Cultural and biological factors in body dysmorphic disorder in East Asia.

Body dysmorphic disorder (BDD) can cause severe distress and impairment in many important areas of functioning. Although BDD has been well studied in Western populations, there is limited information on BDD in other cultures. In this review, we discuss the prevalence and presentation of BDD in East Asian countries and the significance of conducting further research in this particular group.

Ethnic/racial and gender differences in body image disorders among a diverse sample of sexual minority U.S. adults.

This study assessed the occurrence of probable eating disorders (EDs), ED symptoms, probable body dysmorphic disorder (BDD), BDD symptoms, drive for muscularity, and appearance and performance enhancement drug (APED) misuse, in an ethnically/racially diverse sample of 962 cisgender sexual minority (SM) individuals in the United States, aged 18-30 years old. The overall occurrence of probable ED, probable BDD, and APED misuse in the current sample was 32.7 %, 50.9 %, and 30.6 %, respectively. With respect to ethnicity/race, Hispanic SMs reported the highest rates of EDs, BDD, APED misuse, and drive for muscularity, and may therefore be particularly at risk for developing body image disorders (BIDs). With respect to gender, SM men reported significantly greater drive for muscularity and APED misuse compared to SM women, while SM women reported significantly higher occurrence of probable ED and ED symptoms. The occurrence of EDs, BDD, and APED misuse were higher among SMs in this sample compared to previous rates found among heterosexual samples, suggesting that SMs, regardless of gender and ethnicity/race, are vulnerable to experiencing BIDs and APED misuse. Future research is needed to identify the mechanisms that place SMs at (increased) risk for BIDs, which will aid prevention/intervention development.

The cross-cultural and transdiagnostic nature of unwanted mental intrusions / Expresión transcultural y naturaleza transdiagnóstica de las intrusiones mentales no deseadas

Background/Objective: Unwanted mental intrusions (UMIs), typically discussed in relation to Obsessive-Compulsive Disorder (OCD), are highly prevalent, regardless of the specific nationality, religion, and/or cultural context. Studies have also shown that UMIs related to Body Dysmorphic Disorder (BDD), Illness anxiety/Hypochondriasis (IA-H), and Eating Disorders (EDs) are commonly experienced. However, the influence of culture on these UMIs and their transdiagnostic nature has not been investigated. Method: Participants were 1,473 non-clinical individuals from seven countries in Europe, the Middle-East, and South America. All the subjects completed the Questionnaire of Unpleasant Intrusive Thoughts, which assesses the occurrence and discomfort of four UMI contents related to OCD, BDD, IA-H, and EDs, and symptom questionnaires on the four disorders. Results: Overall, 64% of the total sample reported having experienced the four UMIs. The EDs intrusions were the most frequently experienced, whereas hypochondriacal intrusions were the least frequent but the most disturbing. All the UMIs were significantly related to each other in frequency and disturbance, and all of them were associated with clinical measures of OCD, BDD, IA-H, and EDs. Conclusions: UMIs are a common phenomenon across different cultural contexts and operate transdiagnostically across clinically different disorders

Introducción/Objetivo: Las intrusiones mentales no deseadas (IM), clásicamente estudiadas en relación con el trastorno obsesivo-compulsivo (TOC), tienen una prevalencia elevada independientemente de la nacionalidad, religión, y/o el contexto cultural. Las investigaciones muestran que también es habitual experimentar IM sobre contenidos relacionados con el trastorno dismórfico corporal (TDC), la ansiedad por la enfermedad/hipocondría (AE-H) y los trastornos alimentarios (TCA). Sin embargo, la influencia de la cultura sobre estas IM y su naturaleza transdiagnóstica no se han investigado. Método: Participaron 1.473 personas de siete países de Europa, Oriente Medio y Suramérica. Todas completaron el Cuestionario de Pensamientos Intrusos Desagradables, que evalúa la ocurrencia y malestar asociados a cuatro contenidos de IM relacionados con TOC, TDC, AE-H y TCA, y cuestionarios sobre síntomas de los cuatro trastornos. Resultados: El 64% de la muestra total había experimentado las cuatro modalidades de IM. Las IM-TCA fueron las más frecuentes y las hipocondríacas las menos, pero las más molestas. Todas las IM mantuvieron relaciones entre sí, tanto en frecuencia como en molestia, y todas se asociaron con las medidas clínicas de TOC, TDC, AE-H y TCA. Conclusiones: Las IM son una experiencia habitual en diferentes contextos culturales y operan de modo transdiagnóstico en trastornos clínicamente distintos

An etiological model of disordered eating behaviors among Brazilian women.

