Body Image 11 (2014) 175–178
Contents lists available at ScienceDirect
Body Image journal homepage: www.elsevier.com/locate/bodyimage
Brief research report
Unique associations between young adult men’s emotional functioning and their body dissatisfaction and disordered eating Scott Griffiths a,∗ , Douglas Angus a , Stuart B. Murray b , Stephen Touyz a a b
School of Psychology, University of Sydney, Sydney, NSW 2006, Australia The Redleaf Practice, Wahroonga, Sydney, NSW 2076, Australia
a r t i c l e
i n f o
a b s t r a c t
Article history: Received 17 June 2013 Received in revised form 3 December 2013 Accepted 5 December 2013 Keywords: Male body image Disordered eating Emotion regulation Emotion recognition Attentional biases
Research on emotional functioning, body dissatisfaction, and disordered eating in males is predominated by studies of negative affect and emotion regulation. Other aspects of emotional functioning, namely emotion recognition and attentional biases toward emotional stimuli, have received little empirical attention. The present study investigated the unique associations between different aspects of men’s emotional functioning and their disordered eating attitudes, muscularity dissatisfaction, and body fat dissatisfaction. Results from 132 male undergraduates showed that muscularity dissatisfaction was uniquely associated with both emotion regulation difficulties and an attentional bias toward rejecting faces. Body fat dissatisfaction was not uniquely associated with any aspect of emotional functioning. Disordered eating was uniquely associated with emotion regulation difficulties. Collectively, the results indicate differences in the patterns of associations between men’s emotional functioning and their body dissatisfaction and disordered eating. © 2013 Elsevier Ltd. All rights reserved.
Introduction Studies investigating the links between males’ emotional functioning and their body dissatisfaction and disordered eating have mostly been limited to two aspects of emotion: negative affect and emotion regulation. Difficulties with emotion regulation are thought to precipitate disordered eating during periods of intense emotional distress and have been consistently associated with disordered eating in North American undergraduate men (DavisBecker, Peterson, & Fischer, 2013; Lavender & Anderson, 2010; Robinson, Kosmerly, Mansfield-Green, & Lafrance, 2013). Studies have also found positive associations between emotion regulation difficulties and undergraduate men’s body dissatisfaction (Lavender & Anderson, 2010), suggesting that emotion regulation is an important factor in men’s body image and eating. Research findings are more equivocal on the links between males’ negative affect, body dissatisfaction, and disordered eating. Associations between negative affect and body dissatisfaction were not found in studies of obese men (Womble et al., 2001) and adolescent boys (McCabe, Ricciardelli, & Banfield, 2001). In contrast, Lavender and Anderson (2010) found that higher levels of negative affect significantly predicted body dissatisfaction in college-age men. These inconsistent results may be due to older research using
∗ Corresponding author. Tel.: +61 4 242 076 54. E-mail addresses: [email protected], scottgriffi[email protected] (S. Griffiths). 1740-1445/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bodyim.2013.12.002
measures of body dissatisfaction that were not designed for males. Moreover, a limitation of the research by Lavender and Anderson is that they did not examine muscularity dissatisfaction and body fat dissatisfaction separately. Research suggests that muscularity dissatisfaction and body fat dissatisfaction are related but distinct components of male body image (Bergeron & Tylka, 2007) that have differential patterns of associations with psychopathology, including disordered eating (Tylka, 2011; Tylka, Bergeron, & Schwartz, 2005). Research is more consistent in showing that negative affect predicts disordered eating in young men (Lavender & Anderson, 2010). Two aspects of emotional functioning that have received limited empirical attention in men are the ability to recognize emotions in others and attentional biases toward emotional stimuli. Difficulties with emotion recognition may lead a person to misconstrue others’ emotions toward them as negative, reinforcing disordered beliefs about eating and body image (Oldershaw, Hambrook, Stahl, Tchanturia, Treasure, & Schmidt, 2011). Emotion recognition difficulties are found in women with non-clinical disordered eating (Ridout, Thom, & Wallis, 2010), women with eating disorders (Harrison, Tchanturia, Naumann, & Treasure, 2011), and men and women with body dysmorphic disorder (Buhlmann, McNally, Etcoff, Tuschen-Caffier, & Wilhelm, 2004). Interestingly, Goddard, Carral-Fernández, Denneny, Campbell, & Treasure (2013) found no significant difference in emotion recognition between men with eating disorders and healthy control men. Collectively, these findings reveal potential sex differences in the link between emotion recognition and disordered eating. No studies of emotion
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recognition and disordered eating or body dissatisfaction have been conducted using non-clinical men. Attentional biases toward aversive emotional stimuli, such as pictures of faces with judgmental or critical facial expressions, are thought to reinforce disordered beliefs surrounding body image and eating (Fairburn, Cooper, & Shafran, 2003). Attentional biases toward emotional stimuli including angry and rejecting faces have been observed in women with eating disorders (Cardi, Matteo, Corfield, & Treasure, 2013; Goddard et al., 2013). However, research by Goddard et al. (2013) comparing men with eating disorders and healthy control men found no significant differences in attentional biases toward angry faces, suggesting that attentional biases toward angry faces are not associated with men’s disordered eating or body dissatisfaction. To date, no studies have investigated the link between these biases and either disordered eating or body dissatisfaction in undergraduate males. The present study investigated the unique associations between men’s emotional functioning and their disordered eating and body dissatisfaction. Four aspects of emotional functioning were assessed: negative affect, emotion regulation, emotion