simply because they do not accurately assess and detail the experiences of men with eating disorders. A 2001 Canadian study published in the American Journal of Psychiatry compared males with full and partial eating disorders and men without eating disorders (Woodside, Garfinkel, Lin, Kaplan, Goldbloom, & Kennedy, 2001). They found the overall combined prevalence rate for full and partial eating disorders was 2.0% of the entire Canadian population of males and females (Woodside, et al. 2001). Furthermore, the research findings are more than likely to be an underestimate due to the diagnosticians, psychometric evaluators, and clinicians inability to properly diagnose and treat these eating disorders. As of now, the Eating Disorder Examination, EDE-Questionnaire, Eating Disorders Inventory, and the Bulimic Inventory Test are used for both males and females. Conversely, only the Drive for Muscularity Scale, along with the Male Body Image Concerns Scale, Male Body Checking Questionnaire, the Body Change Inventory, the Obligatory Exercise Questionnaire and the Appearance and Performance Enhancing Drug Use Schedule are the top notch tests that have been established for men only (Woodside, et al. 2001). While most exhibited great reliability, consistency and validity, the need for more updated test construction is required to evaluate specific behaviors of men with eating disorders. Treating Disorders Traditionally, men have been raised to play the role of the “strong oak”. Normally, they are taught to be strong, dedicated and hard workers who become self-sustaining and never show their emotions. These cultural hetero-hyper masculine standards alienate these men from achieving proper treatment and recovery in their eating disorders. Furthermore, higher levels of
  19. 19. Hartman 19 gender role conflicts and traditional masculine ideals may be associated with negative attitudes toward psychological help. For those who decide to admit to requiring psychiatric and medical help, the steps to recovery are possible. More likely than not, an eating disorder patient is stabilized through weight restoration through decreased restraint and restriction. Additionally, binge eating and compensatory behaviors (such as exercising, laxative use, and purging) are eliminated as well. Conventional psychotherapy for men suffering from eating disorders is the typical route for many patients. CBT and DBT, which stand for Cognitive Behavioral Therapy and Dialectical Behavioral Therapy, are the usual standard procedure for treatment of these disorders. Both therapies place a strong emphasis on the mindfulness of emotional control and stability as well as self-awareness. Moreover, coping strategies are associated through internal experiences of episodes of the disorder. Sometimes, men may feel shameful and guilty about their position as the client, which may cause them to become withdrawn, thus disturbing the therapeutic process. Diener, Hilsenroth, & Weinberger (2007) asserted that therapists who included discussions of the clients roles as leaders, fathers, sons, brothers, and husbands may help ease the process. This allows the male to open up with his experiences, as well as be more susceptible to taking the therapy seriously. Furthermore, without treatment being a long, arduous role for both client and therapist, there are chances of relapse and discomfort on both sides of the therapeutic relationship. Data and Methods This research uses data drawn from semi-structured in-depth interviews with young college men who attended John Carroll University and who agreed to discuss their perceptions on their body image. The research currently being studied is on body image and perception of
  20. 20. Hartman 20 body satisfaction; five John Carroll University male students were recruited. Convenience sampling, specifically, snowball sampling, was the method of choice to gather participants for this study. Snowball sampling is a sociological sampling technique in which existing study subjects recruit future subjects from among their acquaintances. This way, data and participant sizes can grow. The sample size was recruited via email, solicitation of friends, and strangers. The use of snowball sampling was used because of the nature of the research; the student body was readily available and easily accessible. Additionally, participants were at least informally acquainted to the researcher prior to the interview; the participants knew of the researcher. Also, it was possible due this style of informal research, the participants may have answered questions more truthfully. Lastly, all students were contacted, and had agreed to help with this study. Typically, the researcher initiated a follow up via email in order to make sure the participant was still interested. Throughout the process of interviewing, participants’ names were coded via the first letter of his name. This measure was done in order to track and differentiate their responses, as well as to keep their identities confidential for publication purposes. Sample Characteristics The range of the participants’ ages was 18–22 years old, with a mean age of 20.8 at the time of the interview. Four males divulged that they were heterosexual, and the other male said that he identified as homosexual. Additionally, the students varied in their class year. Three males reported that it was their senior year, the last semester before graduation. Furthermore, the remaining males consisted of one junior and one freshman male. All males had self-reported as middle class, varying from “firm middle class” to “low middle class”. The sample size gathered consisted of males who all self-reported as White/Caucasian. Lastly, and interestingly enough, one male had disclosed he currently suffers from obsessive-compulsive personality disorder.
