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Drive for thinness and pursuit of muscularity: the role of gender ideologies/ Impulso a la delgadez y busqueda de la muscularidad: el rol de las ideologias de genero.

Introduction

In Western cultures there is a great emphasis on physical appearance as a determinant of people's personal value (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). According to these authors, the female sociocultural beauty ideal is ultra-thin, while the male beauty ideal is related with a muscular body. Attempting and failing to approximate this unattainable beauty ideal for both men and women may be related with the apparition of disordered eating, as shows the fact that drive for thinness and the pursuit of muscularity are related to eating disorders (Rodgers, Ganchou, Franko, & Chabrol, 2012).

While anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified are the most frequent disorders in women (Hudson, Hiripi, Pope, & Kessler, 2007), muscle dysmorphia or bigorexia is generally found in men (Pope, Gruber, Choi, Olivardia, & Phillips, 1997). It is important to remark that although muscle dysmorphia is not currently a diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders, fith Edition (DSM-V, American Psychiatric Association, 2013), as other eating disorders, experts agree that the disorder exists (Grieve, 2007). The main characteristics are a strong desire to increase musculature (Robert, Munroe-Chandler, & Gammage, 2009) and the addition of dietary supplements and drugs such as anabolic steroids to increase lean muscle mass (Olivardia, 2001). Some authors argue that the pursuit of muscularity component in muscle dysmorphia is parallel to drive for thinness in anorexia because of the similarities of the symptoms and the high attention to diet, as well as the compensatory behavior of excessive exercise (Murray, Rieger, Touyz, & De la Garza, 2010).

According to experts, disordered eating in Western societies is one of the major public health concerns (Suelves, 2006). As a matter of fact, in the last few years eating disorders are increasing (Mitchison, Hay, Slewa-Younan, & Mond, 2012), and some authors suggest it may be related to gender issues (McCabe & Ricardelli, 2004), but the reasons underlying the observed gender differences are poorly understood. Specifically, gender ideology is known to play an important role in relation to disordered eating (De Young, Lavender, & Anderson, 2010) but further research is needed to a better understanding of disordered eating in males and females.

Gender role norms are socially constructed expectations about behavior and traits considered appropriate for men and women in a specific culture (Pleck, Sonenstein, & Ku, 1993) and gender ideology is the individual internalization of these gender role norms (Pleck et al., 1993). The internalization of this set of social and behavioral norms that are generally considered appropriate for men and women also refers to the way that men and women should look (thin in the case of women and muscular in the case of men, as it has been pointed out before). These roles differentially shape women and men's attitudes, preferences, emotional and physiological reactions, and behaviors (Moore & Stuart, 2004). For example, a meta-analysis has showed that gender ideologies are related with disordered eating in both women and men (Murnen & Smolak, 1997). For this reason, in this research it is studied if gender ideologies may be related with the differences that exist in disordered eating in men and women (Morgan, 2012).

Drive for thinness

Thinness is highly valued in Western culture in the case of women and is considered a key attribute of female beauty, and being thin is perhaps one of the most desirable conditions in society (Levitt, 2004). According to experts, dieting and drive for thinness are more typical of female concerns than male concerns (Grogan & Richards, 2002). In addition, although more men than women are overweight, more women than men reported weight dissatisfaction (Forrester-Knauss & Zemp, 2012). In general, it can be concluded, that women report more drive for thinness than men (Striegel-Moore et al., 2009).

Previous studies have showed that gender ideology, that may be defined as the individual internalization of societal and cultural beliefs about gender roles and appearance (Levant, 1996), may be related with disordered eating. Williams and Ricciardelli (2001) reported that female college students who displayed symptoms of disordered eating showed more feminine traits. In the same line, a significant correlation between gender ideologies with scores on symptoms of disordered eating has been found (Bekker & Boselie, 2002). In addition, Pritchard (2008) has found that feminine women are more vulnerable to disordered eating behaviors than masculine and androgynous women and adds that gender ideologies are related with disordered eating in both men and women. For this reason, it is expected that participants high in a traditional gender ideology scale will report more drive for thinness than those with lower scores.

