Background: Disordered eating in young women is positively associated with their admiration for women with anorexia nervosa. However, little is known about sex differences in this association, or whether the association extends to muscle dysmorphia. Aims: The present study aimed to investigate sex differences in the associations between young peoples’ disordered eating and their admiration for people with anorexia nervosa and muscle dysmorphia. Method: Male (n = 174) and female (n = 325) undergraduates read one of four descriptions of a male or female character with anorexia nervosa or muscle dysmorphia. Participants then answered questions about their admiration for the characters and completed a measure of disordered eating. Results: Averaged across character diagnosis and character sex, female participants expressed greater desire to be like the characters than males. For females, moderate to large positive correlations were observed between disordered eating and admiration for characters with both anorexia nervosa and muscle dysmorphia. For males, moderate positive correlations emerged between disordered eating and admiration for muscle dysmorphia, and a single small positive correlation was observed for anorexia nervosa. Conclusions: The results indicate important sex differences in the associations between young peoples’ disordered eating and their admiration for anorexia nervosa and muscle dysmorphia.

1. Scott Griffiths | Prof. Stephen Touyz | Dr. Stuart Murray | A/Prof Jonathan Mond
SEX DIFFERENCES IN THE LINKS BETWEEN
YOUNG PEOPLE’S DISORDERED EATING AND
THEIR ADMIRATION FOR PEOPLE WITH
ANOREXIA NERVOSA AND MUSCLE
DYSMORPHIA

2. Introduction – positive beliefs about anorexia
› People with anorexia nervosa may percieve their symptoms as positive or
comforting (Guarda, 2008)
- Delayed treatment seeking
- Poor engagement with treatment
- Treatment refusal
› Young people's positive beliefs about people with anorexia nervosa are
associated with higher levels of eating disorder symptoms. (Mond,
Robertson-Smith, & Vetere, 2006)
2

3. Introduction – limitations of current research
› To date, research on admiration for people with eating disorders has been
confined to:
- The positive beliefs held by young women…
- about women with anorexia nervosa.
› It is unclear whether sex differences qualify the association between
admiration and disordered eating
- Need to examine the beliefs of young men
- Need to examine the influence of the sex of the eating disorder sufferer
- Need to examine the "predominant male experience" of disordered eating/body
dissatisfaction
- Muscle dysmorphia, and
- Muscularity-oriented disordered eating
3

4. 4
Introduction – muscle dysmorphia
› "Discovered" in 1993 and named "reverse
anorexia" (Pope, Katz & Hudson, 1993)
› Renamed "muscle dysmorphia" in 2001
› Criteria
- Preoccupation with being lean and muscular
- At least 2 of the following:
- Giving up important activities due to a
compulsive need to work out and diet
- Avoiding body exposure/enduring body
exposure with intense anxiety and distress
- The preoccupation with body size/musculature
causes impairments in important activities
- Continuing to work out, diet or use steroids
despite knowledge of adverse physical or
psychological outcomes

5. 5
Muscle dysmorphia
› Mean age: 25 years
› Insight into their preoccupation: 50%
› Steroid use: ~36%
› Gay men overrepresented
› Current or past history of an eating disorder: ~18%
› Lower quality of life; poorer mental health and interpersonal functioning
› Suicide attempts: ~50%
› Lifetime history of substance abuse: 85.7%
› Lifetime history of a mood disorder: 74% to 85.7%
› On average, report spending 4 hours per day thinking about getting bigger
› On average, check mirrors 13 times per day

6. 6
Study aims and hypotheses
› Aim
- To investigate sex differences in the associations between young
peoples' disordered eating and their admiration for people with anorexia
nervosa and muscle dysmorphia
› Hypotheses:
- #1 Young women's disordered eating would be positively correlated with
their admiration for anorexia nervosa
- #2 Young men's disordered eating would be positively correlated with
their admiration for muscle dysmorphia

7. 7
Methods - participants
› Data excluded if participants…
- failed both valid-responding checks (n = 11), did not complete more than 50% of
the survey (n = 5), were over 25 years of age (n = 17), or were transgender (n =
1).
› Final sample (N = 499)
- 160 males, 288 females
- 16 to 25 years of age (M = 19)
- Mostly Australian (56.7%) or Asian (26.4%) background
- BMI from 15.52 to 47.18 (M = 22.50, SD = 3.87)
- Men only (M = 23.92, SD = 3.52)
- Women only (M = 21.74, SD = 3.83)

8. 8
Methods – materials and measures
› Character descriptions
- Man ("Michael") or woman ("Kelly") with anorexia nervosa or muscle dysmorphia
- Adapted from Griffiths, Mond, Murray & Touyz (2013)
› Positive beliefs
- "How much do you admire Kelly/Michael's ability to control his/her eating?"
- "How much do you admire Kelly/Michael's abiliuty to control his/her exercise?"
- "Have you ever thought it might not be too bad to be someone like Kelly/Michael?"
- Adapted from Mond and colleagues (2004, 2006)
› Disordered eating
- Thinness-oriented disordered eating = global score on the EDE-Q
- Muscularity-oriented disordered eating = global score on the modified EDE-Q
- Adapted from Murray et al. (2012) and Griffiths, Murray, & Touyz (2013)

