Measuring masculine body ideal distress: development of a measure.This paper describes the construction of the Masculine Body Ideal Distress Scale (MBIDS) and an initial study examining its psychometric psy·cho·met·rics n. (used with a sing. verb) The branch of psychology that deals with the design, administration, and interpretation of quantitative tests for the measurement of psychological variables such as intelligence, aptitude, and properties. For the study, 154 mostly Caucasian and heterosexual college males completed the MBIDS along with a measure of body dissatisfaction and a measure of conformity to masculinity norms. Results indicated that the Masculine Body Ideal Distress Scale consisted of one factor, had very high internal consistency In statistics and research, internal consistency is a measure based on the correlations between different items on the same test (or the same subscale on a larger test). It measures whether several items that propose to measure the same general construct produce similar scores. , and related to both higher levels of body dissatisfaction and conformity to masculine norms. The discussion focuses on future research using the MBIDS and limitations to the study. Keywords: body dissatisfaction, conformity to masculinity norms, psychometric measures ********** There is increasing evidence that body image concerns pose significant health risks for males in terms of their use of anabolic steroids Anabolic steroids A group of drugs derived from the male sex hormone testosterone, most commonly prescribed to promote growth or to help the body repair tissues weakened by severe illness or aging. Some anabolic steroids are given as appetite stimulants. and the development of eating disorders eating disorders, in psychology, disorders in eating patterns that comprise four categories: anorexia nervosa, bulimia, rumination disorder, and pica. Anorexia nervosa is characterized by self-starvation to avoid obesity. and poorer psychological functioning (Cafri, Strauss, & Thompson, 2002; Connan, 1998; Kanayama, Pope, Cohane, & Hudson, 2003). Although men usually report higher levels of body satisfaction than women, research shows that boys and men are increasingly presented with more muscular and unattainable masculine ideal body images than 10 or 20 years ago (Pope, Olivardia, Gruber, & Borowiecki, 1999). For example, analysis of toy action figures (e.g., GI Joe) showed dramatic increases in muscularity with the body proportions of the most recent action figures being unattainable (Pope et al., 1999). Some suggest that the increasingly unattainable body proportions presented to men account for the fact that adult males' body ideals have also grown increasingly muscular in recent years (Leit, Pope, & Gray, 2001). These trends are particularly problematic when viewed from a social comparison framework. The specific source of concern is that, because negative self-perceptions occur when people see themselves as worse than others on a specific dimension (Festinger, 1954), boys and men are comparing themselves to increasingly unattainable masculine body images and are thus increasingly likely to evaluate their body image negatively. Support for this idea has been found in research examining boys' dissatisfaction with their bodies (Jones, 2001) and findings that men's body satisfaction decreases when they view muscular sociocultural so·ci·o·cul·tur·al adj. Of or involving both social and cultural factors. so ci·o·cul ideals (Leit, Gray, & Pope, 2002).Summarizing both the trend of males' increasing body dissatisfaction and its negative health effects, a recent review concluded that "the male body ideal is becoming more muscular; and adolescent males are increasingly experiencing body dissatisfaction, engaging in disordered eating Disordered Eating is a term that is used by some people to describe a wide variety of irregularities in eating behavior that do not warrant a diagnosis of a specific eating disorder such as anorexia nervosa or bulimia nervosa. , and using anabolic steroids and untested dietary supplements Noun 1. dietary supplement - something added to complete a diet or to make up for a dietary deficiency diet - a prescribed selection of foods vitamin pill - a pill containing one or more vitamins; taken as a dietary supplement to control their weight and gain muscle" (Labre, 2002, p. 233). In studying these issues, researchers have relied primarily on indices of body dissatisfaction typically assessed by determining the discrepancy between an individual's ideal body type and his perceived body type. As an illustration, the Body Image Assessment measure calculates the discrepancy between