Predicting Psychosocial Factors That Influence Traits of Muscle Dysmorphia and Body Dysmorphia

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Predicting Psychosocial Factors That Influence Traits of Muscle Dysmorphia and Body Dysmorphia Amongst Males; a Quantitative Design.

Objectives

a)      To determine psychosocial factors, that are predictive of behaviour associated with Muscle Dysmorphia (MD) and/or Body Dysmorphia (BD).

b)      To establish how differing levels of Anxiety and Self-Esteem are correlated with concerning attitudes regarding BD/MD.

c)      Investigating whether social media influences direct associations between, psychosocial factors and BD/MD.

Summary

There is a substantial amount research on BD particularly in females however, MD is a relatively new phenomenon with little research, that primarily affects men that engage in weightlifting. Individuals tend to obsess over their muscularity and believe they are inadequately muscular, regardless of being on average more muscular. They may also maintain a strict diet and training routine and have consistent negative thoughts about their appearance. This study will investigate whether individuals who engage in excessively strict dieting and gym routines display more traits of BD and/or MD compared with males, who have less rigid routines. Self-esteem and anxiety levels of participating males will be correlated with traits of BD and MD as well as, diet and gym rigidity in order to determine how these factors influence BD and MD. Social media usage will also be studied to determine the interrelationship it has with the factors mentioned above.

Scientific background

The DSM-5 categorises Body dysmorphic disorder (BBD) as having a persistent dissatisfaction and concern with one’s physical appearance, about an imagined or minor imperfection resulting in considerable distress and/or impairment of social and occupational functioning. Muscle dysmorphia (MD) was formerly referred to as ‘reverse anorexia’, due to individuals displaying similar concerns and behaviours as those with anorexia nervosa (Hildebrandt, Langenbucher and Chung, 2006). MD is now classified as a subtype of BDD by Pope, Gruber, Choi, Olivardia, and Phillips (1997), that defines the disorder as having “a preoccupation with the idea that one’s body is not sufficiently lean and muscular”, “associated behaviours include long hours of lifting weights and excessive attention to diet” and “the preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning” (Pope et al, 1997, p.556).

Research regarding body image concerns have primarily been focused on women nonetheless, in the last decade there has been a heightened awareness of body image concerns and dietary practices in males (Lavender, Brown, and Murray, 2017).

Individuals that partake in weightlifting have displayed obsessive behaviours and characteristics comparable to those with developing eating disorders and are often preoccupied with the thought of feeling less muscular or lean than they actually are (Smith, 2018). These persistent thoughts can hinder daily functioning due to men upholding a strict diet and workout routine, resulting in giving up aspects of their social life, to be able to adhere to their routines. With male body dissatisfaction rates increasing from 15% to 43% over the last 30 years, this area of research has considerable implications for males engaging in weightlifting, as men need to be made aware of the risks involved in weightlifting (Goldfield, Blouin, and Woodside,2006).

Men with the perception of being underweight primarily desire to have more muscle rather than fat and often display behaviours comparable with eating disorders such as binge eating, anorexia, and bulimia nervosa (Mangweth et al, 2001).  For instance, during the muscle gaining phase of their diet also known as the “bulking phase”, bodybuilders consume up to 6000 calories a day, they avoid social situations which may have an impact on their diet and consume high quantities of protein, protein powders and other supplements (Petrocelli, Oberweis & Petrocelli, 2008). The calorie surplus allows muscle to be built and food consumption is often based around a schedule rather than being based on hunger (Mangweth et al, 2001).

After the “bulking” period, a “cutting” phase will begin in order to reduce fat and show lean muscle. This involves reducing calories and fats whilst consuming high amounts of protein to maintain muscle as well as increasing cardio. This preoccupation with food and restrictive lifestyle shares similarities with eating disorders such as anorexia nervosa (Mangweth et al, 2001 & Petrocelli, Oberweis & Petrocelli, 2008). In addition to dieting, males with MD are likely to attend the gym daily spend excessive time lifting weights and in some cases, they may also feel anxious as a result of not going to the gym (Harvey and Robinson, 2003). It is expected that males that have adopted a strict dieting and gym routine that also engage in periods of “bulking” and “cutting” will show more traits of MD and BD than those with a less rigid routine.

Self-esteem is also a factor that can influence behaviours associated with BD and/or MD. Research has found men who feel under pressure to look a certain way have low self-esteem particularly due to their perceived body image. There is a strong association between body dissatisfaction and low self-esteem which can cause an individual to focus more on their perceived flaws (Fritts, 2016; Olivardia Pope, Borowiecki & Cohane, 2004). Research suggests anxiety can be a predictor of BD/MD as a result of an individual having continuous thoughts about their physical appearance. Hildebrandt, Langenbucher & Chung (2006), found dysmorphic males and muscle concerned males had significantly greater functional impairment and distress than normal males. Dysmorphic males had significantly high body exposure anxiety and appearance anxiety than the control group, the muscle group was also above average in comparison to the control group. This emphasises how self-esteem and anxiety can influence individuals to focus on improving their physical appearance, by causing them to engage in certain behaviours, such as weight-lifting (Ozimok, Lamarche & Gammage, 2015).

