Advertisement

Muscle Dysmorphia: Where Body Image Obsession, Compulsive Exercise, Disordered Eating, and Substance Abuse Intersect in Susceptible Males

  • S. E. SpecterEmail author
  • David A. Wiss
Chapter

Abstract

A growing number of adolescent and adult males are dissatisfied, preoccupied - even impaired by concerns about their physical appearance. Feelings of discontent and insecurity can lead to disordered eating and substance abuse when males compare themselves against popularized cultural standards of attractiveness and see themselves falling short. When body image dissatisfaction, compulsive exercise, and food intake dysregulation combine and intensify, risk increases for a psychiatric condition identified within the past 20 years known as muscle dysmorphia, a disturbance of self-perception in which individuals are obsessively preoccupied with the belief they are insufficiently large or muscular. Muscle dysmorphia shares characteristics with eating disorders (such as persistent attention to intake and compensatory behaviors focused on control of weight/shape), obsessive–compulsive disorder (excessive body monitoring and physical activity), and body dysmorphic disorder (including extreme attention to outward appearance). The condition is frequently associated with anabolic androgenic steroid abuse, which may exacerbate an observed exercise dependence or compulsive drive for muscularity. Therapeutic approaches are guided by the individual symptom picture with respect to issues such as obsessional thoughts/compulsive behaviors, mood dysregulation, and anxiety, and have principally been derived from clinical studies examining body dysmorphic disorder, for which both psychotropic medications and cognitive behavioral therapy are considered first-line treatment. Nutrition education and support is also warranted. More research is needed to increase understanding regarding the unique pressures and profound subjective distress males can experience with respect to accepting their bodies, as well as to develop better approaches to assessment and treatment of this complex condition.

Keywords

Anabolic-androgenic steroids Bigorexia Binge-eating disorder Body dysmorphic disorder Eating disorder Exercise Males Muscle dysmorphia Obsessive-compulsive disorder Substance use disorder 

References

  1. Alfano, L., Hildebrandt, T., Bannon, K., Walker, C., & Walton, K. E. (2011). The impact of gender on the assessment of body checking behavior. Body Image, 8(1), 20–25. doi: 10.1016/j.bodyim.2010.09.005.PubMedCentralPubMedCrossRefGoogle Scholar
  2. Allen, A., & Hollander, E. (2005). Diagnosis and treatment of obsessive-compulsive disorder. Primary Psychiatry, 12, 34–42.Google Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  4. Arvary, D., & Pope, H. G., Jr. (2000). Anabolic-androgenic steroids as a gateway to opioid dependence. New England Journal of Medicine, 342(20), 1532.PubMedCrossRefGoogle Scholar
  5. Atmaca, M., Bingol, I., Aydin, A., Yildrim, H., Okur, I., Yildrim, M. A., … Gurok, M. G. (2010). Brain morphology of patients with body dysmorphic disorder. Journal of Affective Disorders, 123, 258-263. doi:10.1016/j.jad.2009.08.012.Google Scholar
  6. Baird, A. L., & Grieve, F. G. (2006). Exposure to male models in advertisements leads to a decrease in men’s body satisfaction. North American Journal of Psychology, 8(1), 115–122.Google Scholar
  7. Barry, D. C., Grilo, C. M., & Masheb, R. M. (2002). Gender differences in patients with binge eating disorder. International Journal of Eating Disorders, 31, 63–70. doi: 10.1002/eat.1112.PubMedCrossRefGoogle Scholar
  8. Barry, D., & Petry, N. M. (2009). Associations between body mass index and substance use disorders differ by gender: Results from the national epidemiological survey on alcohol and related conditions. Addictive Behavior, 34(1), 51–60. doi: 10.1016/j.addbeh.2008.08.008.CrossRefGoogle Scholar
