Critical comments about the body and muscle dysmorphia symptoms in collegiate men.
Keywords: muscle dysmorphia, body satisfaction, body dysmorphic disorder, socialization, peer pressure
In the last 15 years, research has focused much more on body dissatisfaction in men and the associated behavioral disturbances than it had previously (Cafri & Thompson, 2004). One particular disorder that relates to the behavioral dysfunctions in men in regards to "improving" their bodies is Muscle Dysmorphia (MD). This disorder is characterized as a person being preoccupied with his or her level of muscularity to a degree that causes distress and impairment in social and occupational functioning (Pope, Gruber, Choi, Olivardia, & Phillips, 1997). Individuals suffering from this disorder spend much of their time lifting weights and focusing on their diets which, in turn, negatively affects their relationships with others and their occupational lives (Pope et al.). MD is a disorder in which an individual has dissatisfaction with his or her current body type and has a strong desire to increase his or her musculature (Grieve, 2007). People with MD strive to achieve their ideal body type by excessively lifting weights and eating large amounts of protein-rich foods (Olivardia, 2001). It is also not uncommon for these people to use drugs or dietary supplements to increase their muscle mass (Olivardia).
Olivardia (2001) proposed diagnostic criteria for MD. First of all, the person must have a preoccupation with his or her body not being sufficiently lean and muscular. This preoccupation must cause the person significant distress or impairment in several areas exhibited by at least two of the following four criteria: (1) the individual gives up important activities because of the need to maintain his or her exercise schedule or diet; (2) the person feels distress when his or her body is exposed to others, or the person attempts to avoid these types of situations altogether; (3) the preoccupation with his or her body causes the person to have marked impairment in an important area of functioning, which usually is a social or occupational area; and (4) the person continues to exercise despite a knowledge and understanding that undesirable physical or psychological consequences may occur as a result. In addition to these criteria, the individual's preoccupation with his or her body must include a focus on being too small and not muscular enough, but not on being fat.
IMPLICATIONS FOR PERSONAL HEALTH AND RELATIONSHIPS
Compared to those without MD, those with the disorder report greater body dissatisfaction and spend more time each day thinking about their muscularity (Choi, Pope, & Olivardia, 2002). They often attempt to conceal their appearance, check mirrors, use steroids, and sacrifice social activities in order to exercise (Olivardia, Pope, & Hudson, 2000). Individuals with MD are concerned about body size and symmetry, have dietary constraints, use pharmacological aids and dietary supplements like anabolic-androgenic steroids and other prohormones or ephedrine, often attempt to hide their bodies because they view themselves as small and weak (what is called physique protection), and experience exercise dependence (Lantz, Rhea, & Mayhew, 2001). Each of these practices involves an increase in health risks such as an increase in the likelihood of injury, heart and liver problems, and an increase in the likelihood of developing another psychological disorder (Blumenthal, O'Toole, & Chang, 1984; Cafri Thompson, Ricciardelli, McCabe, Smolak, & Yesalis, 2005; Krowchuck, Kreiter, Woods, Sinal, & DuRant, 1998).
In addition to health risks, individuals with MD experience aversive psychological states such as alienation, feelings of inadequacy, narcissism, depression, and social physique anxiety (Chandler, Grieve, Derryberry, & Pegg, 2009; Ebbeck, Watson, Concepciion, Cardinal, & Hammermeister, 2009; Lantz et al., 2001). Alienation occurs when someone, like a bodybuilder, does nothing but train and thinks about training. This preoccupation leaves little time for social activities that are not related to training (Fisher, 1997). Another consequence is that they feel inadequate and often engage in physical activities to compensate for these feelings. After their physical development, people with this disorder affirm their existence by the attention of others, whether that attention is positive or negative. This leads them to adopt a narcissistic attitude in which they become so preoccupied with themselves that all others are excluded (Klein, 1993; Lowen, 1983).
Higher levels of MD have been associated with a higher endorsement of body work; a term that encompasses a number of activities associated with body transformation and includes shaving, tanning, and cosmetic surgery (Reynolds, 2010). Further, stress related to physical attractiveness has been shown to be predictive of symptoms of MD (Readdy, Watkins, & Cardinal, 2011). Thus, it appears that men, contrary to past common wisdom, do pay attention to their bodies and find body image issues important.
