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Evolving eating disorder psychopathology: Conceptualising muscularity-oriented disordered eating

  • Stuart B. Murray (a1), Scott Griffiths (a2) and Jonathan M. Mond (a3)
Summary

Eating disorders, once thought to be largely confined to females, are increasingly common in males. However, the presentation of disordered eating among males is often distinct to that observed in females and this diversity is not accommodated in current classification schemes. Here, we consider the diagnostic and clinical challenges presented by these distinctive presentations.

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Copyright
Corresponding author
Dr Stuart B. Murray, Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143, USA. Email: stuart.murray@ucsf.edu
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Mitchison, D, Hay, P, Slewa-Younan, A, Mond, JM. The changing demographic profile of eating disorder behaviors in the community. BMC Public Health 2014; 14: 943.
2 Griffiths, S, Mond, JM, Murray, SB, Touyz, S. The prevalence and adverse associations of stigmatization in people with eating disorders. Int J Eat Disord 2015; 48: 767–74.
3 Mond, JM. Eating disorders ‘mental health literacy’: an introduction. J Ment Health 2014; 23: 51–4.
4 Pope, HG, Phillips, KA, Olivardia, R. The Adonis Complex: How to Identify, Treat, and Prevent Body Obsession in Men and Boys. Free Press, 2002.
5 Eisenberg, ME, Wall, M, Neumark-Sztainer, D. Muscle-enhancing behaviours among adolescent girls and boys. Pediatrics 2012; 130: 1019–26.
6 Field, AE, Sonnenville, KR, Crosby, RD, Swanson, SA, Eddy, KT, Camargo, CA, et al. Prospective association of concerns about physique and the development of obesity, binge drinking, and drug use among adolescent boys and young adult men. JAMA Pediatrics 2014; 168: 34–9.
7 Murray, SB, Rieger, E, Hildebrandt, T, Karlov, L, Russell, J, Boon, E, et al. A comparison of eating, exercise, shape, and weight related symptomatology in males with muscle dysmorphia and anorexia nervosa. Body Image 2012; 9: 193200.
8 Fairburn, CG, Cooper, Z, Shafran, R. Cognitive behaviour therapy for eating disorders: a ‘transdiagnostic’ theory and treatment. Behav Res Ther 2003; 41: 509–28.
9 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). APA, 2013.
10 Veale, D, Matsunaga, H. Body dysmorphic disorder and olfactory reference disorder: proposals for ICD-11. Rev Bras Psiquiatr 2014; 36: S1420.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Evolving eating disorder psychopathology: Conceptualising muscularity-oriented disordered eating

  • Stuart B. Murray (a1), Scott Griffiths (a2) and Jonathan M. Mond (a3)
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eLetters

Evolution shapes vulnerability and not disorders: Dispelling common misunderstandings

Riadh T Abed, Psychiatrist, Mental Health Tribunals, Ministry of Justice, England
14 November 2016

While I am grateful to Murray et al for taking the time to respond to my letter regarding the importance of the evolutionary perspective on eating disorders and especially the new male variant of 'drive for muscularity', I cannot conceal my disappointment at the misunderstandings contained in their response. By way of clarification I would like to make the following points:

1. A common error made by critics of the evolutionary approach is the assumption that diseases and disorders are shaped by selection when it is the vulnerability to disorder that is shaped and not the disorder itself (Nesse & Williams, 1996). Therefore, an understanding of the evolutionary roots of vulnerability to disorder is fundamentally important to answering the question of why a disorder exists and why it presents in a particular way.

2. The sexual competition hypothesis (SCH) (Abed, 1998) suggests that the vulnerability to eating disorders arises from the process intra-sexual competition that is mismatched to the novel western and westernised urban environments. Crucially, mismatch is a process whereby a novel environment uncovers a vulnerability that had remained dormant in the organism’s natural environment. There is no suggestion anywhere within the hypothesis that eating disorders are adaptive or that they confer an evolutionary advantage on their sufferers. Importantly intra-sexual competition is sexually dimorphic (unlike appetite and hunger for example) and therefore it is likely to result in different vulnerabilities in males and females, resulting in dimorphic presentations. Hence my suggestion in my original response to the authors that the new variant of the drive for muscularity in males can fit in very well (certainly better than any alternative in the current literature) within the SCH framework. It does, therefore, seem somewhat hasty of the authors to summarily dismiss my suggestion on the grounds that all current data on SCH relate to the drive for thinness (the female variant of eating disorder).