one's current and ideal body size (see Williamson, Davis, Bennett, Goreczny, & Gleaves, 1989), and the Body Ideal Questionnaire (Cash & Szymanski, 1995) assesses the discrepancy between an individual's ideal and self-perceived image while accounting for how important the ideals are to the individual. However, these measures do not directly assess distress arising from men's concerns about not having a muscular masculine body, which may be the source of their problematic health behaviors (e.g., anabolic steroid use Anabolic Steroid Use Definition Anabolic steroids are drugs containing hormones, or hormone-like substances, that are used to increase strength and promote muscle growth. ). We believe that such distress is important to examine for two reasons. First, a person may experience a large discrepancy between his real and ideal body image, but the discrepancy is not a cause of worry or source of distress. Second, distress is strongly associated with poor health outcomes (e.g., Wyshak, 2003) and, as such, may be a better indicator of body-image related health risk than body dissatisfaction. Given these two reasons, we were interested in developing an instrument to assess masculine body ideal distress to measure directly the stress males experience from failing to live up to masculine body ideals. DEVELOPMENT OF THE MASCULINE BODY IDEAL DISTRESS SCALE Several steps were used to develop the inventory. To begin with, the first author met with a focus group of six young adult men [five White, one bi-racial who averaged 26.5 years of age (SD = 3.75)] and asked them to describe "what is important about an ideal masculine body?" Participants' responses were recorded and examined for redundancies. For example, multiple responses regarding the importance of "six-pack abs," a flat stomach, and strong abdomen were all considered to reflect the importance of good abdominal muscles abdominal muscles Clinical anatomy The large muscles of the anterior abdominal wall–external oblique, internal oblique, rectus abdominalis, which help in breathing, support spinal muscles while lifting, and help maintain abdominal organs and GI tract in their . After identifying seven general areas that participants' responses fell into (i.e., arms, legs, pectorals, abdominals, weight, muscle definition, and strength), 12 initial items were developed, and these items were reviewed to reduce negative statements, eliminate "double-barreled" items, and improve readability. Following this step, three focus group members then reviewed the items with instructions to indicate which items most reflected masculine body ideals, which items least reflected masculine body ideals, which items were confusing to read, and whether there were areas reflecting masculine body ideals that were not represented. Based on this feedback, eight items were retained for use as the MBIDS items (see Table 1 for list of items). To assess distress from failing to live up to these masculine body ideals, the scale's instructions asked participants to indicate, "How distressing would it be for you if the following statements were true of your physical appearance?" Respondents to the Masculine Body Ideal Distress Scale (MBIDS) then indicate their expected level of distress to items (e.g., "having a weak body) on a four-point scale (i.e., 1 = "not distressing at all," 2 = "mildly distressing," 3 = "moderately distressing," and 4 = "very distressing"). The purpose of this study, therefore, was to examine the psychometric properties of the MBIDS. Specifically, we examined the factor structure of the scale and the internal consistency of items and hypothesized that scale scores should relate positively to indicators of body dissatisfaction and conformity to masculinity. METHOD PARTICIPANTS Participants were recruited in undergraduate introduction to biology classes at a northeastern university Northeastern University, at Boston, Mass.; coeducational; founded 1898 as a program within the Boston YMCA, inc. 1916, university status 1922, fully independent of the YMCA 1948. and received extra credit from the class instructor. One hundred fifty-four college-aged men participated in the study. They averaged 19.33 years of age (SD = 1.00) and were predominantly White (129 Caucasian, 12 African American African American Multiculture A person having origins in any of the black racial groups of Africa. See Race. , six Asian or Asian American A·sian A·mer·i·can also A·sian-A·mer·i·can n. A U.S. citizen or resident of Asian descent. See Usage Note at Amerasian. A , four Hispanic/Latino, one bi-racial, and two who described themselves as "other"). All men were single and attending a university