  21. 21. Hartman 21 Research Design and Analysis The nature of the interview varied in length, due to sets of questions asked. Typically, the interviews ranged between 30 minutes and 60 minutes. The interview topics incorporated specific status identities that were formed into questions related to body image, body image and perceptions of healthy behavior and eating habits, as well as questions regarding exercise and comparing themselves to other males. Some of the topic questions include: “How satisfied would you say you are with your body?”, “Do you think you have a positive or negative body image?”, Have you ever suffered from body image problems or serious body dissatisfaction?”, “In what ways do you think your gender influences your body image and/or satisfaction?”, and “Do you think your sexual orientation influences what you would like your body to look like?”. The participants gave the student researcher oral consent before the interview, and informed the researcher he was over the age of 18. Also, all participants voluntarily participated, and all information was gathered via an audio recording device. Additionally, all audio-recording files were kept on a laptop that was password-protected to the researcher and his advisor. Following the interviews, the student researcher transcribed all responses. Afterwards, the transcriptions were organized and then coded by themes. The themes were created by including characteristics and patterns of the responses, in addition to being included for simpler data analysis. Furthermore, similar replies were organized and grouped together in order to accurately depict the degree of replies of a particular question. Findings Overall, there were three main patterns of results found in the interviews with the participants. These patterns included: gender and body image, sexual orientation, and influences of sports and media on body image.
  22. 22. Hartman 22 Gender and Body Image Gender was a major topic under discussion with the current research. Questions probed the students for their perceptions on their gender conformity, how their body image directly or indirectly influenced how they should look, and how they felt about those gender statuses. All participants reported having their body image affected by being male. Furthermore, all of their experiences were uniquely different from one another. Generally speaking, media, sports, and family upbringings affected their body images. All participants agreed that men in general were not supposed to talk about or worry about their body, because it was not seen as “masculine”. One participant had commented on the stigma, I think it's more acceptable, but there’s definitely still a stigma for whatever reason. And, I think it goes back to the old hyper-masculine paradigm, or stereotype of men where you know, unemotional, very compartmentalized…Women have their own issues. So, I think unfortunately, it's the fact that 20th century perception of gender particularly about males that prevents a better dialogue. [Participant, #1] This finding supports previous data found by Strother et al. (2012) in which men are to act as masculine, strong, and not bothered by issues of weight and body image. Another participant had offered his take on masculine expectations, …socially acceptable? No, I don’t think so. It’s frowned upon…I think that it is more of a feminine, considered a feminine thing to try to care about weight, whereas men are not supposed to care. You get a beer gut and whatever, or something like that because that’s "manly". Yah, so I think that it just has to do with the fact that men in general are expected not to talk about, you know, issues that they have with themselves and things like that. So, this is just another example of one of those issues being in this case, body image, where I think it wouldn’t be as acceptable to talk about. [Participant #1] Additionally, one participant sampled in this study felt society asks for men and young boys to be more manly and tough. This construct is a similar component negating the acceptability of males openly discussing concerns of body image. Another participant explained,
  23. 23. Hartman 23 I think that’s kinda the manhood, the manliness that society, that we ask of ourselves. We ask of our boys and men, so I, ugh . . . I barely, let alone, I don’t think it’s acceptable for some boys, for some boys to eat vegetables because that’s seen as girly. [Participant, #3] This quote brings up concerns about what males eat. This participant argues what goes into the bodies of men can dictate how manly or girly they are perceived. Eating foods without second thought is something this participant explains as commonplace, starting in younger ages, You know, in the cafeteria, oh, chicken, fries, man. I think that there's that attitude. So I think to, to be able to actually have the freedom to express yourself in food, to begin with, in a lot of high schools, and in middle school, that’s a step. [Participant, #3] Ultimately, the ability to express oneself in food can be channeled into the freedom to express one’s body.. In addition to expression, men who eat what they want, when they want, however