3. Science advances through the generation of hypotheses that have better explanatory value than existing ones and then proceeds by testing the predictions these hypotheses make. Therefore, proposing an explanatory hypothesis will have to occur prior to the availability of empirical data but Murray et al appear to unreasonably object to this approach.

References:

1. Nesse, RM, Williams, GC. Why We Get Sick: The New Science of Darwinian Medicine. Vintage Books, 1996.

2. Abed, R. The sexual competition hypothesis for eating disorders. Br J Med Psychol 1998; 71: 525-47.

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Conflict of interest: None Declared

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Evolving disordered eating psychopathology neglects to cite evolutionary theories

Riadh T Abed, Psychiatrist, Mental Health Tribunals, Ministry of Justice, England
06 May 2016

It was disappointing to find that the editorial by Murray et al (1) ‘Evolving eating disorder psychopathology: conceptualising muscularity-oriented disordered eating’ made no mention of evolutionary formulations of eating disorders despite the somewhat suggestive title. This is a significant omission as evolutionary theories provide a cogent explanatory framework not only for the newly described male variant of eating disorder referred to in the article but also for eating disorders as a whole. Also, the editorial’s title promised to deliver a new conceptual framework for eating disorders in the light of this new variant but then all it did was produce the familiar tautology regarding cultural body ideals that have had such poor explanatory value in the case of female eating disorders. The formulation’s lack of predictive power has meant that little if any progress has been made in the past few decades in researching the aetiology of these conditions despite the huge quantities of data collected. The weakness of the cultural norm (of desirable shape, beauty etc.) formulation is evident from the fact that it attempts to explain the phenomena of eating disorder by assigning causation to the very thing it is meant to explain (e.g. the drive for thinness in women or muscularity in men).

Hence, if these society ideals are arbitrary and not related to any underlying biologically based motives, we should observe the reverse pattern in some societies (e.g. more men than women wishing to be thinner and more women than men wishing to be more muscular) but there is no evidence of such a scenario.

The Sexual Competition Hypothesis (SCH) for eating disorders (2) is an evolutionary formulation that can help answer the ‘why’ question that has so far defeated mainstream, non-evolutionary theories. It proposes that all eating disorders stem from the phenomenon of intra-sexual competition taken to pathological extremes. In the case of females, competition is primarily through the display of signs of youth (where thinness is a marker for youth). Youth is a major determinant of reproductive potential in females whereas men compete among themselves through the display of physical dominance and prowess which is enhanced through the size and muscularity of the upper body. The increase in the rates of eating disorders in the last several decades in western and westernised countries is explained by the ‘mismatch’ between the human psychological systems for mate attraction and retention and for competing with same sex rivals that evolved in small scale societies on the one hand and the novel realities of the modern urban western environment on the other.

The SCH has been supported by findings of studies of disordered eating in non-clinical populations (female undergraduates) both in the US (3) and the UK (4). Further support for the predictions made by SCH came from another US study of disordered eating in a non-clinical population of male and female homosexual and heterosexual subjects (5).

The consistency of the clinical features of eating disorder across different developed countries as well as their persistence (or even rising levels) argues strongly against the arbitrary cultural standard view dominant in eating disorder circles and in favour of a model where these disorders are the outcome of a gene-environment interaction.

References:

1.Murray, S.B., Griffiths, S. & Mond, J.M. Evolving eating disorder psychopathology: Conceptualising muscularity-oriented disordered eating. Br J Psychiatry 2016; 208: 414-415.

2.Abed, R. The sexual competition hypothesis for eating disorders. British Journal of Medical Psychology, 1998; 71: 525–547.

3.Faer, L., Hendriks, A., Abed, R., & Figueredo, A. J. The evolutionary psychology of eating disorders: Female competition for mates or status? Psychology and Psychotherapy, Theory Research and Practice 2005; 78: 397–417.

4.Abed, R., Mehta, S., Figueredo, A. J., Aldridge, S., Balson, H., Meyer, C., & Palmer, R. Eating disorders and intrasexual competition: Testing an evolutionary hypothesis among young women. TheScientificWorldJOURNAL 2012; http://www.tswj.com/2012/290813/

5.Li, N. P., Smith, A. R., Griskevicius, V., Cason, M. J., & Bryan, A. Intrasexual competition and eating restriction in heterosexual and homosexual individuals. Evolution and Human Behavior 2010; 31: 365–372.

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