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Gender differences in the experience of body image dissatisfaction and eating disorders
Although in the past decades psychologists have conducted little research on males and body image, it has only been within the past 10-15 years that adequate studies have been completed (Cafri et al., 2005). As asserted by Kevin Thompson, Leslie Heinberg, Madeline Altabe and Stacey Tantleff-Dun (1999) most research pertaining to body image has been dominated by females, focusing on the female ideal for thinness, and predicting the development of eating disorders (McCreary, 2007). New research on males reveals that body image and eating disorder concerns are not limited to only females (Olivardia, 2000). Do males and females experience body image dissatisfaction and eating disorders the same? Through comparisons of studies of females and males with body image dissatisfaction and eating disorder it is argued that there is less than a difference in than popularly perceived.
There are several sources for body image dissatisfaction (BID), but the most influential is the media exposure of women and men to cultural ideals that are often unattainable (Dalley, Buunk, Umit, 2009). Simon Dalley, Abraham Buunk and Turual Umit (2009) assert that media exposure is a form of social comparison that is spontaneous, effortless and unintentional. Self evaluation is created through contrast with the target, which are thinner media images. Kevin Thompson and Leslie Heinberg (1999) affirm that although there are individual variations in the internalization of the media pressures, investigations show that the media is a significant factor developing eating disorders. Eating disorders are classified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, (DSM IV-TR1) as syndromes characterized by disturbances in eating behaviour, accompanied by grief /extreme concern about body shape and or weight, which are sub-categorized by anorexia nervosa, bulimia and eating disorders not otherwise specified (Levenson, 2005). Eating disorders commonly occur in industrial cultures where there is access to food and thinness is considered attractive. Due to globalization, eating disorders are quickly spreading around the world, but they are most common in predominately Caucasian developed nations such as United States, Canada, Europe, Australia, New Zealand and South Africa (Fairburn & Harrison, 2003).
Body Image Dissatisfaction in Females
Body image dissatisfaction is a significant predictor of eating behaviours in females (Dalley, Bunnk & Umit, 2009). Although there are several sources that create body image dissatisfaction (BID), the most influential is the media which exposes women to cultural thin ideals that are often unattainable. While there are individual differences that influence that impact of exposure to thin ideals, many researchers have concluded that there is a distinct correlation between thin media exposure and female BID (Dalley, Bunnk & Umit, 2009). Kimberly Vaughan and Gregory Fouts (2003) reported that the “ultra-slender ideal-body image” that is depicted within media texts is 15% below the weight of an average woman, and 90% of female models are below average weight. Combined with the unrealistically thin ideals represented by female models, digital enhancement of images adds to unattainable standards. Sonia Tucci and Jennifer Peters (2008) noted that high levels of body dissatisfaction are associated with emotional distress, appearance rumination and cosmetic surgery. In a study conducted at the University of Liverpool of female students between the ages of 18 and 25 years it was found that exposure to thin-ideals in media images reduces body satisfaction scores (Tucci & Peters, 2008). The opposite was found when the same participants were exposed to images of larger models, resulting in an increase of body satisfaction scores. Tucci and Peters (2008) additionally found that eating disorders, the drive for thinness and body dissatisfaction increased after the subjects were shown thin images.
“Fat talk” is a notable subject in discussing body image dissatisfaction. As first suggested by Mimi Nichter (2000), “fat talk” is the tendency of females to belittle their bodies by claiming they are fat, even when it is not true. Although Nichter (2000) describes the social value of fat talk as a way for girls to bond through socially expected gender roles (dieting, weight loss and the pre-occupation of the body), “fat talk” creates body image dissatisfaction regardless of the initial reason for engaging (Tuckers, Martz, Curtin & Bazzini, 2007). Katheryn Tucker, Denise Martz, Lisa Curtin and Doris Bazzini’s (2007) study of south-eastern American university female students, found that personal body image dissatisfaction is influenced by the social norms of “fat talk”. These findings suggest that regardless of actual body image dissatisfaction, there is a normative unhappiness of body size in women, which further is increased by the pressure to perform “fat talk”.
Eating Disorders in Females
Nancy Moses, Mansour-Max Banilivy and Fima Lifshitz (1989) conducted a study that examined the perception of weight, dieting and nutrition among adolescent high school girls in comparison to their body weight. The subjects reported a high concern with obesity regardless of their current body weight and nutrition knowledge. Over half of the underweight (anthropometric measured) sub-category of females (51%) described themselves as having an extreme fear of being overweight. The underweight category also reported having a pre-occupation with body fat (36%). Although normal and overweight girls were better able to perceive their actual body weight for height, the frequency of reported binge eating, and vomiting behaviours was similar among all three groups (underweight, normal weight and overweight). Moses, Banilivy and Lifshitz (1989) concluded that a fear of obesity and eating disorders were common amongst adolescent girls despite of body weight and knowledge of nutrition.