recognition, and attentional biases toward emotional stimuli. Men’s muscularity and body fat dissatisfaction were assessed separately. It was hypothesized that higher levels of negative affect and poorer emotion regulation would uniquely predict men’s disordered eating, muscularity dissatisfaction, and body fat dissatisfaction. Conflicting or absent evidence precluded the formulation of hypotheses about the links that emotion recognition and attentional biases would have with men’s body dissatisfaction and disordered eating. Method Participants One hundred and forty males enrolled in an undergraduate psychology course at the University of Sydney, Australia, participated in the study in return for course credit. Data from eight participants were excluded, five were over 25 years of age, two failed the validity-check (“For validity purposes, please select “Markedly” as your answer to this question”) and one was unable to complete the computer tasks due to a power outage. The final sample size was 132. Participants’ ages ranged from 17 to 25 years (M = 18.58, SD = 1.37). Participants were predominantly Australian (51.5%), followed by North-East Asian (21.2%) and South-East Asian (11.4%), with 18.9% indicating other nationalities. Eighty-four percent of participants were exclusively heterosexual, 4.5% were exclusively gay, and 11.5% endorsed a degree of bisexuality. Measures Muscularity and body fat dissatisfaction. The 10-item Muscularity Dissatisfaction subscale and 8-item Body Fat Dissatisfaction subscale of the Male Body Attitudes Scale (MBAS; Tylka et al., 2005) were used to assess males’ dissatisfaction with their muscularity and body fat, respectively. Participants rated the extent to which each statement was true of them using a 6-point scale (1 = never, 6 = always). Both subscales have demonstrated good test–retest reliability over a 2-week period, excellent internal consistency (˛s = .89–.95), and convergent and discriminant validity in undergraduate men (Tylka et al., 2005). In the present study, Cronbach’s ˛ for the Muscularity Dissatisfaction and Body Fat Dissatisfaction subscales were .91 and .93, respectively. Disordered eating. Two subscales of the Eating Disorder Examination Questionnaire (EDE-Q; Fairburn & Beglin, 1994), Dietary Restraint and Eating Concern, were used to assess disordered eating attitudes. The EDE-Q is a 28-item self-report questionnaire
which asks participants how frequently various disordered eating attitudes occur during the past 28 days using a 6-point scale (0 = no days, 6 = every day). Mean scores on the two subscales were averaged to form a global EDE-Q score. The EDE-Q has demonstrated adequate test–retest reliability over a median period of 315 days and both concurrent and criterion validity in non-clinical females (Mond, Hay, Rodgers, Owen, & Beumont, 2004a; Mond, Hay, Rodgers, Owen, & Beumont, 2004b), although internal consistency has tended to be lower for non-clinical males (Reas, Øverås, & Rø, 2012), and test–retest reliability data for males is not yet available. Cronbach’s ˛ was .74 in this sample. Negative affect. The 10-item Negative Affect subscale of the 20-item Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) assessed the extent to which participants generally felt negative affect (e.g., guilt, shame, distress). Participants responded using a 5-point scale (1 = very slight or not at all, 5 = extremely). The Negative Affect subscale has demonstrated convergent validity and adequate test–retest reliability over a 2-month period (Watson et al., 1988). Cronbach’s ˛ in the present study was .86. Emotion regulation. The 36-item Difficulties with Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) asks participants to rate how frequently various statements apply to them using a 5-point scale (1 = almost never, 0–10%; 5 = almost always, 91–100%). A sample item is, “When I’m upset, I become out of control.” Higher total scores on the DERS indicate greater overall emotion regulation difficulties. DERS total scores have demonstrated adequate test–rest reliability over a period ranging from 4 to 8 weeks and excellent internal consistency in undergraduate males (Gratz & Roemer, 2004). Cronbach’s ˛ for the total score was .93. Emotion recognition. A revised Reading the Mind in the Eyes Task (RMET; Baron-Cohen, Wheelwright, Hill, Raste, & Plumb, 2001) assessed emotion recognition. Participants viewed 36 photos of eyes (19 male, 17 female) and were asked to choose which of four emotions, all of similar valence, was best matched to what the person in the picture was feeling. The number of correct responses was used as a predictor variable in subsequent analyses, with more correct responses indicating superior emotion recognition. Attentional biases. The dot-probe task developed by Dandeneau, Baldwin, Baccus, and Sakellaropoulo (2007) was used to assess attentional biases toward accepting and rejecting faces. Stimuli were 64 achromatic pictures of male and female faces providing matched neutral, rejecting, and accepting facial expressions. For each trial, a fixation cross appeared for 500 ms, followed by a picture pair for 500 ms, and then the probe (two dots arranged vertically or horizontally) which replaced one of the pictures and remained visible until the participant made a response on the keyboard. The task consisted of 16 practice and 64 experimental trials, including 32 rejecting face trials and 32 accepting face trials, presented in random order.
Procedure Participants completed the questionnaires in private. Afterwards, a male experimenter administered the RMET and dot probe to each participant individually. Dot-probe data were cleaned and analyzed in accordance with the procedures described by Dandeneau et al. (2007). Trials with errors were discarded, and reaction times 2 SD for each participant’s overall mean reaction time were discarded as per Dandeneau et al. To calculate the rejection bias score, the mean reaction time for valid trials (probe and rejecting face in same location) was subtracted from invalid trials (probe and rejecting face at different locations). The same procedure was used to calculate acceptance bias scores. Higher positive bias scores indicate an attentional bias toward
S. Griffiths et al. / Body Image 11 (2014) 175–178
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Table 1 Descriptive statistics and correlations. Variable
Mean (SD)
1.