Pursuit of muscularity

Females report greater concerns about their weight, but males inform of a greater pursuit of muscularity (Grossbard, Lee, Neighbors, & Larimer, 2009). According to the research conducted so far, men score significantly higher on drive for muscularity -a perception of having an underdeveloped musculature combined with a desire to increase muscle mass--than do women (Bratland & Sundgot, 2012). These findings have led to the suggestion that drive for muscularity plays a central role to understanding men's body dissatisfaction (Smolak & Stein, 2006).

It is important to remark that it has been observed that men with an elevated drive for muscularity are more likely to identify with traditional male-stereotyped roles (McCreary, Saucier, & Courtenay, 2005). In addition, it has been found that men who have a high score in a masculinity scale reported higher drive for muscularity and less eating concerns than individuals with lower scores (Magallares, 2013). This last result suggests that a strong male ideology may be related with the apparition of muscle dysmorphia. But what happens with women who endorse a non-traditional female ideology? Although there are not many studies about the relationship between pursuit of muscularity and women, it has been found that female student-athletes, who are less feminine than "normal" girls, report significantly higher pursuit of muscularity scores than female students (Steinfeldt, Carter, Benton, & M. Steinfeldt, 2011). For this reason, it is expected that women with low scores in a gender ideology scale should report more drive for muscularity than those who score high in the same scale.

To the date, there are not studies measuring at the same time drive for thinness and pursuit of muscularity in a sample of women. For this reason, it is conducted a study with a sample of young women, in order to analyze if there is a connection between gender ideology, drive for thinness and pursuit of muscularity. According to the reviewed literature the following hypothesis are expected: 1. Female individuals high in a traditional gender role scale will score more in a drive for thinness scale than those who score low (Bekker & Boselie, 2002). 2. Female individuals high in a traditional gender role scale will score, less in a drive muscularity scale than those who score low in female gender ideology scale (Steinfeldt et al., 2011).

Method

Sample

Participants were 615 Spanish female students of the UNED (Spanish Open University) from 18 to 30 years (age: M = 25.56, SD = 4.29) who were enrolled in a psychology course and who received extra credit for their participation. All participants were normal weight (Body Mass Index or BMI between 18 and 30; Mean = 22.17, SD = 3.31). Participants who had a BMI lower than 18 (underweight) or higher to 30 (obesity) were excluded from the final analysis in order to make the sample the most homogenous possible.

Procedure

To recruit participants, students of all the Spanish territory were contacted trough the webpage of the university. Students were informed on the general purposes of the research and those who voluntarily wanted to participate filled out a booklet with the different questionnaires that was available for a short period of time in the webpage to be downloaded. After completing all the scales, participants deliver their answers by post to the main researcher.

Instruments

To measure drive for thinness it was used the Spanish version of The Eating Disorder Inventory 2 (EDI-2) (English version: Garner, Olmsted, & Polivy, 1983; Garner, 1991; Spanish version: Corral, Gonzales, Perena, & Seisdedos, 2006). The EDI-2 is a self-report questionnaire widely used both in research and in clinical settings to assess the symptoms and psychological features of eating disorders. The original version of the EDI was developed in 1983 by Garner and has been used worldwide to screen for eating disorders in the general population, to measure treatment effect and outcome, as well as in routine clinical evaluations. The EDI-2 (Garner, 2004) consists of 91 items scored on a 5-point Likert scale ranging from "never" (1) to "always" (5). For the purpose of the investigation the sub-scale of Drive for Thinness was used (8 items). This subscale measures if participants have an excessive concern with dieting, preoccupation with weight, and fear of weight gain ([alpha] = 0.97). A score was computed by averaging the 8 items of the subscale. Higher scores on the Drive for Thinness subscale of the EDI-2 reflect greater drive for thinness.

To measure female gender ideology it was used the Gender Ideology Scale (GIS) (Spanish version: Moya, Navas, & Gomez, 1991; Moya, Exposito, & Padilla, 2006). The GIS evaluates if women endorse or not a traditional gender ideology. Traditional gender ideology includes a preference for the conventional division of labor between male providers and female homemakers and for the associated patriarchal system that cedes more power and status to the male provider (Glick & Fiske, 2001). The GIS ([alpha] = 0.87) consists of 12 items scored on a 5-point Likert scale ranging from "strongly disagree" (1) to "strongly agree" (5). A score was computed by averaging the 12 items of the scale. Higher scores on the GIS reflect greater endorsement of the traditional female ideology.

