Roberto Olivardia

Biceps and Body Image: The Relationship Between Muscularity and Self-Esteem, Depression, and Eating Disorder Symptoms.

The present study examined body image and associated psychological traits in 154 college men. The comprehensive battery of measures included a novel computerized test of body image perception, the Somatomorphic Matrix, in which subjects could navigate through a range of body images, spanning a wide range of body fat and muscularity, to answer various questions posed by the computer. Subjects also completed paper-and-pencil instruments assessing depression, characteristics of eating disorders, self-esteem, and use of performance-enhancing substances. Findings suggest that contemporary American men display substantial body dissatisfaction and that this dissatisfaction is closely associated with depression, measures of eating pathology, use of performance-enhancing substances, and low self-esteem. Muscle belittlement, believing that one is less muscular than he is, presented as an important construct in the body dissatisfaction of men.

The Growing Commercial Value of the Male Body: A Longitudinal Survey of Advertising in Women’s Magazines

Background: With the advances of feminism, men have gradually relinquished their once-exclusive ‘masculine’ roles as fighters and breadwinners. In response to this change, the male body may have gained in relative importance as one of the few surviving marks of masculinity. We hypothesized that these trends might be quantified by using a commercial measure such as advertising. Methods: We examined the proportion of exposed male and female bodies portrayed in advertisements between 1958 and 1998 in two leading American women’s magazines. Results: In both magazines, the proportion of undressed women in the advertisements has changed little over the last 40 years, whereas the proportion of undressed men has increased dramatically, especially since the early 1980s. Conclusions: Trends in commercial advertising offer tentative support for the hypothesis that the male body is increasing in importance as a mark of masculinity – at least as judged from the actions of advertisers seeking to influence women’s attitudes.

Muscle dysmorphia: a new syndrome in weightlifters

Recently more men have reported a desire for larger, more muscular bodies. Muscle dysmorphia (MD) is a new syndrome in which individuals (usually men), although highly muscular, have a pathological belief that they are of very small musculature. As more men are motivated to take up training with weights in order to develop greater musculature, more cases of MD are likely to be encountered. A greater understanding and awareness of the syndrome are therefore needed. Therefore the aim of this study was to investigate perceptions of physical self in male weightlifters, one group with MD (n = 24) and one without (n = 30). Between group comparisons were made using the multidimensional body-self relations questionnaire. The findings confirm the nature of the disorder in that those with MD syndrome have poorer body image and are less happy with their bodies. Moreover, in addition to a desire for greater muscularity, they are very concerned not to gain fat. The results also suggest that future research into perceptions of specific body parts and health is warranted.

Symptom characteristics and psychiatric comorbidity among males with muscle dysmorphia

OBJECTIVE Muscle dysmorphia has been described as a disorder in which individuals are pathologically preoccupied with their muscularity. This study was designed to further investigate the symptom characteristics and psychiatric conditions associated with the disorder. METHOD Weight lifting males meeting current criteria for muscle dysmorphia (n = 15), past muscle dysmorphia (n = 8), and no history of muscle dysmorphia (n = 28) responded to advertisements placed in gymnasium and nutrition stores. Structured and semistructured interviews were administered, as well as survey measures. RESULTS Relative to controls, males with current muscle dysmorphia experienced more aversive symptoms related to the appearance of their bodies, including more often thinking about their muscularity, dissatisfaction with appearance, appearance checking, bodybuilding dependence, and functional impairment. Higher rates of mood and anxiety disorders were found among individuals with a history of muscle dysmorphia relative to individuals with no history of muscle dysmorphia. CONCLUSIONS The findings suggest that muscle dysmorphia can be distinguished from normal weight lifting on a number of clinical dimensions. Muscle dysmorphia appears to be comorbid with other psychiatric conditions. Limitations of the current study and directions for future research are considered.

Eating Disorders in Austrian Men: An Intracultural and Crosscultural Comparison Study

Background: We compared 30 male university students with eating disorders and 30 male comparison subjects without eating disorders recruited by advertisement at Innsbruck University, Austria. Methods: Subjects were interviewed using instruments that we had previously used in a controlled study of college men with eating disorders in the United States. Results: The Austrian men with eating disorders differed sharply from Austrian comparison subjects, but closely resembled their American counterparts, on prevalence of personal and familial psychopathology, adverse family experiences, and scores on rating scales for eating disorder. Interstingly, dissatisfaction with body image was consistently greater among American subjects regardless of eating disorder status. Conclusions: Our data suggest a weak association between eating disorders and homosexual or bisexual orientation in men, and no consistent association between eating disorders and childhood sexual abuse.

