Publications by authors named "Scott Griffiths"

117 Publications

Weight stigma predicts reduced psychological wellbeing and weight gain among sexual minority men: A 12-month longitudinal cohort study using random intercept cross-lagged panel models.

Body Image 2021 Nov 17;40:19-29. Epub 2021 Nov 17.

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.

Weight stigma among sexual minority men predicts negative health outcomes; however, existing research is cross-sectional. Therefore, we longitudinally examined the presence, strength, and direction of relationships between weight stigma and health outcomes in a multi-national cohort of 2953 sexual minority men (M = 37.70, SD = 13.70). Participants reported their Body Mass Index (BMI), experiences of weight discrimination, internalized weight bias, and psychological quality of life at three time-points over 12 months (~August 2019-20). Analyses revealed feedback loops of internalized weight bias with BMI and psychological quality of life: over time, increases in internalized weight bias were associated with small BMI increases (β = 0.07) and small decreases in psychological quality of life (β = 0.12). Reciprocally, increases in BMI and decreases in psychological quality of life were associated with increases in internalized weight bias (βs = 0.18). Experiences of weight discrimination were not longitudinally predictive and were associated with higher BMI (β = 0.29), greater internalized weight bias (β = 0.29), and lower psychological quality of life (β = 0.26) between-persons/cross-sectionally only. Weight stigma is longitudinally and reciprocally associated with reduced psychological wellbeing and weight gain among sexual minority men. Internalized weight bias is a particularly promising intervention target.
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http://dx.doi.org/10.1016/j.bodyim.2021.10.006DOI Listing
November 2021

Androgen abuse among gay and bisexual men.

Curr Opin Endocrinol Diabetes Obes 2021 12;28(6):589-594

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.

Purpose Of Review: Androgen abuse is more prevalent among gay and bisexual (i.e. sexual minority) men than heterosexual men. We review recent research about androgen abuse in sexual minority men and provide relevant social, cultural, and historical contexts.

Recent Findings: Androgen abuse among sexual minority men is shaped by the intersections of sexuality, desirability, masculinity, and race. Muscular male bodies are desired and - in erotic settings especially - prized as literal embodiments of masculinity. Racist stereotypes unjustly diminish the desirability and masculinity of sexual minority men who belong to racial minorities, especially those who are Asian or Black, and the higher rates of androgen abuse among these racial minorities may reflect a compensatory motivation for these diminishments. The historical context for sexual minority men - decades of subjugation alongside stereotypes of masculinity-compromising effeminacy - further complicate the intersections of sexuality with androgen abuse. Harm minimization efforts led by empathetic endocrinologists stand the best chance of achieving positive outcomes for sexual minority men who use androgens.

Summary: More dedicated research on androgen abuse among sexual minority men is needed as this population requires thoughtfully designed research that is incorporative - at a minimum - of the complexities of sexuality, desirability, masculinity, and race.
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http://dx.doi.org/10.1097/MED.0000000000000684DOI Listing
December 2021

Under the knife: Unfavorable perceptions of women who seek plastic surgery.

PLoS One 2021 7;16(9):e0257145. Epub 2021 Sep 7.

Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.

Plastic surgery is growing in popularity. Despite this, there has been little exploration to date regarding the psychosocial consequences of seeking plastic surgery. Our study investigated how women seeking plastic surgery are perceived by others. We presented a random sample of 985 adults (men = 54%, Mage = 35.84 years, SDage = 10.59) recruited via Amazon's Mechanical Turk with a series of experimental stimuli consisting of a photographed woman (attractive versus unattractive) and a vignette describing an activity she plans to engage in (plastic surgery versus control activity). Participants rated stimuli on perceived warmth, competence, morality, and humanness. We ran linear mixed-effect models to assess all study hypotheses. There was a negative plastic surgery effect; that is, women seeking plastic surgery were perceived less favorably than those planning to complete control activities across all outcome variables (warmth, competence, morality, and humanness). These relationships were moderated by physical attractiveness; while attractive women planning to undergo plastic surgery were perceived less favorably than attractive women planning to engage in control activities, perceptions of unattractive individuals remained unchanged by plastic surgery status. We theorized that empathy toward unattractive women seeking plastic surgery mitigated the negative plastic surgery effect for these women. In sum, our results suggest that perceptions of attractive women are worsened when these women decide to seek cosmetic surgery. Perceptions of warmth and competence have implications for an individual's self-esteem and interpersonal relationships, while perceptions of morality and humanness can impact an individual's ability to fulfil their psychological needs. As such, we concluded that attractive women seeking plastic surgery are potentially subject to experience negative psychosocial outcomes. Future research ought to examine whether perceptions and outcomes differ for women seeking reconstructive plastic surgery (versus cosmetic plastic surgery) and whether they differ across different types of surgeries (i.e. face versus body).
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257145PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423238PMC
November 2021

Validation of the factor structure of the Eating Pathology Symptoms Inventory in an international sample of sexual minority men.

Eat Behav 2021 08 26;42:101511. Epub 2021 Apr 26.

University of Melbourne, Department of Psychology, Parkville, VIC 3010, Australia.