Prevalence of MD and Risk Factors Tied to Development
It is estimated that between 5% and 10% of weightlifters, as well as 9% of those with Body Dysmorphic Disorder (BDD), have MD (Olivardia, 2001). However, it is not clear how common this disorder is in the general population (Grieve, 2007). Large scale studies on MD have not yet been performed (Cororve & Gleaves, 2001). Although MD is not currently listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; APA, 2000), it is considered to be a sub-category of BDD (Grieve, 2007; Pope et al., 1997); however, this disorder also shares characteristics with eating disorders (Grieve; Maida & Armstrong, 2005). For example, in both MD and in eating disorders, a person's self-opinion is highly influenced by his or her shape or size (Grieve).
There are many risk factors for developing MD (Grieve, 2007) that influence the likelihood of engaging in risky behaviors for the sake of increasing muscularity (McCabe & Ricciardelli, 2004). In a model proposed by Grieve (2007), several specific factors contribute to the development of MD: body dissatisfaction, body distortion, body mass, media influences, ideal body internalization, sports participation, low self-esteem, perfectionism, and negative affect (Grieve). Social influences, such as messages from parents and peers (Cafri, Yamamiya, Brannick, & Thompson, 2006), could also drive the development of MD. One type of social influence that has not yet been explored is the experience that one has when others make negative comments about their body. One could reasonably expect this factor to increase the likelihood of the emergence of MD symptoms, especially if the comments have a great impact on the individual or are perceived as particularly hurtful.
The Influence of Social Messages on Body Dissatisfaction
In research on female eating disorders, there is evidence that media influences are associated with disordered eating and body dissatisfaction (Cafri et al., 2006). It is assumed that the sociocultural influences that contribute to eating disorders in women are similar to those that contribute to the drive for muscularity in men. For one, family members can have a significant impact on one's feelings about his or her appearance and, in turn, also affect his or her dieting or exercise practices (Stanford & McCabe, 2005). Because of this, messages that men receive from parents, peers, and the media have been repeatedly assessed (Cafri et al., 2005). These sociocultural influences predict body dissatisfaction (Stanford & McCabe, 2005), muscle building activities in adolescent boys (Smolak, Mumen, & Thompson, 2005), and symptoms of MD in college students (Readdy et al., 2011). Interestingly, research from Stanford and McCabe (2005) suggests that parental messages influence a male's appearance more than the media does.
Past research has found a direct relationship between parental and peer influence and MD symptoms. For example, exposure to perceived negative messages from parents and peers predicted a greater likelihood to engage in strategies to increase weight and muscle mass (McCabe & Ricciardelli, 2003). Body dissatisfaction is also correlated with parental expectations and criticism (Lamanna, Grieve, Derryberry, Hakman, & McClure, 2010). Individuals who receive critical messages from their parents about their body are less satisfied with their muscles, overall body, food intake, and exercise plan (Stanford & McCabe, 2005). In fact, parents have more of an influence on their son's dieting and muscle building behaviors than do the media or their peers (Lamanna et al.). Moreover, perceived messages from fathers are more associated with the son engaging in muscle building activities than messages from their mothers (Stanford & McCabe, 2005). Boys who indicated that it was important to their fathers that they not be overweight were likely to be constant dieters (Field, Camargo, Taylor, Berkley, Robert, & Colditz, 2001). Messages from peers have been found to be more influential than messages from parents (Stanford & McCabe, 2002). Teasing from peers during childhood is negatively correlated with body image in young adulthood (Gleason, Alexander, & Somers, 2000). Likewise, popularity among peers is weakly correlated with efforts to increase muscle mass among adolescent males (McCabe, Ricciardelli, & Finemore, 2002).
In sum, sociocultural influences are frequently implicated as predictors of MD symptomatology (Lamanna et al., 2010). Ricciardelli and McCabe (2001) reported that boys are likely to engage in activities to enhance their muscles if they perceive pressures from their fathers, female friends, and the media, and if they have low self-esteem and high levels of negative affect. Clearly, the negative messages from peers, family, and the media have the potential to promote body dissatisfaction, a factor that has consistently been found to predict the emergence of MD (Grieve, 2007).