Eating disorders are also evident in women attending college. Dean Krahn, Candance Kurth, Edith Gomberg and Adam Drewnowski (2005), reported that due to the intensity and frequency of college women dieting behaviour, two-thirds are at risk for eating disorders. A study conducted at a large Midwestern university of 324 female students concluded that a high proportion (49%) of subjects report binge eating, and/or compensatory behaviours such as excessive exercise at least once a week (Berg, Frazier & Sherr, 2009). Non-purging compensatory behaviours (excessive exercise and fasting) are the most common form of eating disorder behaviours. Kelly Berg, Patricia Frazier and Laura Sherr (2009) also established that there are high rates of binge eating amongst female students but in contrast, purging behaviours (vomiting, laxative use, diuretics) were executed less frequently. Very little research has examined sexual orientation in a relation to eating disorders in females.
i) Body Image Dissatisfaction in Males
Unlike females desire to obtain thinness, men experience anguish when they perceive their body to be underweight (Olivardia, Pope, Borowiecki & Cohane, 2004). Roberto Olivardia (2007) found that the male desire is to obtain a lean muscular physique (mesomorphic body type), which is produced by Western ideals (McCreary, 2007). In a study conducted by Christopher Ochner, James Gray and Katrina Brickner (2009) of male students attending a Mid-Atlantic college, it was found that body dissatisfaction was present in the male population through the desire for an increase in muscle gain (86%), as measured by the Male Body Dissatisfaction Scale. While much of the sample wanted to gain more muscle, 34% also wanted to gain weight, and 31% wanted to lose weight. Only 34% of the subjects were happy with their current weight (Ochner, Gray & Brickner, 2009). In order to obtain a muscular physique with little body fat men engage in such practices as steroid use, ephedrine use, and dieting (Cafri et al., 2005). The use of illicit anabolic-androgenic steroid (AAS) is reported to be between 3% to 12% of American adolescent males. A study conducted at examining legal steroids, also known as prohormones revealed that the lifetime use is 4.5% in adolescent males (Cafri, Thompson & Yesalis, 2004). Harrison Pope, Amanda Gruber, Precilla Choi, Roberto Olivardia and Katharine Phillips (1997) make known a form of body dysmorphic disorder called “muscle dysmorphia”. Men who suffer from muscle dysmorphia are concerned that they are not large or muscular enough. In order to create a desirable physique, men participate in obsessive weight lifting and dieting, which still does not eliminate the distress of being too small (Pope et al., 1997). Precilla Choi, Harrison Pope and Roberto Olivardia (2002) conducted a small sample of weightlifters with and without muscle dysmorphic disorder. The men with muscle dsymorphic disorder reported significantly higher body image dissatisfaction, as well as reporting frequent thoughts about their muscularity, and missed social opportunities for working out (Choi, Pope & Olivardia, 2002). Men commented on concealing their appearances through clothing, checking mirrors and the use of steroids, all contributing to the experience of body dissatisfaction through body dysmorphic disorder (Choi, Pope & Olivardia, 2002).
Eating Disorders in Males
Previously noted research in male body image is a relatively new area; the same pertains to eating disorders. Daniel Carlat, Carlos Camargo, and David Herzog (1997) assert that information on eating disorders in males inadequate and often restricted to small cases studies. Although research is restricted, eating disorders are not unusual in males (Carlat, Camargo & Herzog, 1997). Differences have been found in the ways that homosexual and heterosexual men experience eating disorders, and body perception (Harvey & Robinson, 2003). Unlike women who use eating disorders to obtain thinness, men strive for a lean body mass (Harvey & Robinson, 2003). For this reason the criteria in diagnosing eating disorders in males is unlike females. Jeffery Harvey and John Robinson (2003) discuss how abuse of steroids and dietary supplement is examined. A 1993 study conducted by Cliff Sharp, Stella Clark, Julie Dunan, Douglas Blackwood and Colin Shapiro (1994) on 24 male anorexics, notes that eating disorders emerge at an older age in males than in females, and men display similar behaviours of binge eating, vomiting and anxiety towards eating. Sharp, Clark, Dunan, Blackwood and Shapiro (1994) also concluded that men display a lower use of laxatives, sexual fears and higher amounts of excessive exercising. The high amounts of exercising are discussed in the context of the high male gender roles and standards set for athleticism in society. Thus Sharp, Clark, Dunan, Blackwood and Shapiro (1994) emphasized that excessive physical activity is more socially acceptable as a means of weight control in order for males to obtain a lean physique.