Sexual minority individuals are at greater risk for the development of eating-disorder (ED) psychopathology. Despite the importance of understanding ED symptoms in sexual minority men, most ED measures were developed and validated in heterosexual, young adult, white women. The psychometric properties of ED measures in diverse populations remain largely unknown. The purpose of this study was to test: 1) whether the eight-factor structure of the Eating Pathology Symptoms Inventory (EPSI) replicated in sexual minority men and 2) group-level mean differences between gay and bisexual men on the eight EPSI scales. International participants (N = 722 sexual minority men from 20 countries) were recruited via the Grindr smartphone application. Confirmatory factor analysis (CFA) was completed using a weighted least square mean and variance adjusted estimator. Group differences in eating pathology between gay and bisexual men were tested using independent samples t-tests. The CFA model fit was good on all fit indices (CFI/TLI > 0.90, RMSEA < 0.06). Gay and bisexual men only differed on the EPSI Binge Eating scale. The results of this investigation suggest that the EPSI may be a useful tool for understanding eating pathology in this population. Using psychometrically sound assessment tools for sexual minority men is a vital piece of treatment planning and clinical decision making. The current study fills an important gap in the clinical and research literature by testing the validity and psychometric properties of a commonly used ED measure in sexual minority men.
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http://dx.doi.org/10.1016/j.eatbeh.2021.101511DOI Listing
August 2021

The cosmetic surgery paradox: Toward a contemporary understanding of cosmetic surgery popularisation and attitudes.

Body Image 2021 Sep 4;38:230-240. Epub 2021 May 4.

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.

Modern women feel compelled to meet near-impossible standards of beauty. For many, this pursuit ultimately culminates in cosmetic surgery - a radical form of beautification that is rapidly becoming popular worldwide. Paradoxically, while prevalent, artificial beauty remains widely unaccepted in contemporary society. This narrative review synthesizes feminist dialogue, recent research, and real-world case studies to argue that female beauty standards account for both the growing popularity of cosmetic surgery and its lack of mainstream acceptance. First, we implicate unrealistic beauty standards and the medicalization of appearance in popularizing cosmetic surgery. Second, we analyze how negative attitudes toward cosmetic surgery are also motivated by unrealistic beauty standards. Finally, we generate a synthesized model of the processes outlined in this review and provide testable predictions for future studies based on this model. Our review is the first to integrate theoretical and empirical evidence into a cohesive narrative that explains the cosmetic surgery paradox; that is, how cosmetic surgery remains secretive, stigmatized, and moralized despite its surging popularity.
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http://dx.doi.org/10.1016/j.bodyim.2021.04.010DOI Listing
September 2021

Beach body ready? Shredding for summer? A first look at "seasonal body image".

Body Image 2021 Jun 20;37:269-281. Epub 2021 Mar 20.

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.

We introduce the term "seasonal body image" to refer to within-person variation in body image that occurs across the Gregorian seasons of Spring, Summer, Autumn, and Winter. Herein, we (i) quantified and visualised seasonal body image and its mechanisms, and (ii) identified individual predictors of seasonal body image. Sexual minority men (N = 823) residing in the Northern Hemisphere (n = 659) and Southern Hemisphere (n = 164) provided cross-sectional data about their experiences of body image phenomena in Spring, Summer, Autumn, and Winter. Most reported seasonal body image (∼70 %). As hypothesised, in Summer we observed peaks for body dissatisfaction alongside peaks in four proposed seasonal body image mechanisms: pressure from media advertisements, pressure from peers on social media, the feeling that one's body is on public display, and appearance comparisons. In Winter, these phenomena were weakest. Effect sizes ranged from small to large (rs = .07-.50) with an average effect size of medium (.38). Seasonal body image was stronger for individuals with greater muscularity dissatisfaction and body fat dissatisfaction, and for higher body-weight and younger individuals. Future research will visualise seasonal body image using a multi-country Twitter database containing several billion tweets spanning multiple calendar years.
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http://dx.doi.org/10.1016/j.bodyim.2021.03.004DOI Listing
June 2021

Prevalence of muscle dysmorphia in adolescents: findings from the study.

Psychol Med 2021 Mar 16:1-8. Epub 2021 Mar 16.

Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA, USA.

Background: We sought to provide the first point prevalence estimates of muscle dysmorphia (MD), a form of body dysmorphic disorder characterized by a preoccupation with perceived insufficient muscularity, in adolescents.

Methods: Data were taken from a survey of 3618 Australian adolescents (11.172-19.76 years; 49.3% girls). Measures captured demographic characteristics, symptoms of MD and eating disorders, psychological distress and functional impairment. Diagnostic criteria for MD developed by Pope et al. (1997, Psychosomatics, 38(6), 548-557) were applied, entailing preoccupation with insufficient muscularity causing significant levels of distress or disability that cannot be better accounted for by an eating disorder.

Results: The point prevalence of MD was 2.2% [95% confidence interval (CI) 1.6-3.0%] among boys and 1.4% (95% CI 0.9-2.0%) among girls. Prevalence was not associated with gender (V = 0.031) or socioeconomic status (SES) (partial η2< 0.001), but was marginally associated with older age (partial η2 = 0.001). Boys with MD were more likely than girls with MD to report severe preoccupation with muscularity (V = 0.259) and a weight-lifting regime that interfered with their life (V = 0.286), whereas girls with MD were more likely to report discomfort with body exposure (V = 0.380).

Conclusions: While future epidemiological research using diagnostic interviews is needed to verify these estimates, the findings suggest that MD is relatively common from early to late adolescence. Gender differences in MD prevalence may be minimal; however, the symptom profile appears to diverge between boys and girls. These findings provide a platform for future, analytical research designed to inform clinical and public health interventions.
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http://dx.doi.org/10.1017/S0033291720005206DOI Listing
March 2021

Inconsistencies in the conceptualisation and operationalisation of internalized weight stigma: A potential way forward.

Body Image 2021 03 23;36:iii-v. Epub 2020 Dec 23.

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.

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http://dx.doi.org/10.1016/j.bodyim.2020.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500548PMC
March 2021

A test of the tripartite influence model of disordered eating among men.

