Purpose of Review
There is growing recognition that eating disorder (ED) symptoms,
particularly those of a muscularity-oriented nature, are more common in men
than previously understood. The purpose of the current review is to describe
contemporary directions and implications of research on traditional and
muscularity-oriented ED symptoms among males.
Recent Findings
Evidence indicates that ED symptoms occur in a substantial minority
of men. Importantly, recent research has focused on muscularity-oriented
body image and disordered eating in males, demonstrating the prevalence,
correlates, and consequences of maladaptive muscularity-oriented attitudes
and behaviors. A growing number of assessments are available to measure
these constructs in males, and preliminary treatment considerations have
begun to be addressed in the literature.
Summary
Research on male EDs and body image is increasingly focusing on
muscularity-oriented manifestations. Continued empirical work will be
critical to improve our understanding of the onset, maintenance, and
treatment of muscularity-oriented disordered eating in males.
Purpose of review
This review summarized trends and key findings from empirical studies conducted between 2011–2017 regarding eating disorders and disordered weight and shape control behaviors among lesbian, gay, bisexual, and other sexual minority (i.e., non-heterosexual) populations.
Recent findings
Recent research has examined disparities through sociocultural and minority stress approaches. Sexual minorities continue to demonstrate higher rates of disordered eating; disparities are more pronounced among males. Emerging data indicates elevated risk for disordered eating pathology among sexual minorities who are transgender or ethnic minorities. Dissonance-based eating disorder prevention programs may hold promise for sexual minority males.
Summary
Continued research must examine the intersections of sexual orientation, gender, and ethnic identities, given emergent data that eating disorder risk may be most prominent among specific subgroups. More research is needed within sexual minorities across the lifespan. There are still a lack of eating disorder treatment and prevention studies for sexual minorities.
Interoceptive awareness (IA), or the awareness of internal body states, is known to be impaired in individuals with eating disorders (EDs); however, little is understood about how IA and ED symptoms are connected. Network analysis is a statistical approach useful for examining how symptoms interrelate and how comorbidities may be maintained. The present study used network analysis to (1) test central symptoms within an IA–ED network, (2) identify symptoms that may bridge the association between IA and ED symptoms, and (3) explore whether central and bridge symptoms predict ED remission at discharge from intensive treatment. A regularized partial correlation network was estimated in a sample of 428 adolescent (n = 187) and adult (n = 241) ED patients in a partial hospital program. IA was assessed using items from the Multidimensional Assessment of Interoceptive Awareness, and ED symptoms were assessed using items from the Eating Disorder Examination–Questionnaire. Central symptoms within the network were strong desire to lose weight, feeling guilty, and listening for information from the body about emotional state. The most central symptom bridging IA and ED symptoms was (not) feeling safe in one’s body. Of the central symptoms, greater desire to lose weight predicted lower likelihood of remission at treatment discharge. Bridge symptoms did not significantly predict remission. Body mistrust may be a mechanism by which associations between IA and EDs are maintained. Findings suggest targeting central and bridge symptoms may be helpful to improve IA and ED symptoms.
Results support that even a 5% weight loss, combined with cognitive concerns, may produce a group with a clinically significant eating disorder. AAN was observed in both healthy weight and overweight/obese adults, highlighting the importance of screening for restrictive eating disorders at all weights.
Objective
Pressures for men to conform to a lean, muscular ideal have, in part, contributed to eating disorder and muscle dysmorphia symptoms, yet few programs have been developed and empirically evaluated to help men. The present study investigated the acceptability and efficacy of a cognitive dissonance-based (DB) intervention in reducing eating disorder and muscle dysmorphia risk factors in men with body dissatisfaction.
Method
Men were randomized to a 2-session DB intervention (n=52) or a waitlist control condition (n=60). Participants completed validated measures assessing eating disorder risk factors pre-intervention, post-intervention, and at 1-month follow-up.
Results
Program ratings indicated high acceptability. The DB condition demonstrated greater decreases in body-ideal internalization, dietary restraint, bulimic symptoms, drive for muscularity, and muscle dysmorphia symptoms compared to controls (p-values < .02; between-condition Cohen’s d = .30–1.11) from pre- to post-intervention. At one-month follow-up, the DB condition demonstrated significantly lower scores for all variables (p-values < .03; between-condition d = .29–1.16). Body-ideal internalization mediated intervention outcomes on bulimic and muscle dysmorphia symptoms.
Discussion
Results support the acceptability and efficacy of The Body Project: More Than Muscles up to one-month post-intervention and should be examined against active control conditions.
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