The Tripartite Influence Model posits that parents, peers and media influences mediated by internalization and appearance social comparison are predictors of body dissatisfaction, a key risk factor for eating disorders. However, the Tripartite Influence Model has not been tested in Brazil where the people are known to have high levels of body image and appearance concerns. This study aimed to test an adapted Tripartite Influence Model of body dissatisfaction and disordered eating behaviors among Brazilian women. A sample of 741 undergraduate students (Mage = 23.55 years, SD = 4.09) completed measures of sociocultural influences, internalization of body ideal, social appearance comparison, body dissatisfaction, muscularity dissatisfaction, disordered eating and body change behaviors. Structural equation modeling analyses indicated that the proposed etiological model for Brazilian women has good fit indexes (χ2(2064) = 6793.232; p = 0.0001; χ2/gl = 3.29; CFI = 0.82; PCFI = 0.79; RMSEA = 0.056 [IC90% = 0.053-0.057]). Parent and media influences were related with both internalization and social comparison, while peer influence with social comparison. A full mediation model was found, with both internalization and social comparison contributing to body dissatisfaction. Finally, body dissatisfaction was associated with disordered eating behaviors. The findings inform the importance of considering cultural aspects that influence body image and eating behaviors, and highlight the validity of the proposed etiological model for Brazilian women, that can be used for research and clinical purposes.

Weight gain, body image and sexual function in young patients treated with contraceptive vaginal ring. A prospective pilot study.

INTRODUCTION: Oral contraceptives could induce mood changes. As far as our knowledge, there are no studies in literature that have examined the role of vaginal contraception in self-perceived body image. AIM: To evaluate the effects of intravaginal contraception on weight gain and perceived body image in relation with the Beck's Depression Inventory questionnaire (BDI) and the McCoy Female Sexuality Questionnaire (MFSQ). METHODS: Twenty-one adult (18-35 years old) eumenorrheic (menstrual cycle of 25-35 days), lean (body mass index - BMI - of 19-25 kg/m2) women who were referred for hormonal contraception were administered the Stunkard Figure Rating Scale (FRS), BDI and MFSQ. Subjects were studied in basal condition and after 6 months of therapy with vaginal contraception (NuvaRing®; Organon-Schering-Plough Italia, Milan, Italy). MAIN OUTCOME MEASURES: BMI, FRS, MFSQ and BDI. RESULTS: After 6 months of therapy with NuvaRing®, both body weight (60.0 ± 8.3; p = 0.050) and BMI (22.1 ± 3.1; p = 0.028) slightly, but statistically, increased. FRS and BDI showed no differences after the vaginal contraception. Hormonal contraception was associated with a significant decrease in the two-factor Italian MFSQ score. CONCLUSIONS: Vaginal ring seems a good alternative to other hormonal contraceptive not significantly altering the female sexuality and not influencing the FRS and BDI.

Predictors of binge eating in male and female youths in the United Arab Emirates.

OBJECTIVE: Binge eating is a health-risk behavior associated with obesity, eating disorders and many other diseases. However, binge eating research remains narrow especially in Arab countries where obesity is a primary health concern but studies on psychological factors of compulsive overeating are rare. The present study addressed this gap by examining prevalence rates and key predictors of binge eating among youths in the United Arab Emirates (UAE). METHOD: Binge eating was assessed together with stress levels, emotional eating, body-related shame and guilt, obsessive-compulsiveness and depression in 254 youths using standardized self-report measures. The study comprised three online-based assessments over a 3-month period. RESULTS: Moderate to severe binge eating was reported by one-third of participants. Emotional eating and body-related guilt were the most consistent and powerful positive binge eating predictors. While stress levels and body-related shame were statistically significant predictors at follow up, neither obsessive-compulsiveness nor depressive symptomatology predicted binge eating in this study. DISCUSSION: Findings highlight binge eating as a common concern among youths in the UAE with prevalence rates similar to Western samples. Furthermore, the data suggest that binge eating may operate as a maladaptive coping strategy by alleviating negative emotions including boredom and loneliness. The finding that body-related guilt predicted binge eating is important as until now inconsistencies persist as to the relationship between body-related guilt and eating pathology. The study points towards multifactorial risk and maintenance factors of binge eating and extends our understanding within a population where until now research is poor.

The effect of low parental warmth and low monitoring on disordered eating in mid-adolescence: Findings from the Australian Temperament Project.

