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![What can I do?
› Breaking down the masculinity / ego-syntonic barrier in that first meeting
- Frame your collaboration as trying to relieve negative emotions, not change
behaviour
- "My goal here is not to try and change your diet or your workouts. I hear you
when you say that watching what you eat and excerising regularly are positives
in your life. What I want for you is to be able to diet and train without the
negatives; the guilt you feel when you eat something you shouldn't, the
embarassment you feel when you examine your physique in the mirror... Does
that sound like something worth working towards?"
- Use whatever terms they use to describe their emotions and be prepared for
little emotional insight and intolerance of emotional vulnerability
- Male with muscle dysmorphia, age 27: "It's like I'm working a dumbell 24/7. It's
physically right there. Gear [steroids] make it go away, training hard make it go
away, but if I stuff up my eating or skip the gym the dumbell is right back there
sitting on my head or in my chest and I have to train it away again. I get so
frustrated that it's even there. Fucking feelings are wrecking my life."
24](https://image.slidesharecdn.com/aspm2013-131023175655-phpapp01/75/Men-muscles-and-masculinity-The-general-practitioner-and-the-male-experience-of-body-dissatisfaction-22-2048.jpg)
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Similar to Men, muscles and masculinity: The general practitioner and the male experience of body dissatisfaction
Men, muscles and masculinity: The general practitioner and the male experience of body dissatisfaction
- 1. MEN, MUSCLES &MASCULINITY: THE GENERAL PRACTITIONER AND THE MALE EXPERIENCE OF BODY DISSATISFACTION Scott Griffiths | Prof. Stephen Touyz | Dr. Stuart Murray | A/Prof Jonathan Mond
- 2. DSM V –“feeding and eating disorders” › Anorexia nervosa - Restriction of energy intake relative to requirements leading to significantly low weight › Bulimia nervosa - Recurrent episodes of binge eating › Binge eating disorders - Recurrent episodes of binge eating - Recurrent inappropriate - The binge eating is not compensatory associated with - Intense fear of gaining behaviours to preent recurrent inappropriate weight or persistent weight gain, e.g. purging compensatory behaviour that interferes behaviours as in bulimia - Self-evaluation unduly with weight gain nervosa influenced by body - Self-evaluation unduly shape and weight influenced by body shape and weight 2
- 3. Prevalence of eatingdisorders in males › Men are no longer "immune" to eating disorders - 15-33% of anorexia and bulimia diagnoses (Hoek & Hueken, 2003; Hudson et al. 2007) - 30-40% of binge eating disorders (Muise et al. 2003) - 25% of early onset eating disorders (Madden et al. 2009) - 100% increase in binge eating, purging and strict dieting amongst males from 1995 to 2005 (Hay et al. 2008) - Rates of disordered eating amongst males are increasing faster than for females (Hay et al. in press) - Young Australian males rate body image as their most significant concern (Mission Australia, 2007, 2010) 3
- 4. But what aboutmen trying to become more muscular? › Like women, men desire a body low in body fat › Unlike women, men rarely describe their ideal body as "skinny" or "thin" › The ideal male body combines low body fat with well-developed muscles › Both components are equally important to male body image (Bergeron & Tylka, 2007) › Men describe their ideal body as "toned," "cut," "athletic", "ripped," or "jacked" 4
- 5. Muscle dysmorphia › "Discovered"in 1993 and named "reverse anorexia" (Pope, Katz & Hudson, 1993) › Renamed "muscle dysmorphia" in 2001 and classified as a subtype of body dysmorphic disorder › Criteria - Preoccupation with being lean and muscular - At least 2 of the following: - Giving up important activities due to a compulsive need to work out and diet - Avoiding body exposure/enduring body exposure with intense anxiety and distress - The preoccupation with body size/musculature causes impairments in important activities - Continuing to work out, diet or use steroids/PEDs despite knowledge of adverse physical or psychological outcomes 5
- 6. Muscularity-oriented disordered eating Definitionof muscularity-oriented disordered eating: “Problematic eating attitudes and behaviours motivated by the desire to become more muscular” What makes an eating attitude or behaviour disordered/problematic? The attitude or behaviour must be 1. Rule-driven, or 2. Compensatory 6