in the northeast, and almost all self-reported as heterosexual (150 heterosexual, three homosexual, and one bi-sexual). We do not have demographic information on non-participants in the class. As this course (i.e., Introduction to Biology) is a required course, the male students in the study should be representative of the larger university population of freshman and sophomore male students. In addition, the demographic characteristics of our sample were very similar to previous samples of male students drawn from the university in other studies. MEASURES The Body Image Ideals Questionnaire (BIQ BIQ Biarritz, France - Parme (Airport Code) BIQ Business Intelligence Quotient BIQ Basic Infantry Qualification (Canadian Forces) BIQ Back in Quarters (emergency response) ; Cash & Szymanski, 1995) was used to measure body dissatisfaction rating 11 physical attributes (e.g., weight, facial features Facial Features See also anatomy; beards; body, human; eyes. gnathism the condition of having an upper jaw that protrudes beyond the plane of the face. — gnathic, adj. , muscle tone/definition, physical strength, overall appearance, etc.) on a four-point scale ranging from 0 to 3. Specifically, the BIQ assesses a person's degree of body-image dissatisfaction by first measuring the degree of discrepancy between the person's self-perceived physical attributes and their idealized i·de·al·ize v. i·de·al·ized, i·de·al·iz·ing, i·de·al·iz·es v.tr. 1. To regard as ideal. 2. To make or envision as ideal. v.intr. 1. physical attributes, then asking the person to evaluate how important each of the physical ideals are to the person. Thus, both one's closeness to the physical ideal and how important it is to meet the physical ideal are considered when computing the BIQ score. To illustrate, participants are asked to respond to a statement such as "My ideal height is" with one of four choices ranging from "0 = Exactly As I Am" to "3 = Very Unlike Me." Then they are asked to indicate "How important to you is your ideal height?" and respond with one of four choices ranging from "0 = Not Important" to "3 = Very Important." Scores for each pair of the 11 sets of items (i.e., 1A and 1B to 11A and 11B) are multiplied together, the 11 products are then summed, and the total sum is divided by 11 to obtain the BIQ score. The BIQ has demonstrated strong validity in several studies through its significant correlation with the Body Areas Satisfaction Scale, the Situational Inventory of Body-Image Dysphoria dysphoria /dys·pho·ria/ (-for´e-ah) [Gr.] disquiet; restlessness; malaise.dysphoret´icdysphor´ic gender dysphoria , the Appearance Schemas Inventory, the Bulimia bulimia: see eating disorders. Test Revised, and the Eating Attitudes Test The Eating Attitudes Test (EAT) is a psychological assessment used to help screen test-takers for clinical or sub-clinical eating disorders. (Cash & Syzmanski, 1995; Syzmanski & Cash, 1995). In addition, the BIQ significantly predicted public self-consciousness, perfectionism per·fec·tion·ism n. A tendency to set rigid high standards of personal performance. per·fec tion·ist adj. & n. ,
social-evaluative anxiety, depression, and eating disturbance. Previous
studies reported the BIQ had a coefficient a = .81 for males (Cash &
Szymanski, 1995). In the current study, internal consistency estimate on
the BIQ total score was a = .87.The Conformity to Masculinity Norms Inventory (CMNI; Mahalik, Locke, Ludlow, Diemer, Scott, Gottfried, & Freitas, 2003) was used to assess conformity to masculine norms in the dominant culture in U.S. society. The inventory consists of 94-items answered on a four-point scale (0 = "Strongly Disagree" to 3 = "Strongly Agree") with factor analysis indicating that the CMNI consists of 11 distinct factors labeled Winning, Emotional Control, Risk-Taking, Violence, Dominance, Playboy Playboy monthly magazine renowned for nude photographs. [Am. Pop. Cult.: Misc.] See : Eroticism , Self-Reliance, Primacy of Work, Power Over Women, Disdain for Homosexuals, and Pursuit of Status (Mahalik et al., 2003). Regarding validity, Mahalik et al. (2003) reported that CMNI scores significantly related to other masculinity-related measures including the Brannon Masculinity Scale (Brannon & Juni, 1984), the Gender Role Conflict Scale (O'Neil et al., 1986), and the Masculine Gender Role Stress Scale (Eisler & Skidmore, 1987). Additionally, CMNI scores were found to relate significantly and positively to psychological distress psychological distress The end result of factors–eg, psychogenic pain, internal conflicts, and external stress that prevent a person from self-actualization and connecting with 'significant