Critical Comments Toward the Body
Individuals who display symptoms of MD are preoccupied with their body shape and weight, and negative critical comments made by others about their bodies may exacerbate the individual's condition. In other words, individuals who are overly concerned with their bodies' appearances may be especially sensitive to comments directing attention to their body. Individuals with diagnosed eating disorders are more likely to respond negatively to chance remarks about their bodies (Lask & Bryant-Waugh, 2000). For instance, comments that individuals receive from parents and peers predict the onset of bulimia nervosa (Palmer, 1998; Stice, 1998). Also, female athletes with disordered eating felt that critical comments made about their bodies from people who were significant to them, such as peers, coaches, and family, represented pivotal points in their lives in regards to their eating behaviors (Muscat & Long, 2008). Interestingly, the greater the level of athletic involvement displayed by the female athletes who participated in this study, the higher the frequency of critical comments that was recalled. When recalling the critical comment, these athletes were more likely to associate stronger negative emotions (e.g., shame and anxiety) with the comment than were non-athlete participants in the control group. In fact, the more severe or threatening a particular comment was perceived to be, the greater the woman's level of disordered eating. In sum, critical comments appear to influence the development of negative affect (Muscat & Long, 2008), which, in men, is associated with higher levels of MD symptoms (Ebbeck et al., 2009; Lantz et al., 2001).
The current study was designed to evaluate the effect of critical comments on MD symptoms in men. Men who could recall critical comments that others have made about their bodies were expected to report that they were experiencing more MD symptoms than men who remembered fewer, or no, such comments (Hypothesis 1). This is consistent with previous research that demonstrated that exposure to negative messages was related to body dissatisfaction as well as more attempts to control weight and increase muscle mass (McCabe & Ricciardelli, 2003; Stanford & McCabe, 2005). Additionally, men who could recall critical comments were expected to report a higher frequency of MD symptoms if they remembered the critical comments as being more severe or threatening (Hypothesis 2). Muscat and Long (2008) reported a similar relationship for female athletes who had recalled critical comments about their bodies as being particularly severe or threatening. Lastly, men who associated more negative emotions with their recalled critical comment were expected to report that they experienced higher levels of reported MD symptoms, as the behaviors that are symptomatic of MD offer those who have been particularly impacted by critical comments a way to resolve their feelings (Grieve, 2007) while remaining focused on their body (i.e., the target of the comment).
As college-age men are at a high risk for developing MD, participants in the current study were men recruited from undergraduate classes at a comprehensive mid-southern university. A total of 118 men completed the study. Ages of the participants ranged from 18 years to 39 years (M = 19.95, SD = 3.67). The sample was 82.2% Caucasian (n = 97), 7.6% African American (n = 9), 3.4% Asian American (n = 4), 0.8% Native-American (n = 1), 0.8% Hispanic (n = 1), and 0.8% Pacific Islander (n = 1). A total of 1.7% of the participants indicated that they were "biracial" (n = 2), and 1.7% of the sample reported "other" ethnicities (n = 2). One person did not indicate ethnicity. The mean number of years of education for the sample was 13.63 (SD = 0.91). The men in this study had a mean self-reported height of 69.73 inches (SD = 4.97), and a mean self-reported weight of 175 pounds (SD = 45.83). The mean Body Mass Index (BMI) score of this study was 26.16 (SD = 7.04). Even though the men were not specifically recruited from gyms, the participants were asked to state whether or not they were generally involved in sports and then to specify the sports activities in which they were involved. Of the 118 men, 81 (68.6%) reported that they were not involved in sports, and 37 (31.4%) reported that they were involved in sports. Football was the most popular sport (n = 12), followed by soccer (n = 6), baseball/softball (n = 4), basketball (n = 4), lacrosse (n = 3), track (n = 2), martial arts (n =2), and a number of other activities only reported by a single participant (e.g., diving, dodge ball, golf, and tennis).
Demographics. The participants were asked to complete a demographics survey that asked for the participant's age, ethnicity, level of education, athletic participation, and self-reported height and weight.
