Body dysmorphic disorder (BDD) is associated with severe comorbidity and impairment. Muscle dysmorphia (MD) is a subtype of BDD which has rarely been assessed outside of undergraduate student ...samples. Further, there are limited data comparing MD to other psychiatric disorders, including BDD. Thus, the aim of the current study is to explore differences in symptom severity and conformity to masculine norms in men diagnosed with BDD or MD. Men from the greater Boston, Massachusetts area completed a one-time assessment, which included clinician-based structured interviews and self-report questionnaires assessing MD symptom severity, BDD symptom severity, and conformity to traditional masculine norms. The sample was N = 30 men (MD: n = 15; BDD: n = 15). Statistically significant medium to large effects emerged with the MD group experiencing greater MD and BDD symptom severity, and positive attitudes towards the use of violence to solve problems. Although not reaching statistical significance, additional medium-to-large effects also emerged with the MD group reporting greater emotional restriction/suppression, heterosexual self-presentation, and desired sexual promiscuity compared to the BDD group. Findings suggest that men diagnosed with MD may experience greater MD/BDD symptom severity and endorsement of some components of 'traditional' masculine norms, compared to men diagnosed with BDD. Results may suggest that addressing some forms of rigid masculine norms (e.g., use of violence) in therapy could be useful in treating MD; however, additional research comparing clinical samples of men with MD and BDD are needed to guide the nosology, assessment, and treatment of MD.
Objective
Using the Interpersonal Theory of Suicide (IPTS) as a framework, this two‐study investigation tested whether burdensomeness and low belongingness explained the association between body and ...muscle dysmorphia symptoms and suicidal ideation (tested in Study 1 and Study 2), and if fearlessness about death and pain tolerance explained the association between dysmorphia symptoms and previous suicide attempt frequency (tested in Study 2).
Methods
Study 1 used a community sample (n = 273) and Study 2 used an at‐risk population sample (n = 261). Participants completed cross‐sectional questionnaires online.
Results
In Study 1, both types of dysmorphic symptoms related to suicidal ideation through burdensomeness, but only body dysmorphic symptoms related to suicidal ideation through low belongingness. In Study 2, results were replicated as both types of dysmorphic symptoms related to suicidal ideation through burdensomeness. While both types of symptoms related to low belonging, low belonging did not relate to suicidal ideation. Neither dysmorphic symptoms nor capability for suicide related to frequency of suicide attempts.
Conclusions
Results suggest that improving interpersonal needs, such as feeling more effective, may be important treatment targets for individuals with dysmorphic symptoms who also experience suicidal ideation. Future work should continue to identify mediators for suicide attempts among individuals with dysmorphia symptoms.
Objective
Eating disorder (ED) symptoms correlate with suicidality; yet the strength of these relationships in men is unclear. Muscle dysmorphia (MD) symptoms may reflect a more accurate index of ...body‐related concerns for men, as they better target muscularity concerns typical of men. However, no studies have tested a model in which ED/MD symptoms and suicidality are simultaneously examined. We longitudinally tested whether ED/MD symptoms were related to suicidal ideation among a community sample of men.
Methods
Men with MD symptoms (N = 272) were recruited to complete three surveys over 6 weeks. A random intercepts cross‐lagged panel model tested predictive associations between ED/MD symptoms and suicidal ideation, while disaggregating between/within‐person variance.
Results
ED/MD symptoms were significantly associated with suicidal ideation at the between‐subjects level (ED: b = .04; MD: b = .09) and showed significant within‐wave covariances with suicidal ideation (ED: b = .02–.04; MD: b = .02–.05). Those who experienced increases in ED symptoms showed increased suicidal ideation at the next wave (b = .32). Those who experienced increases in suicidal ideation showed increases in MD symptoms at the next wave (b = .85).
Discussion
Results highlight ED symptoms as a potential risk factor for suicidal ideation among men. Further, suicidal ideation predicted MD symptoms. ED symptoms may create intra‐ and interpersonal distress predicting suicidal ideation. Suicidal ideation may lead to muscle‐building behaviors to cope with suicidal thoughts. Clinicians should assess for suicidal ideation among men at risk for MD/EDs, and for MD symptoms among those reporting suicidal ideation.
Public Significance
Eating disorder (ED) symptoms are related to suicidality, but these relationships are understudied among men. Since men report concerns surrounding muscularity, muscle dysmorphia (MD) may be a better ED index for this population. However, little research has investigated relationships between ED symptoms, MD symptoms, and suicidality among men. This study investigated relationships between ED/MD symptoms and suicidality among 272 men. Results may inform clinical assessment, treatment, and classification of MD.
•Body dissatisfaction was central across three networks of eating disorder symptoms.•Overexercise, binge eating, and diuretics use were central across multiple networks.•Military eating disorder ...interventions should address body dissatisfaction.
