Body Image Concerns Among Male Adolescents with AN

In what is believed to be the first study of the perception of body image and eating attitudes among male teenagers with anorexia nervosa (AN), Araceli Gila, PhD and co-workers at the University of Barcelona found distinct differences between male patients with AN and control subjects from the general population (J Adolescent Health 2005; 36: 221).

The patient group was made up of 30 boys and male adolescents aged 11 to 18 who fulfilled the DSM-IV diagnostic criteria for AN. The comparison group was made up of 421 boys of similar social and cultural backgrounds from the general population attending nine different schools. They were also 11 to 18 years of age.

The Subjective Body Dimensions Apparatus (SBDA) is a cylindrical pole 190 cm high supported by a base. The pole has several holders to support small sticks that represent different parts of the body—shoulders, waist, thorax, hips, thighs, and calves. On both sides of the sticks are several rings with a string passing through them, which can adjust the position of the sticks, changing the overall silhouette. A researcher works with the subject to develop a body image that is equivalent to one that would be seen in a full-length mirror, and the final subjective image is compared with the real silhouette. Eating attitudes were evaluated with the Eating Attitudes Test in the 26-question version (EAT-26). The Eating Disorders Inventory (EDI) was also administered to 19 anorexic patients and 200 boys from the comparison group.

The mean age of the two groups was similar but there were statistically significant differences in height, weight, body mass index (BMI, kg/m2) and total EAT-26 score. In the EDI scales, on the Body Dissatisfaction scale showed statistically significant differences between the two groups. Among anorexic patients, the correlation between BMI and the EAT score was particularly high and negative. The Drive for Thinness scale had a high and positive correlation with the EAT score and a high but negative correlation with age.

Both groups overestimated body size

Male teens from the general population overestimated all parts of their bodies, especially the thorax, waist, and hips. However, the overestimations by the anorexic patients were greater in most measures than those of the controls. The differences between the groups in shoulders, hips, and thighs were statistically significant. The fact that male adolescents overestimate some parts of the body more than others may indicate that they are concerned with specific areas of the body. The authors noted that the global percentage of overestimation in boys (14.8%) did not differ greatly from that found in girls from the general population using the same technique (11.5%).

Thus, anorexic boys overestimate certain parts of their bodies more than do boys from the general population and have higher mean scores on the EAT-26 and some EDI scales such as Body Dissatisfaction. Other EDI scales do not differentiate between male anorexic patients and persons from the general population, suggesting to the authors that some of the aspects evaluated by this inventory may not be adequate for assessing relevant characteristics of AN in males.