much they want, allows them to raise their disinterest in worries about body image. Additionally, this expressive eating behavior allows men to assert their masculinity without displaying anxiety or worry about body image to others. Not surprisingly, all five of the participants cited media images affecting the “typical” male in his idea of body image. Furthermore, they all believed that most men are concerned with getting bigger, or more muscular, rather than smaller in response to messages portrayed by the media. One participant had cited a strong media influence to his perceived standard body image, …well, growing up, I was always a sport fan. So, there was that image of again, the big, strong, athletic, fast, guys that was always my like, if I had, I’d say from early on elementary school all through high school. I was always watching sports, you know, on TV all I watched was ESPN, so that only male, the only image I ever had of masculinity was these crazy athletic, you know. So, that was I guess, that affected my image, and that I wanted to be like that. [Participant, #2] This response mirrors cultivation theory (Gerbner, 1969) in which people internalize media messages. At a young age, this participant felt his only image of the ideal male was through sports. A result of this can include how the media skews the male perception of toned, fit,
  24. 24. Hartman 24 athletic men as the only type of accepted body image. One participant who was a little different from some of the others explained his viewpoint when he said, On the male side, I think that there's two prongs for most men. It’s about you know, being very athletic, being very muscular, being in shape, etc. And that in itself is a form of body issue. For me personally, though, I've been more so toward the anorexia, thin, side of it, which can kind of encompass this weird kind of positioning of my gender. Because, I think most guys my age are about getting bigger, and getting athletic, I’m just like, you know, trying to be my thin little self [Participant, #1] Though this point is important, it does not mean that the men believed their body image was affected by media messages; it was generally purported others were affected, rather than themselves. Interestingly, the point made by these men is reminiscent of previous research conducted by Hargreaves & Tiggemann (2006). This study found that people believe that body image portrayed in the media has little or no influences on the self but has great influence on their peers. This phenomenon may help explain how men have a realization of media affecting others. Therefore, a man’s perception of his body is safe and untouched by media. The participant quoted above is not alone in being male and wanting to appear or feel thinner. Though many of the participants reported not worrying about getting bigger, or fatter, some reported the opposite. Two participants reported they were worried about being overweight, and one revealed that he intentionally calorie restricts on days when he did not feel satisfactory. In fact, this participant disclosed he was suffering from obsessive-compulsive personality disorder, which he blamed as the reason for his anxious and obsessive need to calorie restrict. He said, Uhm, I would say just based on the whole idea on the calorie restriction, there are some days where for whatever reason there’s like an off or fat day, I will potentially calorie restrict, uhm that was again, maybe the self-destructive pattern of behaviors. [Participant, #1]
  25. 25. Hartman 25 Furthermore, his reaction toward his body image was more aligned to wanting to be thinner and smaller than the other participants who felt getting bigger, more muscular, and stronger was important. Another participant reported when he was younger in college, he was more overweight than he was during his interview. He had admitted to abusing pills and powders that he would use to flush out the negative body image and excess weight. He clarified, Yah, I would go to CVS, uhm, I’m trying to remember, this was years ago, but I went to CVS. I didn’t have a car, so I walked. I was scanning the shelves and thinking, ‘what’s gonna lose me weight--what’s gonna get rid of fat?’ and I would just try a couple things and uhm, yah. I would try them and I wouldn’t really tell anybody what they were, ‘cause when it’s powder, you just stir it into a water and it looks like fruit punch, uhm, and it didn’t work. [Participant, #3] In this explanation, it is apparent that this participant did not want others to know he was preoccupied with his weight or trying to lose weight. As mentioned earlier, he thought it would appear emasculating if other men knew of these feelings and behaviors. Sexuality and Body Image In regards to sexual orientation, most men had referred to questions regarding body image and sexuality as connected. To these men, sexual orientation influenced how they felt their body should look. One participant clarified, Well, straight men wouldn’t really care about his body image as much because a gay man would. Uhm, they, you know, they’ll eat whatever. They [straight men] care about, you know, ripping it up in the gym here and there, but besides from that, it’s prevalent, it’s the idea, it’s, the biggest concern for the average straight guy I hang out with, is getting some on the weekend. It's not about what they're eating. [Participant, #3] Here, this participant argued straight men cared about being tougher in order to have a partner, regardless of the worries of food intake. Additionally, the participant implied gay men may care about their body image more, which opens up new segments of food intake, exercise, and internalizing of media messages more than their heterosexual counterparts. Another male shared the above participant’s viewpoint,