Military membership may put individuals at risk for eating disorders (EDs) due to military specific risk factors such as strict physical fitness requirements, increased salience of weight, and exposure to trauma. Current ED assessments and treatments do not account for these military-specific risk factors. Empirically identifying maintaining factors for EDs can clarify which specific ED symptoms may be efficacious treatment targets for service members and veterans. Thus, we employed network analysis within a military sample to identify central ED symptoms and compare if these symptoms changed across three time-points. We hypothesized that body dissatisfaction and overexercise would be identified as central symptoms across all three time-points. Individuals in the military (73.7% male, 84.8% active duty, Mage=30.74) completed the Eating Pathology Symptom Inventory (EPSI; Forbush et al., 2013) at baseline (n = 216), and at 1-month (n = 191) and 3-month follow-up (n = 176). We computed cross-sectional graphical LASSO networks and found that the most central symptoms were related to body dissatisfaction, overexercise, binge eating and diet pill/diuretics; these symptoms were largely stable across multiple time-points. Body dissatisfaction was identified as central across all three time-points and overexercise, binge eating, and diet pill/diuretics were identified as central across two timepoints. These findings are in line with network studies among men and clinical patients that find weight/shape concerns consistently emerge as central ED symptoms. Given that overexercise and diuretics are both central symptoms and frequently employed by military populations, providers should assess these symptoms and work to treat them in a culturally responsive way when they arise.
•Few risk factors for Muscle Dysmorphia (MD) development have been identified.•Longitudinal relationships between masculinity and MD symptoms were investigated.•Specific masculine norms were ...bidirectionally related to MD symptoms over time.•Masculine discrepancy stress did not mediate these relationships as hypothesized.•Conformity to specific masculine norms may be a risk factor for MD development.
Muscle dysmorphia (MD) is a severe psychiatric illness; however, little is known regarding risk factors for MD development. Conformity to masculine norms may represent a risk factor for MD, but research has yet to establish temporal ordering for these relationships. Masculine discrepancy stress (distress at not amounting to masculine stereotypes) could represent a mechanism underlying these relationships. Therefore, the current study examined longitudinal relationships between conformity to masculine norms, masculine discrepancy stress, and MD symptoms. Participants were 272 men displaying elevated MD symptoms who completed self-report questionnaires at three timepoints. An autoregressive cross-lagged mediation model was specified to examine relationships between conformity to masculine norms and MD symptoms and test if masculine discrepancy stress mediated these relationships. Masculine discrepancy stress did not mediate relationships between masculine norms and MD symptoms. However, MD symptoms predicted increased masculine discrepancy stress, and conformity to masculine norms was related to MD symptoms. MD symptoms were both a predictor and outcome of masculine norms, and signs for relationships differed on the masculine norm endorsed. Conformity to masculine norms may represent a risk factor and outcome for MD symptoms. If clinicians provide clients with tools to reduce rigid adherence to masculine identities, this may prevent MD symptom development.
Introduction
Suicidal thoughts are relatively common among college students in Iran. However, measures frequently used to assess suicidality or specific aspects of suicidal ideation in the United ...States have yet to be validated in Iran. Thus, the present study validated Farsi versions of the Depressive Symptom Inventory Suicidality Subscale (F‐DSI‐SS) and Suicide Rumination Scale (F‐SRS) among Iranian college students.
Methods
College students (N = 1043; 88.1% women) completed the F‐DSI‐SS. Forty‐six percent (n = 481) of participants reported the presence of suicidal thoughts and were eligible to fill out the F‐SRS. Analyses focused on validating the factor structure, construct, and convergent validity of the F‐DSI‐SS and F‐SRS among college students, as well as testing measurement invariance by gender of the F‐DSI‐SS.
Results
Confirmatory factor analysis (CFA) indicated that the F‐DSI‐SS and F‐SRS had good fit to the data and each displayed a one‐factor structure. Furthermore, the F‐DSI‐SS showed strong measurement invariance across genders. Internal consistency of the F‐DSI‐SS and F‐SRS was good. Lastly, the F‐DSI‐SS and F‐SRS's items and their total scores were intercorrelated and demonstrated good convergent validity.
Conclusion
Findings suggest that the F‐DSI‐SS and F‐SRS will enable researchers to examine suicidal thoughts and suicide‐specific rumination in Iran.
Muscle dysmorphia (MD) is a psychiatric illness characterized by preoccupation and compulsive behaviors to increase muscle size/definition. Despite its severity, few risk factors/mechanisms for MD ...have been identified. Conformity to masculine norms may be a MD risk factor. Furthermore, interoceptive dysfunction may facilitate MD. symptoms, as well as underlie relationships between conformity to masculine norms and MD symptoms. However, research has yet to test the mediating role of interoceptive dysfunction for said relationships. The current study tested if interoceptive dysfunction underlies relationships between conformity to masculine norms and MD symptoms among 269 US men who completed three surveys separated by one month that contained measures of focal constructs. Our sample was majority White, heterosexual, and non-Hispanic. A three-wave autoregressive mediation model was tested in which conformity to masculine norms predicted interoceptive dysfunction, which then predicted MD symptoms. Results indicated that conformity to specific masculine norms predicted both interoceptive dysfunction and MD symptoms over time. Furthermore, our hypothesized mediation pathways were not discovered. Conformity to masculine norms appears to be a risk factor for MD symptoms and interoceptive dysfunction. If clinicians can reduce rigid adherence to masculine stereotypes, this may increase connection with one’s body and reduce subsequent MD symptoms.