  9. Beasley, J. M., Ange, B. A., Anderson, C. A., Miller lii, E. R., Holbrook, J. T., & Appel, L. J. (2009). Characteristics associated with fasting appetite hormones (obestatin, ghrelin, and leptin). Obesity, 17(2), 349–354.PubMedCentralPubMedCrossRefGoogle Scholar
  10. Beaver, K. M., Vaughn, M. G., DeLisi, M., & Wright, J. P. (2008). Anabolic-androgenic steroid use and involvement in violent behavior in a nationally representative sample of young adult males in the United States. American Journal of Public Health, 98, 2185–2187. doi: 10.2105/AJPH.2008.137018.PubMedCentralPubMedCrossRefGoogle Scholar
  11. Blouin, A. G., & Goldfield, G. S. (1995). Body image and steroid use in male bodybuilders. International Journal of Eating Disorders, 18(2), 159–165.PubMedCrossRefGoogle Scholar
  12. Button, E., Aldridge, S., & Palmer, R. (2008). Males assessed by a specialized adult eating disorders service: patterns over time and comparisons with females. International Journal of Eating Disorders, 41, 758–761.PubMedCrossRefGoogle Scholar
  13. Cafri, G., Thompson, J. K., Ricciardelli, L., McCabe, M., Smolak, L., & Yesalis, C. (2005). Pursuit of the muscular ideal: Physical and psychological consequences and risk factors. Clinical Psychology Review, 25, 215–239. doi: 10.1016/j.cpr.2004.09.003.PubMedCrossRefGoogle Scholar
  14. Calogero, R. M., & Pedrotty, K. N. (2004). The practice and process of healthy exercise: An investigation of the treatment of exercise abuse in women with eating disorders. Eating Disorders: The Journal of Treatment and Prevention, 12(4), 273–291. doi: 10.1080/10640260490521352.CrossRefGoogle Scholar
  15. Carper, T. L. M., Negy, C., & Tantleff-Dunn, S. (2010). Relations among media influence, body image, eating concerns, and sexual orientation in men: A preliminary investigation. Body Image, 7, 301–309. doi: 10.1016/j.bodyim.2010.07.002.PubMedCrossRefGoogle Scholar
  16. Casavant, M. J., Blake, K., Griffith, J., Yates, A., & Copley, L. M. (2007). Consequences of anabolic androgenic steroids. Pediatric Clinics of North America, 54, 677–690. doi: 10.1016/j.pcl.2007.04.001.PubMedCrossRefGoogle Scholar
  17. De Bruin, A. P., Woertman, L., Bakker, F. C., & Oudejans, R. R. D. (2009). Weight-related sport motives and girl’s body image, weight control behaviors, and self-esteem. Sex Roles, 60(9), 6628–6641.Google Scholar
  18. 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. doi: 10.1002/eat.20779.PubMedCrossRefGoogle Scholar
  19. Edwards, S., & Launder, C. (2000). Investigating muscularity concerns in male body image: development of the Swansea Muscularity Attitudes Questionnaire. International Journal of Eating Disorders, 28, 120–124.PubMedCrossRefGoogle Scholar
  20. Eichen, D. M., Conner, B. T., Daly, B. P., & Fauber, R. L. (2012). Weight perception, substance use, and disordered eating behaviors: Comparing normal weight and overweight high-school students. Journal of Youth and Adolescence, 41(1), 1–13. doi: 10.1007/s10964-010-9612-8.PubMedCrossRefGoogle Scholar
  21. Eisenberg, M. E., Wall, M., & Neumark-Sztainer, D. (2012). Muscle-enhancing behaviors among adolescent girls and boys. Pediatrics, 130(6), 1019–1026. doi: 10.1542/peds.2012-0095.PubMedCentralPubMedCrossRefGoogle Scholar
  22. Fairburn, C. G., & Beglin, S. J. (1994). The assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363–370.PubMedGoogle Scholar
  23. Feldman, M. B., & Meyer, I. H. (2010). Comorbidity and age of onset of eating disorders in gay men, lesbians, and bisexuals. Psychiatry Research, 180, 126–131. doi: 10.1016/j.psychres.2009.10.013.PubMedCentralPubMedCrossRefGoogle Scholar
  24. Food and Nutrition Board. Institute of Medicine of the National Academies. (2005). Dietary reference intakes for energy, carbohydrates, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Washington, DC: The National Academies Press.Google Scholar