Moreover, previous research regarding BD/MD predates social media, however with 79% of young people using social media daily and “fitness inspiration” pages becoming an emerging trend this can have an impact how males perceive themselves (Carrotte, Prichard and Lim, 2017). When males are exposed to images of muscular ideal men it can greatly increase their muscle dissatisfaction, leading them to engage in self-improving behaviour as a result of a higher drive for muscularity (Schneider et al, 2017). Agliata and Tantleff-Dunn, 2004, found males exposed to neutral advertisements had lower levels of anxiety compared to males who were shown advertisements displaying ideal images of attractiveness. This could be due to upward social comparisons, by comparing themselves with individuals who are superior it can lead to feelings of anxiety and low self-esteem (Woods & Scott, 2016).

As mentioned previously low self-esteem and high levels of anxiety can be the catalyst for engaging in behaviours associated with MD/BD, therefore this study hypothesises high levels of anxiety and low self-esteem will be associated with traits of BD/MD. Moreover, this study expects higher social media usage to be positively correlated with traits of BD/MD but to also have an impact on levels of anxiety and self-esteem.

Method

Design

The proposed quantitative study will use a cross-sectional design; the Independent variables are diet, diet and gym routine rigidity, anxiety, self-esteem, and social media usage. The Dependent variables are the level of BD.

 

Participants

30 individuals will be required to participate in this study. All participants have to be Male, and over the age of 18 in order to participate.

 

Measures

The questionnaire will be measuring the age of participants, whether they compete professionally in bodybuilding, how many times a week they go to the gym and for how long as well as, how long they spend on social media. There will be questions asking whether they “bulk” and “shred” as part of their diet/gym routine as well as, how many calories they consume during each of these phases, their protein intake and whether they use supplements e.g. protein powder (Appendix 1).

 

All of the scales used in the questionnaire will be self-report questionnaires. Traits of BD will be measured using the Dysmorphic Concern Questionnaire (DCQ) (appendix, 2). It contains 7-items whereby, respondents rate their physical appearance concerns using a 4-point scale (Oosthuizen, Lambert and Castle, 1998). Traits of MD will be measured using the Muscle Dysmorphic Disorder Inventory (MDDI); a 13 item survey, using three subscales measuring, appearance intolerance, functional impairment and drive for size (Hildebrandt, Langenbucher and Schlundt, 2004) (Appendix 3).  Perceptual body image disturbance will be measured using the Bodybuilder Image Grid (BIG) (Appendix 4), which shows silhouettes of differing muscularity and body fat in which, participants select which silhouette represents their current self and ideal size (Hildebrandt, Langenbucher & Schlundt, 2004).

Anxiety levels will be measured using the Anxiety Subscale of the Hospital Anxiety and Depression Scale (HADs) by, Zigmond and Snaith, 1983. It consists of 7-items that measure anxiety on a 4-point Likert scale (Appendix 5). Lastly, self-esteem will be measured using the 10-item, Rosenberg Self-Esteem scale (appendix 6) measuring global self-esteem, via a 4-point Likert scale (Rosenberg, 1965).

Procedure

Participants will be recruited using social media for instance, by advertising the study on Facebook and they will complete the questionnaire online, as it will be made accessible via Qualtrics. The data will then be anaylsed using a regressional analysis in order to establish how all the independent variables influence traits of MD and BD. If direct associations are found a mediation analysis will be conducted (Kenny, 2016).

Ethical considerations

This study will commence, only once ethical approval has been granted by the School of Natural Sciences and Psychology Research Ethics Panel (PSYREP). Before completing the questionnaire participants will be informed that their data is confidential and they will remain anonymous throughout the study. Participants will give implied consent by completing the questionnaire and will be made aware that they have a right withdraw their data, until the point of analysis (typically 2 weeks following participation) as well as receive a debrief information sheet with details of the study. Due to the nature of this study, on the debrief sheet there will be a section with information about the ‘Body Dysmorphic Disorder Foundation’ for anybody who would like additional support if affected by any questions on the questionnaire.