1. Muscularity dissatisfaction 2. Body fat dissatisfaction 3. Disordered eating 4. Negative affect 5. Emotion regulation difficulties 6. Emotion recognition 7. Rejection bias 8. Acceptance bias
3.23 (1.11) 2.64 (1.19) 0.36 (0.16) 19.28 (6.31) 93.59 (20.20) 25.80 (3.41) 2.29 (35.31) −1.14 (33.68)
–
* ** ***
2. .26** –
3.
4.
5.
6.
7.
8.
.60*** .46*** –
.23** .28** .31*** –
.33*** .29** .35*** .68*** –
−.07 −.10 −.14 −.12 −.19* –
.17* −.04 .10 .07 −.03 .01 –
.19* .21* .22* .16 .17 −.16 .11 –
p < .05. p < .01. p < .001.
Table 2 Simultaneous multiple regressions predicting muscularity dissatisfaction, body fat dissatisfaction and disordered eating. Variable
Muscularity dissatisfaction
Negative affect Emotion regulation difficulties Emotion recognition Rejection bias Acceptance bias * **
Body fat dissatisfaction
Disordered eating
R
B
SE B
ˇ
R
B
SE B
ˇ
R
B
SE B
ˇ
2
.16**
−.01 .02 .00 .01 .00
.02 .01 .03 .00 .00
−.04 .34** .01 .17* .12
.00 .07 .00 .03 .02
.13**
.03 .01 −.01 .00 .01
.02 .01 .03 .00 .00
.15 .16 −.02 −.07 .16
.01 .02 .00 .01 .03
.17**
.00 .00 −.00 .00 .00
.00 .00 .00 .00 .00
.12 .23* −.06 .09 .14
.01 .03 .00 .01 .02
2
2
2
2
2
p < .05. p < .01.
rejecting/accepting faces, whereas negative bias scores indicate disengagement or inhibition.
uniquely positively associated with disordered eating, ˇ = .23, t(126) = 2.04, p = .043. No other significant unique predictors of disordered eating emerged.
Statistical Analyses The EDE-Q score was positively skewed and included zero values. As suggested by Tabachnick and Fidell (2007) the scores were transformed using log10(X + C), where X = the EDE-Q score and C = the constant, 1. Following the data transformation, all the assumptions of multiple regression were met. Three simultaneous multiple regressions were conducted predicting muscularity dissatisfaction, body fat dissatisfaction and disordered eating, with negative affect, emotion regulation difficulties, emotion recognition, rejecting bias, and accepting bias entered as predictors. Effect-sizes are given as partial-eta squared (2 ). Results Table 1 reports the observed range, means, standard deviations, and intercorrelations for all variables. Results from the three simultaneous multiple regression analyses are shown in Table 2. The predictors accounted for 15.7% of the variance in muscularity dissatisfaction, F(5,126) = 4.68, p < .001. Emotion regulation difficulties were uniquely positively associated with muscularity dissatisfaction, ˇ = .34, t(126) = 3.01, p = .003. Rejection bias scores were also uniquely positively associated with muscularity dissatisfaction, such that for each standard deviation increase in the rejection bias score (indicating an attentional bias toward rejecting faces), a 0.17 SD increase in muscularity dissatisfaction was predicted, t(126) = 2.07, p = .040. No other significant unique predictors of muscularity dissatisfaction emerged. The predictors accounted for 12.6% of the variance in body fat dissatisfaction, which was significant, F(5,126) = 2.99, p = .004. However, no significant unique predictors of body fat dissatisfaction emerged. The predictors accounted for 16.5% of the variance in disordered eating, F(5,126) = 4.97, p < .001. Emotion regulation difficulties were
Discussion The present study investigated the unique associations between emotional functioning, disordered eating, and body dissatisfaction in male undergraduates. The results showed that negative affect was not significantly uniquely associated with disordered eating, muscularity or body fat dissatisfaction. Emotion regulation difficulties were uniquely positively associated with muscularity dissatisfaction and disordered eating, but not with body fat dissatisfaction. Emotion recognition was not associated with disordered eating or either measure of body dissatisfaction. An attentional bias toward rejecting faces was associated with greater muscularity dissatisfaction. The finding that emotion recognition was not predictive of men’s body dissatisfaction or disordered eating is consistent with research by Goddard et al. (2013) showing equal emotion recognition ability in men with eating disorders and healthy control men. Lack of power is unlikely to be the explanation, given the effect sizes for emotion recognition (all 2 < .01). Rather, it may be that difficulties in recognizing emotions in others do not influence males’ body dissatisfaction and eating to any appreciable extent. Emotion recognition in healthy control men is as poor as in women with eating disorders (Goddard et al., 2013) and was similarly poor, on average, in the present study. In addition to being less likely to correctly judge others’ emotions, it may be that men are also less likely to internalize the emotional states of others and to link them to judgements about their own body image and eating. The association between muscularity dissatisfaction and attentional biases toward rejecting faces suggests that men with higher levels of concern about the appearance of their muscles may have a habit of directing their attention toward people whose faces convey judgment or rejection. Researchers have also shown this bias in women with eating disorders using the same procedure and
