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2 - Differential and clinical > Lecture 7 - Muscle dysmorphia > Flashcards

Lecture 7 - Muscle dysmorphia Flashcards

1
Q

What are people with muscle dysmorphia preoccupied with?

A

Their appearance - concerned that they are insufficiently large and muscular

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2
Q

What behaviours occur in muscle dysmorphia?

A

Their lives are consumed by activities aimed at increasing muscularity, such as weightlifting and following a specific dietary pattern

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3
Q

Do people with muscle dysmorphia:
experience severe distress about having their bodies viewed by others?
experience impaired occupational and social functioning?

A

Yes

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4
Q

What risky health behaviours do people with MD do?

A

The use of physique-enhancing drugs, overly restrictive diets, and excessive exercise when contraindicated

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5
Q

Is muscle dysmorphia classified as an eating disorder?

A

No - Muscle dysmorphia is not currently classified as an eating disorder.

The diagnostic category for body- and appearance-related concerns which are NOT weight/thinness-oriented is body dysmorphic disorder (BDD). MD is a subtype of BDD.

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6
Q

DSM 5 criteria for BDD/MD: what are people preoccupied with?

A

Appearance preoccupation: preoccupation with one or more non-existent or slight defects or flaws in physical appearance

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7
Q

DSM 5 criteria for BDD/MD: what repetitive behaviours occur?

A

Repetitive or compulsive behaviours in response to the appearance concerns (e.g., mirror checking, skin picking)

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8
Q

DSM 5 criteria for BDD/MD: what does clinical significance mean?

A

Clinical significance: must cause distress or impairment in social, occupational, or other important areas of functioning

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9
Q

DSM 5 criteria for BDD/MD: how does it need to differentiate from an eating disorder?

A

Differentiation from an eating disorder: if concerns are focused exclusively on weight or fat, an ED may better account for symptoms

Focus on muscle

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10
Q

What is a specifier for muscle dysmorphic subtype of BDD?

A

Specifier: level of insight
Good or fair; poor insight; absent insight / delusional beliefs
Bad insight is believing that others can see a very small change as an extreme change, good insight is realising that while they themselves notice changes, others probably do not notice

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11
Q

What are masculine ideal body attributes and why are these dangerous to try and achieve?

A
  • Qualitative study of specific body ideals with 30 cis men
    • Muscularity key to ideal overall body composition: large size, strong, athletic, and big . . . but not too big
      Leanness (low body fat) and height emphasised
      Body areas of special concern: “waist up” most important. Emphasis on abdominal region, arms, chest
      Also valued were shoulders and back, upper legs and calves
    • “The dual focus on both leanness and muscularity may motivate a particularly maladaptive set of behaviours designed to achieve these goals”
    • As we gain muscle, it is healthy to gain fat also in case of illness or no access to food
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12
Q

What does muscularity-oriented eating look like?

A
  • Very high protein consumption,
    • Restriction of non-protein dietary components,
    • Interrupting important activities to accommodate frequent eating,
    • Food consumption despite feeling full
    • Frequent eating (every 2 to 3 hours)
    • Liquefying /blending food for easier intake
    • Compensatory restriction of carbohydrates or fats due to ‘deviation’ from training regime,
    • Struggle to eat if nutritional info (e.g., macronutrients: protein) not provided
    • Failure to adhere to diet plans -> intense anxiety and guilt -> compensation (e.g., extra work out, increase protein consumption)
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13
Q

How does MD present in terms of exercise?

A

Excessive exercise - 4-5 hours a day (esp. weights)
Gives up social / occupational / recreational activities to work out - sometimes work in fitness industry as it allows them to work out excessively while having a job
Continues to work out, diet, or use ergogenic substances despite knowing about or experiencing adverse consequences

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14
Q

How does MD present in terms of body image?

A
  • Mirror checking, baggy clothes i.e., body image avoidance
    • Avoids situations in which the body is exposed to others – feels distress/anxiety if exposure happens
    • Preoccupation about inadequate size / musculature causes distress & functional impairment
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15
Q

How does anabolic steroid use manifest in MD?

A
  • Use of appearance enhancing drugs such as steroids, “testosterone boosters” and other supplements is common
    • Typically used in cycles / combinations to minimize unwanted side-effects and maximise muscle gain
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16
Q

What are the negative side-effects of anabolic steroid use?