To measure pursuit of muscularity, the Spanish version of The Muscle Appearance Satisfaction Scale (MASS) (English version: Mayville, Williamson, White, Netemeyer, & Drab, 2002; Spanish version: Gonzalez-Marti, Fernandez-Bustos, Contreras-Jordan, & Mayville, 2012) was used. The MASS is a scale that assesses characteristics of muscle dysmorphia. This 19-item self-report measure was developed based on the criteria for bigorexia. All ratings are on a 5-point Likert scale, with 1 being "definitely disagree" and 5 being "definitely agree". A score was computed by averaging the 19 items of the MASS scale ([alpha] = 0.88). Higher scores on the MASS reflect greater pursuit of muscularity.

BMI was calculated as the relationship between weight (kg) and height squared (m). Weight and height were provided by the participants of the study.

Results

The gender ideology variable was dichotomized. The groups of participants (low scores and high scores on GIS) were formed by categorizing those individuals with the higher and lower scores on the gender ideology scale (50% upper and 50% below). This procedure is a common approach (see for example, Turner, Dobson, & Pocock, 2010). These groups were correctly formed, given that the mean scores on classification variables (GIS) were significantly different between groups [low score on GIS = 1.17, SD = 0.17 vs high score on GIS = 2.27, SD = 0.73 [F.sub.1,613] = 750.12, p < 0.01].

Cohen's ds (Cohen, 1988) were also calculated as indices of effect size. Cohen (1988) defined d as the difference between means divided by standard deviation of either group (ds [greater than or equal to] 0.2 are considered medium effect sizes and ds [greater than or equal to] 0.8 large effect sizes). Participants with medium scores were not selected for the final sample and were excluded of the analysis.

A one-way Analysis of Variance (ANOVA) was conducted (see Table 1) with gender ideology (GIS) as the Independent Variable (IV) and drive for thinness (EDI-2) and pursuit of muscularity (MASS) as Dependents Variables (DV). As it can be seen in Table 1, female participants with high scores on GIS reported more drive for thinness and less pursuit of muscularity than women with low scores on the gender ideology scale. These differences are significant according to the Fs found. In addition, it can be said and the effect sizes found are medium.

Discussion

It has been found that female individuals high in a traditional gender role scale score more in a drive for thinness scale (Bekker & Boselie, 2002) and less in a pursuit of muscularity scale (Steinfeldt et al., 2011) than those participants who score low in a female ideology scale. This result shows that women who endorse a traditional gender ideology are more worried about their thinness but not to develop a muscular body (which is more consistent with the traditional male ideology). These results suggest that the endorsement of a traditional gender of ideology for women may be related with disordered eating. Taken together, it can be said that results give support to the hypotheses of the study.

In general, it can be said that the results suggest that the associations between gender ideology and disordered eating behavior (drive for thinness) should be considered in the development of effective prevention programs against disordered eating in women. Given the different pattern of prevalence and predictors of weight dissatisfaction and disordered eating behaviors in women compared to men, a better understanding of these related factors is important for the development of gender-appropriate prevention or intervention programs to reduce disordered eating.

Finally, in this paper it is suggested that the differences in the endorsement of the traditional gender ideology, the internalization of a common set of standards and expectations associated with the traditional masculine role (Levant & Richmond, 2007), may have a very important role in the explanation of the differences between men and women in disordered eating.

The current study is subject to some limitations that deserve mention. First of all, it should be noted that the sample consisted of psychology students and that it would be necessary to reply these findings with clinical samples in order to improve the quality of the study. Second, in the research self-reports has been used. It would be necessary, for future investigations, to conduct studies with the same goals, using not only self-reports, but also more objective criteria, evaluating the same constructs with alternative measures. Finally, it is a cross-sectional study. However, only longitudinal research could help clarify the role of the studied variables in the development of disordered eating. Despite these limitations, the study provides new data with potential applications.