  25. Forrester-Knauss, C., & Stutz, E. Z. (2012). Gender differences in disordered eating and weight dissatisfaction in Swiss adults: Which factors matter? Biomed Central Public Health, 12, 809. Retrieved from http://www.biomedcentral.com/1471-2458/12/809
  26. Franchini, E., Brito, C. J., & Artioli, G. G. (2012). Weight loss in combat sports: Physiological, psychological and performance effects. Journal of the International Society of Sports Nutrition, 9(52). Retrieved from http://www.jissn.com/content/9/1/52
  27. Franzoi, S. L., & Shields, S. A. (1984). The Body-Esteem Scale: Multidimensional structure and sex differences in a college population. Journal of Personality Assessment, 48, 173–178.PubMedCrossRefGoogle Scholar
  28. Geller, G., Johnston, C., & Madsen, K. (1997). The role of shape and weight in self-concept: The shape and weight based self-esteem inventory. Cognitive Therapy and Research, 21(1), 5–24.CrossRefGoogle Scholar
  29. Gjerde, F., Block, J., & Block, J. H. (1988). Depressive symptoms and personality during late adolescence: gender differences in the externalization-internalization of symptom expression. Journal of Abnormal Psychology, 97(4), 475–486.PubMedCrossRefGoogle Scholar
  30. Goldfield, G. S., Blouin, A. G., & Woodside, D. B. (2006). Body image, binge eating, and bulimia nervosa in male bodybuilders. Canadian Journal of Psychiatry, 51(3), 160–168.Google Scholar
  31. Greenberg, S. T., & Schoen, E. G. (2008). Males and eating disorders: Gender-based therapy for eating disorder recovery. Professional Psychology: Research and Practice, 39(4), 464–471. doi: 10.1037/0735-7028.39.4.464.CrossRefGoogle Scholar
  32. Grieve, F. S., Truba, N., & Bowersox, S. (2009). Etiology, assessment, and treatment of muscle dysmorphia. Journal of Cognitive Psychotherapy: An International Quarterly, 23(4), 306–314. doi: 10.1891/0889-8391.23.4.306.CrossRefGoogle Scholar
  33. Hackler, A. H., Vogel, D. L., & Wade, N. G. (2010). Attitudes towards seeking professional help for an eating disorder: The role of stigma and anticipated outcomes. Journal of Counseling and Development, 88(4), 424–431.CrossRefGoogle Scholar
  34. Hale, B. D., Roth, A. D., DeLong, R. E., & Briggs, M. S. (2010). Exercise dependence and the drive for muscularity in male bodybuilders, power lifters, and fitness lifters. Body Image, 7, 234–239. doi: 10.1016/j.bodyim.2010.02.001.PubMedCrossRefGoogle Scholar
  35. Hausenblas, H. A., Cook, B. J., & Chittester, N. I. (2008). Can exercise treat eating disorders? Exercise and Sport Sciences Review, 36(1), 43–47.CrossRefGoogle Scholar
  36. Hildebrandt, T., Langenbucher, J. W., Lai, J. K., Loeb, K. L., & Hollander, E. (2011). Development and validation of the appearance and performance enhancing drug schedule. Addictive Behavior, 36(10), 949–958. doi: 10.1016/j.addbeh.2011.05.002.CrossRefGoogle Scholar
  37. Hildebrandt, T., Langenbucher, J., & Schlundt, D. G. (2004). Muscularity concerns among men: Development of attitudinal and perceptual measures. Body Image, 1(2), 169–181.PubMedCrossRefGoogle Scholar
  38. Hitzeroth, V., Wessels, C., Zungu-Dirwayi, N., Oosthuizen, P., & Stein, D. J. (2001). Muscle dysmorphia: A South African sample. Psychiatry and Clinical Neurosciences., 55(5), 521–523.PubMedCrossRefGoogle Scholar
  39. Hollander, E., Allen, A., Kwon, J., Aronowitz, B., Schmeidler, J., Wong, C., Simeon, D. (1999). Clomipramine vs. desipramine crossover trial in body dysmorphic disorder: Selective efficacy of a serotonin reuptake inhibitor in imagined ugliness. Archives of General Psychiatry, 56, 1033–1039.Google Scholar
  40. Horstmann, A., Busse, F. P., Mathar, D., Muller, K., Lepsien, J., Schlogl, H., Pleger, B. (2011). Obesity-related differences between women and men in brain structure and goal-directed behavior. Frontiers in Human Neuroscience, 5(58), 1–9. doi: 10.3389/fnhum.2011.00058.
