STIGMATISATION OF ANOREXIA NERVOSA AND MUSCLE DYSMORPHIAGriffiths, S., Mond, J. M., Murray, S. B., & Touyz, S. (In-press).

Young peoples’ stigmatizing attitudes and beliefs about anorexia and muscle dysmorphia. International Journal of Eating Disorders. doi:10.1002/eat.2222

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Sex differences in eating disorder prevalence

Anorexia Nervosa

Bulimia Nervosa

Binge Eating Disorder

EDNOS Muscle Dysmorphia

0%

50%

100%

25% 30%

50%40%

90%

75% 70%

50%60%

10%

(Hoek & Hueken, 2003; Hudson et al. 2007; Madden et al. 2009; Muise et al. 2003)

Men Women

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Two ends of a spectrum?

Anorexia nervosa Muscle dysmorphia

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Stigma and eating disorders

› Eating disorders are stigmatised

› People with anorexia = attention seekers who are personally responsible for their illness (Crisafulli; Holle, & Bulik, 2008; Crisp, Gelder, Rix, Meltzer, & Rowlands, 2000; Mond, Robertson-Smith, & Vetere, 2006; Roehrig & McLean, 2010)

› Stigma is assumed to be the reason why so few males are in treatment

› Eating disorders are a “girl's problem" (Robinson et al. 2012)

› However, studies examining stigma toward male and female eating disorder sufferers have found few (if any) differences (Wingfield, Kelly, Serdar, Shivy, & Mazzeo, 2011)

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Masculinity, stigma and eating disorders

› Adherence to masculine norms is consistently negatively associated with men’s willingness to seek professional help (Addis & Mahalik, 2003; Courtenay, 2000; Levant & Richmond, 2007; Manfield, Addis & Mahalik, 2003; O’Neil, 2008)

› Especially resistant to taking medication (Berger et al. 2013)

› Men prefer talk-therapy with a psychotherapist over other forms of professional help-seeking (Berger et al. 2013)

› Men react more positively to seeking professional treatment at the suggestion of a psychotherapist compared with a medical doctor or romantic partner (Berger et al. 2013)

Anorexia Nervosa

Muscle DysmorphiaAnorexia Nervosa

Muscle Dysmorphia

Exploring stigma toward anorexia and muscle dysmorphia

N = 343

Large Medium Small The character is… Small Medium Large

X Weird

X Narcissistic

X An attention-seeker

X Less likely to be talked to about their problem by

the participant

X Less likely to be watched or monitored by the

participant

X Less likely to be watched or monitored by others

Higher for male participants Higher for female participants

Main effects of participant sex (male or female)

Large Medium Small The character is… Small Medium Large

X Masculine

Feminine X

More likely to be watched/monitored

X

More uncomfortable to talk to

X

More psychologically fragile

X

Less likely to recover easily

X

X Less likely to be discriminated against

Higher for male characters Higher for female characters

Main effects of character sex (male or female)

Large Medium Small The character is… Small Medium Large

X Unintelligent

X Less competent than their peers

X Self-destructive

X Will put strain on your friendship

X Likely to be watched or monitored by the participant

X Likely to be watched or monitored by others

Likely to recover easily X

X Likely to be talked to about their problem by the participant

X Going to require caution so as to not upset them

X Physically fragile

Higher for anorexia nervosa Higher for muscle dysmorphia

Main effects of character diagnosis (anorexia or muscle dysmorphia)

Anorexia nervosa

Muscle dysmorphia

1

2

3

4

5 Male partic-ipantsn = 113

Female par-ticipantsn = 230

Character diagnosis

Me

an

pe

rce

ive

d m

asc

ulin

ity

› To what extent do you agree with the following statement: Kelly/Michael is masculine

- 5 = strongly agree

- 4 = agree

- 3 = neither agree nor disagree

- 2 = disagree

- 1 = strongly disagree

› Size of this effect size is very large (η2 = .23)

- Even stronger for male participants (interaction η2 = .03, p = .002)

Stigma and gender-role expectations

*p < .001

1

2

3

4

5 Malesn = 26

Femalesn = 192

Me

an

fre

que

ncy

of s

tigm

atis

atio

n

› How often are you subjected to the attitude or belief that you are “less of a man/woman” because of your eating disorder?

- 5 = always

- 4 = often

- 3 = sometimes

- 2 = rarely

- 1 = never

› Size of this effect size is moderate (η2 = .07)

Gender-role stigmatisation in eating disorders

*p < .001

Directions for future research

N = 173

› Is stigma associated with more negative attitudes about seeking psychological treatment in people with eating disorders?

- N = 173Aspect of eating disorder

stigmatisationNegative attitudes about seeking

psychological treatment

Alienation r = .40***Stereotype endorsement r = .30***Discrimination experience r = .25**Social withdrawal r = .36***Perceived devaluation & discrimination

r = .36***

Conclusions

N = 173

› Anorexia nervosa is stigmatised more than muscle dysmorphia

› Undergraduate men in first-year psychology stigmatise people with these conditions more than undergraduate women

› In broad terms, male characters with anorexia or muscle dysmorphia are not stigmatised more than female characters

› However, characters with anorexia nervosa are perceived as much less masculine than people with muscle dysmorphia

- Even after accounting for the sex of the character

- Undergraduate men exhibit this stigma more than women

› Perception that people with anorexia nervosa are stigmatised as less masculine is supported by emerging results from men with anorexia nervosa