Body Image 2021 Mar 8;36:172-179. Epub 2020 Dec 8.

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia.

Studies of the Tripartite Influence Model conducted with female samples suggest that thinness-oriented pressures, internalization, and appearance comparisons may be risk factors for disordered eating. However, limited work has investigated this model among men utilizing measures specifically designed to assess both muscularity- and thinness-oriented processes, which characterize male body image concerns. To address this gap, the current study examined the Tripartite Influence Model of disordered eating among men using a battery of such measures. A convenience sample of 265 male undergraduates completed validated, self-report measures of disordered eating, muscularity- and thinness-oriented appearance pressures, internalization, and appearance comparisons. Path analyses supported a slightly modified version of the Tripartite Influence Model, indicating direct and indirect paths from sociocultural pressures to disordered eating via internalization and appearance comparisons. These results provide support for a version of the Tripartite Influence Model among men. Specifically, muscularity- and thinness-oriented pressures appear to be related to disordered eating among college men via indirect pathways involving thin internalization, muscular internalization, and appearance comparisons. Future work is needed, however, to examine whether the model would generalize to muscularity-oriented disordered eating.
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http://dx.doi.org/10.1016/j.bodyim.2020.11.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987734PMC
March 2021

The effects of fitspiration images on body attributes, mood and eating behaviors: An experimental Ecological Momentary Assessment study in females.

Body Image 2020 Dec 6;35:279-287. Epub 2020 Nov 6.

Melbourne School of Psychological Sciences, The University of Melbourne, Redmond Barry Building, Melbourne, VIC, 3010, Australia; Evolution and Ecology Research Centre, School of Biological, Earth and Environment Sciences, UNSW Sydney, Sydney, NSW, 2052, Australia. Electronic address:

Through an experimental Ecological Momentary Assessment (EMA) design, we assessed the effects of fitspiration images (relative to neutral) on body image, mood and disordered eating and whether trait body dissatisfaction, thin-ideal internalization and pressures from the media, family and peers moderated these effects. After completing trait-based measures, 85 women were prompted via a mobile application 6 times daily for 7 days to view an image (fitspiration or neutral) and report on state levels of perceived pressures to attain an idealized physique, satisfaction with various body attributes, mood and eating behavior. When participants were exposed to fitspiration images, their perceived pressure to attain an idealized physique was significantly higher than after exposure to the control images. This effect was most pronounced for women experiencing pressure from the media. Furthermore, fitspiration images lowered the extent to which women felt that idealized physiques were attainable, and decreased satisfaction with current fitness. There were no significant effects on mood and disordered eating. Exposure to fitspiration content predicted only a few adverse outcomes in terms of negative body attributes and perceived pressures to attain a similar physique, suggesting that its content is not as detrimental as initially believed, but further research is needed.
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http://dx.doi.org/10.1016/j.bodyim.2020.09.011DOI Listing
December 2020

Associations between weight/shape overvaluation, sociodemographic features and BMI: 10-year time trends.

Eat Weight Disord 2021 Aug 23;26(6):2001-2009. Epub 2020 Oct 23.

Translational Health Research Institute, School of Medicine, Western Sydney University, New South Wales, Australia.

Purpose: To investigate the prevalence of overvaluation across sociodemographic features and weight status over time.

Methods: The data included sequential cross-sectional surveys with representative samples of the adolescent and adult (15 years or older) population in South Australia. Five surveys that assessed overvaluation were conducted in the years 2005 (n = 3047), 2008 (n = 3034), 2009 (n = 3007), 2015 (n = 3005) and 2016 (n = 3047). Overvaluation was assessed by structured interview based on the Eating Disorder Examination. To examine unique effects of demographic variables on the likelihood to report overvaluation, and also to examine whether this varied as a function of time, a multivariate binary logistic regression was computed.

Results: Across survey years, participants who were more likely to endorse overvaluation were female (2005: OR 2.85, CI 2.04-3.99; 2008/9: OR 1.74, CI 1.50-2.01; 2015/6: OR 1.54, CI 1.34-1.76), had a BMI > 30 (2005: OR 3.93, CI 1.49-10.34; 2008/9: OR 2.22, CI 1.31-3.78; 2015/6: OR 2.09, CI 1.19-3.67), had left school (2015/6: OR 1.36, CI 1.14-1.63), and lived in the country (2015/6: OR 1.95, CI 1.69-2.24). Being in the oldest age group was protective against endorsing overvaluation in each survey year. There was also a main effect of survey year, with participants in the 2015/6 survey more likely to endorse overvaluation (p < 0.001).

Conclusions: Female, young and obese people were more likely to endorse overvaluation; however, the prevalence of overvaluation increased significantly in all sociodemographic and BMI groups in since 2005-2016.

Evidence-based Medicine: Level IV, evidence obtained from multiple time series with or without the intervention, such as case studies.
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http://dx.doi.org/10.1007/s40519-020-01046-8DOI Listing
August 2021

Body Positivity (#BoPo) in everyday life: An ecological momentary assessment study showing potential benefits to individuals' body image and emotional wellbeing.

Body Image 2020 Dec 14;35:181-191. Epub 2020 Oct 14.