others'. See Humanistic psychology. , social dominance, aggression, and the drive for muscularity and significantly and negatively to attitudes toward psychological help-seeking (Mahalik et al., 2003). Addressing reliability, Mahalik et al. (2003) reported that internal consistency estimates ranged from .73 to .91 for the 11 Masculinity Norms with a coefficient alpha of .94 for the CMNI total score. Test-retest over a two to three week period ranged from .51 to .96 for the 11 Masculinity Norms with a test-retest coefficient of .96 for the CMNI Total Score. In the current study, as ranged from .73 to .90 for 10 of the 11 Masculinity Norms (a = .59 for Dominance) and was .93 for the CMNI Total score. Mean substitution was used for missing data on all measures. Specifically, the mean was calculated for each item, and any missing data received the mean value for that item. PROCEDURES All participants were provided with an Internet address There are two kinds of addresses that are widely used on the Internet. One is a person's e-mail address, and the other is the address of a Web site, which is known as a URL. Following is an explanation of Internet e-mail addresses only. For more on URLs, see URL and Internet domain name. that directed them to the informed-consent page where they indicated their willingness to participate by clicking on a hyperlink at the bottom of the page. They were then directed to the survey, which took approximately 30 minutes to complete. Following completion of the survey, participants were then directed to a debriefing de·brief·ing n. 1. The act or process of debriefing or of being debriefed. 2. The information imparted during the process of being debriefed. Noun 1. page. RESULTS PRELIMINARY ANALYSES Prior to the main analyses in the study, the Body Image Ideals Questionnaire scores (BIQ), the 11 Masculinity Norms scores, and CMNI Total score were examined to determine if they met the assumptions of normality normality, in chemistry: see concentration. . As each variable's skewness Skewness A statistical term used to describe a situation's asymmetry in relation to a normal distribution. Notes: A positive skew describes a distribution favoring the right tail, whereas a negative skew describes a distribution favoring the left tail. score was less than |1.00|, this indicated that the scores were normally distributed. However, four of the masculinity variables had kurtosis Kurtosis A statistical measure used to describe the distribution of observed data around the mean. Notes: Used generally in the statistical field, it describes trends in charts. scores greater than |1.00| (i.e., Risk-Taking = 2.41, Violence = 1.14, Power Over Women = 1.64, and CMNI Total = 1.05). Thus, we attempted to transform these four scores to meet kurtosis assumptions (e.g., using logarithm logarithm (lŏg`ərĭthəm) [Gr.,=relation number], number associated with a positive number, being the power to which a third number, called the base, must be raised in order to obtain the given positive number. , square root, square root of a constant minus the value, inverse) but our transformations failed to improve the kurtosis values below 1.00. Examining the means and standard deviations In statistics, the average amount a number varies from the average number in a series of numbers. (statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. of the BIQ and CMNI indicated that men in our sample scored similarly to comparison samples on these measures. Specifically, men in our sample scored within half a standard deviation of Cash and Szymanski's (1995) sample mean on the BIQ and also half a standard deviation of Mahalik et al.'s (2003) sample on all 11 Masculinity Norms and the CMNI Total score (see Table 2 for means and standard deviations). FACTOR STRUCTURE OF MBIDS The dimensions underlying the eight items of the Masculine Body Ideal Distress Scale were investigated using a principal components analysis. The Kaiser-Meyer-Olkin measure of sampling adequacy (Kaiser, 1974) was computed as .88, indicating that factor analysis was appropriate for the data set. Results from the principal components analysis using oblique o·blique adj. Situated in a slanting position; not transverse or longitudinal. oblique slanting; inclined. rotation indicated that the MBIDS contained one factor with an eigenvalue eigenvalue In mathematical analysis, one of a set of discrete values of a parameter, k, in an equation of the form Lx = kx. Such characteristic equations are particularly useful in solving differential equations, integral equations, and systems of greater than 1.0 (i.e., 4.55) and that all eight items loaded on that factor higher than .5 (see