Muscle Dysmorphia Questionnaire. Participants were asked to complete the Muscle Dysmorphia Questionnaire (MDQ; Grieve et al., 2012; Short, 2005). The MDQ is made up of 34 statements, such as "When I see my reflection in the mirror or window, I feel badly about my body size or shape," and "I have difficulty maintaining relationships because of thoughts of my body." The MDQ measures variables including: a person's level of body anxiety, compulsivity, and inappropriate eating habits. Response choices on the MDQ are arranged on a six-point Likert-type scale from 1 (never) to 6 (always). Higher scores indicate higher levels of MD symptomology. Past Cronbach's Alpha for the MDQ was calculated to be .87, indicating that the MDQ has a high level of internal consistency (Short, 2005).
Due to a mechanical error when collecting the data used for analysis, items 4 through 12 on the MDQ were not included in the present study. Cronbach's Alpha for the 25-item MDQ used for this study was .84, indicating that it still has high internal consistency. (1)
Social Hassles Questionnaire. The participants were given the Social Hassles Questionnaire (SHQ; Muscat & Long, 2008) to elicit whether participants remembered critical comments about their bodies by others, the participants' emotional responses to the comments, the source of the comments, and the content of each comment. The original SHQ was modified to include an additional item that asked whether a person who was significant to the participant had ever made a comment that recommended increasing the amount of exercise or attempts to increase muscle mass. Overall, the SHQ consists of 12 items, such as "Do you remember someone ever making a critical comment that your body should be a certain shape, weight, or that there was a need to gain muscle mass?" and "To what degree did you feel upset by the person's comment about your body?" The SHQ also asks the participant to identify who made the critical comment. Cronbach's Alpha for the items on the SHQ that assessed participants' reactions was .90, indicating that this section has excellent internal consistency.
In addition to the SHQ, participants were asked to evaluate the emotions that they felt after receiving the comments. They responded to a list of positive (relief, hope, love, gratitude, compassion, pride, and happiness) and negative (anger, anxiety, fright, guilt, shame, sadness, envy, and jealousy) emotions, and rated how much they experienced each emotion between 0 (Not at all) and 5 (Extremely). Cronbach's Alpha for the negative emotion scale was found to be .91, and the Cronbach's Alpha for the positive emotion scale was .95.
After receiving Institutional Review Board approval, participants were recruited from undergraduate courses at the university. Students accessed an online data collection system that directed them to the current study. Participants read and agreed to an online Informed Consent Document. Next, they completed the questionnaire, which contained the demographics section, the SHQ, and the MDQ. Debriefing occurred after the students completed the questionnaires.
The total score for the MDQ was calculated by summing the participants' responses. This yielded a mean score of 69.71 (SD = 16.21), with a range of 33 to 118. To determine how upset participants were following the comments, five questions from the SHQ (Question 5 through Question 9) were summed. This yielded a mean score of 9.15 (SD = 3.95), with a range of 5 to 20. The emotional reactions to the comments were evaluated by calculating the average score across both negative and positive emotions. The mean of the negative emotion score was 2.18 (SD = 1.03), with a range of 1 to 5; the mean of the positive emotion score was 1.95 (SD = 1.09), with a range of 1 to 4.57.
The Impact of Critical Comments on MD Symptomology
Men who could recall critical comments about their bodies were expected to report more MD symptomology than those who remembered no such comments. In the study, 59.3% of participants reported that they recalled a critical comment (N = 70), and 40.7% of the participants did not report recalling any comments (N = 48). An independent samples t-test showed no significant differences on MD symptoms between participants who recalled comments about their bodies (M = 70.86, SD = 16.05) and those who did not recall comments about their bodies (M = 67.93, SD = 16.49), t(113) = -0.94, p = .35.
Feeling Threatened by Comment Increases MD Symptomology
With respect to those men who could recall a critical comment, higher levels of MD symptomology were expected from those men who felt more threatened by the comment. Correlational analyses were conducted to determine if there was a relationship between how threatened a participant reported feeling about the critical comment made about his body and his current level of MD symptomology. A significant positive correlation (r = .43, N = 70, p < .001) was found between scores on the MDQ and scores on the SHQ that assessed the degree to which the participant felt threatened by the comment.