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia. Electronic address:

Experimental studies of Body Positivity (BoPo), referring to social media content that challenges status-quo beauty ideals by portraying and promoting diverse physical appearances, are suggestive of mental health benefits. To date, no research has examined BoPo using naturalistic study designs that maximise ecological validity. Undergraduate students (N = 113, 83.2 % female, 26.6 % White) completed a 1-week, smartphone-facilitated ecological momentary assessment protocol containing self-report measures of state body satisfaction, state affective functioning, and BoPo exposure. Students also reported the social media platforms where their BoPo exposures occurred. Our main finding was that students exposed to BoPo subsequently reported higher levels of body satisfaction (Cohen's d = 0.05, small) and positive affect (d = 0.06, small), together with lower negative affect (d = -0.03, small). Instagram accounted for half of all BoPo exposures (46.1 %), followed by Facebook (17.4 %), Youtube (8.9 %), and Snapchat (8.9 %). Conclusions were three-fold: (i) viewing BoPo may lead people to experience higher body satisfaction and improved emotional wellbeing, (ii) Instagram is a particularly important social media platform for BoPo exposures, and (iii) encouraging social media users to follow BoPo social media accounts may be a useful way to protect and enhance users' body image and emotional wellbeing, pending further research.
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http://dx.doi.org/10.1016/j.bodyim.2020.09.003DOI Listing
December 2020

The differential impact of viewing fitspiration and thinspiration images on men's body image concerns: An experimental ecological momentary assessment study.

Body Image 2020 Dec 22;35:96-107. Epub 2020 Sep 22.

Melbourne School of Psychological Sciences, The University of Melbourne, Redmond Barry Building, Melbourne, VIC, 3010, Australia. Electronic address:

To date, little is known about the impact of fitspiration and thinspiration exposure on men, as previous studies on these social media trends were primarily conducted on women. Male participants (n = 223) completed baseline measures of trait body image, then used a smartphone application to complete up to six state-based assessments daily for seven days. In each assessment, participants were randomly assigned to one of three image conditions (fitspiration, thinspiration, or neutral). Before and after viewing each image, they reported state body fat dissatisfaction, muscularity dissatisfaction, negative mood, and urge to engage in behaviours to reduce body fat and increase muscularity. Multi-level analyses revealed that compared to viewing neutral images, viewing fitspiration images increased men's body dissatisfaction, whereas viewing thinspiration images decreased body dissatisfaction. Viewing either fit- or thinspiration images also led to lower mood and greater urges to increase muscularity, whereas only fitspiration images increased urges to reduce body fat. Men with greater baseline muscularity dissatisfaction and higher appearance comparison were most vulnerable to muscularity dissatisfaction after viewing fitspiration images. Findings suggest the importance of limiting exposure to fitspiration imagery and implementing social media literacy programmes for men and well as women.
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http://dx.doi.org/10.1016/j.bodyim.2020.08.008DOI Listing
December 2020

Differences between Australian adolescents with eating disorder symptoms who are in treatment or not in treatment for an eating disorder.

Early Interv Psychiatry 2021 08 2;15(4):882-888. Epub 2020 Sep 2.

Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.

Background: Mental health problems frequently occur during adolescence, however, few adolescents seek treatment for these problems, especially for eating disorders. The current study aimed to quantify how adolescents in a clinical sample (ie, those receiving treatment for an eating disorder), differ in terms of psychological factors (eating disorder symptoms and psychological distress), compared to adolescents with eating pathology in a community sample (ie, those not receiving treatment).

Method: Data were used from a community sample of adolescents with eating disorder pathology who have not sought treatment (n = 1011) and a clinical sample of adolescents presenting at eating disorder services for treatment (n = 153). Participants reported demographics and completed questionnaires assessing weight/shape concerns, disordered eating and psychological distress.

Results: Adolescents with a lower BMI, more frequent purging and higher weight/shape concerns were more common in the clinical sample, while those engaging in more frequent driven exercise were less common in the clinical sample. The samples did not differ in severity of psychological distress.

Conclusions: The findings highlight the need for increasing mental health literacy about the role of BMI and driven exercise in eating disorder symptom presentation to increase early detection of these disorders among adolescents.
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http://dx.doi.org/10.1111/eip.13027DOI Listing
August 2021

Differences in weight stigma between gay, bisexual, and heterosexual men.

Body Image 2020 Dec 20;35:30-40. Epub 2020 Aug 20.

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.

Gay and bisexual men may experience more weight stigma than heterosexual men; however, research is limited. We examined differences in experienced weight discrimination, weight bias, and internalized weight bias in two studies: the first comprising gay (n = 351), bisexual (n = 357), and heterosexual (n = 408) men, and the second comprising gay (n = 614) and bisexual (n = 123) men. In Study 1, bisexual men reported experiencing more weight discrimination than gay (r = .07) and heterosexual (r = .08) men. Bisexual (Glass' Δ = 0.41) and gay (Δ = 0.37) men reported greater internalized weight bias than heterosexual men. Heterosexual men reported more weight bias than gay (Cohen's d = 0.35) and bisexual (d = 0.46) men. In Study 2, gay men reported more internalized weight bias than bisexual men (d = 0.26). Sexual orientation did not moderate the relationships of weight stigma with either body dissatisfaction or psychological quality of life. Among gay and bisexual men, experiencing weight discrimination predicted diminished psychological quality of life through internalized weight bias and body dissatisfaction. Our research emphasizes the importance of assessing weight stigma among sexual minorities and suggests bisexual men might be particularly vulnerable to weight stigma.
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http://dx.doi.org/10.1016/j.bodyim.2020.08.002DOI Listing
December 2020

Prevalence and correlates of muscle-enhancing behaviors among adolescents and young adults in the United States.

Int J Adolesc Med Health 2020 Jun 5. Epub 2020 Jun 5.

Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA.