Table 1). INTERNAL CONSISTENCY OF THE MBIDS To examine the internal consistency of the MBIDS, coefficient alpha was calculated. Results indicated the coefficient o for the 8-item MBIDS was .89 with item-total correlations all exceeding .42 (see Table 1 for corrected item-total correlations). RELATIONSHIP OF MBIDS SCORES TO OTHER CONSTRUCTS As the MBIDS was designed to measure distress arising from not meeting the masculine body ideal, we examined MBIDS scores in relation to body satisfaction and conformity to masculinity norms. Pearson correlations indicated that MBIDS scores were positively and significantly related to BIQ scores (r = .23, p < .01), the CMNI Total score (r = .23, p < .01), and conformity to Winning (r = .31, p < .001), Playboy (r = .16, p < .05), Primacy of Work (r = .15, p < .05), Disdain for Homosexuals (r = .17, p < .05), and Pursuit of Status (r = .14, p < .001) at the one-tail level. DISCUSSION Results indicated that the Masculine Body Ideal Distress Scale consisted of one factor and had very high internal consistency and scores related to both higher levels of body dissatisfaction and conformity to masculine norms. In particular, masculine body ideal distress appears to be most related to the masculine dimensions of being a winner and significantly, but at lower levels, to pursuing status, putting work ahead of everything else, being a playboy, and disdaining homosexuality. We note several limitations for the study. Specifically, the participants were young adults who were mostly White, mostly heterosexual, and of sufficient economic means to be attending a private college, thus limiting generalizability of the findings. In addition, our development process led to items that focused on muscularity and strength. However, the construct of "the ideal masculine body" may be a broader construct including facial features, attractiveness, and sexual potency and not necessarily limited to the muscularity and strength items we identified in this study. In addition, we did not replicate the factor structure with a second sample and recognize that our factor structure solution may be sample-dependent. As such, future research should attempt to cross-validate the single-factor structure we identified in this study. In addition, future research needs to explore psychometric information about the MBIDS with other groups of men from diverse racial, sexual-orientation, economic, and age backgrounds to determine if the same characteristics reported in this study extend to other samples with other groups. This is particularly important because masculinity is culturally constructed such that masculine body ideals may differ in different cultural contexts such as socioeconomic or sexual orientation sexual orientation n. The direction of one's sexual interest toward members of the same, opposite, or both sexes, especially a direction seen to be dictated by physiologic rather than sociologic forces. . For example, scholars examining the gay community have speculated that some gay men may develop a hypermasculine persona that presents itself in the desire for a powerful masculine physique physique /phy·sique/ (fi-zek´) the body organization, development, and structure. phy·sique n. The body considered with reference to its proportions, muscular development, and appearance. as a defensive reaction to the dominant societal belief that they are not real men because of their sexual orientation (Pope, Phillips, & Olivardia, 2000; Signorile, 1997). As this study did not test the convergent validity Convergent validity is the degree to which an operation is similar to (converges on) other operations that it theoretically should also be similar to. For instance, to show the convergent validity of a test of mathematics skills, the scores on the test can be correlated with scores of the MBIDS, future research must also examine the relationship of the MBIDS to other measures that assess masculine body-related constructs (e.g., the Drive for Muscularity Scale, McCreary & Sasse, 2000). In addition to determining whether the MBIDS relates to such constructs, it needs to be determined whether the measure explains additional variance beyond these current measures. For example, McCreary and Sasse (2000) report that the Drive for Muscularity Scale significantly predicted higher levels of men's depression and lower levels of self-esteem. However, we believe that masculine body ideal distress is likely to be a better predictor of these types of psychological and health outcome variables because the MBIDS items reflect distress about one's body rather than the muscularity oriented body image and muscularity behavior constructs that the DMS (1) (Document Management System) See document management. (2) (Defense Messaging System) An X.500-compliant messaging system developed by the U.S. Dept. of Defense. assesses (McCreary, Sasse, Saucier