- 7. Associations with muscularity-orienteddisordered eating Emotion regulation deficits Attentional biases Cognitive deficits (Griffiths, Angus, Murray, &Touyz, unde r review in Body Image) (Griffiths, Angus, Murray, &Touyz, unde r review in Body Image) (Griffiths, Murray, & Touyz, in press in Body Image) MUSCULARITY MUSCULARITY -ORIENTED ORIENTED DISORDERED DISORDERED EATING EATING Masculinity Admiration of muscle dysmorphia (Griffiths, Murray, &Touyz, under review in Psychology of Men & Masculinity) (Griffiths, Mond, Murray &Touyz, under review in International Journal of Eating Disorders) Thinness-oriented disordered eating
- 8. Body dissatisfaction inyoung men Body fat dissatisfaction (mean scores) Muscle dissatisfaction (mean scores) N = 286 Mean = 2.87 Often to Always = 18% N = 286 Mean = 3.14 Often to Always = 20% 9
- 9. Why are menso bothered by their appearance? › Men are being exposed to increasingly muscular bodies 11
- 10. Why are menso bothered by their appearance? › Video games feature hypermuscular male bodies (Barlett& Harris, 2008) 12
- 11. Why are menso bothered by their appearance? › Advertising on campus at the University of Sydney 13
- 12. Why are menso bothered by their appearance? › Messages communicated to young boys 14
- 13. Why are sofew males in treatment? › Men with eating disorders tell us that society believes eating disorders are a "female issue/girl's problem" (Robinson et al. 2012) › Health professionals may believe that eating disorders are a "female issue" and may not ask the right questions › Many psychologists will tell you that men with eating disorders are stigmatised more than women with eating disorders, but evidence for this is lacking › Eating disorders and mental health in general are stigmatised already › What additional elements of stigmatisation apply to men? › Studying anorexia nervosa and muscle dysmorphia together is useful › Anorexia nervosa may be perceived as a “female problem” › Muscle dysmorphia may be perceived as a “male problem” 15
- 14. Anorexia Nervosa Muscle Dysmorphia AnorexiaNervosa Muscle Dysmorphia
- 15. Stigmatisation and societalgender role expectations Perceived masculinity (mean) 5 *** 4 3 Male participants Female participants = no less or more masculine › Exhibiting thiness-focused versus muscularity-focused psychopathology has a significant effect on how masculine one is perceived › Size of this effect size is very large (η2 = .23) 2 - The effect is even stronger amongst male participants 1 - 3 times larger than the effect of participant sex on masculinity (η2 = .07) Anorexia Muscle nervosa dysmorphia Characterdiagnosis
- 16. Conformity to masculinerole (mean) Masculinity and femininity in men with anorexia and muscle dysmorphia Healthy controls 150 Anorexia nervosa Muscle dysmorphia 100 50 0 › Men with muscle dysmorphia exhibit greater masculinity than healthy control men › However, men with anorexia nervosa are just as masculine as healthy controls
- 17. Knowledge of anorexiavs. muscle dysmorphia 100% much did you know about _________ _ before taking this survey?” Percentage of responses “How Never heard of it 75% 50% Heard of it, but don’t know much about it 25% I know a lot about it 0% Anorexia Nervosa Muscle Dysmorphia Character Diagnosis
- 18. Prevalence of thinness-vs. muscularity-focused psychopathology “Do you n.s. p>.05 know anyone who has had a problem like ________ ” N = 343 Error bars = 95% CIs
- 19. What can Ido? Challenge your stereotypes Eating disorders are not a "female" problem Males account for 25-33% of anorexia nervosa diagnoses Males account for ~25% of bulimia nervosa diagnoses Males account for 40-50% of binge eating disorder diagnoses Males probably account for >85% of muscle dysmorphia diagnoses Men with eating disorders are no less masculine than other men - Even for anorexia nervosa, which may be perceived as the most "female/girlish" of the eating disorders 21
- 20. What can Ido? Ask questions How important is it to you that you get your ideal physique? Some guys (particularly young guys and masculine guys) baulk at discussing "body image" Concept of body image is viewed as feminine, girlish, effeminate "Physique" is interpreted as more gender-neutral Do you have definite rules about eating? E.g., the types of food you can eat, when you can eat it, how much you have to eat? What happens if you break those rules? How do you feel when you meet your physique or diet goals? Do you feel content? Do you immediately re-set your goals? How would you feel if you had a setback? For example, you badly sprained your wrist during a workout and could not train for two months? 22