Objectives To determine the prevalence of muscle-enhancing behaviors in adolescents and young adults using a nationally representative sample in the USA and to examine differences by sex, race/ethnicity, age, socioeconomic status, body mass index, and participation in team sports. Methods Prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves I through III (1994-2002) were analyzed. Engagement in muscle-enhancing behaviors including dietary changes, exercise and weightlifting, supplement use, performance-enhancing substances, and anabolic androgenic steroids were recorded. Multiple logistic regression models using generalized estimating equations, incorporating robust standard errors with clustering by school and within persons, and using national sample weighting, were used to determine associations with muscle-enhancing behaviors across three data collection waves. Results Of the 18,924 adolescents at baseline, 29.2% of males and 7.0% of females reported weight gain attempts, while 25.2% of males and 3.8% of females reported any muscle-enhancing behavior. All muscle-enhancing behaviors were more common in males compared to females (p<0.001). Among young men 18-26 years old, 15.6% reported using legal performance enhancing substances and 2.7% reported using androgenic anabolic steroids. Factors that were associated with muscle-enhancing behaviors in males across three data collection waves included Black or Hispanic/Latino race/ethnicity, age over 14 years, higher parental education, lower body mass index, and participation in team sports. Conclusions Muscle-enhancing behaviors ranging from dietary changes to supplement and androgenic anabolic steroid use are common among adolescent and young adult males. Clinicians should consider screening for muscle-enhancing behaviors in these populations.
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http://dx.doi.org/10.1515/ijamh-2020-0001DOI Listing
June 2020

Seeing yourself clearly: Self-identification of a body image problem in adolescents with an eating disorder.

Early Interv Psychiatry 2021 06 19;15(3):577-584. Epub 2020 May 19.

Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.

Aim: Many adolescents who meet diagnostic criteria for an eating disorder do not self-identify as having a problem and may consequently be less likely to seek help. Extant research investigating self-identification has been limited to specific populations (ie, girls meeting criteria for bulimic-type eating disorders). This study investigated how self-identification varied across sex, eating disorder diagnoses, and the presence of extreme eating behaviours, and how self-identification was related to help-seeking in adolescents.

Methods: Participants included 1002 Australian school students (75.5% female, M = 15.14 years, SD = 1.40) who met DSM-5 diagnostic criteria for an eating disorder. An online survey assessed self-identification of having a body image problem, as well as sex, eating disorder diagnosis, extreme eating behaviours, help-seeking for a body image problem, and other potential correlates of self-identification (demographics, psychological distress, social function, weight and shape concerns).

Results: Approximately, 2 in 3 adolescents with an eating disorder self-identified as having a body image problem. Girls who met criteria for a major eating disorder diagnosis, and those engaging in extreme eating behaviours, were more likely to self-identify. When adjusting for covariates, only sex remained significantly associated with self-identification. Adolescents who self-identified were 2.71 times more likely to seek help for a body image problem, adjusting for covariates.

Conclusions: Public health strategies ought to promote awareness regarding the different ways that body image problems might manifest among both girls and boys, as well as the potential gravity of such problems. Awareness among parents, teachers and primary care providers should also be considered.
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http://dx.doi.org/10.1111/eip.12987DOI Listing
June 2021

An investigation of distress tolerance and difficulties in emotion regulation in the drive for muscularity among women.

Body Image 2020 Jun 11;33:207-213. Epub 2020 May 11.

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.

Despite the negative emotional experiences that often accompany the pursuit of an idealized appearance, we know little about emotion regulation in the context of female drive for muscularity. To address this knowledge gap, we examined whether distress tolerance and difficulties in emotion regulation were significantly associated with the drive for toned muscularity among women. In this study, 221 Australian university women completed an online survey assessing drive for muscularity, distress tolerance, and emotion regulation difficulties. Results revealed that low distress tolerance and emotion regulation difficulties were positively associated with drive for muscularity attitudes and behaviors, after controlling for body mass index and general negative affect. Our findings suggest that women with a range of distress tolerance and emotion regulation difficulties, particularly the urgent need to regulate, and non-acceptance of, distress may experience a higher drive for muscularity. This study provides preliminary evidence that specific aspects of distress tolerance and poor emotion regulation may be promising targets in prevention and treatment interventions aimed to address the excessive drive for muscularity among women.
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http://dx.doi.org/10.1016/j.bodyim.2020.03.004DOI Listing
June 2020

Protect me from my selfie: Examining the association between photo-based social media behaviors and self-reported eating disorders in adolescence.

Int J Eat Disord 2020 05 7;53(5):485-496. Epub 2020 Apr 7.

Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.

Objective: This study examined whether social media behaviors were associated with higher odds of meeting criteria for an eating disorder and whether gender moderated these relationships.

Method: Australian adolescents (N = 4,209; 53.15% girls) completed the self-report photo investment and manipulation scales. Additional self-report items assessed avoidance of posting selfies and investment in others' selfies. Eating disorders were identified by the Eating Disorder Examination Questionnaire and other self-report measures aligned with diagnostic and statistical manual for mental disorders-5 criteria.

Results: A multinomial logistic regression examining the effect of avoidance of posting selfies, photo investment, photo manipulation, and investment in others' selfies on the likelihood of meeting criteria for an eating disorder, compared to no disorder, was significant (χ [42] = 1,128.93, p < .001). Greater avoidance was associated with higher odds of meeting criteria for all disorders except clinical/subclinical binge-eating disorder and purging disorder. Increased photo investment was related to greater odds of meeting criteria for all disorders. A similar relationship emerged for photo manipulation, with the exception of clinical/subclinical binge-eating disorder, and unspecified feeding and eating disorder. Investment in others' selfies was associated with higher odds of meeting criteria for all disorders except clinical/subclinical anorexia nervosa and purging disorder. There was a significant interaction between gender and avoidance (χ [1] = 5.23, p = .025, OR = 1.74), whereby boys were more likely to meet criteria for clinical/subclinical anorexia nervosa in the context of greater avoidance of posting selfies.

