Body Image Disorders Among Men

Two studies explore this often-neglected territory.

Reprinted from Eating Disorders Review
March/April Volume 27, Number 2
©2016 IAEDP

Eating disorders are often viewed as disorders of women, and thus men’s body image concerns tend to be “underdiagnosed, undertreated and misunderstood,” according to researchers such as Eric Strother et al. (Eat Disord. 2012. 20:346). A prime example is muscle dysmorphia, or MD, which is largely characterized by the obsessive belief that one’s body lacks sufficient muscle mass. This condition can lead to clinical distress and functional impairment among men.

Men with MD usually develop dysfunctional beliefs and behaviors similar to those of women with eating disorders; however, their concerns about body image are expressed in a very different way. Typically men attempt to increase body size and muscle development rather than the pattern more common among women, a drive for thinness.

Men with anorexia nervosa and men with MD have similar clinical profiles (Body Image. 2012. 9:193). In addition, these men adhere to strict diets high in protein and low in fat and also follow a very strict limit on daily calories. They exercise excessively and use binge eating and purging to regulate their emotions.

Several factors also get in the way of making the diagnosis of MD, according to Emilio J. Compte and colleagues in Buenos Aires and Madrid (Int J Eat Disord. 2015. 48:1092). For example, traditional diagnostic instruments assess body dissatisfaction and eating disorders from a female perspective, and the criteria for eating disorders given in the DSM-IV and DSM-5 are not particularly relevant for males with MD. 

Compte and colleagues designed a study to estimate the prevalence of eating disorders among male university students, using a two-stage format with a control group. Their secondary goal was to establish the prevalence of possible cases of MD and to compare the psychological characteristics of men at risk for developing an eating disorder or MD. The researchers found that the prevalence of eating disorders among the university male students was 1.9%, and all the men with an eating disorder had an eating disorder not otherwise specified (EDNOS). The Drive for Muscularity Scale identified possible cases of MD in nearly 7% of the male students. This suggested that drive for muscularity is the male analogue to the drive for thinness noted in women with eating disorders.

The effect of peer perceptions about muscularity

In a separate study, Linda Lin and Frank DeCusati from Emmanuel College, Boston, explored MD and how perceptions of specific peer group preferences are related to men’s body image concerns and behaviors (Am J Men’s Health. 2015. 1:11).

In this study, data on MD and the perceptions of peer muscularity norms were collected from 117 male college students ranging in age from 18 to 22. The students had an average body mass index of 25 kg/m2. Participants viewed nine male figure drawings ranging from very thin to very muscular, and were then asked to identify the drawing that most matched their current shape and also to indicate which matched their ideal shape. Then the students were given the Muscle Appearance Satisfaction Scale (Assessment. 2002. 9:351) to determine symptoms of muscle dysmorphia. This 19-item questionnaire presents statements such as “I would try anything to get my muscles to grow,” and “I must get bigger muscles by any means possible.”

The results showed that men are more likely to view their male peers as having higher standards for muscularity than their female peers and therefore may be more likely to feel inadequate when comparing their bodies with the muscularity preferences of their male peers. This might be a reflection of the different media messages about male muscularity expressed to male and female audiences. Media aimed at male audiences through action movies, video games, and male’s magazines tend to show male characters with very developed muscularity in the male leads. This contrasts with media developed for female audiences, which usually portray male characters with less developed muscularity.

One of the areas the researchers examined was how perceived muscularity preferences of men’s peers were related to symptoms of MD. Contrary to their original hypothesis, the men who perceived their close female peers as preferring greater muscularity were more likely to have symptoms of MD.