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stimuli (Cardi et al., 2013). However, a link between disordered eating and a bias toward rejecting faces was not observed in the present study. Emotion regulation difficulties were significantly associated with muscularity dissatisfaction and disordered eating, but not with body fat dissatisfaction. It may be that men with high levels of muscularity dissatisfaction endorse more traditional notions of masculinity that discourage emotional vulnerability and emotional expressiveness (Blashill, 2011). In support of this notion, men with clinical levels of muscularity-oriented psychopathology have been shown to endorse higher levels of masculinity than men with thinness-oriented psychopathology (Murray, Rieger, Karlov, & Touyz, 2012). The association between emotion regulation difficulties and disordered eating is consistent with one recent study of emotion regulation difficulties in undergraduate men (Lavender & Anderson, 2010). Interestingly, negative affect was not uniquely associated with either muscularity or body fat dissatisfaction, adding to the mixed findings already present in the literature. However, unlike early research that observed no associations but which used measures of body image that were not designed for men (e.g., McCabe et al., 2001), the present study used a measure of body image specifically designed for men, suggesting that explanations based on improper assessment of male body image may not account for the discordant results. Moreover, negative affect was not uniquely associated with disordered eating, in contrast to previous research on undergraduate men (Lavender & Anderson, 2010). Several limitations of the present study are noted. First, attentional biases were investigated using only accepting and rejecting faces. Other types of stimuli, including angry faces, unpleasant pictures, and unpleasant video clips, have been used in previous research (e.g., Davies, Schmidt, Stahl, & Tchanturia, 2011). Second, participants in the study were non-clinical young adults and these findings may not generalize to males with clinical disorders or to older men. Lastly, the correlational design of this study precluded statements about causation. In conclusion, the present study examined the unique associations between aspects of emotional functioning and young men’s body dissatisfaction and disordered eating. The results suggest that some elements of emotional functioning, namely recognition of emotions in others and negative affect, may not be associated with men’s body dissatisfaction and disordered eating. Emotion regulation difficulties, however, were associated with both disordered eating and muscularity dissatisfaction, and an attentional bias toward rejecting faces was associated with muscularity dissatisfaction, suggesting that these elements of emotional functioning may be relatively more important in young men. References Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., & Plumb, I. (2001). The “Reading the Mind in the Eyes” Test revised version: A study with normal adults, and adults with Asperger syndrome or high-functioning autism. Journal of Child Clinical Psychology, 42, 241–251. http://dx.doi.org/10.1111/1469-7610.00715 Bergeron, D., & Tylka, T. L. (2007). Support for the uniqueness of body dissatisfaction from drive for muscularity among men. Body Image, 4, 288–295. http://dx.doi.org/10.1016/j.bodyim.2007.05.002 Blashill, A. J. (2011). Gender roles, eating pathology, and body dissatisfaction in men: A meta-analysis. Body Image, 8, 1–11. http://dx.doi.org/10.1016/ j.bodyim.2010.09.002 Buhlmann, U., McNally, R. J., Etcoff, N. L., Tuschen-Caffier, B., & Wilhelm, S. (2004). Emotion recognition deficits in body dysmorphic disorder. Journal of Psychiatric Research, 38, 201–206. http://dx.doi.org/10.1016/S0022-3956(03)00107-9 Cardi, V., Matteo, R. D., Corfield, F., & Treasure, J. (2013). Social reward and rejection sensitivity in eating disorders: An investigation of attentional bias and early experiences. World Journal of Biological Psychiatry, 14, 622–633.
http://dx.doi.org/10.3109/15622975.2012.665479 (advance online publication) Dandeneau, S. D., Baldwin, M. W., Baccus, J. R., & Sakellaropoulo, M. (2007). Cutting stress off at the pass: Reducing vigilance and responsiveness to social threat by manipulating attention. Journal of Personality and Social Psychology, 93, 651–666. http://dx.doi.org/10.1037/0022-3514.93.4.651 Davies, H., Schmidt, U., Stahl, D., & Tchanturia, K. (2011). Evoked facial emotional expression and emotional experience in people with anorexia nervosa. International Journal of Eating Disorders, 44, 531–539. http://dx.doi.org/10.1002/eat.20852 Davis-Becker, K., Peterson, C. M., & Fischer, S. (2013). The relationship of trait negative urgency and negative affect to disordered eating in men and women. Personality and Individual Differences, http://dx.doi.org/10.1016/j.paid.2013.08.010 (advance online publication) Fairburn, C., & Beglin, S. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363–370. http://dx.doi.org/10.1002/1098-108X(199412)16:4 3.0.CO;2 Fairburn, C., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–528. http://dx.doi.org/10.1016/S0005-7967(02)00088-8 Goddard, E., Carral-Fernández, L., Denneny, E., Campbell, I. C., & Treasure, J. (2013). Cognitive flexibility, central coherence and social emotional processing in males with an eating disorder. World Journal of Biological Psychiatry, http://dx.doi.org/10.3109/15622975.2012.750014 (advance online publication) Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54. http://dx.doi.org/10.1023/B:JOBA.0000007455.08539.94 Harrison, A., Tchanturia, K., Naumann, U., & Treasure, J. (2011). Social emotional functioning and cognitive styles in eating disorders. British Journal of Clinical Psychology, 51, 261–279. http://dx.doi.org/10.1111/j.2044-8260.2011.02026.x Lavender, J. M., & Anderson, D. A. (2010). Contribution of emotion regulation difficulties to disordered eating and body dissatisfaction in college men. International Journal of Eating Disorders, 43, 352–357. http://dx.doi.org/10.1002/eat.20705 McCabe, M. P., Ricciardelli, L. A., & Banfield, S. (2001). Body image, strategies to change muscles and weight, and puberty: Do they impact on positive and negative affect among adolescent boys and girls? Eating Behaviors, 2, 129–149. http://dx.doi.org/10.1016/S1471-0153(01)00025-3 Mond, J. M., Hay, P. J., Rodgers, B., Owen, C., & Beumont, P. J. V. (2004a). Temporal stability of the Eating Disorder Examination Questionnaire. International Journal of Eating Disorders, 36, 195–203. http://dx.doi.org/10.1002/eat.20017 Mond, J. M., Hay, P. J., Rodgers, B., Owen, C., & Beumont, P. J. V. (2004b). Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples. Behaviour Research and Therapy, 42, 551–567. http://dx.doi.org/10.1016/S0005-7967(03)00161-X Murray, S. B., Rieger, E., Karlov, L., & Touyz, S. W. (2012). Masculinity and femininity in the divergence of male body image concerns. Journal of Eating Disorders, 1, 11. http://dx.doi.org/10.1186/2050-2974-1-11 Oldershaw, A., Hambrook, D., Stahl, D., Tchanturia, K., Treasure, J., & Schmidt, U. (2011). The socio-emotional processing stream in anorexia nervosa. Neuroscience and Biobehavioural Reviews, 35, 970–988. http://dx.doi.org/10.1016/j.neubiorev.2010.11.001 Reas, D. L., Øverås, M., & Rø, O. (2012). Norms for the Eating Disorder Examination Questionnaire (EDE-Q) among high school and university men. Eating Disorders: The Journal of Treatment and Prevention, 20, 437–443. http://dx.doi.org/10.1080/10640266.2012.715523 Ridout, N., Thom, C., & Wallis, D. J. (2010). Emotion recognition and alexithymia in females with non-clinical disordered eating. Eating Behaviors, 11, 1–5. http://dx.doi.org/10.1016/j.eatbeh.2009.07.008 Robinson, A., Kosmerly, S., Mansfield-Green, S., & Lafrance, G. (2013). Disordered eating behaviours in an undergraduate sample: Associations among gender, body mass index, and difficulties in emotion regulation. Canadian Journal of Behavioural Science, http://dx.doi.org/10.1037/a0031123 (advance online publication) Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston: Allyn and Bacon. Tylka, T. L. (2011). Refinement of the tripartite influence model for men: Dual body image pathways to body change behaviors. Body Image, 8, 199–207. http://dx.doi.org/10.1016/j.bodyim.2011.04.008 Tylka, T. L., Bergeron, D., & Schwartz, J. P. (2005). Development and psychometric evaluation of the Male Body Attitudes Scale (MBAS). Body Image, 2, 161–175. http://dx.doi.org/10.1016/j.bodyim.2005.03.001 Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070. http://dx.doi.org/10.1037/0022-3514.54.6.1063 Womble, L. G., Williamson, D. A., Martin, C. K., Zucker, N. L., Thaw, J. M., Netemeyer, R., Lovejoy, J. C., & Greenway, F. L. (2001). Psychosocial variables associated with binge eating in obese males and females. International Journal of Eating Disorders, 30, 217–221. http://dx.doi.org/10.1002/eat.1076
Contents lists available at ScienceDirect
Body Image journal homepage: www.elsevier.com/locate/bodyimage
Brief research report
Unique associations between young adult men’s emotional functioning and their body dissatisfaction and disordered eating Scott Griffiths a,∗ , Douglas Angus a , Stuart B. Murray b , Stephen Touyz a a b
School of Psychology, University of Sydney, Sydney, NSW 2006, Australia The Redleaf Practice, Wahroonga, Sydney, NSW 2076, Australia
a r t i c l e
i n f o
a b s t r a c t
Article history: Received 17 June 2013 Received in revised form 3 December 2013 Accepted 5 December 2013 Keywords: Male body image Disordered eating Emotion regulation Emotion recognition Attentional biases
Research on emotional functioning, body dissatisfaction, and disordered eating in males is predominated by studies of negative affect and emotion regulation. Other aspects of emotional functioning, namely emotion recognition and attentional biases toward emotional stimuli, have received little empirical attention. The present study investigated the unique associations between different aspects of men’s emotional functioning and their disordered eating attitudes, muscularity dissatisfaction, and body fat dissatisfaction. Results from 132 male undergraduates showed that muscularity dissatisfaction was uniquely associated with both emotion regulation difficulties and an attentional bias toward rejecting faces. Body fat dissatisfaction was not uniquely associated with any aspect of emotional functioning. Disordered eating was uniquely associated with emotion regulation difficulties. Collectively, the results indicate differences in the patterns of associations between men’s emotional functioning and their body dissatisfaction and disordered eating. © 2013 Elsevier Ltd. All rights reserved.