Discussion: Appearance-related social media behaviors may be indicative of eating disorder risk. Implications for clinicians and advancements for social media screening tools are discussed.
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http://dx.doi.org/10.1002/eat.23256DOI Listing
May 2020

Further development of the 12-item EDE-QS: identifying a cut-off for screening purposes.

BMC Psychiatry 2020 04 3;20(1):146. Epub 2020 Apr 3.

School of Medicine, Western Sydney University, Sydney, Australia.

Background: The Eating Disorder Examination - Questionnaire Short (EDE-QS) was developed as a 12-item version of the Eating Disorder Examination Questionnaire (EDE-Q) with a 4-point response scale that assesses eating disorder (ED) symptoms over the preceding 7 days. It has demonstrated good psychometric properties at initial testing. The purpose of this brief report is to determine a threshold score that could be used in screening for probable ED cases in community settings.

Methods: Data collected from Gideon et al. (2016) were re-analyzed. In their study, 559 participants (80.86% female; 9.66% self-reported ED diagnosis) completed the EDE-Q, EDE-QS, SCOFF, and Clinical Impairment Assessment (CIA). Discriminatory power was compared between ED instruments using receiver operating characteristic (ROC) curve analyses.

Results: A score of 15 emerged as the threshold that ensured the best trade-off between sensitivity (.83) and specificity (.85), and good positive predictive value (.37) for the EDE-QS, with discriminatory power comparable to other ED instruments.

Conclusion: The EDE-QS appears to be an instrument with good discriminatory power that could be used for ED screening purposes.
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http://dx.doi.org/10.1186/s12888-020-02565-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118929PMC
April 2020

Eating disorders "mental health literacy": a scoping review.

J Ment Health 2020 Jun 10;29(3):336-349. Epub 2020 Feb 10.

Department of Psychology, Macquarie University, Sydney, Australia.

While it is apparent that much has been learned about "mental health literacy" (MHL) relating to certain mental health problems, such as depression, in recent years, what has been learned about MHL relating to eating disorders (ED-MHL) is unclear. A scoping review was conducted to inform the current state of knowledge in this field. A systematic search of relevant literature published between 1997 and 2017 was followed by a narrative synthesis of the findings. The number of eligible studies increased from 32 in 1997-2001 to 98 in 2012-2017 (total = 264). Most studies originated from North America or Europe, recruited individuals with EDs receiving treatment or college students and included both female and male or only female participants. The majority of studies examined MHL relating to anorexia nervosa or bulimia nervosa and examined attitudes which facilitate recognition and appropriate help-seeking and knowledge and beliefs about professional help available. Interest in ED-MHL is increasing and there is now a considerable body of research addressing some aspects of ED-MHL in a range of study populations. Notable gaps in the literature exist, including a paucity of information about ED-MHL relating to EDs other than anorexia nervosa and bulimia nervosa, ED behaviour in males and the use of self-help interventions. We hope the findings will provide an incentive to further research in these and other aspects of ED-MHL.
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http://dx.doi.org/10.1080/09638237.2020.1713996DOI Listing
June 2020

Study protocol for Goodform - a classroom-based intervention to enhance body image and prevent doping and supplement use in adolescent boys.

BMC Public Health 2020 Jan 14;20(1):59. Epub 2020 Jan 14.

College of Arts and Education, Victoria University, Footscray Park, Footscray, Australia.

Background: Very few programs aimed at improving body image among adolescent boys have been effective, and there is still no clear evidence as to what will work for universal prevention of eating disorders and body dissatisfaction with this group. We combined two previously efficacious programs and used a design thinking framework to optimise program content alongside potential end-users including adolescent boys, teachers, parents, and experts. Goodform is a four-session universal program that aims to reduce body dissatisfaction and prevent the use of muscle-building supplements among 14-to-16 year old adolescent boys.

Methods/design: Goodform will be trialled using a cluster randomised controlled trial (RCT) conducted in Australian schools, with Year 9 boys as participants. The intervention is teacher-delivered. Data will be collected at three time points: baseline, post-intervention, and follow-up (2 months). Three primary outcome constructs will be examined, including body dissatisfaction (Male Body Attitudes Scale-Revised) and attitudes towards appearance and performance enhancing substances (APES; Outcome Expectations for Steroid and Supplement Use, Intentions to use APES) and actual use of APES at each time point. Three secondary outcome constructs will be examined, which are social norms for APES (adapted Peer Norms Scale), negative body talk (Male Body Talk Scale), and internalisation of and pressure to attain appearance ideals (Sociocultural Attitudes Towards Appearance Questionnaire-4 Revised). Internalisation of appearance ideals will also be examined as a mediator of change in primary outcomes. Teachers will provide data on adherence to lessons, student engagement/enjoyment, and understanding of the content.

Discussion: The GoodForm RCT will trial a novel, generalizable, and extensively developed program intended to improve boys' body image and reduce actual and intended APES use. We anticipate that it will provide a novel contribution to the field of boys' body dissatisfaction prevention.

Trial Registration: This trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry on May 14th 2019, registration number ACTRN12619000725167.
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http://dx.doi.org/10.1186/s12889-020-8166-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961244PMC
January 2020

Community norms for the Eating Disorder Examination Questionnaire among cisgender gay men.

Eur Eat Disord Rev 2020 01 2;28(1):92-101. Epub 2019 Dec 2.