Carlat, Camargo and Herzog’s (1997) sample size of 135 males concluded that bulimia nervosa is the most common eating disorder, affecting 46% of males. An alarming 32% of the males suffered symptoms of eating disorders not otherwise specified. Only 2% of the males were diagnosed with anorexia nervosa. Significantly noted, binge eating affected 11 patients. A study conducted by Daniel Carlat, Carlos Camargo and David Herzog (1997) revealed that a high number of males suffering with eating disorders are of homosexual orientation. Although only a small portion of the population identifies themselves as homosexual (3-5%), Arnold Anderson suggests that a quarter of these men may have an eating disorder (Anderson, 1999). The risks of developing eating disorders are higher for homosexual males due to the overall less satisfaction with their bodies (Herzog, Newman & Warshaw, 1991). In a nonclinical sample of 43 homosexual and 32 heterosexual males by David Herzog, Kerry Newman and Meredith Warshaw (1991) it was found that although males in both sexual orientations current and ideal bodies selected were similar, homosexual males aspired for a physique that was underweight. The researchers attribute this desire to place men at a higher risk of developing eating disorders. Harvey and Robinson (1999) contribute the differences between homosexual and heterosexual males and the development of eating disorders are due to the societal factors surrounding the gender roles of masculinity and femininity.
Looking at both
Body dissatisfaction and eating disorders in males and females are experience in different ways. As noted by Christine Knauss, Susan Paxtaon and Francois Alsaker (2007), females strive for thinness while males have a goal to lose or gain weight or gain more lean muscle. Although there has not been subsequent research examining the causes of gender difference in body dissatisfaction, Nita McKinely (1999) emphasises that there is larger socio-cultural demand for females to be physically attractive in Western societies, therefore creating greater body dissatisfaction amongst girls and women. Although researchers argue that there are greater media influences on females to obtain thinness (Vaughn & Fouts, 2003), males also undergo similar influences but with lean, muscular physiques (Olivardia, 2007). Over time males have been exposed to an increasingly muscular body that is contributes to higher numbers of males experiencing body image dissatisfaction (Olivardia, Pope, Borowiecki & Cohane, 2004). Neala Ambrosi-Randic (2000) conducted a study on children aged 5-6 years as to their perceptions of both current and ideal body size. Ambrosi-Randic (2000) had the children indicate current and desired body size on a picture of male and female figures pre-adolescent in age. Sex differences were found in the ideal figure in females, with the girls preferring a thinner figure than boys.
A 2007 study by Knauss, Paxtaon and Alsaker examined the relationships between body dissatisfaction and the internalization as well as pressure of media images in both sexes. Through a sample of 1610 adolescent males and males from different schools and socioeconomic status regions in Switzerland, the researchers found that girls felt that there is more pressure from the media to achieve ideals (d=.36), as well there is a higher internalization of body ideals (d=.37) (Knauss, Paxtaon & Alsaker, 2007). Predictors of body dissatisfaction also have sex differences. Girls reveal a high correlation between body dissatisfaction and internalization (.62), and internalization and pressure (.71). A medium strength correlation is scored between BMI and body dissatisfaction (.38) and a low strength between internalization and BMI and pressure (.22). Boys displayed a medium correlation between body dissatisfaction and internalization (.38) and dissatisfaction and pressure (.41). Internalization and pressure scored a high correlation (.55), while BMI and internalization, as well as pressure and body dissatisfaction were low (.07). Knauss, Paxtaon and Alsaker (2007) concluded that there is a variance in body dissatisfaction between girls and boys, with female subjects displaying a higher overall body dissatisfaction than boys. Females internalize and feel more pressure from media ideals than boys. Males as well as females body dissatisfaction can be predicted by internalization, pressure, and BMI (Knauss, Paxtaon & Alsaker, 2007).
In a study examining university students from a Midwestern university, gender differences in body dissatisfaction was examined (Penkal & Kurdek, 2007). It was found that women had a stronger dissatisfaction with middle parts of the body such as waist, stomach as was as display higher levels of physique anxiety. Males have a stronger dissatisfaction with facial parts (Penkal & Kurdek, 2007). Jessica Lynn Penkal and Lawrence Kurdek attribute male’s higher dissatisfaction with facial body parts due to the evidence that women describe facial characteristics as an important desirable body characteristic (2007).
In a 2004 Youth Risk behaviour study conducted by Grunbaum et al. it was reported that
females engage in more eating disorder behaviours then males. Grunbaum et al. (2004), found that 29.6% of students reported themselves as being overweight, but the prevalence in females (36.1%) was much higher than males. This is not to say that males do not perceive themselves to be overweight as 23.5% of interviewed men claim to be fat (Grunbaum ,2004). In a 1989 groundbreaking meta-analysis by Geroge Hsu, asserted that eating disorders are more prevalent in women due to greater dysmorphia, poor self image and body concept, and role confusion that can occur during adolescent years. Hsu (1989) analysis revealed that over all females have higher rates of eating disorders, in a female to male ratio of 10 to 1. Although Hsu’s study is over 20 years old, he raise several questions that researchers are currently examining, such as the socio-cultural pressures to be thin, why there are higher occurrences in adolescents as a part of self and body concepts, identity formation and reasons for overall increase prevalence in women.