  41. Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61, 348–358. doi: 10.1016/j.biopsych.2006.03.040.PubMedCentralPubMedCrossRefGoogle Scholar
  42. Ip, E. J., Barnett, M. J., Tenerowicz, M. J., & Perry, P. J. (2011). The anabolic 500 survey: characteristics of male users versus nonusers of anabolic-androgenic steroids for strength training. Pharmacotherapy, 31(8), 757–766. doi: 10.1592/phco.31.8.757.PubMedCrossRefGoogle Scholar
  43. Ipser, J. C., Sander, C., & Stein, D. J. (2009, Jan 21). Pharmacotherapy and psychotherapy for body dysmorphic disorder. Cochrane Database Systematic Review, (1).Google Scholar
  44. Jackson, T. D., & Grilo, C. M. (2002). Weight and eating concerns in outpatient men and women being treated for substance abuse. Eating and Weight Disorders, 7(4), 276–283.PubMedCrossRefGoogle Scholar
  45. Kaminski, P. L., Chapman, B. P., Haynes, S. D., & Own, L. (2005). Body image, eating behaviors, and attitudes towards exercise among gay and straight men. Eating Behaviors, 6, 179–187. doi: 10.1016/j.eatbeh.2004.11.003.PubMedCrossRefGoogle Scholar
  46. Kanayama, G., Brower, K. J., Wood, R. I., Hudson, J. I., & Pope, H. G., Jr. (2010). Treatment of anabolic-androgenic steroid dependence: Emerging evidence and its implications. Drug and Alcohol Dependence, 109(1–3), 6–13.PubMedCentralPubMedCrossRefGoogle Scholar
  47. Kanayama, G., Hudson, J. I., & Pope, H. G., Jr. (2008). Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse. Drug and Alcohol Dependence, 98(1–2), 1–12. doi: 10.1016/j.drugalcdep.2008.05.004.PubMedCentralPubMedCrossRefGoogle Scholar
  48. Kimmel, S., & Mahalik, J. (2004). Measuring masculine body ideal distress: Development of a measure. International Journal of Men’s Health, 3(1), 1–10.CrossRefGoogle Scholar
  49. Knoesen, N., Thai Vo, S., & Castle, D. (2009). To be Superman–the male looks obsession. Australian Family Physician, 38(3), 131–133.PubMedGoogle Scholar
  50. Kollei, I., Schieber, K., de Zwaan, M., Svitak, M., & Martin, A. (2013). Body dysmorphic disorder and nonweight-related body image concerns in individuals with eating disorders. International Journal of Eating Disorders, 46(1), 52–59. doi: 10.1002/eat.22067.PubMedCrossRefGoogle Scholar
  51. Lambert, C., & Jones, B. (2010). Alternatives to rapid weight loss in US wrestling. International Journal of Sports Medicine, 31(8), 523–528. doi: 10.1055/s-0030-1254177.PubMedCrossRefGoogle Scholar
  52. 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(4), 351–360.PubMedCrossRefGoogle Scholar
  53. McCreary, D. R., Hildebrandt, T. B., Heinberg, L. J., Boroughs, M., & Thompson, J. K. (2007). A review of body image influences on men’s fitness goals and supplement use. American Journal of Men’s Health, 1(4), 307–316. doi: 10.1177/1557988306309408.PubMedGoogle Scholar
  54. McCreary, D. R., & Sasse, D. K. (2000). Exploring the drive for muscularity in adolescent boys and girls. Journal of American College Health, 48, 297–304.PubMedCrossRefGoogle Scholar
  55. McFarland, M. B., & Petrie, T. A. (2012). Male body satisfaction: Factorial and construct validity of the body parts satisfaction scale for men. Journal of Counseling Psychology, 59(2), 329–337.PubMedCrossRefGoogle Scholar
