The truth behind "the bigger the better": muscle dysmorphia as an expression of cultural and social standard influence

Body Dysmorphic Disorder (BDD) is a complex scenario characterized by the excessive concern and preoccupation of an imaginary body defect or a slight physical anomaly. Since its inclusion in psycho-pathological nosography nearly thirty years ago, BDD evolution through the years has provided an indirect measure of how the sociocultural environment could influences body image perceptions. Multiple factors have collaborated in these changing parameters, with a major responsibility certainly ascribable to the entertainment business and its notable capability to promote and establish new standards in terms of beauty and physical attractiveness. Additionally, technological advancement and world-wide-web exponential enlargement have substantially contributed into the spreading of new ideas of the "healthy" and "attractive" male and female body. On one side, this complex amalgam of social, psychological and cultural factors have generated a wholesome drive to improve one's own body shape and reach new social status through this, with an increase of self-efficacy, self-esteem and other psychological features ascribed to an increased well-being. On the other hand, there have been some distortions in body image standard setting, with the onset of previously unimaginable pathological conditions like muscle dysmorphia (MD), a subtype of BDD also known as "reverse anorexia". In the last 20 years, several authors have reported evidence of body image disturbances in male and female weightlifters, with an MD prevalence higher than what could be expected, especially in non-professional bodybuilders and, more importantly, also in non-competing gyms customers. Moreover, a cultural-dependentmodulation of MD expression seems present, as we recently documented in a study on Italian professional and non-professional bodybuilders, where a different organization of MD symptoms have been found in respect to US bodybuilders. In this chapter, we will cover all principal features of BDD and MD, in terms of their diagnostic criteria and treatment opportunities, and subsequently discuss possible cultural and gender related differences linked to muscularity and physical attractiveness in modern society. © 2013 Nova Science Publishers, Inc

Borderline, avoidant, sadistic personality traits and emotion dysregulation predict different pathological skin picking subtypes in a community sample

Andrea Pozza,1,2 Nicoletta Giaquinta,2,3 Davide Dèttore4 1Department of Experimental and Clinical Medicine, University of Florence, Florence, 2Miller Institute of Behavioral and Cognitive Psychotherapy, Genoa, 3Centre of Cognitive and Behavioural Therapy (CTCC), Florence, 4Department of Health Sciences, University of Florence, Florence, Italy Abstract: Pathological skin picking (SP) is a strongly impairing condition characterized by repetitive picking behaviors resulting in significant tissue damage and distress. Recent research suggested the presence of different subtypes of SP. No study has investigated which personality traits could be specifically associated with different subtypes. In a community sample (N=285, 71.20% females, mean age =34.98 years, standard deviation =15.91), this cross-sectional study investigated which personality traits and emotion regulation deficits could predict specific SP subtypes. Participants completed the Milwaukee Inventory for the Dimensions of Adult Skin Picking (MIDAS), Millon Clinical Multiaxial Inventory-III personality scales (MCMI-III), and Difficulties in Emotion Regulation Scale (DERS) questionnaires. Higher scores on the MCMI-III borderline (β=0.28, t=4.88, P<0.001), MCMI-III avoidant scale (β=0.18, t=2.59, P<0.01), and DERS difficulties engaging in goal-directed behavior (β=0.19, t=3.27, P<0.01) predicted higher scores on the MIDAS automatic scale. Higher scores on the MCMI-III borderline (β=0.30, t=5.23, P<0.001) and DERS difficulties engaging in goal-directed behavior (β=0.15, t=2.52, P<0.05) and DERS limited access to emotion regulation strategies (β=0.21, t=3.26, P<0.01) predicted higher scores on the MIDAS focused scale. Higher scores on the MCMI-III sadistic (β=0.19, t=3.30, P<0.001) and DERS difficulties engaging in goal-directed behavior (β=0.15, t=2.68, P<0.01) predicted higher scores on the MIDAS mixed scale. Implications for future research and treatment are discussed. Keywords: skin picking, personality traits, emotion dysregulation, subtypes, MIDA

Psychological characteristics of Italian gender dysphoric adolescents: a case–control study

Purpose Gender dysphoria (GD) is associated with clinically significant distress and impairment in social, scholastic, and other important areas of functioning, especially when early onset is reported. The aim of the present study is to assess the psychopathological features associated with GD in adolescence, comparing a group of gender dysphoric adolescents (GDs) with a group of non-referred adolescents (NRs), in terms of body uneasiness, suicide risk, psychological functioning, and intensity of GD. Methods A sample of 46 adolescents with GD and 46 agematched NRs was evaluated (mean ± SD age = 16.00 ± 1.49 and 16.59 ± 1.11 respectively, p > 0.05). Subjects were asked to complete the Body Uneasiness Test (BUT) to explore body uneasiness, the Youth Self Report (YSR) to measure psychological functioning, the Multi-Attitude Suicide Tendency Scale (MAST) for suicide risk, and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA) for GD assessment. Results Adolescents with GD reported significantly higher levels of body uneasiness (BUT-GSI, F = 380.13, p < 0.0001), as well as a worse psychological functioning (YSR, F = 13.06 and p < 0.0001 for “total problem scale” and F = 12.53, p = 0.001 for “internalizing” scale) as compared to NRs. When YSR subscales were considered, GDs showed significantly higher scores in the “withdrawal/ depression”, “anxiety/depression”, and “social problems” (all p < 0.0001). In addition, GDs showed significantly higher levels in the “attraction to death” and “repulsion by life” scales and lower scores in the “attraction to life” scale (all p < 0.0001). Finally, GIDYQ-AA score was significantly lower (meaning a higher level of gender dysphoria symptoms) in GDs vs. NRs (p < 0.0001). Conclusions GD adolescents reported significantly higher body dissatisfaction and suicidal risk compared to NRs. In addition, results confirmed a significant impairment in social psychological functioning in adolescents with GD