Negative Emotions Evoked by the Comment Tied to Increased MD Symptomology
For those men who could recall a critical comment, men who more strongly experienced negative emotions as a result of the comment were expected to display higher levels of MD symptomology. A correlational analysis revealed a significant positive relationship between associating negative emotions with the critical comment and having higher levels of MD symptomology (r = .53, N = 51, p < .001). No significant relationship was found between reporting feeling positive emotions after receiving the critical comment and MD symptomology (r = .18, N = 49, p = .22).
The 70 participants who reported that they could recall a critical comment made about their bodies were asked to indicate who it was that made the comment. Many of these participants listed more than one person who made the particular comment; therefore, the following percentages do not equal 100%, as some participants listed more than one person: friend = 51.4% (N = 36), coach = 27.1% (N = 19), girlfriend = 14.3% (N = 10), mother = 11.4% (N = 8), father = 10.0% (N = 7), teacher = 7.1% (N = 5), boyfriend = 2.9% (N = 2), and "other" = 14.3% (N = 10). Participants who marked "other" specified this individual as being a cousin, aunt, uncle, step-parent, sibling, grandparent, prostitute, military recruiter, or classmate.
The intensity of reported positive emotions in response to comments was compared to the reported intensity of negative emotions. Results of a paired t-test indicated that there was no difference between the intensity of positive emotions (M = 1.93, SD = 1.06) and intensity of negative emotions (M = 2.19, SD = 1.03), t(60) = 1.47,p = .14.
Finally, no significant correlation was found between how long ago the comment occurred and participants' current levels of MD symptomology (r = - .02, N = 70, p = .88). The relationship between how well a person remembered the comment and his level of MD symptomology approached significance (r = .22, N = 70, p = .07).
The purpose of the current study was to extend the existing research examining effects of receiving critical comments about one's body. The extant research has examined how women react to criticism of their bodies; this study was designed to examine how men react to critical comments.
There were three hypotheses under study. The first hypothesis stated that men who could recall critical comments about their bodies would report more MD symptoms than men who remembered no such comments. Results of the study did not support this hypothesis. Men who recalled critical comments about their bodies did not have a significantly higher level of MD symptoms than those who did not recall such comments. This finding contradicts research done with women that found that those women who could recall a critical comment made about their bodies reported higher levels of disordered eating (Muscat & Long, 2008). It is probable that MD is caused by more than critical comments made by others (see Grieve, 2007, or Lantz et al., 2001, for etiological models); therefore, it is not surprising to see that there is no difference in symptom level between those who reported critical comments and those who did not.
The second hypothesis postulated that, out of those who recall critical comments, the more severe or threatening they remember the comment being, the more MD symptoms they would report. The results supported this hypothesis. Severity of recalled comments was positively correlated with MD symptoms. Muscat and Long (2008) found that, the more severe or threatening that a particular comment was, the greater the woman's level of disordered eating. The same results were found with this male sample in regards to MD symptoms. These results underscore the importance of the personal interpretation made by the participants about the nature of the comments. Comments that were interpreted as threatening had more impact on the participants than comments that were interpreted as not threatening.
The third hypothesis was that men who associated the comment with feeling more negative emotions at the time would report more MD symptoms. The results supported the hypothesis and were consistent with Muscat and Long's (2008) findings for a female sample. Additionally, they found that the intensity of negative emotions, such as anxiety and shame, was greater than the intensity of positive emotions, which was not found in the present study. Findings supporting hypothesis one also support Grieve's (2007) etiological model for MD, specifically the link between negative emotions and MD symptoms. This pathway in the model has received limited support, with some studies that examined parts of the model finding a relationship (i.e., Chandler et al., 2009) and others not finding a relationship (i.e., Lamanna et al., 2010). Other research (i.e., Ebbeck et al., 2009; Lantz et al., 2001) has demonstrated a relationship between negative affect and the development of MD.