Introduction Studies investigating the links between males’ emotional functioning and their body dissatisfaction and disordered eating have mostly been limited to two aspects of emotion: negative affect and emotion regulation. Difficulties with emotion regulation are thought to precipitate disordered eating during periods of intense emotional distress and have been consistently associated with disordered eating in North American undergraduate men (DavisBecker, Peterson, & Fischer, 2013; Lavender & Anderson, 2010; Robinson, Kosmerly, Mansfield-Green, & Lafrance, 2013). Studies have also found positive associations between emotion regulation difficulties and undergraduate men’s body dissatisfaction (Lavender & Anderson, 2010), suggesting that emotion regulation is an important factor in men’s body image and eating. Research findings are more equivocal on the links between males’ negative affect, body dissatisfaction, and disordered eating. Associations between negative affect and body dissatisfaction were not found in studies of obese men (Womble et al., 2001) and adolescent boys (McCabe, Ricciardelli, & Banfield, 2001). In contrast, Lavender and Anderson (2010) found that higher levels of negative affect significantly predicted body dissatisfaction in college-age men. These inconsistent results may be due to older research using
∗ Corresponding author. Tel.: +61 4 242 076 54. E-mail addresses: [email protected], scottgriffi[email protected] (S. Griffiths). 1740-1445/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bodyim.2013.12.002
measures of body dissatisfaction that were not designed for males. Moreover, a limitation of the research by Lavender and Anderson is that they did not examine muscularity dissatisfaction and body fat dissatisfaction separately. Research suggests that muscularity dissatisfaction and body fat dissatisfaction are related but distinct components of male body image (Bergeron & Tylka, 2007) that have differential patterns of associations with psychopathology, including disordered eating (Tylka, 2011; Tylka, Bergeron, & Schwartz, 2005). Research is more consistent in showing that negative affect predicts disordered eating in young men (Lavender & Anderson, 2010). Two aspects of emotional functioning that have received limited empirical attention in men are the ability to recognize emotions in others and attentional biases toward emotional stimuli. Difficulties with emotion recognition may lead a person to misconstrue others’ emotions toward them as negative, reinforcing disordered beliefs about eating and body image (Oldershaw, Hambrook, Stahl, Tchanturia, Treasure, & Schmidt, 2011). Emotion recognition difficulties are found in women with non-clinical disordered eating (Ridout, Thom, & Wallis, 2010), women with eating disorders (Harrison, Tchanturia, Naumann, & Treasure, 2011), and men and women with body dysmorphic disorder (Buhlmann, McNally, Etcoff, Tuschen-Caffier, & Wilhelm, 2004). Interestingly, Goddard, Carral-Fernández, Denneny, Campbell, & Treasure (2013) found no significant difference in emotion recognition between men with eating disorders and healthy control men. Collectively, these findings reveal potential sex differences in the link between emotion recognition and disordered eating. No studies of emotion
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recognition and disordered eating or body dissatisfaction have been conducted using non-clinical men. Attentional biases toward aversive emotional stimuli, such as pictures of faces with judgmental or critical facial expressions, are thought to reinforce disordered beliefs surrounding body image and eating (Fairburn, Cooper, & Shafran, 2003). Attentional biases toward emotional stimuli including angry and rejecting faces have been observed in women with eating disorders (Cardi, Matteo, Corfield, & Treasure, 2013; Goddard et al., 2013). However, research by Goddard et al. (2013) comparing men with eating disorders and healthy control men found no significant differences in attentional biases toward angry faces, suggesting that attentional biases toward angry faces are not associated with men’s disordered eating or body dissatisfaction. To date, no studies have investigated the link between these biases and either disordered eating or body dissatisfaction in undergraduate males. The present study investigated the unique associations between men’s emotional functioning and their disordered eating and body dissatisfaction. Four aspects of emotional functioning were assessed: negative affect, emotion regulation, emotion recognition, and attentional biases toward emotional stimuli. Men’s muscularity and body fat dissatisfaction were assessed separately. It was hypothesized that higher levels of negative affect and poorer emotion regulation would uniquely predict men’s disordered eating, muscularity dissatisfaction, and body fat dissatisfaction. Conflicting or absent evidence precluded the formulation of hypotheses about the links that emotion recognition and attentional biases would have with men’s body dissatisfaction and disordered eating. Method Participants One hundred and forty males enrolled in an undergraduate psychology course at the University of Sydney, Australia, participated in the study in return for course credit. Data from eight participants were excluded, five were over 25 years of age, two failed the validity-check (“For validity purposes, please select “Markedly” as your answer to this question”) and one was unable to complete the computer tasks due to a power outage. The final sample size was 132. Participants’ ages ranged from 17 to 25 years (M = 18.58, SD = 1.37). Participants were predominantly Australian (51.5%), followed by North-East Asian (21.2%) and South-East Asian (11.4%), with 18.9% indicating other nationalities. Eighty-four percent of participants were exclusively heterosexual, 4.5% were exclusively gay, and 11.5% endorsed a degree of bisexuality. Measures Muscularity and body fat dissatisfaction. The 10-item Muscularity Dissatisfaction subscale and 8-item Body Fat Dissatisfaction subscale of the Male Body Attitudes Scale (MBAS; Tylka et al., 2005) were used to assess males’ dissatisfaction with their muscularity and body fat, respectively. Participants rated the extent to which each statement was true of them using a 6-point scale (1 = never, 6 = always). Both subscales have demonstrated good test–retest reliability over a 2-week period, excellent internal consistency (˛s = .89–.95), and convergent and discriminant validity in undergraduate men (Tylka et al., 2005). In the present study, Cronbach’s ˛ for the Muscularity Dissatisfaction and Body Fat Dissatisfaction subscales were .91 and .93, respectively. Disordered eating. Two subscales of the Eating Disorder Examination Questionnaire (EDE-Q; Fairburn & Beglin, 1994), Dietary Restraint and Eating Concern, were used to assess disordered eating attitudes. The EDE-Q is a 28-item self-report questionnaire