Jeffery Harvey and John Robinson (2003) suggest that symptoms of eating disorders are similar between men and women but anorexia nervosa is the most challenging to diagnose in males due to amenorrhea being one of the critical warning signs in women. Amenorrhea is usually one of the first discovered symptoms of eating disorders, therefore for this reason men are often overlooked (Harvey & Robinson, 2003). Another critical difference between the ways that women and men experience eating disorders is men often believe that their body is not too thin, while women continue to believe that they overweight (body dysmorphia) (Harvey & Robinson, 2003).
Establishing the prevalence of eating disorders in adolescents of both genders, Einar Kjelsås, Christian Bjørnstrøm and Gunnar Götestam (2004) examined 1960 adolescents (1026 girls and 934 boys), 14 to 15 years of age. According to the diagnosing criteria in the DSM-IV and DSM-III-R, females experience a higher lifetime prevalence of all eating disorders (17.9%, 18.6%), anorexia nervosa (0.7%), bulimia nervosa (1.2%, 3.6%), binge eating disorder (1.5%) and eating disorders otherwise not specified (14.6%, 12.9%) (Kjelsås, Bjørnstrøm & Götestam, 2004). Although males did not display the same prevalence of eating disorders (6.5%), Kjelsås, Bjørnstrøm, and Götestam (2004) found high numbers of boys with anorexia nervosa (0.2%), bulimia nervosa (0.4%, 0.6%), binge eating disorder (0.9%) and eating disorders otherwise not specified (5.0%, 4.%). Kjelsås, Bjørnstrøm and Götestam (2004) final ratio results for eating disorders in female to males was 2.8:1, anorexia nervosa 3.5:1. Bulimia nervosa revealed a ratio of female to male of 2:1, while females and males were closely diagnosed with binge eating, with a ratio of 1.7:1. Eating disorders otherwise specific female to male ratio was 2.9:1. The total number of girls who thought they were very/slightly obese was 32.3% while only 2.6% were classified as obese (Kjelsås, Bjørnstrøm & Götestam, 2004). Only 15.9% of males reported perceiving themselves as very/slightly obese, while 5.1% were classified as obese. Both sexes displayed subjects who considered themselves as obese when classified as underweight or normal weight, girls 74.3% and boys 62.1% displaying distinct body image dissatisfaction (Kjelsås, Bjørnstrøm & Götestam , 2004).
Females appear to be at a greater risk for developing body image dissatisfaction and eating disorders through the internalization and pressure from the media (Knauss, Paxtaon & Alsaker, 2007) and a higher socio-cultural demand to be physically attractive (McKinely, 1999). Although research predominately examines females, males should not be forgotten. As asserted by Olivardia (2007), males also undergo similar influences by the media. Both men and women experience anxiety towards their body, but it is experienced in different ways, therefore body dissatisfaction and eating disorders are not the same in the sexes. Females have an overwhelming desire to obtain thinness often through calorie restriction, excessive exercise and fasting (Berg, Frazier & Sherr, 2009). Males desire is to attain a lean, muscular physique (Olivardia, 2007), therefore engage in such practices dieting, exercise and more dangerously steroid and ephedrine use (Harvey & Robinson, 2003).
In order to fully answer whether males and females experience body image dissatisfaction and eating disorders the same more research needs to be conducted examining males, body image dissatisfaction and eating disorders. Additionally several factors should be taken into account while conducting such research. Body dissatisfaction and eating disorder research often uses the self-report method, therefore under or over reporting is subject to occur. Kjelsås, Bjørnstrøm and Götestam (2004) discuss the complications in creating survey questionnaires that are concise but can discriminate those with and without eating disorders in difference sexes. Females might over-report the rates of body dissatisfaction due to engaging in the socially valuable “fat talk”, as first asserted by Mimi Nitcher (2000). It has also been noted that when self reporting on body dissatisfaction males answers are superficial because they do not feel that the content applies to them (Kjelsås, Bjørnstrøm & Götestam, 2004). Many of the studies on body dissatisfaction and eating disorders use Caucasian students. This is disconcerting because the subjects are apart small population (Caucasian, educated) to draw conclusions upon. Future research needs to completed to investigate not only male body dissatisfaction and eating disorders, but also race, age and different socioeconomic statuses. Extreme dieting, supplement use and other new methods of weight loss (ex. infrared sauna) should be closely examined in future research in both males and females to understand if there are new trends in body dissatisfaction and eating disorders.
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