In addition, there is a body of literature that indicates that girls who are teased about their bodies are at a higher risk for developing eating disorders (c.f., Agliata, Tantleff-Dunn, & Renk, 2007). The present results support these findings, as critical comments can be seen as a form of teasing. Further, the results of the present study indicate that men are as susceptible to the negative results of teasing as women. Teasing often has a negative effect on an individual's self-esteem, emotional state, and body satisfaction. Thus, disordered eating in women and symptoms of MD in men could be seen as coping mechanisms to attempt to reduce or control future teasing and/or critical comments.
An interesting finding from the present study is that there was no significant relationship between how long ago the comment was made and a person's current level of MD symptoms, but there was a significant relationship between the how well a person remembered the comment and his current level of MD symptoms. This is noteworthy because it implies that men who were the most disturbed by the comments remembered them the best, contributing to their current level of MD symptoms. It is noteworthy that the percentage of male participants who recalled critical comments in this study (59%) was virtually the same as the percentage of female participants (58%) in Muscat and Long's (2008) study who recalled critical comments. This indicates that men and women have equivalent experiences in terms of critical comments they receive about their bodies from significant others.
The biggest implication of the research is that men's opinions about their bodies are influenced by others, just as women's opinions are. While there was no difference in severity of symptoms between those who remembered comments from a long time ago and those who remembered recent comments, the data suggested that some participants received what they perceived as critical comments at a young age. Thus, it is important for teachers, coaches, and parents to recognize that the comments they make to the boys in their care can have an impact on those boys when they grow up into adults. It also may be helpful to develop interventions that help boys and men understand and appropriately deal with critical comments made by others.
Limitations of the present study should be considered. First, all of the men who participated in the study were college students. There was little variability in the participants' ages, races, and education levels. A more diverse group of men would be more representative of the general public and could be lead to better generalizability. The study did not employ a measure of muscular fitness activities; therefore, it was not possible to determine to what extent the attitudes of the participants were reflected by behavioral indices. In addition, all of the data was self-reported. When relying on self-reporting for data collection, there is concern that participants may under or over report (Schwarz, 1999). Finally, poor recall of past critical comments may have also affected the results. It is likely that the participants received more critical comments about their bodies than they could remember or were willing to admit.
Future research should focus on comparing male athletes and non-athletes in regards to critical comments and levels of MD symptoms. Research should focus on whether male athletes can recall more critical comments, just as Muscat and Long (2008) found that women athletes could recall critical comments more easily. It is interesting that women named family first and men named friends first as the people who made the comments. Future research should examine if family members are more critical of their female family members' bodies than they are of their male family members' bodies, or if men are simply just not as bothered by such comments as women are and consequently do not remember them. Over half of the critical comments that were made to the men came from friends. Are men and boys really more likely to be critical of their male friends' bodies, or are those the comments that were taken to heart the most?
In conclusion, the current study examined the relationship between critical comments made to men and MD symptoms. Analyses did not show a significant relationship between higher levels of MD symptoms with the ability to recall critical comments; however, out of the men that recalled a critical comment, the more threatening or upset they reported being from the comment, the more MD symptoms they reported. Also, a significant relationship was found between associating negative emotions with the comment and higher levels of MD symptomology. This research extends on what is known about the development of MD, and how criticism affects one's level of body dissatisfaction.
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(1) The items omitted from the MDQ fell in the following subscales: Inadequacy (two of five items from the subscale were omitted), Persistence (two of three items from the subscale were omitted), Preoccupation (two of four items from the subscale were omitted), Illusory Correlations (one of two items from the subscale were omitted), Social Sacrifice (one of three items from the subscale was omitted), and Muscularity Drive (one of four items from the subscale was omitted). Three subscales--Body Anxiety, Compulsivity, and Inadequacy--did not have any of the items on the subscale omitted.
LAUREN MENEES M.A. *, FREDERICK G. GRIEVE PH.D.*, ANDREW MIENALTOWSKI PH.D.*, and JACQUELINE POPE PH.D *
* Western Kentucky University.
Correspondence concerning this article should be addressed to Frederick G. Grieve, 1906 College Heights Blvd. #21030, Bowling Green, KY 42101. Email: firstname.lastname@example.org
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|Author:||Menees, Lauren; Grieve, Frederick G.; Mienaetowski, Andrew; Pope, Jacqueline|
|Publication:||International Journal of Men's Health|
|Date:||Mar 22, 2013|
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