Preamble

Eating and body image disorders have typically been considered as the disorders of women, although recent evidence suggests the emergence of these disorders among men as well. The results of the studies conducted over the last two decades indicate that more men report being dissatisfied with their muscularity than before (Grieve, Wann, Henson, & Ford, 2006; Mishkind, Rodin, Silberstein, & Siegel-Moore, 1986; Pope, Phillips, & Olivardia, 2000; Vartanian, Giant, & Passino, 2001). While 25% of men reported muscle dissatisfaction in 1972, this number increased to 32% and 45% in 1985 and 1996 respectively (Berscheid, Walster, & Bohrmstedt, 1973; Cash, Winstead, &

Janda, 1986; Garner, 1997). Several studies have documented muscle dissatisfaction and a desire for a more muscular ideal body among men (Fredrick, Fessler & Hazelton, 2005; Lynch & Zellner, 1999; McCreary & Sasse, 2000; Olivardia, Pope, Borowiecki,

& Cohane, 2004).

According to a theory, women have reached parity with men in many domains of life in the last few decades, and this led to a crisis in masculinity (Pope, Phillips, & Olivardia, 2000). Therefore, muscularity is one of the few characteristics left for men to emphasize their masculinity. In line with this, in cultures where the traditional male roles (e.g., as breadwinners, protectors) have not declined over the years, the pursuit of the muscular ideal has not been found as prevalent (Yang, Gray, & Pope, 2005; overview: Gray &

Ginsberg, 2007). From an evolutionary perspective, the biological and evolutionary factors are believed to define the drive for muscularity in males (i.e., muscular appearance –broad chest, smaller waist) is more attractive to women (Jackson, 2002;

overview: Gray & Ginsberg, 2007).

Besides the evolutionary factors, culture also designates the appealing body. As the gender difference in relating to body appearance decreases, more and more males experience almost the same sociocultural pressure relating to their appearance as the females do (Miller & Halberstadt, 2005; Hungarian review: Túry, Lukács, Babusa, &

Pászthy, 2008). While women experience pressure towards thinness, men often report pressure to obtain and maintain muscularity (Pope, et al., 2001). In the past few years, the number of magazines on male body appearance has been expanding and men now spend considerable amount of money and time on toiletries (Blond, 2008). The increasing body dissatisfaction among males is one of the consequences of these changing societal demands (Jones, Bain, & King, 2008). Males’ body dissatisfaction is often associated with excessive exercise and the use of anabolic-androgenic steroids (Smolak & Stein, 2006).

Body dissatisfaction accompanied by body image distortion can lead to the development of muscle dysmorphia (MD; Grieve, 2007; Pope, Katz, & Hudson, 1993). MD is characterized by a pathological preoccupation with muscle size and muscularity. Men with MD have a pathological belief that they are weak and small, while in reality they look unusually muscular (Olivardia, 2001). This special male body image disorder often causes impairment in social and occupational functioning, distress and adoption of unhealthy behaviours, such as bodybuilding dependence, rigid adherence to dietary regimens, or anabolic-androgenic steroid abuse/dependence (Hale, Roth, DeLong, &

Briggs, 2010; Kanayama, Barry, Hudson, & Pope, 2006; Pope & Katz, 1994).

The preoccupation with the appearance of the body may be as intense and prevalent in males as in females. The bodybuilding or „muscle-building” is a consequence of this intense obsession, and an increasing industry (e.g., fitness rooms, conditioning sports, anabolic steroids, nutritional supplements, cosmetic surgery, etc.) supports this

preoccupation. This is very similar –although with an opposite tendency– to the body image disorders of the female population, resulting in the development of traditional eating disorders (anorexia and bulimia nervosa). These disorders are supported by the slimness ideal, and the fitness and beauty industry.

The phenomenon of this male body obsession causes a challenge to the psychiatry, because most of the cases are underrecognized. According to Pope et al. (2000), “the male body dissatisfaction is a silent epidemic”. In conclusion, the new forms of body image disorders and modern obsessions/addictions need extended research to understand their pathogenesis and ultimately to develop effective therapeutical approaches.

The overwhelming majority of eating disorder literature comes from Western countries, giving the impression that eating disorders are culture bound problems of these regions.

In the last two decades an increasing interest in eating disorders can be observed in Central and Eastern Europe as well. This is due to the relatively high prevalence and incidence rates of anorexia nervosa (AN) and bulimia nervosa (BN) in some countries of this region (Túry, Babusa, Dukay-Szabó, & Varga, 2010; Túry, Babusa, & Varga, 2010).

The vast majority of studies on MD and muscle dissatisfaction among males have also been conducted in Western countries –mostly in the United States. Only little is known about this muscle appearance related body image disorder in the Central-Eastern European region, including Hungary and only few studies examined the body image related disorders, such as MD, among men in other countries than the U.S. The present study fills a niche, since it aimed to examine MD, related psychological correlates, and anabolic-androgenic steroid use in Hungarian male weightlifters. Additionally, exploring cultural differences in the manifestation of male body image disorders (i.e., prevalence rates, morbidity) may improve our understanding of these disorders as the desire for muscularity may vary from culture to culture.