A
  • Anabolic steroid use  increased fat-free mass and strength, decreased body fat  LDL/HDL changes: increased bad cholesterol/decreased good cholesterol  risk of CV disease increases
    • Increases odds of coronary heart disease, stroke, myocardial infarction, liver and kidney disease, as well as endocrine disorders and side effects e.g., gynecomastia (developing breast tissue) in cis men.
    • Linked to mental health difficulties and symptoms including anger, low mood and mood swings, paranoia and delusions
    • Very difficult to stop using steroids once you start
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17
Q

What are physical complications of exercise and eating in MD?

A
  • Frequent injuries from over-exercising can result in damage to muscles, joints and tendons
    • If exercising when injured, bones can fail to set appropriately
    • Restricted and protein-heavy diet can result in nutritional deficiencies
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18
Q

What is typical age at onset?

A

18-20 years

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19
Q

After 4 years, what is the cumulative probability of full remission for BDD?

A

20%
BDD very persistent - likely so is MDD

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20
Q

What MH conditions are comorbid with MD?

A

Major depressive disorder, bipolar disorder, substance use disorders, anxiety disorders

21
Q

How much of BDD cases do MD cases make up?

A

9-25%
BDD has around 0.7% to 2.4% prevalence in population - definitely underdiagnosed

22
Q

What are higher-risk populations for prevalence of MD?

A

army recruits (13%)5, body builders (58%), sports science students (11%)

23
Q

What is the male to female ratio of people with MD?

24
Q

In comparison to people with BDD, people with MD have a higher risk of what?
Why might this be?

A

Suicidality, substance misuse including anabolic steroids, substance abuse

Dual burden of symptoms and not accepting they have a health problem:
- MD includes the behaviours of BDD (e.g., mirror-checking, reassurance seeking)
- & those unique to MD (e.g., dieting to increase muscle mass, anabolic steroid use),

Also, people often won’t accept that they have a health problem - they just view the problem as being too small and do not think they have mental health or physical health problems.