A Saucier [sosˈje] , & Dorsch, 2004). Our point is that, although the Drive for Muscularity Scale should be able to predict whether men work out, diet, or take anabolic steroids, the Masculine Body Ideal Distress Scale should be a better predictor of reasons why they do so (e.g., to boost their self-esteem, to manage the anxiety associated with perceiving their body as small or weak). Specifically, we are suggesting that masculine body ideal distress may contribute the motivation that gives rise to risky behaviors such as trying to reduce mass in some regions of the body through eating-disordered behavior and increase mass in other regions of the body through steroid use. Thus, future research should determine whether the MBIDS accounts for variance in these types of phenomena beyond other body-related measures not assessing distress. In addition, research should examine the temporal stability of the measure through test-retest reliability test-retest reliability Psychology A measure of the ability of a psychologic testing instrument to yield the same result for a single Pt at 2 different test periods, which are closely spaced so that any variation detected reflects reliability of the instrument studies and the temporal changes that may occur through longitudinal research of males through critical periods such as adolescence. It would also be important to examine the MBIDS in relation to other constructs contained in its nomological net such as masculine gender-role stress (Eisler, 1995). Specifically, distress associated with perceived failure to meet societal expectations of the male body image are likely to be associated with masculine gender-role stress as it reflects stress associated with failure to meet societal expectations for men and masculinity. Finally, to establish that the MBIDS scores reflect masculine body-ideal distress and not general body-ideal distress, research should examine men and women on their respective levels of masculine body ideal-distress to determine if men actually score higher than women on the MBIDS. Although these are only the initial findings for the measure, this study offers evidence supporting the reliability and validity of the eight-item MBIDS. As such, the MBIDS might be a useful tool to assess males' distress connected to concerns about not meeting a masculine body ideal rather than only assessing their more general body dissatisfaction. The MBIDS may also be a useful tool alongside other measures assessing masculine body-related constructs such as the Drive for Muscularity Scale (McCreary & Sasse, 2000) that measure attitudes and behaviors associated with becoming more muscular. Such a battery of instruments may be particularly useful to understand the actions, attitudes, and motivation of males who engage in disordered eating or anabolic steroid use. We also believe that developing a measure of masculine body-ideal distress is important as it helps to focus research efforts in an area that has typically examined mostly women's body-image concerns. Although research seems to suggest that males and females are both susceptible to social comparison effects in the development of body-image concerns (Jones, 2001), the meaning and consequences of body-related concerns are likely to be different for males and females. In conclusion, we were interested in developing an instrument to assess masculine body-ideal distress to provide a tool to examine questions related to the gendered context of men's body-image concerns. We believe that such a tool may be useful to examine a number of theoretical questions and address some increasingly common clinical problems in men such as eating-disordered behavior, steroid use, and body-related concerns that might range from a drive for muscularity to muscle dysphoria problems.
Table 1
Masculine Body Ideal Distress Scale Items, Factor Loadings, and
Corrected Item Total Correlations
MBID Item Factor Item
Loadings Total Mean (SD)
1. Not having "six pack" .75 .66 1.96 (.86)
abdominal muscles
2. Having flabby pectoral .83 .75 2.52 (.85)
muscles
(i.e., chest muscles)
3. Having a weak body .73 .64 2.88 (.92)
4. Not having a chiseled
body with well-defined .84 .76 2.17 (.90)
muscles
5. Being fat .51 .42 3.43 (.77)
6. Having small arm .82 .74 2.50 (.89)
muscles
7. Having scrawny legs .79 .70 2.24 (.96)
8. Having "love handles"
(i.e., fat around the
side of the stomach) .72 .63 2.62 (.93)
Note. N = 154. Item-total correlations are corrected.