The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.

Objective: Prior norms of the Eating Disorders Examination Questionnaire (EDE-Q) among men have not considered sexual orientation. This study's objective was to assess EDE-Q community norms among cisgender gay men.

Method: Participants were 978 self-identified cisgender gay men from The PRIDE Study recruited in 2018.

Results: We present mean scores and standard deviations for the EDE-Q among cisgender gay men ages 18-82. Among cisgender gay men, 4.0% scored in the clinically significant range on the global score, 5.7% on the restraint, 2.1% on the eating concern, 10.5% on the weight concern, and 21.4% on the shape concern subscales of the EDE-Q. The global score as well as weight and shape concerns in a young adult subsample (18-26 years) from The PRIDE Study were higher than previously reported norms in young men (Lavender, 2010). Participants reported any occurrence (≥1/28 days) of dietary restraint (19.8%), objective binge episodes (10.9%), excessive exercise (10.1%), laxative misuse (1.1%), and self-induced vomiting (0.6%). Binge eating, excessive exercise, and self-induced vomiting in The PRIDE Study subsample were lower than previously reported in young men.

Discussion: We provide EDE-Q norms among cisgender gay men, which should aid clinicians and researchers to interpret the EDE-Q scores of cisgender gay men.
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http://dx.doi.org/10.1002/erv.2708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275693PMC
January 2020

Athleisure: A qualitative investigation of a multi-billion-dollar clothing trend.

Body Image 2020 Mar 19;32:5-13. Epub 2019 Nov 19.

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, AU.

Clothes play a ubiquitous, yet under-appreciated social role. In the context of body image, clothes may both reflect and facilitate wearers' ideals and anxieties about their physical appearance. Athleisure, referring to athletic-inspired workout apparel that explicitly accentuates wearers' physiques, is a hitherto unexamined clothing trend worth tens of billions of dollars annually (and growing) in the United States consumer market alone. We conducted the first qualitative examination of athleisure by interviewing 20 women who regularly wore athleisure. Four master themes emerged from the data: (1) the athleisure lifestyle, (2) the conditional nature of athleisure, (3) athleisure embodiment, and (4) athleisure-linked cognitive dissonance. Our results suggest that wearing athleisure communicates to others an adherence to the lifestyles depicted in fitspiration - a class of social media imagery that glorifies thin-fit bodies. Participants articulated that athleisure encouraged them to feel more confident and athletic; athleisure also emphasized the women's physiques, and whether they aligned with the thin-fit ideal. Thus, the act of wearing athleisure motivated participants to engage in fitspiration-based activities. Given the (a) massive public demand for athleisure, and (b) industry projections for continued growth in athleisure spending, our findings compel additional research on the connections between clothing and body image.
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http://dx.doi.org/10.1016/j.bodyim.2019.10.009DOI Listing
March 2020

Registration, reporting, and replication in clinical trials: The case of anorexia nervosa.

Int J Eat Disord 2020 01 22;53(1):138-142. Epub 2019 Oct 22.

Department of Pediatrics, University of California, San Francisco, San Francisco, California.

Objective: Treatment outcomes for anorexia nervosa (AN) remain modest, and recent research suggests that clinical trials may be of limited methodological quality. With increasing evidence illustrating the irreproducibility of psychological research, no research to date has systematically examined the cumulative effect of bias in research relating to the treatment of AN.

Method: We identified all AN trials listed on ClinicalTrials.gov between 2000 and 2018 and examined rates of (a) the noncompletion of clinical trials, the (b) nonpublication of trials once listed as completed, (c) the nonprospective registration of clinical trials, and (d) the nonreplication of findings.

Results: We note that of 201 trials listed on ClinicalTrials.gov, only 101 have been completed, and of those, only 41 have been published. Moreover, of these 41 published trials, only eight demonstrated evidence of prospective trial registration, and only seven have had their primary findings replicated in other studies.

Discussion: These results illustrate the profound cumulative effect of methodological bias in registered trials for AN, which may have a significant impact both on what appears in the current evidence base, and on the reproducibility of studies comprising this evidence base.
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http://dx.doi.org/10.1002/eat.23187DOI Listing
January 2020

Negative psychological correlates of the pursuit of muscularity among women.

Int J Eat Disord 2019 11 14;52(11):1326-1331. Epub 2019 Oct 14.

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.

Objective: There is increasing public and scientific focus on women's pursuit of a muscular and toned appearance. However, the psychological correlates of women's drive for muscularity are currently unclear. Therefore, we examined the associations of drive for muscularity with four important negative psychological indices among women: eating disorder (ED) symptoms, and symptoms of depression, anxiety, and stress.

Method: A sample of 221 university women completed an online survey that included measures assessing the aforementioned constructs.

Results: Drive for muscularity evidenced positive associations with all negative psychological indices, except for anxiety. Muscularity-oriented attitudes, as opposed to behaviors, demonstrated the strongest associations with ED and depression symptoms.

Discussion: Our findings make a novel contribution to the scant literature by demonstrating that women who endorse attitudes and/or behaviors geared toward attaining the female muscular ideal may be susceptible to experiencing ED symptoms and negative emotional states. This study provides preliminary evidence that muscularity-oriented attitudes, in particular, may be a promising target for the treatment of EDs and negative emotional states in women with a preoccupation toward muscularity.
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http://dx.doi.org/10.1002/eat.23178DOI Listing
November 2019

Introduction to a special issue on eating disorders and related symptomatology in male populations.

Int J Eat Disord 2019 12 14;52(12):1339-1342. Epub 2019 Oct 14.

Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Objective: It is our sincere pleasure to introduce a special issue of the International Journal of Eating Disorders focused on eating disorders and related symptoms in male populations.

Method: Contributions focused on three main themes among male populations: (a) the nature of eating disorder symptoms and recovery; (b) long-term outcomes following eating disorders treatment; and (c) muscularity-oriented symptoms of eating pathology.

Results: The contributions to this special issue highlight the importance of better understanding how eating disorder symptoms manifest, may be maintained, and respond to treatment among male populations. Findings across the articles demonstrate some similarities between male and female samples with respect to core eating disorder symptoms, as well as important differences, particularly with respect to muscularity-oriented disordered eating. Findings related to treatment outcome also highlight the suboptimal long-term remission rates and elevated mortality among male inpatients with eating disorders.

Discussion: The diverse range of samples, methodologies, and research questions addressed within this collection of papers demonstrates the breadth of the important scientific work on this topic. As eating disorders and related symptoms in male populations continue to be underrecognized and underserved, we hope that this special issue will encourage further high-quality clinical research in this area.
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http://dx.doi.org/10.1002/eat.23184DOI Listing
December 2019

Does masculinity moderate the relationship of height with height dissatisfaction? Findings from an Internet forum for short statured men.

Body Image 2019 Dec 27;31:112-119. Epub 2019 Sep 27.

Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia.

Research suggests that height is fundamental to Western conceptualisations of masculinity. However, researchers are yet to examine whether individual differences in conformity to Western masculine norms can help to explain why men experience height dissatisfaction. Thus, we investigated conformity to Western masculine norms as a moderator of the relationship between men's height and height dissatisfaction. Men experiencing height dissatisfaction (N = 249) were recruited from an Internet forum that functions as a discussion space for short-statured individuals. Results indicated that shorter men and more masculine men reported greater height dissatisfaction. As hypothesised, we observed a significant interaction between height and masculinity, such that the strength of the relationship of short stature with height dissatisfaction was stronger for more masculine men. Crucially, results from a Johnson-Neyman analysis indicated that it was only for men extremely low in their endorsement of masculine norms (i.e., the 2 percentile or lower) that the relationship of height with height dissatisfaction was nonsignificant, suggesting that, in the near-absence of masculine norm conformity, height no longer contributes to male body dissatisfaction. Whilst acknowledging that our findings require further exploration, we propose that conformity to masculine norms may be an influential factor in males' experience of height dissatisfaction.
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http://dx.doi.org/10.1016/j.bodyim.2019.09.002DOI Listing
December 2019

Help-seeking for body image problems among adolescents with eating disorders: findings from the EveryBODY study.

Eat Weight Disord 2020 Oct 2;25(5):1267-1275. Epub 2019 Aug 2.

Department of Psychology, Centre for Emotional Health, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW, 2109, Australia.

Purpose: Little is known regarding correlates of help-seeking for a body image problem in adolescents with an eating disorder. This study provides the first population-based investigation of help-seeking correlates among adolescents with an eating disorder.

Methods: Australian adolescents (N = 1002, 75.5% female, mean age = 15.14, SD = 1.40) who met operational diagnostic criteria for an eating disorder completed a survey assessing help-seeking, and potential correlates of help-seeking (sex, age, body mass index, socio-economic status, migrant status, sexuality, eating disorder diagnosis, psychological distress, and quality of life).

Results: Only 10.1% of participants reported having sought help. Bivariate analyses revealed that increased likelihood of help-seeking was associated with female sex, sexual minority status, being born outside Australia, older age, having a major eating disorder (compared to having an unspecified or other specified feeding or other eating disorder diagnosis), higher psychological distress, and reduced psychological and social functioning. Older age, being born outside of Australia, and having a major eating disorder were significant independent correlates of help-seeking.

Conclusions: Very few adolescents with an eating disorder seek help for a body image problem. Promoting early, appropriate help-seeking among those who are younger and/or those with less well-known disorders may be particularly important.

Level Of Evidence: Level III, case-control analytic study.
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http://dx.doi.org/10.1007/s40519-019-00759-9DOI Listing
October 2020

Thinspiration and fitspiration in everyday life: An experience sampling study.

Body Image 2019 Sep 9;30:135-144. Epub 2019 Jul 9.

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.

We used experience sampling to examine thinspiration and fitspiration in the everyday lives of women and men. Undergraduates (N = 108, 21% men) completed a 1-week smartphone-facilitated experience sampling protocol containing self-report measures of thinspiration and fitspiration exposure, body satisfaction, and affective functioning. Multi-level, gender-adjusted models examined the unique and interactive associations of exposure to thinspiration and fitspiration. Women reported a weekly average of 8.4 thinspiration exposures and 9.5 fitspiration exposures, while men reported 2.3 and 4.9 exposures, respectively. The median self-reported duration of each exposure was 2-3 min, with no difference in exposure duration between thinspiration and fitspiration. Unique thinspiration exposure was associated with lower body satisfaction, lower positive affect, and higher negative affect (Cohen's ds = |0.07-0.09|, small). Unique fitspiration exposure was associated with lower body satisfaction and positive affect (ds = |0.03-0.04|, small), but not negative affect. The pattern of associations for interactive exposure (i.e., exposure to both thinspiration and fitspiration) was near-identical to the pattern for unique thinspiration exposure (ds = |0.06-0.08|). We conclude that women and men exposed to thinspiration and fitspiration in their everyday lives may subsequently experience lower body satisfaction and poorer affective functioning.
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http://dx.doi.org/10.1016/j.bodyim.2019.07.002DOI Listing
September 2019
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