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing. http://dx.doi. org/10.1176/appi.books.9780890425596.744053

Bekker, M., & Boselie, K. (2002). Gender and stress: Is gender role stress? A re-examination of the relationship between feminine gender role stress and eating disorders. Stress and Health: Journal of the International Society for the Investigation of Stress, 18, 141-149. http://dx.doi.org/10.1002/smi.933

Bratland-Sanda S, Sundgot-Borgen J. (2012). Symptoms of eating disorders, drive for muscularity and physical activity among Norwegian adolescents. European eating disorders review: the journal of the Eating Disorders Association, 20, 287-93. http:// dx.doi.org/10.1002/erv.1156

Cohen, J. (1988). Statistical power analysis for the behavior sciences. New York: Lawrence Earlbaum Associates.

Corral, S. Gonzales, M. Perena, J., & Seisdedos, N. (2006). Manual inventario de trastornos de la conducta alimentaria EDI-2[Eating disorder inventory-2. Professional manual]. Madrid: TEA Ediciones.

De Young, K.P., Lavender, J.M., & Anderson, D.A. (2010). Binge eating is not associated with elevated eating, weight, or shape concerns in the absence of the desire to lose weight in men. International Journal of Eating Disorders, 43, 732-736. http:// dx.doi.org/10.1002/eat.20779

Forrester-Knauss, C., & Zemp, S. (2012). Gender differences in disordered eating and weight dissatisfaction in Swiss adults: which factors matter? BMC Public Health, 12, 809. http://dx.doi. org/10.1186/1471-2458-12-809

Garner, D. M. (1991). Eating disorder inventory-2. Professional manual. Odessa: Psychological Assessment Research.

Garner, D. M. (2004). Eating Disorder Inventory-3. Professional Manual. Lutz: Psychological Assessment Resources.

Garner, D.M., Olmsted, M.P., & Polivy, J. (1983). Development and validation of a multidimensional EDI for anorexia nervosa and bulimia. International Journal of Eating Disorders. 2, 15-34. http://dx.doi. org/10.1002/1098-108X(198321)2:2<15::AIDEAT2260020203>3.0.CO;2-6

Glick, P., & Fiske, S. T. (2001). An ambivalent alliance: Hostile and benevolent sexism as complementary justifications for gender inequality. American Psychologist, 56, 109-118. http://dx.doi. org/10.1037//003-066x.56.2.109

Gonzalez-Marti, I., Fernandez-Bustos, J., Contreras-Jordan, O., & Mayville, S. (2012). Validation of a Spanish version of the Muscle Appearance Satisfaction Scale: Escala de Satisfaccion Muscular. Body Image, 9, 517-523. http://dx.doi.org/10.1016/). bodyim.2012.05.002

Grieve, F. G. (2007). A conceptual model of factors contributing to the development of muscle dysmorphia. Eating Disorders, 15, 63-80. http://dx.doi. org/10.1080/10640260601044535

Grogan, S., & Richards, H. (2002). Body image: Focus groups with boys and men. Men and Masculinities, 4, 219-233. http://dx.doi. org/10.1177/1097184X02004003001

Grossbard, J., Lee, C., Neighbors, C., & Larimer, M. (2009) Body Image Concerns and Contingent Self-Esteem in Male and Female College Students. Sex Roles, 60, 198-207. http://dx.doi.org/10.1007/ s11199-008-9535-y.

Hudson, J.I., Hiripi, E., Pope, H.G., & Kessler, R.C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological psychiatry, 61, 348-358. http://dx.doi.org/10.1016/jibiopsych.2006.03.040

Levant, R. F. (1996). The New Psychology of Men. Professional Psychology: Research and Practice, 27, 259265. http://dx.doi.org/10.1037/0735-7028.27.3.259

Levant, R., & Richmond, K. (2007). A Review of Research on Masculinity Ideologies Using the Male Role Norms Inventory. The Journal of Men's Studies, 15, 130-146. http://dx.doi.org/10.3149/jms.1502.130