25
A cross-sectional survey with individuals aged 11-20 years old found diagnostic-level symptoms in what % of boys and girls?
2.2% boys 1.4% girls
26
How do boys and girls differ in presentation of MD?
Boys with MD more preoccupied with muscularity. Girls with MD had higher discomfort with body exposure. Both equally likely to eat high protein diet, lift weights, use steroids, have distress, and low quality of life
27
What factors are associated with higher drive for muscularity?
gender (higher in men), negative affect, behaviours to gain body mass, internalization of muscular body ideal association with physical activity, exercise dependence (emotional dependence on exercise - addictive), dietary supplement consumption, disordered eating
28
Do trans men have the same drive for muscularity as cis men?
Yes
29
Is drive for muscularity the same as MD symptoms?
No
30
In a population of trans women and men, and gender expansive people, who had the highest MD symptoms?
- Transgender men had the highest MD symptoms and greatest distress about not being large enough, followed by gender-expansive people, then transgender women.
31
What does drive for size drive?
Differences in MD symptoms
32
What % of gender-expansive people, trans men and trans women reported using appearance and performance-enhancing drugs and supplements (APEDS)? What was this positively associated with?
30.7% of gender-expansive people, 45.2% of transgender men, and 14.9% of transgender women had used APEDS at least once - Drug/ supplement use was positively associated with eating disorder symptoms in all groups - Drug/ supplement use was associated with MD symptoms in gender expansive people and transgender men, but not transgender women - ED symptoms co-occur but are associated with muscular body ideals - Likely due to access of gender-affirming healthcare - turn to less-controlled substances
33
What later adverse outcomes does drive for muscularity predict?
Drive for muscularity increased the risk of later depressive symptoms, binge drinking, dieting and use of muscle-building products
34
Do heterosexual men have higher drive for muscularity than gay and bisexual men?
No - gay and bisexual participants had higher drive for muscularity compared to heterosexual men
35
What are 6 social and situational risk factors for MD?
- Previous physical and/or sexual assault - Early life bullying & victimization - Later onset of puberty in boys - MD compensates - Engagement in body building / similar sports (can expose people to disordered views and use of steroids) - Use of anabolic steroids Genetics (based on findings from BDD and related OC disorders)
36
What is visual processing like in BDD?
People very detail-oriented with visual processing - Fits with clinical observations of detail-oriented visual perceptual biases in BDD (bottom-up processing differences) and enhanced visual processing of emotionally salient stimuli.
37
What neural differences are there in BDD?
Differences in brain activity, structure, and connectivity in frontostriatal, limbic, and visual system regions when compared to control and other clinical groups.
38
Study: Looking patterns of 24 men with MD, 24 weight-training controls, and 24 non-weight training controls Showed them pictures of their own body, an average male body, a lean-muscular body, and a hyper-muscular body What did different groups preferentially look at on each body?
Men with MD and non-weight training controls, looked more at own body areas that they evaluated negatively (felt bad about) Hypermuscular body looking patterns: Only men with MD displayed biases toward ‘positive’ areas of the hyper-muscular body (areas they loved and were keen to have) Only men with MD reacted with a large, significant deterioration in state body image and emotion to hyper-muscular figures Take-home point: Attentional biases possibly contribute to the negative effects of critical examinations of one’s body and of upward comparisons in MD.
39
How does MD symptom prevalence differ between body builders and non-body building resistance trainers? Why is it important to compare these two groups?
- Medium-large effects for greater MD symptoms in BBs than in NBBRTs (five studies) - Competitive BBs more symptoms than non-competitive BBs Should compare disordered MD ppts with people who use the gym but re not disordered Body building is a risk factor but most control groups (random people who never go to the gym) have been inappropriate.
40
What mental health issues are MD symptoms associated with?
- MD symptoms associated with anxiety, social physique anxiety, depression, neuroticism, and perfectionism - MD symptoms inversely associated with self-concept and self-esteem
41
What are cause and effect issues when looking at MD symptoms in body builders?
Does BB cause MD, or does MD mindset cause people to BB? Are these characteristics caused by bodybuilding? Do people with these characteristics choose bodybuilding?
42
How is eating disorder criteria gender biased?
DSM 5 (APA, 2013): Drive for thinness, energy restriction for weight loss/ behaviour interfering with weight gain, fear of weight gain Assessment Commonly used psychometric ED scales: “I think that my stomach is too big” “I think that my thighs are too large” “I think my hips are too big” Stigma of a ‘feminine’ problem  reduced recognition, help seeking Men and people with other gender identities often excluded from research studies (because of lower numbers, but this has perpetuated problem)
43
In what two ways are men with EDs portrayed as anomolous?
- atypical of men - atypical of those with EDs The teenage girl is portrayed as the norm. Also, Depiction of transgender and gender non-binary people with EDs almost absent.
44
How are EDs portrayed as a women's illness?
- suggested that, when EDs do occur in men, only in adolescents. Men with EDs portrayed as less manly, and feel shame - lived experiences include barriers to help-seeking & treatment; men feel disbelieved / dismissed
45
What is argument for re-conceptualising EDs to include MD?
Consider an individual who desires thinness and eats infrequently, and another individual who desires increased muscularity and eats often. The rule that makes this behaviour disordered in both individuals is that they eat meals based on time intervals not hunger. Multiple body ideals, from thin to very muscular, motivate disordered eating. However, the current conceptualisation of disordered eating is concerned only with thinness, weight loss and calorie restriction, making it outdated. Shoudl focus on the core psychopathology that underlies the disordered eating and behaviour rather than the specific direction of the behaviour (thin vs muscular)
46
How do medical professionals go about treating someone with MD by helping them come off steroids?
Stopping steroid use is vital but difficult: loss of muscle mass is inevitable The fear of muscle mass loss acts as a maintaining (perpetuating) factor which keeps symptoms going When taking hormones, body loses some of its ability to make own hormones - must be medically supervised Physical and psychological withdrawal effects can be extreme even beyond muscle loss – as natural levels of testosterone and other hormones are greatly depleted. Professional endocrinological treatment is often needed to help re-regulate hormones.
47
What drug is used as first line of therapy for BDD? What is used if these do not work?
SSRIs Good evidence for effectiveness - reduce symptoms over several months, particularly in terms of reduced obsessive thought patterns. Insight also appears to improve. Antipsychotics such as clomipramine can be used if there is no response to SSRIs to reduce obsessive compulsive aspects. However, limited evidence as to whether they are useful to MD
48
Is CBT effective treatment for BDD?
Yes and no CBT is efficacious in reducing BDD severity vs no treatment or waitlist control conditions. Both adults and adolescent populations 46%–60% of BDD trial participants do not respond sufficiently to CBT Remission rates are low
49
What limitations are there in the literature surrounding muscle dysmorphia?
Generally small samples, many non-clinical Inconsistent use of control groups Predominantly cross-sectional (not prospective) Use of non-clinical measures (e.g., DFM) Terminology used inconsistently Possible risk of over-pathologising people's behaviours

2 - Differential and clinical (18 decks)

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