which asks participants how frequently various disordered eating attitudes occur during the past 28 days using a 6-point scale (0 = no days, 6 = every day). Mean scores on the two subscales were averaged to form a global EDE-Q score. The EDE-Q has demonstrated adequate test–retest reliability over a median period of 315 days and both concurrent and criterion validity in non-clinical females (Mond, Hay, Rodgers, Owen, & Beumont, 2004a; Mond, Hay, Rodgers, Owen, & Beumont, 2004b), although internal consistency has tended to be lower for non-clinical males (Reas, Øverås, & Rø, 2012), and test–retest reliability data for males is not yet available. Cronbach’s ˛ was .74 in this sample. Negative affect. The 10-item Negative Affect subscale of the 20-item Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) assessed the extent to which participants generally felt negative affect (e.g., guilt, shame, distress). Participants responded using a 5-point scale (1 = very slight or not at all, 5 = extremely). The Negative Affect subscale has demonstrated convergent validity and adequate test–retest reliability over a 2-month period (Watson et al., 1988). Cronbach’s ˛ in the present study was .86. Emotion regulation. The 36-item Difficulties with Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) asks participants to rate how frequently various statements apply to them using a 5-point scale (1 = almost never, 0–10%; 5 = almost always, 91–100%). A sample item is, “When I’m upset, I become out of control.” Higher total scores on the DERS indicate greater overall emotion regulation difficulties. DERS total scores have demonstrated adequate test–rest reliability over a period ranging from 4 to 8 weeks and excellent internal consistency in undergraduate males (Gratz & Roemer, 2004). Cronbach’s ˛ for the total score was .93. Emotion recognition. A revised Reading the Mind in the Eyes Task (RMET; Baron-Cohen, Wheelwright, Hill, Raste, & Plumb, 2001) assessed emotion recognition. Participants viewed 36 photos of eyes (19 male, 17 female) and were asked to choose which of four emotions, all of similar valence, was best matched to what the person in the picture was feeling. The number of correct responses was used as a predictor variable in subsequent analyses, with more correct responses indicating superior emotion recognition. Attentional biases. The dot-probe task developed by Dandeneau, Baldwin, Baccus, and Sakellaropoulo (2007) was used to assess attentional biases toward accepting and rejecting faces. Stimuli were 64 achromatic pictures of male and female faces providing matched neutral, rejecting, and accepting facial expressions. For each trial, a fixation cross appeared for 500 ms, followed by a picture pair for 500 ms, and then the probe (two dots arranged vertically or horizontally) which replaced one of the pictures and remained visible until the participant made a response on the keyboard. The task consisted of 16 practice and 64 experimental trials, including 32 rejecting face trials and 32 accepting face trials, presented in random order.
Procedure Participants completed the questionnaires in private. Afterwards, a male experimenter administered the RMET and dot probe to each participant individually. Dot-probe data were cleaned and analyzed in accordance with the procedures described by Dandeneau et al. (2007). Trials with errors were discarded, and reaction times 2 SD for each participant’s overall mean reaction time were discarded as per Dandeneau et al. To calculate the rejection bias score, the mean reaction time for valid trials (probe and rejecting face in same location) was subtracted from invalid trials (probe and rejecting face at different locations). The same procedure was used to calculate acceptance bias scores. Higher positive bias scores indicate an attentional bias toward
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177
Table 1 Descriptive statistics and correlations. Variable
Mean (SD)
1.
1. Muscularity dissatisfaction 2. Body fat dissatisfaction 3. Disordered eating 4. Negative affect 5. Emotion regulation difficulties 6. Emotion recognition 7. Rejection bias 8. Acceptance bias
3.23 (1.11) 2.64 (1.19) 0.36 (0.16) 19.28 (6.31) 93.59 (20.20) 25.80 (3.41) 2.29 (35.31) −1.14 (33.68)
–
* ** ***
2. .26** –
3.
4.
5.
6.
7.
8.
.60*** .46*** –
.23** .28** .31*** –
.33*** .29** .35*** .68*** –
−.07 −.10 −.14 −.12 −.19* –
.17* −.04 .10 .07 −.03 .01 –
.19* .21* .22* .16 .17 −.16 .11 –
p < .05. p < .01. p < .001.
Table 2 Simultaneous multiple regressions predicting muscularity dissatisfaction, body fat dissatisfaction and disordered eating. Variable
Muscularity dissatisfaction
Negative affect Emotion regulation difficulties Emotion recognition Rejection bias Acceptance bias * **
Body fat dissatisfaction
Disordered eating
R
B
SE B
ˇ
R
B
SE B
ˇ
R
B
SE B
ˇ
2
.16**
−.01 .02 .00 .01 .00
.02 .01 .03 .00 .00
−.04 .34** .01 .17* .12
.00 .07 .00 .03 .02
.13**
.03 .01 −.01 .00 .01
.02 .01 .03 .00 .00
.15 .16 −.02 −.07 .16
.01 .02 .00 .01 .03
.17**
.00 .00 −.00 .00 .00
.00 .00 .00 .00 .00
.12 .23* −.06 .09 .14
.01 .03 .00 .01 .02
2
2
2
2
2
p < .05. p < .01.
rejecting/accepting faces, whereas negative bias scores indicate disengagement or inhibition.
uniquely positively associated with disordered eating, ˇ = .23, t(126) = 2.04, p = .043. No other significant unique predictors of disordered eating emerged.