Levitt, D. (2004). Drive for Thinness and Fear of Fat among College Women: Implications for Practice and Assessment. Journal of College Counseling, 7, 109-117. http://dx.doi.org/10.1002Zj.2161-1882.2004. tb00242.x

Magallares, A. (2013). Masculinity, drive for muscularity, and eating concerns in a sample of men. Suma Psicologica, 20, 83-88. http://dx.doi.org/10.14349/ sumapsi2013.1353

Mayville, S.B., Williamson, D.A., White, M.A., Netemeyer, R.G., & Drab, D.L. (2002). Development of the Muscle Appearance Satisfaction Scale: A self-report measure for the assessment of muscle dysmorphia symptoms. Assessment, 9, 351-360. http://dx.doi.org/10.1177/1073191102238156

McCabe, M.P. & Ricciardelli, L.A. (2004). Body image dissatisfaction among males across the lifespan: A review of past literature. Journal of Psychosomatic Research, 56, 675-685. http://dx.doi.org/10.1016/ S0022-3999(03)00129-6

McCreary, D. R., Saucier, D. M., & Courtenay, W. H. (2005). The drive for muscularity and masculinity: Testing the associations among gender-role traits, behaviors, attitudes, and conflict. Psychology of Men & Masculinity, 6, 83-94. http://dx.doi. org/10.1037/1524-9220.6.2.83

Mitchison D, Hay, P., Slewa-Younan, S., & Mond, J. (2012). Time Trends in Population Prevalence of Eating Disorder Behaviors and Their Relationship to Quality of Life. PLoS ONE, 7, 1-7. http://dx.doi. org/10.1371/journal.pone.0048450

Moore, T. M., & Stuart, G. L. (2004). Effects of masculine gender role stress on men's cognitive, affective, physiological, and aggressive responses to intimate conflict situations. Psychology of Men & Masculinity, 5, 132-142. http://dx.doi.org/10.1037/15249220.5.2.132

Morgan, J. (2012). Male eating disorders. In A. June & J. Treasure (eds.), A collaborative approach to eating disorders (pp. 272-278). New York: Taylor & Francis Group.

Mosley, P. (2009). Bigorexia: bodybuilding and muscle dysmorphia. European Eating Disorders Review, 17, 191-198. http://dx.doi.org/10.1002/erv.89

Moya, M.C., Navas, M., & Gomez, C. (1991). Escala sobre Ideologia del Rol Sexual [Gender Ideology Scale]. Libro de comunicaciones del III Congreso Nacional de Psicologia Social. Vol.1. Santiago de Compostela (Spain). Act of congress (pp. 554-566).

Moya, M., Exposito, F., & Padilla, J. L. (2006). Revision de las propiedades psicometricas de las versiones larga y reducida de la escala sobre ideologia de genero [Review of psychometric properties of the long and the short versions of the Gender Ideology Scale]. International Journal of Clinical and Health Psychology, 6, 709-727.

Murnen, S. K., & Smolak, L. (1997). Femininity, masculinity, and disordered eating: A meta-analytic review. International Journal of Eating Disorders, 22, 231-242. http://dx.doi.org/10.1002/(SICI)1098108X(199711)22:3<231::AID-EAT2>3.0.CO;2-O

Murray, S. B., Rieger, E., Touyz, S. W., & De la Garza, Y. (2010). Muscle dysmorphia and the DSM-V conundrum: Where does it belong? A review paper. International Journal of Eating Disorders, 43, 483491. http://dx.doi.org/10.1002/eat.20828.

Olivardia, R. (2001). Mirror, mirror on the wall, who's the largest of them all? The features and phenomenology of muscle dysmorphia. Harvard Review of Psychiatry, 9, 254-259. http://dx.doi. org/10.1080/10673220127900

Pleck, J. H., Sonenstein, F. L., & Ku, L. C. (1993). Masculinity ideology: Its impact on adolescent males' heterosexual relationships. Journal of Social Issues, 49, 11-29. http://dx.doi.org/10.1111/j.1540-4560.1993. tb01166.x