  56. Mitchell, K. S., Mazzeo, S. E., Schlesinger, M. R., Brewerton, T. D., & Smith, B. N. (2012). Comorbidity of partial and subthreshold PTSD among men and women with eating disorders in the national comorbidity survey-replication survey. International Journal of Eating Disorders, 45, 307–315.PubMedCentralPubMedCrossRefGoogle Scholar
  57. Mosley, P. E. (2008). Bigorexia: Bodybuilding and muscle dysmorphia. European Eating Disorders Review, 17, 191–198. doi: 10.1002/erv.897.CrossRefGoogle Scholar
  58. Muise, A. M., Stein, D. G., & Arbess, G. (2003). Eating disorders in adolescent boys: A review of the adolescent and young adult literature. Journal of Adolescent Health, 33(6), 427–435.PubMedCrossRefGoogle Scholar
  59. Nunez-Navarro, A., Aguero, Z., Krug, I., Jimenez-Murcia, S., Sanchez, I., Araguz, N., … Fernandez-Aranda, F. (2012). Do men with eating disorders differ from women in clinics, psychopathology and personality? European Eating Disorders Review, 20, 23–31. doi: 10.1002/erv.1146.Google Scholar
  60. Olivardia, R., Pope, H. G., & Hudson, J. I. (2000). Muscle dysmorphia in male weight-lifters: A case–control study. American Journal of Psychiatry, 157, 1291–1296.PubMedCrossRefGoogle Scholar
  61. Phillips, K. A. (1996). An open study of buspirone augmentation of serotonin-reuptake inhibitors in body dysmorphic disorder. Psychopharmacology Bulletin, 32(1), 175–180.PubMedGoogle Scholar
  62. Phillips, K. A. (2005a). The broken mirror: Understanding and treating body dysmorphic disorder (revised and expanded edition). New York: Oxford University Press.Google Scholar
  63. Phillips, K. A. (2005b). Placebo-controlled study of pimozide augmentation of fluoxetine in body dysmorphic disorder. American Journal of Psychiatry, 162(2), 377–379.PubMedCentralPubMedCrossRefGoogle Scholar
  64. Phillips, K. A., Albertini, R. S., Siniscalchi, J. M., Khan, A., & Robinson, M. (2001). Effectiveness of pharmacotherapy for body dysmorphic disorder: A chart-review study. Journal of Clinical Psychology, 62(9), 721–727.Google Scholar
  65. Phillips, K. A., & Diaz, S. (1997). Gender differences in body dysmorphic disorder. Journal of Nervous and Mental Disease, 185, 570–577.PubMedCrossRefGoogle Scholar
  66. Phillips, K. A., Gunderson, C. G., Mallya, G., & Carter, W. (1998). A comparison study of body dysmorphic disorder and obsessive-compulsive disorder. Journal of Clinical Psychiatry, 59, 568–575.PubMedCrossRefGoogle Scholar
  67. Phillips, K. A., & Hollander, E. (2008). Treating body dysmorphic disorder with medication: Evidence, misconceptions, and a suggested approach. Body Image, 5(1), 13–27.PubMedCentralPubMedCrossRefGoogle Scholar
  68. Phillips, K. A., Hollander, E., Rasmussen, S. A., Aronowitz, B. R., DeCaria, G., & Goodman, W. K. (1997). A severity rating for body dysmorphic disorder: Development, reliability, and validity of a modified version of the Yale-Brown obsessive-compulsive scale. Psychopharmacology Bulletin, 33, 17–22.PubMedGoogle Scholar
  69. Phillips, K. A., McElroy, S. L., Dwight, M. M., Eisen, J. L., & Rasmussen, S. A. (2001). Delusionality and response to open label fluvoxamine in body dysmorphic disorder. Journal of Clinical Psychiatry, 62, 87–91.PubMedCrossRefGoogle Scholar
  70. Phillips, K. A., McElroy, S. L., Keck, P. E., Jr., Pope, H. G., Jr., & Hudson, H. I. (1994). A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases. Psychopharmacology Bulletin, 30, 179–186.PubMedGoogle Scholar