OBJECTIVE: To investigate the interactions between low parental warmth and monitoring at age 13-14 years and disordered eating attitudes and behaviours at age 15-16 years. METHOD: Data on 1300 (667 females) adolescents and their parents were drawn from The Australian Temperament Project (ATP), a 30 year (15 wave) population based longitudinal study of social-emotional development. Parent participants completed surveys on parenting practices in late childhood, and adolescent participants reported disordered eating using the drive for thinness and bulimia subscales of the Eating Disorder Inventory (EDI) and an additional body dissatisfaction scale. Interaction was examined on the additive scale by estimating super-additive risk; i.e., risk in excess of the sum of individual risks. RESULTS: For boys, neither parental warmth or monitoring, nor their interaction, was related to disordered eating. For girls, low parental warmth (alone) was associated with bulimic behaviours. In contrast, exposure to both low monitoring and warmth was associated with ∼3½-fold, ∼4-fold and ∼5-fold increases in the odds of reporting body dissatisfaction, drive for thinness and bulimia, respectively. For body dissatisfaction and drive for thinness, risk associated with joint exposure exceeded the sum of individual risks, suggesting an additive interaction between parenting styles. CONCLUSION: Further investment in family-level interventions that focus on promoting parental monitoring behaviour and a warm parent-child relationship remain important strategies for preventing a range of disordered eating behaviours in adolescents.

Associations between Chinese/Asian versus Western mass media influences and body image disturbances of young Chinese women.

In this study, we evaluated associations of experiences with mass media imported from Western nations such as the United States versus mass media from China and other Asian countries with eating and body image disturbances of young Chinese women. Participating women (N=456) completed self-report measures of disordered eating, specific sources of appearance dissatisfaction (fatness, facial features, stature), and Western versus Chinese/Asian mass media influences. The sample was significantly more likely to report perceived pressure from, comparisons with, and preferences for physical appearance depictions in Chinese/Asian mass media than Western media. Chinese/Asian media influences also combined for more unique variance in prediction models for all disturbances except stature concerns. While experiences with Western media were related to disturbances as well, the overall impact of Chinese/Asian media influences was more prominent.

Adolescent Body Image Distortion: A Consideration of Immigrant Generational Status, Immigrant Concentration, Sex and Body Dissatisfaction.

Immigrant adolescents represent a significant and growing proportion of the population in the United States. Yet, little is known about their experiences of body image distortion. This is particularly concerning given that body image distortion has been identified as a significant and modifiable risk factor for a number of mental illnesses, including depression and eating disorders. This study uses multi-level modeling to examine the associations between immigrant generational status, neighborhood immigrant concentration, sex, body dissatisfaction and risk for body image distortion. Data come from the National Longitudinal Study of Adolescent Health and includes 10,962 11-19 year olds (49.6 % female). First generation immigrant females were significantly more likely than 3rd generation-or-later adolescents to experience underweight body image distortion. There was no association between neighborhood immigrant concentration and risk for body image distortion. Body dissatisfaction was associated with greater risk for underweight and overweight body image distortion, with the magnitude of underweight distortion risk significantly greater among 1st generation immigrants. Interventions that encourage the development of a healthy body image have the potential to reduce the onset and duration of body image distortion among immigrant and non-immigrant adolescents.

The Muscle Appearance Satisfaction Scale: A factorial analysis of validity and reliability for its use on adult Chinese male weightlifters.

Muscle dysmorphia (MD) is the distorted perception of men's own muscle appearance. The increasing popularity of weightlifting in Chinese men suggests the presence of MD. The study assessed the validity and reliability of the Muscle Appearance Satisfaction Scale (MASS) for its use on adult Chinese males. Exploratory and confirmatory factor analyses of responses from 225 and 592 participants confirmed the same five factors for the 17-item Chinese version as the original MASS (CFI=.931, RMSEA=.052). The internal consistency for all factors were acceptable (Cronbach's α=.636 to .737). Correlation levels of its subscales with converging measurements indicated that the revised MASS is effective in assessing MD in Chinese male weightlifters. Differences in the importance of the factors suggest an influence of Chinese culture in the symptoms of MD and the need of assessing the MASS with populations from distinct demographics in China and from different cultures.

Predictive factors of disordered eating and body image satisfaction in cyprus.

OBJECTIVE: This study aimed to assess possible relationships and predictor variables between disordered eating attitudes and behaviors, the internalization of the thin ideal construct, body image satisfaction, body image investment, weight-related anxiety, and body mass index (BMI) among Greek-Cypriot female university students in Cyprus. METHOD: A total of 243 female university students responded to self-report measures assessing disordered eating, internalization of the thin ideal, body satisfaction, body image investment, and weight-related anxiety. RESULTS: Disordered eating was positively correlated to the internalization of the thin ideal, body image investment, weight-related anxiety, and BMI and negatively correlated with body image satisfaction. The internalization of the thin ideal was also positively correlated to weight-related anxiety and body image investment and negatively correlated to body image satisfaction. Furthermore, weight-related anxiety and internalization of the thin ideal have been found to be significant predictors of disordered eating attitudes. DISCUSSION: Possible explanations and vulnerability factors are addressed, as well as implication for prevention strategies and future research.