Pope, H. G., Gruber, A., Choi, P., Olivardia, R., & Phillips, K. (1997). Muscle dysmorphia: An under recognized form of body dysmorphic disorder. Psy chomatics, 38, 548-557. http://dx.doi.org/10.1016/ S0033-3182(97)71400-2

Pritchard, M. (2008). Disordered Eating in Undergraduates: Does Gender Role Orientation Influence Men and Women the Same Way? Sex Roles, 59, 282-289. http://dx.doi.org/10.1007/ s11199-008-9449-8

Robert, C., Munroe-Chandler, K. & Gammage, K. (2009). The relationship between the drive for muscularity and muscle dysmorphia in male and female weight trainers. The Journal of Strength & Conditioning Research, 23, 1656-1662. http://dx.doi. org/10.1519/JSC.0b013e3181b3dc2f.

Rodgers, R.F., Ganchou, C., Franko, D.L., & Chabrol, H. (2012). Drive for muscularity and disordered eating among French adolescent boys: a sociocultural model. Body Image, 9, 318-323. http://dx.doi. org/10.1016/j.bodyim.2012.03.002

Smolak, L., & Stein, J. A. (2006). The relationship of drive for muscularity to sociocultural factors, selfesteem, physical attribute gender role, and socialcomparison in middle school boys. Body Image, 3, 121-129. http://dx.doi.org/10.1016/j.bodyim.2006.03.002

Steinfeldt, J., Carter, H., Benton, E., & Steinfeldt, M. (2011). Muscularity Beliefs of Female College Student-Athletes. Sex Roles, 64, 543-554. http:// dx.doi.org/10.1007/s11199-011-9935-2.

Striegel-Moore, R.H., Rosselli, F., Perrin, N., DeBar, L., Wilson, G.T., May, A., & Kraemer, H.C. (2009). Gender difference in the prevalence of eating disorder symptoms. The International Journal of Eating Disorders, 42, 471-474. http://dx.doi. org/10.1002/eat.20625

Suelves, J. (2006). Eating Disorders: A Public Health Concern in Developed Countries. PsycCRITIQUES, 51. http://dx.doi.org/10.1037/ a0003393

Thompson, J. K., Heinberg, L. J., Altabe, M. N., & Tantleff-Dunn, S. (1999). Exacting beauty: Theory, assessment and treatment of body image disturbance. Washington: American Psychological Association. http://dx.doi.org/10.1037/10312-000

Turner, E., Dobson, J. & Pocock, S. (2010). Categorisation of continuous risk factors in epidemiological publications: a survey of current practice. Epidemiologic Perspectives & Innovations, 7, 9. http:// dx.doi.org/10.1186/1742-5573-7-9

Williams, R. J., & Ricciardelli, L. A. (2001). Sex-role traits and the comorbidity of symptoms of disordered eating and problem drinking. Eating Behaviours, 2, 67-77. http://dx.doi.org/10.1016/S14710153(00)00024-6

Alejandro Magallares **

Universidad Nacional de Educacion a Distancia

doi: 10.11144/Javeriana.upsy15-2.dtpm

Recibido: 10 de junio de 2013 | Aceptado: 23 de junio de 2016

* Articulo de investigacion cientifica y tecnologica.

** Profesor Ayudante Doctor, Departamento de Psicologia Social y de las Organizaciones, Universidad Nacional de Educacion a Distancia (UNED), C/Juan del Rosal, 10, 28040 Madrid, Espana.
Table 1
Mean and Standard Deviations of the DVs of the study by
GIS of the participants

        GIS     M      SD      F     Sig.    [[eta].sub.p.sup.2]

EDI-2   Low    2.40   0.86   31.41   <0.01          0.05
        High   2.82   0.99

MASS    Low    1.95   0.69   14.90   <0.01          0.09
        High   1.76   0.49

        GIS     N      d

EDI-2   Low    358   0.45
        High   257

MASS    Low    358   -0.31
        High   257

Note. EDI-2 = Eating Disorder Inventory 2 (drive for thinness)
(scale from 1 to 5); MASS: Muscle Appearance Satisfaction Scale
(pursuit of muscularity) (scale from 1 to 5); GIS: Gender
Ideology

Source: own work
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Date:Apr 1, 2016
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