- 21. What can Ido? "Ye shall not judge" - Anorexia and muscle dysmorphia are ego-syntonic - Good chance they are in your office because of a co-morbid issue that has developed because of / in conjuntion with the eating disorder - Depression and anxiety are common, but also substance abuse, bipolar disorder, obsessive-compulsive disorder - If disclosed to you, do not pass strong negative judgements about steroid use - Steroid use in samples of men with muscle dysmorphia has ranged from 33% to 90% - Men with muscle dysmorphia who use steroids are not "junkies," they extend the same metitcioulsness over their diet and training to their steroid use - Attacking the steroids might win you the battle but will cost you the war 23
- 22. What can Ido? › Breaking down the masculinity / ego-syntonic barrier in that first meeting - Frame your collaboration as trying to relieve negative emotions, not change behaviour - "My goal here is not to try and change your diet or your workouts. I hear you when you say that watching what you eat and excerising regularly are positives in your life. What I want for you is to be able to diet and train without the negatives; the guilt you feel when you eat something you shouldn't, the embarassment you feel when you examine your physique in the mirror... Does that sound like something worth working towards?" - Use whatever terms they use to describe their emotions and be prepared for little emotional insight and intolerance of emotional vulnerability - Male with muscle dysmorphia, age 27: "It's like I'm working a dumbell 24/7. It's physically right there. Gear [steroids] make it go away, training hard make it go away, but if I stuff up my eating or skip the gym the dumbell is right back there sitting on my head or in my chest and I have to train it away again. I get so frustrated that it's even there. Fucking feelings are wrecking my life." 24
Editor's Notes
- #2 Hi, I’m Scott Griffiths, I’m a PhD student at the University of Sydney. I’m studying eating and body image disorders in males under the supervision of Stephen Touyz.
- #8 This is a modified version of the EDE-Q completed by a young male diagnosed with muscle dysmorphia.
- #10 Lots of males, especially young males, suffer from body dissatisfaction. In fact, we might be approaching a point at which body dissatisfaction in young men is normative. The blue and red graphs are frequency histograms depicting the mean scores of 286 male psychology undergraduates who completed the Male Body Attitudes Scale for a related but separate study to the one I am presenting today. The blue graph is the frequency histogram for mean scores on the Muscle Dissatisfaction subscale of the Male Body Attitudes Scale, which measures males’ dissatisfaction with their muscularity. Similarly, the body fat dissatisfaction subscale measures dissatisfaction with body fatBoth scales ask participants to rate their level of agreement with statements about the body, such as “I think my arms should be more muscular” or “I think I have too much fat on my body”. Both measures use the 6-point Likert scales at the bottom of each histogram. The mean level of muscle dissatisfaction in these 286 males is 3.14, which corresponds to someone agreeing “sometimes” to “often” with questions such as “I wish my chest was broader” and “I think I have too little muscle mass on my body.” Worryingly, almost 1 in 5 or 20% are, on average, agreeing “often” to “always” with these statements.Body fat concerns appear less marked overall than muscle concerns, but high nonetheless.Thus, amongst University of Sydney psychology graduates at least, muscle dissatisfaction is almost the norm.
- #11 I had 343 male and female undergraduates read a vignette describing a character with anorexia nervosa or muscle dysmorphia named Michael or Kelly. The muscle dysmorphia vignette described a male with an intense fear of losing his muscle mass, and who redoubled his efforts in the gym and with his diet if he found it difficult to control his eating and workouts, and who thought he was scrawny and underweight despite being very muscular with little body fat. Without telling them the diagnosis, I asked them to indicate if they knew anyone who has had a problem like Michael/Kelly.? 343 undergraduates answered this question, meaning there was plenty of power to detect a significant difference in the pattern of responses. However, the differences were not significant, suggesting that people are as familiar with muscularity-focused psychopathology as they are thinness-oriented psychopathology.