  71. Pope, H. G., Jr., 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.PubMedCrossRefGoogle Scholar
  72. Pope, H. G., & Katz, D. L. (1994). Psychiatric and medical effects of anabolic-androgenic steroids: A controlled study of 160 male athletes. Archives of General Psychiatry, 51, 375–382.PubMedCrossRefGoogle Scholar
  73. Pope, H. G., Jr., Phillips, K. A., & Olivardia, R. (2000). The Adonis complex: The secret crisis of male body obsession. New York, NY: The Free Press.Google Scholar
  74. Pope, C. G., Pope, H. G., Menard, W., Fay, C., Olivardia, R., & Phillips, K. A. (2005). Clinical features of muscle dysmorphia among males with body dysmorphic disorder. Body Image, 2, 395–400. doi: 10.1016/j.bodyim.2005.09.001.PubMedCentralPubMedCrossRefGoogle Scholar
  75. Rhea, D. J., Lantz, C. D., & Cornelius, A. E. (2004). Development of the muscle dysmorphia inventory (MDI). Journal of Sports Medicine and Physical Fitness, 44(4), 428–435.PubMedGoogle Scholar
  76. Robert, C. A., Munroe-Chandler, K. J., & Gammage, K. L. (2009). The relationship between the drive for muscularity and muscle dysmorphia in male and female weight trainers. Journal of Strength and Conditioning Research, 23(6), 1656–1662.PubMedCrossRefGoogle Scholar
  77. Robinson, K. J., Mountford, V. A., & Sperlinger, D. J. (2013). Being men with eating disorders: Perspectives of male eating disorder service-users. Journal of Health Psychology, 18(2), 176–186. doi: 10.1177/1359105312440298.PubMedCrossRefGoogle Scholar
  78. Rohman, L. (2009). The relationship between anabolic androgenic steroids and muscle dysmorphia: A review. Eating Disorders, 17, 187–199. doi: 10.1080/10640260902848477.PubMedCrossRefGoogle Scholar
  79. Rolls, B. J., Fedoroff, I. C., & Guthrie, J. F. (1991). Gender differences in eating behavior and body weight regulation. Health Psychology, 10, 133–142.PubMedCrossRefGoogle Scholar
  80. Root, T. L., Pisetsky, E. M., Thornton, L., Lichtenstein, P., Pedersen, N. L., & Bulik, C. M. (2010). Patterns of comorbidity of eating disorders and substance use in Swedish females. Psychological Medicine, 40(1), 105–115. doi: 10.1017/S0033291709005662.PubMedCentralPubMedCrossRefGoogle Scholar
  81. Scagliusi, F. B., Nakagawa, K. A., Campos, R. M., Kotait, M., Fabbri, A., Sato, P., & Cordas, T. A. (2009). Nutritional knowledge, eating attitudes and chronic dietary restraint among men with eating disorders. Appetite, 53(3), 446–449. doi: 10.1016/j.appet.2009.08.010.Google Scholar
  82. Somashekar, B., Jainer, A., & Wuntakal, B. (2013). Psychopharmacotherapy of somatic symptoms disorders. International Review of Psychiatry, 25(1), 107–115.PubMedCrossRefGoogle Scholar
  83. Souza, P. D., & Ciclitira, K. E. (2005). Men and dieting: A qualitative analysis. Journal of Health Psychology, 10(6), 793–804. doi: 10.1177/1359105305057314.PubMedCrossRefGoogle Scholar
  84. Stanford, S. C., & Lemberg, R. (2012). Measuring eating disorders in men: Development of the eating disorder assessment for men (EDAM). Eating Disorders: The Journal of Treatment and Prevention, 20(5), 427–436. doi: 10.1080/10640266.2012.715522.CrossRefGoogle Scholar
  85. Striegal, R. H., Bedrosian, R., Wang, C., & Schwartz, S. (2012). Why men should be included in research on binge eating: Results from a comparison of psychosocial impairment in men and women. International Journal of Eating Disorders, 45, 233–240.CrossRefGoogle Scholar