9. Anorexia Nervosa
Muscle
Dysmorphia
Anorexia Nervosa
Muscle
Dysmorphia
Methods – participants randomly allocated to read 1 of
4 character descriptions (between subjects design)
N = 499

10. 1
2
3
4
5
Admire
eating
Admire
exercise
Desire to
be like
Male
participants
Female
participants
Positive belief
Levelofendorsement
› Main effects of
participant sex
- Averaged over character
sex and character
diagnosis
› Young women
endorsed a stronger
desire to be like the
characters than young
men
- η2 = .03 (small effect)
Results – main effects of participant sex
**
** p < .01

11. 1
2
3
4
5
Admire
eating
Admire
exercise
Desire to
be like
Male
participants
Female
participants
Positive belief
Levelofendorsement
› Main effects of
character sex
- Averaged over
participant sex and
character diagnosis
› No significant main
effects of character sex
Results – main effects of character sex

12. 1
2
3
4
5
Admire
eating
Admire
exercise
Desire to
be like
Muscle
dysmorphia
Anorexia
nervosa
Positive belief
Levelofendorsement
› Main effects of
character diagnosis
- Averaged over
participant sex and
character sex
› Characters with muscle
dysmorphia elicited
more…
- admiration for their
ability to control their
eating (η2 = .10, large
effect) and exercise (η2
= .03, small effect)
- desire to be like them
(η2 = .03, small effect)
Results – main effects of character diagnosis
***
***
***
*** p < .001

13. Results - correlations
1. 2. 3. 4. 5.
1. Thinness-oriented disordered eating
- .83*** .11 .16 .19
2. Muscularity-oriented disordered eating
.94*** - .21 .18 .24*
3. Admiration for character’s control over
eating
.40*** .37*** - .54**
*
.23*
4. Admiration for character’s control over
exercise
.35*** .33*** .69*** - .33**
5. Desire to be someone like the
character
.58*** .55*** .37*** .42** -
› Correlation coefficients for male and female participants who read about the
characters with anorexia nervosa.
› Correlations for male participants and female participants appear above the
diagonal and below the diagonal respectively.

14. Results - correlations
1. 2. 3. 4. 5.
1. Thinness-oriented disordered eating
- .87*** .20 .07 .32**
2. Muscularity-oriented disordered eating
.95*** - .15 .04 .31**
3. Admiration for character’s control over
eating
.37*** .39*** - .66**
*
.42**
*
4. Admiration for character’s control over
exercise
.41*** .46*** .82*** - .49**
*
5. Desire to be someone like the
› Correlation coefficients for male and female participants who read about the
characters with muscle dysmorphia.
› Correlations for male participants and female participants appear above the
diagonal and below the diagonal respectively.

15. 15
Discussion – Hypotheses
› #1 Young women's disordered eating would be positively
correlated with their admiration for anorexia nervosa
- Broadly supported
- Young women's disordered eating was significantly positively
correlated with admiration for control over eating and exercise, and
desire to be like the character with anorexia nervosa
› #2 Young men's disordered eating would be positively correlated
with their admiration for muscle dysmorphia
- Limited support
- Young men's disordered eating was significantly positively correlated
only with desire to be like the character with muscle dysmorphia

16. 16
Discussion
› Young women's disordered eating was positively correlated with
admiration for both anorexia nervosa and muscle dysmorphia
- Could this reflect a general admiration for anyone who is able to successfully
exert control over their eating and exercise?
› Young men's disordered eating more strongly associated with admiration
for muscle dysmorphia than anorexia nervosa insofar as they desired to
be like the character
- But no associations with admiration for ability to control eating or exercise.
- Could this suggest that young men's desire to be like someone with muscle
dysmorphia is based on some other factor, for example, the masculinity of men
with muscle dysmorphia?
- Young men perceieve characters with muscle dysmorphia as more masculine
than characters with anorexia nervosa (Griffiths, Mond, Murray, & Touyz, 2013)

17. 17
Limitations and conclusion
› Limitations
- Lack of published psychometric data for modified EDE-Q
- Small number of items used to assess "admirability/desirability"
- Issues of generalisability inherent in the recruitment of a university sample
› Conclusions
- There are sex differences in the association between young people's disordered
eating and their admiration for people with anorexia nervosa
- The association between young people's disordered eating and their admiration
for people with anorexia nervosa also extends to people with muscle dysmorphia
- There are sex differences in the association between young people's disordered
eating and their admiration for people with muscle dysmorphia