Statistical Analyses The EDE-Q score was positively skewed and included zero values. As suggested by Tabachnick and Fidell (2007) the scores were transformed using log10(X + C), where X = the EDE-Q score and C = the constant, 1. Following the data transformation, all the assumptions of multiple regression were met. Three simultaneous multiple regressions were conducted predicting muscularity dissatisfaction, body fat dissatisfaction and disordered eating, with negative affect, emotion regulation difficulties, emotion recognition, rejecting bias, and accepting bias entered as predictors. Effect-sizes are given as partial-eta squared (2 ). Results Table 1 reports the observed range, means, standard deviations, and intercorrelations for all variables. Results from the three simultaneous multiple regression analyses are shown in Table 2. The predictors accounted for 15.7% of the variance in muscularity dissatisfaction, F(5,126) = 4.68, p < .001. Emotion regulation difficulties were uniquely positively associated with muscularity dissatisfaction, ˇ = .34, t(126) = 3.01, p = .003. Rejection bias scores were also uniquely positively associated with muscularity dissatisfaction, such that for each standard deviation increase in the rejection bias score (indicating an attentional bias toward rejecting faces), a 0.17 SD increase in muscularity dissatisfaction was predicted, t(126) = 2.07, p = .040. No other significant unique predictors of muscularity dissatisfaction emerged. The predictors accounted for 12.6% of the variance in body fat dissatisfaction, which was significant, F(5,126) = 2.99, p = .004. However, no significant unique predictors of body fat dissatisfaction emerged. The predictors accounted for 16.5% of the variance in disordered eating, F(5,126) = 4.97, p < .001. Emotion regulation difficulties were
Discussion The present study investigated the unique associations between emotional functioning, disordered eating, and body dissatisfaction in male undergraduates. The results showed that negative affect was not significantly uniquely associated with disordered eating, muscularity or body fat dissatisfaction. Emotion regulation difficulties were uniquely positively associated with muscularity dissatisfaction and disordered eating, but not with body fat dissatisfaction. Emotion recognition was not associated with disordered eating or either measure of body dissatisfaction. An attentional bias toward rejecting faces was associated with greater muscularity dissatisfaction. The finding that emotion recognition was not predictive of men’s body dissatisfaction or disordered eating is consistent with research by Goddard et al. (2013) showing equal emotion recognition ability in men with eating disorders and healthy control men. Lack of power is unlikely to be the explanation, given the effect sizes for emotion recognition (all 2 < .01). Rather, it may be that difficulties in recognizing emotions in others do not influence males’ body dissatisfaction and eating to any appreciable extent. Emotion recognition in healthy control men is as poor as in women with eating disorders (Goddard et al., 2013) and was similarly poor, on average, in the present study. In addition to being less likely to correctly judge others’ emotions, it may be that men are also less likely to internalize the emotional states of others and to link them to judgements about their own body image and eating. The association between muscularity dissatisfaction and attentional biases toward rejecting faces suggests that men with higher levels of concern about the appearance of their muscles may have a habit of directing their attention toward people whose faces convey judgment or rejection. Researchers have also shown this bias in women with eating disorders using the same procedure and
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stimuli (Cardi et al., 2013). However, a link between disordered eating and a bias toward rejecting faces was not observed in the present study. Emotion regulation difficulties were significantly associated with muscularity dissatisfaction and disordered eating, but not with body fat dissatisfaction. It may be that men with high levels of muscularity dissatisfaction endorse more traditional notions of masculinity that discourage emotional vulnerability and emotional expressiveness (Blashill, 2011). In support of this notion, men with clinical levels of muscularity-oriented psychopathology have been shown to endorse higher levels of masculinity than men with thinness-oriented psychopathology (Murray, Rieger, Karlov, & Touyz, 2012). The association between emotion regulation difficulties and disordered eating is consistent with one recent study of emotion regulation difficulties in undergraduate men (Lavender & Anderson, 2010). Interestingly, negative affect was not uniquely associated with either muscularity or body fat dissatisfaction, adding to the mixed findings already present in the literature. However, unlike early research that observed no associations but which used measures of body image that were not designed for men (e.g., McCabe et al., 2001), the present study used a measure of body image specifically designed for men, suggesting that explanations based on improper assessment of male body image may not account for the discordant results. Moreover, negative affect was not uniquely associated with disordered eating, in contrast to previous research on undergraduate men (Lavender & Anderson, 2010). Several limitations of the present study are noted. First, attentional biases were investigated using only accepting and rejecting faces. Other types of stimuli, including angry faces, unpleasant pictures, and unpleasant video clips, have been used in previous research (e.g., Davies, Schmidt, Stahl, & Tchanturia, 2011). Second, participants in the study were non-clinical young adults and these findings may not generalize to males with clinical disorders or to older men. Lastly, the correlational design of this study precluded statements about causation. In conclusion, the present study examined the unique associations between aspects of emotional functioning and young men’s body dissatisfaction and disordered eating. The results suggest that some elements of emotional functioning, namely recognition of emotions in others and negative affect, may not be associated with men’s body dissatisfaction and disordered eating. Emotion regulation difficulties, however, were associated with both disordered eating and muscularity dissatisfaction, and an attentional bias toward rejecting faces was associated with muscularity dissatisfaction, suggesting that these elements of emotional functioning may be relatively more important in young men. References Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., & Plumb, I. (2001). The “Reading the Mind in the Eyes” Test revised version: A study with normal adults, and adults with Asperger syndrome or high-functioning autism. Journal of Child Clinical Psychology, 42, 241–251. http://dx.doi.org/10.1111/1469-7610.00715 Bergeron, D., & Tylka, T. L. (2007). Support for the uniqueness of body dissatisfaction from drive for muscularity among men. Body Image, 4, 288–295. http://dx.doi.org/10.1016/j.bodyim.2007.05.002 Blashill, A. J. (2011). Gender roles, eating pathology, and body dissatisfaction in men: A meta-analysis. Body Image, 8, 1–11. http://dx.doi.org/10.1016/ j.bodyim.2010.09.002 Buhlmann, U., McNally, R. J., Etcoff, N. L., Tuschen-Caffier, B., & Wilhelm, S. (2004). Emotion recognition deficits in body dysmorphic disorder. Journal of Psychiatric Research, 38, 201–206. http://dx.doi.org/10.1016/S0022-3956(03)00107-9 Cardi, V., Matteo, R. D., Corfield, F., & Treasure, J. (2013). Social reward and rejection sensitivity in eating disorders: An investigation of attentional bias and early experiences. World Journal of Biological Psychiatry, 14, 622–633.
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