  26. 26. Hartman 26 …you know, you have to go get a girl. You have to compete against other people who you know, might be big, bigger macho with you. Machoer than so, you know you, but for me, doesn't play that big of a role. [Participant, #4] This response is similar to the previous above response in that to get a partner in a heterosexual relationship, he understands there is a competing, macho-masculine aspect of dating. Additionally, he implied it had not played a big role for him, rather, it affected others. This implication mirrors the belief mentioned earlier, in which men only believe society affects other men’s image and perception of their body (Hargreaves & Tiggemann, 2006). Furthermore, all of the participants argued that straight men would not care so much about their bodies because it was not masculine to worry about their body image in this way. Also, straight men were perceived to be preoccupied with other things such as dating, going to the gym, and eating whatever they wanted. This type of explanation stems from previous research stating gay men may put body consciousness and awareness first in social settings (Duggan & McCreary, 2004). This emphasis on body image contrasts with that of straight men, mirroring previous research in which homosexual men may tend to have greater social physique anxiety (Duggan & McCreary, 2004). Sports, Media Influences, and Body Image In addition to gender and sexuality as factors in eating disorder and body image symptomatology, sports, athletics, and media influence impact men as well. Many of the participants mentioned sports and athletics were important and influenced how they thought about their bodies. Specifically, competition was important; athletics drove many participants to define their body satisfaction around having the most fit, toned, and abled body in order to do well in sports. One participant argued,
  27. 27. Hartman 27 If someone performs better than me, it’s generally because they're in better shape than I am, right? So, they might be stronger, or lighter, you know, weigh less, and that would be a chance for me to say that I need to change something about myself. [Participant, #2] This claim spoke volumes about how some men may be willing to change themselves in the name of competition, and of body image value. In this example, competition was only important if the participant was able to compete, succeed, and defeat his athletic opponents. In regards to overall body satisfaction, he also mentioned in a previous response, I'm, I mean physically, just, like a healthy weight, I guess just being able to do anything that I would want to do. Physically, you know, if I want to go for a run, I can do that. If I want to, you know, play basketball, I can do that, you know. I, I guess I’m not held back by anything. [Participant, #2] Therefore, the idea that this participant may be constantly willing to change himself to be bigger and better may imply that he is open to changing certain aspects of his body in order to be happier. Furthermore, this participant’s attitude toward his body was a reflection on his sport performance. This point is the opposite to the data found by Marino-Carper et al. (2010) in which they defined men who were obsessed with body surveillance as aesthetics over functions. Here, this participant claims the opposite in which functions comes first, which in turn causes happiness and confidence in the ability to compete in athletics. Another participant admitted to anxiety and distress in regards to his body image, with emphasis on comparing himself to athletes. In regards to anxiety, some men pointed out comparing their bodies to others caused them distress. Most had not considered themselves pound watchers however, many of them mentioned comparing themselves to other athletes and friends sometimes led to a negative mood and negative sensation about the way they felt about their body image. In order to justify this claim, one participant stated,