Timetable

STAGE

START DATE

COMPLETION DATE

Complete and submit the research proposal 

N/A

9/11/2018

Submit draft ethics form

N/A

9/11/2018

Submit reviewed ethics form

N/A

15/11/2018

Commencement of introduction for a personal review

9/11/2018

15/01/2019

Complete methods section

01/09/2018

1/01/2019

Data collection

20/10/2018

15/01/2019

Data analysis

20/10/2018

15/03/2019

Complete Results section

N/A

03/02/2019

Complete Discussion section

15/01/2019

01/03/2019

Complete and submit draft dissertation

N/A

15/03/2019

Make amendments to the dissertation after feedback

N/A

01/04/2019

Submit final dissertation

N/A

06/04/2019

References:

  • Agliata, D., & Tantleff-Dunn, S. (2004). The impact of media exposure on males’ body image. Journal of Social and Clinical Psychology, 23(1), 7-22.
  • American Psychological Association. (2013). Diagnostic and Statistical Manual of Mental 10 Disorders (V). Washington DC: American Pychological Association.
  • Carrotte, E. R., Prichard, I., & Lim, M. S. C. (2017). “Fitspiration” on social media: A content analysis of gendered images. Journal of medical Internet research, 19(3).
  • Fritts, J. T. (2016). Predictive Factors of Muscle Dysmorphia, Intent to Use Steroids, and Non-Intuitive Eating in Male Recreational Weightlifters (Doctoral dissertation).
  • Goldfield, G. S., Blouin, A. G., & Woodside, D. B. (2006). Body image, binge eating, and bulimia nervosa in male bodybuilders. The Canadian journal of psychiatry, 51(3), 160-168.
  • Grieve, F. G. (2007). A conceptual model of factors contributing to the development of muscle dysmorphia. Eating disorders, 15(1), 63-80.
  • Harvey, J. A., & Robinson, J. D. (2003). Eating disorders in men: Current considerations. Journal of Clinical Psychology in Medical Settings, 10(4), 297-306.
  • Hildebrandt, T., Langenbucher, J., & Schlundt, D. G. (2004). Muscularity concerns among men: Development of attitudinal and perceptual measures. Body Image, 1(2), 169-181.
  • Hildebrandt, T., Schlundt, D., Langenbucher, J., & Chung, T. (2006). Presence of muscle dysmorphia symptomology among male weightlifters. Comprehensive psychiatry, 47(2), 127-135.
  • Kenny, D. A., Korchmaros, J. D., & Bolger, N. (2003). Lower level mediation in multilevel models. Psychological methods, 8(2), 115.
  • Lavender, J. M., Brown, T. A., & Murray, S. B. (2017). Men, muscles, and eating disorders: an overview of traditional and muscularity-oriented disordered eating. Current psychiatry reports, 19(6), 32.
  • Mangweth, B., Pope Jr, H. G., Kemmler, G., Ebenbichler, C., Hausmann, A., De Col, C., … & Biebl, W. (2001). Body image and psychopathology in male bodybuilders. Psychotherapy and psychosomatics, 70(1), 38-43.
  • Olivardia, R., Pope Jr, H. G., Borowiecki III, J. J., & Cohane, G. H. (2004). Biceps and body image: the relationship between muscularity and self-esteem, depression, and eating disorder symptoms. Psychology of men & masculinity, 5(2), 112.
  • Oosthuizen, P., Lambert, T., & Castle, D. J. (1998). Dysmorphic concern: prevalence and associations with clinical variables. Australian & New Zealand Journal of Psychiatry, 32(1), 129-132.
  • Ozimok, B., Lamarche, L., & Gammage, K. L. (2015). The relative contributions of body image evaluation and investment in the prediction of dietary restraint in men. Journal of health psychology, 20(5), 592-601.
  • Petrocelli, M., Oberweis, T., & Petrocelli, J. (2008). Getting huge, getting ripped: a qualitative exploration of recreational steroid use. Journal of Drug Issues, 38(4), 1187-1205.
  • Pope Jr, H. G., Gruber, A. J., Choi, P., Olivardia, R., & Phillips, K. A. (1997). Muscle dysmorphia: An underrecognized form of body dysmorphic disorder. Psychosomatics, 38(6), 548-557.
  • Schneider, C., Agthe, M., Yanagida, T., Voracek, M., & Hennig-Fast, K. (2017). Effects of muscle dysmorphia, social comparisons and body schema priming on desire for social interaction: an experimental approach. BMC psychology, 5(1), 19.
  • Smith, K. C. (2018). The Eating Behaviors, Body Image Concerns, and Psychological Traits of Female Competitive Bodybuilder (Doctoral dissertation, Alliant International University).
  • Rosenberg, M. (1965). The measurement of self-esteem, Society and the adolescent self-image. Princeton, 16-36.
  • Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta psychiatrica scandinavica, 67(6), 361-370.

Appendices

Appendix 1 –

Appendix 2 –

Appendix 3  –

Appendix 4 –

Which image represents your current body best?

Which image represents your ideal body?

Appendix 5 –

H

Appendix 6 –

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