Body checking behaviors in men

Abstract

Males have been facing increasing pressure from the media to attain a lean, muscular physique, and are at risk for body dissatisfaction, disturbed eating and exercise behaviors, and abuse of appearance- and performance-enhancing drugs (APEDs). The aim of the current study was to examine the relationship between body checking and mood, symptoms of muscle dysmorphia, importance of shape and weight, and APED use in undergraduate males. Body checking in males was correlated with weight and shape concern, symptoms of muscle dysmorphia, depression, negative affect, and APED use. Body checking predicted APED use and uniquely accounted for the largest amount of variance in Muscle Dysmorphic Disorder Inventory (MDDI) scores (16%). Findings support the view that body checking is an important construct in male body image, muscle dysmorphia, and body change strategies and suggest a need for further research.

Introduction

Body checking describes frequent evaluation of one's body to gain information about size, shape, or weight (American Psychiatric Association, 2000, Shafran et al., 2004). Examples include repeated weighing, checking specific body parts in mirrors and other reflective surfaces, asking for others’ opinions about one's body, comparing oneself to others, feeling for bones, and checking the fit of certain items of clothing. Avoidance behaviors encompass a range of behaviors aimed at avoiding information about one's weight, shape, or size, such as not weighing oneself, wearing loose-fitting clothing, avoiding looking in mirrors, and avoiding situations in which revealing clothing is worn, such as the gym or the beach.

Body checking behaviors have been incorporated into descriptions of eating disorders, body dysmorphic disorder (BDD; American Psychiatric Association, 2000), and muscle dysmorphia (MD; Pope, Gruber, Choi, Olivardia, & Phillips, 1997). Leading evidence-based treatments for bulimia nervosa (Fairburn, Marcus, & Wilson, 1993), body image disturbance (Cash, 2008, Cash and Pruzinsky, 2004) and BDD (Rosen, 1995, Rosen et al., 1995) include components designed to reduce compulsive body checking and avoidance behaviors. In addition, recent theoretical models propose that body checking and avoidance are both behavioral manifestations of core eating disorder psychopathology and maintaining factors of eating- and body-related problems (Shafran et al., 2004).

In a sample of women with eating disorders, Shafran et al. (2004) found that 92% of the females reported body checking and that 70% of participants engaged in various body checking behaviors on a regular basis. The focus of these behaviors was almost always on specific body parts that they disliked. Only 5% of their sample reported improved mood following body checking. In both clinical and non-clinical female samples, body checking and avoidance behaviors are positively associated with increased shape and weight concern (Farrell et al., 2004, Reas et al., 2005; Shafran et al.). Experimental manipulations of body checking suggest that high levels of body checking yield significant, but temporary, worsening of body image self-reports (Shafran, Lee, Payne, & Fairburn, 2007). Insights into the role of body checking in males are limited to a handful of mixed-gender studies in overweight or obese participants. Generally, these studies indicate that body checking is frequently endorsed and is significantly associated with overconcern with shape and weight, restraint, poorer weight loss outcome, greater fear of fat, body dissatisfaction, perceived struggle in weight loss treatment, and lower self-esteem (Grilo et al., 2005, Latner, 2008, Reas et al., 2005). This relationship, when compared, appears to be similar in men and women. In addition, body avoidance was significantly associated with binge eating (Grilo et al.). In a small sample of treatment-seeking binge eating disorder patients (N = 73, including 22 men), Reas, White, and Grilo (2006) found significant relationships between body checking and age, body mass index (BMI), body image dissatisfaction, and overevaluation of shape and weight only in women, although this may be due to the limited sample of men.

Only in the past 10–15 years have psychologists paid adequate attention to body image disturbance and related behavioral dysfunctions in males (Cafri, Thompson, Ricciardelli, McCabe, Smolak, & Yesalis, 2005). The male body ideal portrayed in the media has become leaner and more muscular over the past few decades, often displaying males with physiques that are difficult to achieve without the use of appearance- and performance-enhancing drugs (APEDs; Hildebrandt et al., 2007, McCreary et al., 2007). It is not surprising that body appearance is of growing concern to men and boys (Grieve, 2007). Given that men and boys are likely to value a lean, muscular physique, behavioral expressions of extreme shape and weight concern are likely to reflect aspects of appearance associated with this idealized male body type.

Currently, body checking and avoidance measures, such as the Body Checking Questionnaire (Reas, Whisenhunt, Netemeyer, & Williamson, 2002), Body Image Avoidance Questionnaire (Rosen, Srebnik, Saltzberg, & Wendt, 1991), Body Shape Questionnaire (Cooper, Taylor, Cooper, & Fairburn, 1987) and Body Checking and Avoidance Questionnaire (Shafran et al., 2004) appear to be more focused on concerns such as trying to elicit comments from others about fatness and pinching flesh on the thighs, stomach, and bottom, all of which are considered typical female “hot spots.” All of the body checking research that has included male participants used these measures and, as a result, may have overlooked key aspects of male body image dissatisfaction. As has been found in non-clinical female samples and mixed-gender overweight and obese samples, it is expected that body checking is present in normal-weight men who do not have eating disorders or extreme body image dissatisfaction. In addition, as is the case in other non-clinical samples, it is hypothesized that body checking will be positively correlated with shape and weight concern. It is not clear whether typical undergraduate males would engage in the same types of checking and avoidance rituals that have been documented in female-only or mixed-gender obese samples. However, it seems likely that these rituals do not overlap completely given that men and boys are much more likely to report a desire to increase muscle mass and decrease body fat (Cafri et al., 2005), and that current weight and shape likely affects whether fat reduction or muscle gain is of more importance to men (Hildebrandt, Schlundt, Langenbucher, & Chung, 2006). When internalized, the difficult-to-achieve male body ideal will affect males’ body esteem and self-worth, (Grieve, 2007), and this internalization increases boys’ and men's vulnerability to psychopathology such as MD and to the use of unhealthy body change strategies, such as APED use.

The purpose of the current study was to determine whether and to what extent body checking behaviors exist in the average male and to determine whether these behaviors are correlated with shape and weight concern. Additionally, it was hypothesized that some behaviors are common among non-clinical males, whereas other behaviors will be largely peculiar to males with greater body-related psychopathology. Body checking behaviors were hypothesized to correlate with negative affect, depression, symptoms of MD, and APED use in undergraduate men. Thus far, no data have been published regarding body checking behavior in normal-weight males, so this study adds an important contribution to our understanding of body-related psychopathology and associated behaviors in men. The current study assessed APED use in a typical sample of undergraduate males, so an additional purpose of the study was to compare these results to previous research, such as work done by Olivardia, Pope, Borowiecki, and Cohane (2004), who found rather high rates (27%) of APED use among college males. Replication of these data would suggest that health professionals and universities should target APED reduction in this population.