The Comorbidity of ADHD and Eating Disorders in a Nationally Representative Sample.

Evidence suggests a comorbidity of childhood attention-deficit/hyperactivity disorder (ADHD) and subsequent eating disorders. However, most studies have assessed this comorbidity among patient populations as opposed to nationally representative samples and have not explored differences by subtype of each disorder. The current study aims to investigate the association between both clinical (i.e., diagnosed) and subclinical (i.e., presence of behaviors but not all diagnostic criteria) ADHD and eating disorders via a secondary data analysis of the National Longitudinal Study of Adolescent Health (n = 12,262). Results reveal that those with clinical ADHD are more likely to experience (a) clinical eating disorder, (b) clinical-level binging and/or purging behaviors, and (c) clinical-level restrictive behaviors. Those with subclinical ADHD (both inattentive and hyperactive/impulsive) were more likely to experience subclinical binging and/or purging behaviors but not subclinical restrictive behaviors. Implications of study findings pertain to both secondary/targeted prevention of eating disorders and tertiary prevention via patient-specific treatment plans.

Demographic and work-related correlates of job burnout in professional eating disorder treatment providers.

Patients with eating disorders present unique challenges to treatment providers that may contribute to job burnout. This study examined demographic and work-related correlates of three primary components of burnout (i.e., emotional exhaustion, cynicism, and lack of personal accomplishment) in a sample of 296 professional eating disorder treatment providers. Participants completed the Maslach Burnout Inventory-Human Services Survey (MBI-HSS; Maslach, Jackson, & Leiter, 1996), demographics, and a questionnaire developed by the authors measuring eating disorder-specific factors theorized to be relevant to burnout. Overall, participants reported comparable levels of emotional exhaustion but significantly less cynicism and lack of personal accomplishment relative to established norms for mental health care providers on the MBI-HSS. Analyses of variance and backward regression analyses suggested that higher levels of burnout were associated with being younger, female, and overweight; working longer hours; having less experience; and experiencing a patients death. Conversely, working in a private practice setting, having children, and having a personal history of an eating disorder were associated with lower burnout levels. Furthermore, over 45% of participants reported that treatment resistance, ego-syntonicity, high relapse rates, worry about patient survival, emotional drain, lack of appropriate financial reimbursement, and extra hours spent working contributed to feelings burned out somewhat to very much. Overall, these data suggest that emotional exhaustion is the most common aspect of burnout experienced by eating disorder treatment providers and highlight some of the key correlates of burnout for this population, which can be used to inform prevention and intervention efforts.

Treatment Providers With a Personal History of Eating Pathology: A Qualitative Examination of Common Experiences

Using qualitative methodology, this study examined the experiences of treatment providers with a personal history of eating pathology. A total of 139 eating disorder treatment providers completed a questionnaire designed by the authors that (a) asked whether and how their personal history influences treatment of patients with eating disorders and (b) elicited feedback for other therapists. Results indicated that the large majority of participants (94%) believed that their eating disorder history positively influenced their treatment of patients (e.g., increased empathy, greater understanding of the disorder, more positive personal outlook). Conversely, only 8% identified ways in which it can negatively influence treatment (e.g., feeling personally triggered, over-identifying with patients). Feedback for other professionals included the importance of personally recovering before treating this population and monitoring ones experiences in session (e.g., notice countertransference). Continued discourse regarding the benefits and challenges of a personal history of eating pathology in treatment providers is warranted.

Treatment Following a Near Fatal Suicide Attempt

This series of discussions is about a patient we call David who made a near lethal suicide attempt. Fortuitously he was found alive and entered the mental health system, where his treatment and recovery began. Parts of this discussion were initially presented at the AAS conference in Boston in 2007. Five senior clinicians take up various aspects of the patient’s presentation and treatment and elaborate various points of view. Obviously, one therapist cannot be all things to every patient, and one patient’s therapy cannot describe all there is to treating such complicated problems. We present here a sampling of interesting and appealing thoughts on the curative process. We start the discussion of this case with Terry Maltsberger’s description of the patient seen as a self in crisis. He recognizes the self as the psychic holder of inner stability. When challenged by loss and depression the self cannot function to provide life sustaining energy and a suicidal crisis results. Elsa Ronningstam discusses the importance of shame as a suicide driving affect. Mark Schechter takes up the patient’s coping abilities and underscores the therapeutic benefits of validation. Mark Goldblatt describes the treatment in light of the patient’s ego defense mechanisms combating internal and external hostility. Roberto Olivardia describes a cognitive behavioral approach to treatment. Through this range of therapeutic options we hope to present some of the complexity involved in dealing with seriously lethal patients and stimulate discussion of effective treatment interventions.