- #18 I had 343 male and female undergraduates read a vignette describing a character with anorexia nervosa or muscle dysmorphia named Michael or Kelly. The muscle dysmorphia vignette described a male with an intense fear of losing his muscle mass, and who redoubled his efforts in the gym and with his diet if he found it difficult to control his eating and workouts, and who thought he was scrawny and underweight despite being very muscular with little body fat. Without telling them the diagnosis, I asked them to indicate if they knew anyone who has had a problem like Michael/Kelly.? 343 undergraduates answered this question, meaning there was plenty of power to detect a significant difference in the pattern of responses. However, the differences were not significant, suggesting that people are as familiar with muscularity-focused psychopathology as they are thinness-oriented psychopathology.
- #19 I had 343 male and female undergraduates read a vignette describing a character with anorexia nervosa or muscle dysmorphia named Michael or Kelly. The muscle dysmorphia vignette described a male with an intense fear of losing his muscle mass, and who redoubled his efforts in the gym and with his diet if he found it difficult to control his eating and workouts, and who thought he was scrawny and underweight despite being very muscular with little body fat. Without telling them the diagnosis, I asked them to indicate if they knew anyone who has had a problem like Michael/Kelly.? 343 undergraduates answered this question, meaning there was plenty of power to detect a significant difference in the pattern of responses. However, the differences were not significant, suggesting that people are as familiar with muscularity-focused psychopathology as they are thinness-oriented psychopathology.
- #20 I had 343 male and female undergraduates read a vignette describing a character with anorexia nervosa or muscle dysmorphia named Michael or Kelly. The muscle dysmorphia vignette described a male with an intense fear of losing his muscle mass, and who redoubled his efforts in the gym and with his diet if he found it difficult to control his eating and workouts, and who thought he was scrawny and underweight despite being very muscular with little body fat. Without telling them the diagnosis, I asked them to indicate if they knew anyone who has had a problem like Michael/Kelly.? 343 undergraduates answered this question, meaning there was plenty of power to detect a significant difference in the pattern of responses. However, the differences were not significant, suggesting that people are as familiar with muscularity-focused psychopathology as they are thinness-oriented psychopathology.
- #21 I had 343 male and female undergraduates read a vignette describing a character with anorexia nervosa or muscle dysmorphia named Michael or Kelly. The muscle dysmorphia vignette described a male with an intense fear of losing his muscle mass, and who redoubled his efforts in the gym and with his diet if he found it difficult to control his eating and workouts, and who thought he was scrawny and underweight despite being very muscular with little body fat. Without telling them the diagnosis, I asked them to indicate if they knew anyone who has had a problem like Michael/Kelly.? 343 undergraduates answered this question, meaning there was plenty of power to detect a significant difference in the pattern of responses. However, the differences were not significant, suggesting that people are as familiar with muscularity-focused psychopathology as they are thinness-oriented psychopathology.
- #22 When we discuss disordered eating we rarely refer to just eating behaviours and body image. We often talk about, or measure, laxative use, diuretic use, vomiting, purging and excessive exercise under the umbrella of disordered eating. Similarly, a framework of muscularity-oriented disordered eating
- #23 When we discuss disordered eating we rarely refer to just eating behaviours and body image. We often talk about, or measure, laxative use, diuretic use, vomiting, purging and excessive exercise under the umbrella of disordered eating. Similarly, a framework of muscularity-oriented disordered eating
- #24 When we discuss disordered eating we rarely refer to just eating behaviours and body image. We often talk about, or measure, laxative use, diuretic use, vomiting, purging and excessive exercise under the umbrella of disordered eating. Similarly, a framework of muscularity-oriented disordered eating
- #25 When we discuss disordered eating we rarely refer to just eating behaviours and body image. We often talk about, or measure, laxative use, diuretic use, vomiting, purging and excessive exercise under the umbrella of disordered eating. Similarly, a framework of muscularity-oriented disordered eating