A prospective study of body image dissatisfaction and BMI change in school-age children.

OBJECTIVE: Body image dissatisfaction (BID) in school-age children is positively associated with weight status in cross-sectional studies; however, it is uncertain whether BID is a risk factor for the development of adiposity over time. The aim of the present study was to examine the association of BID with changes in BMI in school-age children. DESIGN: Longitudinal study. At recruitment, children were asked to indicate the silhouette that most closely represented their current and desired body shapes using child-adapted Stunkard scales. Baseline BID was calculated as the difference of current minus desired body image. Height and weight were measured at recruitment and then annually for a median of 2·5 years. Sex-specific BMI-for-age curves were estimated by levels of baseline BID, using mixed-effects models with restricted cubic splines. SETTING: Public primary schools in Bogotá, Colombia. SUBJECTS: Six hundred and twenty-nine children aged 5-12 years. RESULTS: In multivariable analyses, thin boys who desired to be thinner gained an estimated 5·8 kg/m2 more BMI from age 6 to 14 years than boys without BID (P = 0·0004). Heavy boys who desired to be heavier or thinner gained significantly more BMI than boys without BID (P = 0·003 and P = 0·007, respectively). Thin girls who desired to be heavier or thinner gained significantly less BMI than girls without BID (P = 0·0008 and P = 0·05, respectively), whereas heavy girls who desired to be heavier gained an estimated 4·8 kg/m2 less BMI than girls without BID (P = 0·0006). BID was not related to BMI change in normal-weight children. CONCLUSIONS: BID is associated with BMI trajectories of school-age children in a sex- and weight-specific manner.

Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty.

Body dysmorphic disorder (BDD) is one of the most common psychiatric conditions found in patients seeking cosmetic surgery. BDD is also a challenge for plastic surgeons because it is still an underdiagnosed mental disorder. The aims of this study were to prospectively investigate whether patients with mild to moderate BDD are suitable for rhinoplasty, and to assess BDD severity and patient satisfaction with the surgical outcome 1 year after the intervention. All women (n = 116) seeking rhinoplasty at a university hospital between September 2009 and August 2010 were recruited for the study and assessed for BDD. The final sample consisted of 31 patients aged 32 (standard deviation (SD), 10) years with mild to moderate BDD who underwent rhinoplasty. The participants were assessed preoperatively (baseline) and 1 year postoperatively with the Body Dysmorphic Disorder Examination (BDDE). Most patients (22/31, 71%) were of African descent. Socio-demographic variables and the extent of the nasal deformities had no effect on the severity of BDD symptoms and patient satisfaction with surgery outcome. At the 1-year postoperative follow-up, there was a significant decrease from baseline in BDDE scores and time spent by patients worrying about their appearance; 25 (25/31, 81%) patients experienced complete remission from BDD and 28 (28/31, 90%) were satisfied with the results of surgery. Rhinoplasty may be indicated in the treatment of female patients with mild to moderate BDD.

Gender and race matter: the importance of considering intersections in Black women's body image.

Traditionally, body image literature has used race as a variable to explain ethnic-specific differences in body satisfaction and the prevalence of eating disorders. Instead of employing race as an explanatory variable, the present study utilized a qualitative method to explore the relationships among race, ethnicity, culture, discrimination, and body image for African American and Black women. The purpose of the study was to gain a deeper understanding of how race and gender interface with and inform body image. Women were recruited through community centers in a major metropolitan city and represented a diversity of ethnicities. In total, 26 women who identified racially as Black (mean age = 26 years) participated in 6 focus groups, which explored body ideals, societal messages, cultural values, racism, and sexism. Narrative data from the focus groups were analyzed using grounded theory. The central category, Body/Self Image, was informed by perceptions of and feelings about not only weight and shape but also hair, skin, and attitude. Three additional categories, each with multiple properties, emerged: Interpersonal Influences, Experiences of Oppression, and Media Messages. These categories interact to explain the central category of Body/Self Image, and an emergent theory is presented. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

BMI and sociodemographic correlates of body image perception and attitudes in school-aged children.