•Interoception may underlie relationships for masculinity and muscle dysmorphia (MD).•Temporal relationships between MD, masculine norms and interoception were examined.•Certain masculine norms predicted increased MD symptoms longitudinally.•Certain masculine norms also predicted interoceptive dysfunction longitudinally.•Clinicians may use cognitive therapy to reduce rigid masculinity and thus MD symptoms.
Suicide is one of the most commonly reported causes of death in individuals with eating disorders. However, the mechanisms underlying the suicide and disordered eating link are largely unknown, and ...current assessments are still unable to accurately predict future suicidal thoughts and behaviors. The purpose of this study is to test the utility of two promising proximal risk factors, sleep quality and agitation, in predicting suicidal ideation in a sample of individuals with elevated suicidal thoughts and behaviors, namely those with eating disorders.
Women (
= 97) receiving treatment at an eating disorder treatment center completed weekly questionnaires assessing suicidal ideation, agitation, and sleep. General linear mixed models examined whether agitation and/or sleep quality were concurrently or prospectively associated with suicidal ideation across 12 weeks of treatment.
There was a significant interaction between within-person agitation and sleep quality on suicidal ideation
(s.e.) = -0.02(0.01),
< 0.05, such that on weeks when an individual experienced both higher than their average agitation and lower than their average sleep quality, they also experienced their highest levels of suicidal ideation. However, neither agitation nor sleep quality prospectively predicted suicidal ideation.
This study was the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results suggest that ongoing assessment for overarousal symptoms, such as agitation and poor sleep quality, in individuals with eating disorders may be warranted in order to manage suicidal ideation among this vulnerable population.
Research on suicidality in muscle dysmorphia is limited despite the high rates of suicidal thoughts and behaviors in related disorders. This study employed network analysis to examine the ...longitudinal relationships between muscle dysmorphia symptoms, as well as the relations between MD symptoms and suicide risk factors. Fifty individuals (Mage = 30.6 years, 63 % male) meeting criteria for muscle dysmorphia received four daily surveys for three weeks. Multi-level vector autoregression analysis was used to estimate associations between muscle dysmorphia- and suicide-related thoughts, emotions, and behaviors. The most central nodes in the muscle dysmorphia networks related to assessing muscle size, dieting, using muscle-building supplements, experiencing body dissatisfaction, seeking reassurance, and avoiding others due to concerns about appearance. In the comorbidity networks, the most central suicide-related factors were feelings of burdensomeness, feeling disgusted, and dwelling on the past. Our findings indicated that various intrusive thoughts (body dissatisfaction, dieting), compulsions (seeking reassurance, body checking, supplement use), and beliefs (burden to others, disgust with oneself) predicted future engagement in muscle dysmorphia and suicide-related symptomology. Targeting intrusive thoughts and compulsions, as well as feelings of disgust and burdensomeness, may reduce the severity of these conditions.
•Intrusive thoughts about dieting and body image may maintain muscle dysmorphia.•Compulsions like body checking and supplement use may maintain muscle dysmorphia.•Feelings of burdensomeness and disgust may increase suicide risk in muscle dysmorphia.
Cognitive behavioral therapy for Avoidant Restrictive Food Intake Disorder (ARFID; CBT-AR) is an emerging treatment for ARFID. However, this treatment modality has yet to be examined among older ...adults (e.g., older than 50 years) or with adults presenting with feeding tubes. To inform future versions of CBT-AR, we present the results of a singular case study (G) of an older male with the sensory sensitivity phenotype of ARFID who presented for treatment with a gastrostomy tube.
G was a 71-year-old male who completed eight sessions of CBT-AR in a doctoral training clinic. ARFID symptom severity and comorbid eating pathology changes were examined pre- and post-treatment.
Posttreatment, G reported significant decreases in ARFID symptom severity and no longer met diagnostic criteria for ARFID. Furthermore, throughout treatment, G reported significant increases in his oral food consumption (vs. calories being pushed through the feeding tube), solid food consumption, and the feeding tube was ultimately removed.
This study provides proof of concept that CBT-AR is potentially effective for older adults and/or those presenting for treatment with feeding tubes. Validation of patient efforts and severity of ARFID symptoms emerged as core to treatment success and should be emphasized when training clinicians in CBT-AR.
Cognitive behavior therapy for ARFID (CBT-AR) is the leading treatment for this disorder; however, it has yet to be tested among older adults or those with feeding tubes. This single-patient case study demonstrates that CBT-AR may be efficacious in reducing ARFID symptom severity among older adults with a feeding tube.
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