Teenagers and Body Image (page 3)

By — NYU Child Study Center
Updated on May 1, 2014

Vulnerability of Boys: The Case of Muscle Dysmorphia

What about adolescent males? While boys do not appear to suffer from body dissatisfaction with quite the same frequency as girls, they are more at risk than was previously realized. Boys are also subject to the media representation of the "ideal" male body - in this case taut and bulging with muscles. The development of males' body image is affected by action toys and an onslaught of images in the media glamorizing the muscular, fit body. A recent study found that Playgirl centerfolds have become more muscular over the magazine's 25 year history,9 reflecting our cultural preoccupation with an ever more muscular male physique. Boys and men with extreme body dissatisfaction are at risk to develop a form of body dysmorphic disorder known as muscle dysmorphia. Previously termed "reverse anorexia," muscle dysmorphia involves a preoccupation with the idea that one's body is not sufficiently lean and muscular.10 The thoughts are intrusive and associated with a great deal of anxiety, and the activities (i.e. weight lifting) can be so timeconsuming that school, work and social life are pushed aside. Muscle dysmorphia involves a distortion in perception, where the level of muscle mass is underestimated. Individuals with muscle dysmorphia are more likely to engage in such dangerous behaviors as steroid use.

Who is at Risk

Over the past decades, the majority of individuals with eating disorders have been young, female, white, and from middle to upper-class families in Western countries and Japan. Girls with anorexia have traditionally been academically successful, first or second-born children and often work as dancers or athletes. They are said to be compliant, approval-seeking, excessively dependent, perfectionistic and socially anxious. Girls with bulimia, in contrast, tend to be more extroverted and more active interpersonally and socially. In the past decade, eating disorders have become more prevalent in the lower socioeconomic classes, among women over 25 years of age and among minority group members.11 The eating disorders often coexist with depression, anxiety and obsessive-compulsive disorder (OCD).

In contrast to the eating disorders, Body Dysmorphic Disorder afflicts nearly equal numbers of males and females and often co-exists with social anxiety, depression and OCD. Muscle dysmorphia, considered a subset of BDD, affects males almost exclusively and is associated with (but not necessarily caused by) low selfesteem and mood and anxiety disorders.

Treatments: The Eating Disorders, BDD and Muscle Dysmorphia

The first step in seeking treatment for these serious disorders is recognizing that the problem exists. As we know many, if not most, adolescent girls want to lose weight. If an adolescent loses as much as 10 pounds, but appears to be eating in a healthy way, there is probably no cause for worry. However, if she seems obsessive, secretive or guilty about her eating, begins to have physical symptoms such as loss of menstruation, or loses more than 10% of her body weight, professional help should be obtained. The first step is a thorough medical evaluation by a pediatrician or family practitioner to rule out any medical cause(s) of weight loss. The next step is a referral to a child and adolescent psychiatrist for a complete psychiatric examination. The most common treatments recommended are a combination of individual therapy, family therapy and nutritional counseling. Psychotropic medication, most commonly antidepressants, are often prescribed, especially if there are coexisting psychiatric conditions such as depression. Unlike the teen with anorexia, the teen with bulimia is usually of normal weight or even slightly heavier. Thus, bulimia can be harder to detect; adolescents with bulimia tend to binge and purge in secret. Some clues might include: missing food, hoarding food, evidence of vomiting and over-the-counter emetics and laxatives in the household.12 If a teen is thought to be binging and purging, professional help should be sought. As with anorexia, consultation with a child and adolescent psychiatrist who is trained in the evaluation and treatment of eating disorders is a good first step. Commonly prescribed treatments include individual psychotherapy, group therapy and/or family therapy. As with anorexia, treatment with various psychotropic medications, most commonly antidepressants, can provide a useful adjunct to therapy.

Treatment for Body Dysmorphic Disorder generally involves a combination of pharmacotherapy and cognitive/behavioral psychotherapy to correct underlying cognitive distortions. Treatment for muscle dysmorphia has not been systematically studied, but the paradigms used to treat BDD and the eating disorders can provide a framework. In this case, the treatment of muscle dysmorphia would involve a combination of psychoeducation, cognitive/behavioral therapy and possibly a serotonin-reuptake inhibitor (SSRI) if depression or obsessions and compulsions are a prominent part of the disorder.

How Schools Can Help

Middle school efforts should:

  • focus on enhancing students' awareness of their bodies by providing didactic material on natural body changes. The psychological and social components of maturation (e.g., increased emotional arousal), relationships with the opposite sex and issues with parents should be included,
  • maintain a library of material on body image distortion and eating disorders as well as literature on nutrition,
  • encourage discussions on sociocultural factors such as worship of thinness and muscularity,
  • provide students with information about the medical consequences of dieting, binging and purging. Many are not aware of the serious physical consequences of using diuretics or laxatives, or other myriad dangers of an extremely limited diet,
  • target prevention efforts at the younger age groups, as cases of anorexia in preteenagers have increased.

How Parents Can Help

What about those teens who have milder forms of body image distress? Parents should:

  • help adolescents realize that they are valued because they are unique, not because of appearance or thinness,
  • accept their children's developing sexuality and encourage open expression of feeling,
  • discuss with their children the emphasis that society places on appearance and encourage them to be critical of advertising claims and the media,
  • praise their children's positive abilities and talents,
  • monitor negative comments about their own bodies.
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