OBJECTIVE: The aim of the present study was to identify correlates of body image perception and dissatisfaction among school-aged children from Colombia, a country undergoing the nutrition transition. DESIGN: Cross-sectional study. Using child-adapted Stunkard scales, children were asked to indicate the silhouette that most closely represented their current and desired body shapes. Body image dissatisfaction (BID) score was estimated as current minus desired silhouette. Height and weight were measured in all children. Sociodemographic data were collected through questionnaires completed by the children's mothers. SETTING: Public primary schools in Bogotá, Colombia. SUBJECTS: Children aged 5-12 years (n 629) and their mothers. RESULTS: Mean BID score was 0·1 (SD 1·7). The strongest predictor of BID was actual BMI-for-age Z-score (BAZ). Compared with children with BAZ ≥ -1 and < 1, those with BAZ ≥ 2 had a 1·9 units higher BID score (P for trend < 0·0001). BID tended to be higher in girls than boys at any level of BAZ. Other correlates of BID included child's height-for-age Z-score, maternal BMI and dissatisfaction with the child's body, and home ownership. CONCLUSIONS: Among school-aged children from a country experiencing the nutrition transition, body image perception was associated with the child's weight and height, and with maternal BMI, dissatisfaction with the child's body and socio-economic level.

Face consciousness among South Korean women: a culture-specific extension of objectification theory.

This study tested key tenets of objectification theory with South Korean women and explored the roles of sexually objectifying media and culture-specific standards of beauty in body image and eating disorder symptoms. Two pilot studies with South Korean college women (n = 40, n = 30) revealed that facial characteristics such as size and shape represent a discrete variable among culture-specific standards of beauty for South Korean women. Results with a sample of 562 South Korean college women indicated that media exposure had significant positive indirect relations with body shame and eating disorder symptoms through the mediating roles of internalization, body surveillance, and face surveillance. Internalization of cultural standards of beauty had significant positive direct relations with body surveillance and face surveillance and had both direct and indirect relations with body shame and eating disorder symptoms. Body and face surveillances had significant positive direct relations with body shame and had indirect relations with eating disorder symptoms. Finally, body shame mediated the links from internalization and surveillance variables to eating disorder symptoms. The results support the applicability of objectification theory as it relates to South Korean women and point to the significance of culture-specific standards of beauty within that framework. These findings could contribute to the broader field of multicultural body image research, with potential implications for therapist practices and training. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Effects of gender, media influences, and traditional gender role orientation on disordered eating and appearance concerns among Latino adolescents.

This study examined the main and interaction effects of gender, traditional gender role orientation, and media-influenced sociocultural values and ideals about appearance in a sample of 96 Latino adolescents controlling for age, country of origin, and BMI. Girls and less traditionally oriented youth reported significantly more disordered eating and appearance concerns than did boys and more traditionally oriented youth. Gender moderated the relationship between traditional gender role orientation and disordered eating and appearance concerns. Contrary to our hypothesis, media-influenced sociocultural values and ideals about appearance did not significantly predict disordered eating and appearance concerns. However, the interaction between gender and sociocultural values and ideals about appearance was significant. Our findings highlight the importance of continued research on gender, media, and cultural influences as they relate to disordered eating and appearance concerns among Latino youth.

Do measures commonly used in body image research perform adequately with African American college women?

This study examines reliability and validity estimates for 3 widely used measures in body image research in a sample of African American college women (N = 278). Internal consistency estimates were adequate (α coefficients above .70) for all measures, and evidence of convergent and discriminant validity was found. Confirmatory factor analyses failed to replicate the hypothesized factor structures of these measures. Exploratory factor analyses indicated that 4 factors found for the Sociocultural Attitudes Toward Appearance Questionnaire were similar to the hypothesized subscales, with fewer items. The factors found for the Multidimensional Body-Self Relations Questionnaire-Appearance Scales and the Body Dissatisfaction subscale of the Eating Disorders Inventory-3 were not similar to the subscales developed by the scale authors. Validity and reliability evidence is discussed for the new factors.

Influence of body dissatisfaction on 1-year change in nutrient intake of overweight and obese inner-city African American children.

This analysis aimed to examine the relationship of baseline body dissatisfaction with 1-year change in nutrient intake of inner-city, overweight and obese, African American children. This is a secondary analysis of 1-year pre-post data available for a convenience sample of 88 children. After adjusting for baseline intake of dietary variables and intervention group status, baseline body dissatisfaction was associated with 1-year increases in intake of energy, and all macronutrients in girls, but not in boys. These relationships were not substantially altered after adjusting for baseline BMIz and global self-worth. After including all adjustment factors, increasing baseline body dissatisfaction in girls was associated with 1-year increased intake of total energy, total sugars, total fat, discretionary fat, and total carbohydrates. This analysis suggests that, in girls but not necessarily in boys, body dissatisfaction might need to be targeted during interventions that aim to improve nutrient intake.