Eating Disorders in Men Flashcards
1
Q
Males sig less lifetime prevalence of EDs
- Anderson 1990
- Udo & Grilo 2018
A
- however over focus on females, most research on F
- -leads to issues of underestimation.
-Anderson 1990- widely assumed M not afflicted with EDs due brain diffs b/w genders.
- Udo & Grilo 2018- nationally representative sample U.S. -prevalence on DSM-5
- -AN- M 0.04% v F 0.12%
- -BN= M 0.03% v F 0.06%
- -BED= M 0.06% v F 0.10%
2
Q
Epidemiology of disordered eating in M
- Mitchison et al 2014
- Madden et al 2009
- Nicholls, Lynn & Viner 2011
- Chapman & Woodman 2015
- Calzo et al 2017
- Eisenberg et al 2012
- US National Co-morbidity Replication Survey 2007
A
- greater proportion of males with EDs during childhood <14 years.
- Mitchison et al 2014- b/w 1998-2008 faster increase in binge eating, purging & strict dieting in M.
- Madden et al 2009- 1 in 4 preadolescent EDs are M in Australia.
- Nicholls, Lynn & Viner 2011- 33% EDs in UK= M.
- Chapman & Woodman 2015- higher in athletes involved in some sport groups & college students.
- -not sure if cohort effect of just more willing to admit they have ED.
-Calzo et al 2017- higher in gay M.
- Eisenberg et al 2012- muscle-enhancing behaviours reported by 60% adolescent boys.
- -what they are eating, physical activity, protein shakes etc…
-US National Co-morbidity Replication Survey 2007- M= 1in 4 cases of AN & BN.
3
Q
Gender bias in diagnosis & assessment
- Murray, Griffiths & Mond 2016
- APA 2013
- Fairburn et al 1993
- Hay et al 2015
A
- Murray, Griffiths & Mond 2016- less 1% contemporary peer-reviewed relate specifically to male presentation of AN.
- Diagnosis- DSM-5 (APA, 2013)- drive for thinness, energy restriction for weight loss/behaviour interfering with weight gain, fear of weight gain.
- Fairburn et al 1993- Assessment: “hips too big” “stomach too big”
- -stigma if “feminine” prob -> reduced recognition, seeking help.
- Males often excluded from research studies due to low numbers= perpetuated problem.
- bone scans due to low weight occur after periods stop- M?
- M often eat fine but carefully watch & issues based around gym regime.
- unusual or “exotic” for M to have an E.
-Hay et al 2015- presentation BED similar in both M & F.
4
Q
Do EDs present diff in M/F?
- Carlat, Camargo & Herzog 1997
- Murray et al 2017
- Murray et al 2017
- Lavender et al 2010
- Darcy 2011
- Tzoneva, Forney & Keel 2015-
A
- Males report: greater range of psychiatric co-morbidities (substance use, psychotic symps).
- Carlat, Camargo & Herzog 1997- M greater array psychiatric co-morbidities.
- later age of onset- typically later adolescence (could be due to later puberty v F?)
- M more prominent history of previous obesity or being overweight.
- more reg experiences of weight-related teasing.
- Anorexia Nervosa- Murray et al 2017
- -M less concerned about weight, equally concerned shape & eating.
- -compulsive exercise more likely to be central presenting prob in M.
- presenting BMI higher in M (body composition).
- Bulimia Nervosa & Bed- Murray et al 2017
- -binging more likely focus on savoury foods.
- -use purging & laxative abuse as compensatory behaviour- less freq.
- -use extreme dietary restriction & exercise more freq.
- —Lavender et al 2010- M less report- lacking in control over eating &/or distress whilst binging.
- Darcy 2011- M more likely to have ED behaviour misdiagnosed as symptom of other mental health probs.
- Tzoneva, Forney & Keel 2015- neg body talk persists in M into midlife v F gradual decline.
5
Q
Compulsive exercise in AN
-Murray et al 2013
A
- function of exercise- rigid, urge to exercise, inability stop, performed despite adverse consequences
- -present in 80% of AN cases in acute phase.