Table 2
Means and Standard Deviations for the Masculine Body
Ideal Distress Scale, Body Ideal Image Questionnaire,
and Conformity to Masculine Norms Inventory Scores
Mean SD
MBIDS 20.32 5.32
BIQ 1.09 1.10
CMNI Total 132.71 23.96
Winning 16.64 4.80
Emotional Control 14.54 5.50
Risk-Taking 15.70 4.24
Violence 12.58 3.69
Power Over Women 9.33 4.00
Dominance 6.43 1.68
Playboy 13.05 6.83
Self-Reliance 7.25 3.33
Primacy of Work 8.87 3.44
Disdain for Homosexuals 16.41 5.84
Pursuit of Status 11.92 2.63
Note. N = 154. MBIDS = Masculine Body Ideal Distress
Scale; BIQ = Body Image Ideals Questionnaire; CMNI
Total = Total Score for the Conformity to Masculine
Norms Inventory.
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McCreary, D.R., Sasse, D.K., Saucier, D.M., & Dorsch, K.D. (2004). Measuring the drive for muscularity: Factorial validity of the Drive for Muscularity Scale in men and women. Psychology of Men and Masculinity, 5, 49-58. O'Neil, J.M., Helms, B., Gable gable Triangular section formed by a roof with two slopes, extending from the eaves to the ridge where the two slopes meet. It may be miniaturized over a dormer window or entranceway. , R. David, L., & Wrightsman, L. (1986). Gender Role Conflict Scale: College men's fear of femininity Femininity Belphoebe perfect maidenhood; epithet of Elizabeth I. [Br. Lit.: Faerie Queene] Darnel, Aurelia personification of femininity. [Br. Lit. . Sex Roles, 14, 335-350. Pope, H.G., Jr., Olivardia, R., Gruber, A., & Borowiecki, J. (1999). Evolving ideals of male body image as seen through action toys. International Journal of Eating Disorders, 26, 65-72. Pope, H.G., Jr., Phillips, K. & Olivardia, R. (2000). The Adonis complex. New York: The Free Press. Signorile, M. (1997). Life outside: The Signorile report on gay men: Sex, drugs, muscles and the passages of life. New York: Harper Collins Publishers. Szymanski, M.L., & Cash, T.F. (1995). Body-image disturbances and self-discrepancy theory: Expansion of the Body-Image Ideals Questionnaire. Journal of Social and Clinical Psychology, 14, 134-146. Williams, D.A., Davis, C.J., Bennett, S.M. Goreczny, A.J., & Gleaves, D.H. (1989). Development of a simple procedure for assessing body disturbance. Behavioral Assessment, 11,433-446. Wyshak, G. (2003). Health ratings in relation to illnesses, physical functioning, general mental health and well-being: Self-reports of college alumnae, ages 40-80 and older. Quality of Life Research, 12, 667-74. Correspondence concerning this article should be either to Sara B. Kimmel, Harvard University Harvard University, mainly at Cambridge, Mass., including Harvard College, the oldest American college. Harvard College Harvard College, originally for men, was founded in 1636 with a grant from the General Court of the Massachusetts Bay Colony. , University Health Services health services Managed care The benefits covered under a health contract , Mental Health Services, 75 Mount Auburn Mount Auburn is the name of several places in the United States:
campion Any of the ornamental rock-garden or border plants that make up the genus Silene, of the pink family, consisting of about 500 species of herbaceous plants found throughout the world. Hall 312, Boston College Boston College, main campus at Chestnut Hill, Mass.; coeducational; Jesuit; est. and opened 1863. Actually a university, the school's Chestnut Hill campus comprises colleges of arts and sciences and business administration, the graduate school, and schools of nursing , Chestnut Hill Chestnut Hill may refer to: In geography:
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