  86. Striegel-Moore, R. H., Rosselli, F., Perrin, N., DeBar, L., Wilson, G. T., May, A., & Kraemer, H. C. (2009). Gender differences in the prevalence of eating disorder symptoms. International Journal of Eating Disorders, 42(5), 471–474. doi: 10.1002/eat.20625.Google Scholar
  87. Szabo, A., & Griffiths, M. D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health Addiction, 5, 25–28. doi: 10.1007/s11469-006-9050-8.CrossRefGoogle Scholar
  88. Tanofsky, M. B., Wilfley, D. E., Spurrell, E. B., Welch, R., & Brownell, K. D. (1997). Comparison of men and women with binge eating disorder. International Journal of Eating Disorders, 21, 49–54.PubMedCrossRefGoogle Scholar
  89. The Eating Disorder Examination (12th ed.) (1993). In C. G Fairburn & G. T. Wilson (Eds). Binge eating: Nature, assessment and treatment (pp. 317–360). New York: GuilfordGoogle Scholar
  90. Thien, V., Thomas, A., Markin, D., & Birmingaham, C. L. (2000). Pilot study of a graded exercise program for the treatment of anorexia nervosa. International Journal of Eating Disorders, 28, 101–106.PubMedCrossRefGoogle Scholar
  91. Tylka, T. L., Bergeron, D., & Schwartz, J. P. (2005). Development and psychometric evaluation of the male body attitudes scale (MBAS). Body Image, 2(2), 161–175.PubMedCrossRefGoogle Scholar
  92. Uzun, O., & Ozdemir, B. (2010). Aripiprazole as an augmentation agent in treatment-resistant body dysmorphic disorder. Clinical Drug Investigation, 30(10), 707–710.PubMedCrossRefGoogle Scholar
  93. Veale, D. (1987). Exercise dependence. British Journal of Addiction, 82, 735–740.CrossRefGoogle Scholar
  94. Veale, D., Eshkevari, E., Kanakam, N., Ellsion, N., Costa, A., & Werner, T. (2013). The appearance anxiety inventory: Validation of a process measure in the treatment of body dysmorphic disorder. Behavioural and Cognitive Psychotherapy, 3, 1–12.Google Scholar
  95. Weltzin, T. E., Cornella-Carlson, T., Fitzpatrick, M. E., Kennington, B., Bean, P., & Jeffries, C. (2012). Treatment issues and outcomes for males with eating disorders. Eating Disorders, 20, 444–459. doi: 10.1080/10640266.2012.715527.PubMedCrossRefGoogle Scholar
  96. Wiseman, M. C., & Moradi, B. (2010). Body image and eating disorder symptoms in sexual minority men: A test and extension of objectification theory. Journal of Counseling Psychology, 57, 154–166.PubMedCrossRefGoogle Scholar
  97. Wong, S. S., Zhou, B., Goebert, D., & Hishinuma, E. S. (2013). The risk of adolescent suicide across patterns of drug use: A nationally representative study of high school students in the United States from 1999 to 2009. Social Psychiatry and Psychiatric Epidemiology. Advance online publicationGoogle Scholar
  98. Woodside, D. B., Garfinkel, P. E., Lin, E., Goering, P., Kaplan, A. S., Goldbloom, D. S., et al. (2001). Comparisons of men with full or partial eating disorders, men without eating disorders, and women with eating disorders in the community. American Journal of Psychiatry, 158(4), 570–574.Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Adult Eating Disorders Program, Resnick Neuropsychiatric HospitalUniversity of CaliforniaLos AngelesUSA
  2. 2.Pyschiatry-Nutrition ScienceW. HollywoodUSA
  3. 3.Nutrition In Recovery, Behavioral Health Nutrition Dietetic Practice Group (Academy of Nutrition and Dietetics)Los AngelesUSA

Personalised recommendations