- Murray et al 2013- 27M & 27F with AN.
- -Compulsive Exercise Test (CET): severity/function of compulsive exercise.
- -avoidance & rule-driven behaviour, weight control exercise, mood improvement, lack of exercise enjoyment, exercise rigidity.
- -M higher compulsive exercise than F- higher mood improvement, avoidance & rule-driven behaviour, exercise rigidity.
- -indicate has strong psychological role (emotional regulation) + calorie-burning/muscle strengthening effects.
6
Q
Male ideal body attributes -Ridgeway & Tylka 2005
- Lavender et al 2017
- Neumark-Sztainer et al 2002
A
Ridgeway & Tylka 2005- 30 M- ideal body study.
- -muscularity, large size, strong, athletic, big but not too big.
- -leanness & tall. -waist up body area most important- abs, chest, arms.
- -less importance shoulders, back, upper legs & calves.
- Lavender et al 2017- “dual focus both leanness & muscularity… may motivate maladaptive set of behaviours designed to achieve these goals”.
- Neumark-Sztainer et al 2002- black M U.S. greater importance/investment in body v white-more important in minority groups.
7
Q
Muscularity-oriented eating behaviours- Murray et al 2012
- Griffiths et al 2013
- Griffiths, Mitchison & Murray 2017
- Connan 1998
A
- Murray et al 2012- v high lvls protein consumption, severe restrictions of non-protein items.
- -interrupting important activities to accommodate freq eating.
- -continued food consumption when feel full.
- -blending to ease consumption.
- -large portion of calories in liquid form.
- -compensatory restriction of carbs or fats due deviation from training regime.
- -use appearance enhancing drugs: steroids, testosterone boosters & others- can lead to breasts & small testicles, infertility.
-Griffiths et al 2013- bulk & cut cycle- distinct eating patterns oriented towards increase muscle, decrease fat.
- Griffiths, Mitchison & Murray 2017- cheat days of body building community- resemble objective binge episodes + believe helps lose weight as offsets metabolic effects.
- –Connan 1998- followed by compensatory behaviours- excessive exercise & increase dietary restraint.
8
Q
Is drive for muscularity an ED symptom? Consequence?
- Eik-Nes et al 2018
- Raevouri et al 2008
A
- Eik-Nes et al 2018- 2640 men aged 18-32 y/o
- -measured drive for muscularity & health outcomes 1 year later= depress symps, overeating, binge eating, purging, binge drinking, use muscle building products.
- gay/bi M higher drive for muscularity v hetero.
- drive muscularity increased risk of later depressive symps, binge drinking, dieting & use of building products.
-Raevouri et al 2008- MD similar genetic to AN- see twin study of males.
9
Q
Re-conceptualisation of EDs in men?
-Griffiths et al 2013
A
- rule makes this behaviour disordered in both those who seek thinness by eating less & muscularity from eating often is
- – Eating Meals Based on Time Intervals Not Hunger.
- multiple body ideals- from thin to very muscular- motivate disordered eating.
- currently only really concerned with thin & restriction= outdated.
-Griffiths et al 2013- focus on rule & Core Psychopathology- underlying disordered eating/behaviour rather than specific direction.
10
Q
DSM-V: Body Dysmorphic Disorder Obsessive-Compulsive Disorders Category (BDD-OCD)
-A-D
A
- (categorised as OCD around exercise- little about food intake).
- A- Appearance Preoccupation: preoccupation with 1 or more non-existent or slight defects or flaws in physical appearance.
- B- Repetitive Behaviours: repetitive or compulsive behaviours in response to appearance concerns (mirror checking, excessive grooming etc…).
- C- Clinical Significance- cause distress or impairment in social, occupational or other important areas of functioning.
- D- Differentiation from an ED: if concerns are focused exclusively on weight or fat, ED may better account for symps.
- -Muscle Dysmorphic Subtype: belief one’s body is too small &/or insufficiently muscular.