  28. 28. Hartman 28 Yah, it’s definitely more so comparative, it’s not necessarily like, ‘oh, I need to drop like 10 pounds’. I’m not much of a weight or pound watcher; I never weigh myself. It’s more so not even really like, again, obviously we all compare, but not necessarily compare in like ‘oh do much curls so I can get better’. I’m just more of a comparison, subconsciously or consciously that leads to [negative] mood, that leads to the [negative] sensation. [Participant, #1] Additionally, some men mentioned that the media portrayals of the ideal male body influenced their perceptions of their bodies. For example, many of the participants acknowledged professional athletes made them aware of what the media portrays, in regards to body image, and what that does to young men in society. One participant rationalized, I see Gaylin—like a fast distance runner—like Gaylin Rupp, or Mo Farah. You think, ‘oh the fastest man in the world, like wow, like, their calves are so defined and their quads and their form is perfect’. Like, that's what I want to be. That would make me the best runner. So, I guess I would strive for that, and definitely, yah, definitely could see that. I mean, there's so many like, if you go, if you see magazines like, buff guys or like, really big lifter guys, and I could see that, absolutely. [Participant, #5]. All of the participants also pointed out the fact they would change themselves to perform better in order to be more competitive, and to assert their dominance over other males. Perhaps this theme incorporates a denial, inability, or unawareness of one’s confidence. What is not discussed is changing one’s body implies one is aspiring to a standard or a goal one does not have at the moment. For example, striving toward what an athlete may look like implies one may also enjoy the power and control that goes along with high-ranked competing athletes. Furthermore, changing one’s body can imply men do not openly regard their current body image as inferior, yet tend to strive for bigger and better as an ever-changing standard of masculinity. Discussion The purpose of this study was to examine perceived attitudes and perceptions of body image satisfaction levels among college-aged male students at John Carroll University. Furthermore, the study aimed at measuring body image with special interests in unique identities
  29. 29. Hartman 29 present in the participants. Overall, the interviewees tended to state being a male was drastically different than being a female with body image issues. The theme of being a male was to be more masculine, tougher, stronger, and less preoccupied with weight and body image. Furthermore, being a male did not allow for them to discuss their views to the general public. Specifically, they felt it was not accepted to discuss their issues on weight and body image as a problem. Another aspect of current body image research is how the media has portrayed and affected men through norms within society. These portrayals give men messages that body image type varies from time to time. Furthermore, adhering to a specific muscular or incredibly thin figure may be unrealistic. In addition, body image norms may change over time, causing inconsistencies and fluctuations in adherence to fads. These mixed signals portrayed by the media (such as those projected into runways, television shows, movies, and pornography, etc.) may create discrepancies between idealized and current body image size. Other results from this study examined the importance of sports in the way in which masculinity is dictated in mainstream media as the expected role for males. Furthermore, society’s construction of the ideal male can skew the line between body image based off of competition and body image based off of happiness in aesthetics. To conclude, the differences in body image perceptions generally reflected previous research. Furthermore, most, of the responses suggested there are patterns of behavior, along with incidences of attitudes toward social conformity concerning male beauty. In this sample, some males mentioned that their ideal body image was to be larger, stronger, and more muscular. Those who reported this varied in their attitudes and perception toward gender and sexual orientation status. This finding demonstrates some straight males who want to be thinner, while others, such as gay males, may wish to be larger, and more husky. Additionally, a few straight
  30. 30. Hartman 30 males also mentioned becoming smaller and thinner was their ideal. These two distinctions in data are relevant in research as well. Furthermore, all but two participants indicated high levels of body dissatisfaction at one point or another in their lives, which is reminiscent of previous research conducted by Mishkind et al. (1986). Perhaps the reasons behind these differences in perception of body image are due to a blend of upbringing, exposure to media, and overall, beliefs toward the concept of masculinity. These three areas of body image research may help explain why there is such a strong emphasis on striving for perceived beauty, strength, and conformity. Although body image and eating disorders are recognized troubles in the 21st century, it is important to incorporate treatment, along with more accepted types of body image that do not shame or guilt men in society. Future research can focus on identifying more specific characteristics such as LGBTQ populations and body image, or heterosexual and homosexual men only, in order to get a more general understanding of a distinct population’s culture and body image norms. Furthermore, including more participants, as well as including more diverse and specific questions would also open up the conversation to more dialogue and more unique experiences!