- —Specifier: “with good or fair insight” “with poor insight” or “with absent insight/delusional beliefs”.
11
Q
Muscle dysmorphic behaviours (“reverse anorexia”)- should it be an ED?
- ee
- fail adhere
- gives up…
- preocc
- continues
A
- excessive exercise (weights), obsessive attention to diet & rigid diet plans.
- experience difficulty eating if nutritional info (macros, protein) not provided.
- failure adhere to diet/exercise plan= intense anxiety/guilty-> compensation (workout extra, increase protein).
- mirror checking, baggy clothes (body image avoidance).
- gives up social/occupational/recreational activities due to workout/diet schedule.
- avoids situations which one’s body exposed to others or endures with marked distress or intense anxiety.
- preoccupation about inadequacy of body size or musculature causes Clinically Significant Distress or Impairment in social/occupational or other important areas of functioning.
- continues work out, diet use ergogenic substances- despite knowledge of adverse physical or psychological consequences.
12
Q
Prevalence & clinical features (hard to tell prevalence)
- Bjornsson et al 2010
- Campagna & Bowsher 2016
- Murray et al 2016
- Tod et al 2016
- BBC
A
- Bjornsson et al 2010- 0.7-2.4% for body dysmorphic disorder in general population.
- -no formal epidemiological studies of MD.
-Campagna & Bowsher 2016- 13% US male army recruits meet criteria.
- Murray et al 2016- MD in men is roughly as prevalent as AN in women (0.5%)
- -onset typically late adolescence- 19 years old.
- Tod et al 2016- high rate psychiatric co-morbidity: eating, mood/anx, substance use, body dysmorphic disorders, attempted suicide, poorer quality of life then men with BDD (non-MD) or general population samples.
- BBC- 427,000 (10% gym population) 0.7% UK population experienced MD.
13
Q
Physical complications
- Vo et al 2016
- Magata et al 2015
A
- freq injuries from over-exercise, dmg muscle, joints, tendons.
- increased risk coronary heart diseases, stroke, myocardial infarction, liver & kidney diseases.
- anabolic steroid use–> increased fat-free mass & strength, decreased body fat-> LDL/HDL changes: increased bad cholesterol/decreased good cholesterol-> risk of diseases.
- Cycling: risks decrease when not using steroids BUT over time risk remains.
- Vo et al 2016- 50%+ study ptcpts criteria for urgent impatient admin for heart rate.
- Nagata et al 2015- 1/3+ males with AN elevated liver enzymes far higher then females.
14
Q
Is MD a feeding or eating disorder?
- 1-2
- Murray et al 2012
- Murray et al 2012
- Tod et al 2016
A
-1- How do psychological profiles of males with MD, AN & gym using controls compare?
- -Murray et al 2012- ptcpts completed measures of EDs, body image, exercise & diet.
- -MD & AN ptcpts similar lvls of symps of disturbed body image, disordered eating & exercise behaviour.
- -diffs b/w 2 conditions were consistent with opposing body ideals pursued (i.e. muscular or thin).
-2- How do variables associated with AN & MD compare?
- -Murray et al 2012- examined components of Transdiagnostic Model in undergraduate males.
- -self-oriented perfectionism, socially prescribed perfectionism, mood intolerance & low self-esteem associated with muscle dysmorphia symps.
- -other-oriented perfectionism & interpersonal probs not associated.
–Tod et al 2016- other factors associated with symps: body dissatisfaction, negative affect (depress/anx) dieting & body building/participation in strength sports, comments about weight, childhood bullying/teasing, acceptance/admiration of media images promoting muscularity, experiences/observed traumatic event, such as a sexual assault or domestic violence.
15
Q
Applying the transdiagnostic model to MD?
look at diagram in notes
A
-binge eating = “cheat day”.
(dysfunctional scheme for self-eval)
(perfectionism)
(core low self-esteem)
(mood intolerance)
-self-oriented, socially-prescribed (not other-oriented)-> internalising disorder.
