Confirmatory Factor and Measurement Invariance Analyses of the Drive for Muscularity Scale in Sexual Minority Men and Women.

The Drive for Muscularity Scale (DMS) is a commonly used measure used to assess the pursuit of muscularity. However, the factor structure of this measure has yet to be confirmed in a sample of sexual minority women. Moreover, the invariance of this measure across gender has also yet to be explored. The aim of the present study was, therefore, to conduct a confirmatory factor analysis (CFA) of the DMS in samples of both cisgender sexual minority men and women, and subsequently evaluate the measurement invariance by gender. The sample consisted of 962 cisgender sexual minority young adult men (N = 479) and women (N = 483). A series of CFAs were conducted, assessing both the one-factor and two-factor solutions of the DMS, with and without the inclusion of item 10 ("I think about taking anabolic steroids"). Across cisgender sexual minority young adult men and women, the 14-item two-factor solution demonstrated most appropriate fit, although the 15-item two-factor solution was also adequate among only women. Measurement invariance analyses indicated that the 14-item two-factor DMS can be used in samples of both cisgender sexual minority men and women. The present study was novel in exploring the factor structure of the DMS in sexual minority women and measurement invariance by gender; however, future research is needed to further corroborate these findings and assess measurement invariance by sexual orientation and race.

Exploring moderators of mirror exposure on pre- to post changes in body image outcomes: Systematic review and meta-analysis.

PURPOSE: Mirror exposure (ME) is embedded within cognitive behavioral treatment of body image concern (BIC), and existing literature demonstrates its potential value as a BIC intervention. The purpose of the study is to provide a meta-analytic review of ME effects on attitudinal and behavioral BIC. METHODS: Twelve studies met inclusion criteria, yielding six between-group and 18 within-group comparisons. RESULTS: Random effects models demonstrated a medium effect of ME versus control conditions, on attitudinal BIC, from pre- to immediate posttreatment, small effect at follow-up (1 to 4 weeks posttreatment), and large effect on behavioral BIC pre- to immediate posttreatment. However, small sample sizes yielded nonsignificant findings and significant heterogeneity. Exploratory moderator analyses-ME type, ME dosage (session frequency, duration), and diagnosis-demonstrated that, among single group pre-post designs, higher ME dosage may be instrumental to pre-posttreatment improvements. Consistent with this finding, individual studies with high dosages of ME demonstrated the largest effect sizes. Conclusion: Results may suggest a strong ME effect on BIC at high dosages (>120 minutes). The current review highlights gaps in ME literature and the need for future clinical trials assessing ME, using a priori, high-quality research designs that further the understanding of ME's mechanisms of change.

Confirmatory factor and measurement invariance analyses of the Eating Disorder Examination Questionnaire in sexual minority men and women.

OBJECTIVE: The present study aimed to investigate the factor structure of the Eating Disorder Examination Questionnaire (EDE-Q) in a large sample of cisgender sexual minority men and women, and subsequently, to evaluate measurement invariance by gender. METHOD: The sample consisted of 962 sexual minority adult men (n = 479) and women (n = 483) who completed online self-report surveys. Confirmatory factor analysis was conducted using two previously supported factor structures (Friborg et al.'s four-factor model and Grilo et al.'s brief three-factor model) as well as the original four-factor structure of the EDE-Q. RESULTS: Results indicated that the best fitting models were Friborg et al.'s four-factor model (CFI = .974, RMSEA = .098, SRMR = .0 70) and Grilo et al.'s brief three-factor model (CFI = .999, RMSEA = .049, SRMR = .017). The model fit of both factor structures were nearly identical when examined separately for men and women. The original four-factor structure could not be supported in this sample. Measurement invariance analyses further indicated that the best fitting models were invariant by gender in sexual minority individuals. Internal consistency was adequate for all subscales of Friborg et al.'s and Grilo et al.'s models. DISCUSSION: The present study provides support for the use of the EDE-Q in sexual minority men and women. Additionally, findings demonstrate that the EDE-Q performs similarly in sexual minority men and women. Future research is needed to further evaluate measurement invariance of the EDE-Q by sexual orientation, gender identity, and race.

Minority stress and body dysmorphic disorder symptoms among sexual minority adolescents and adult men.

Body dysmorphic disorder (BDD) has a prevalence rate of 2.4 % among U.S. adults; however, little is known about BDD among sexual minority men. Minority stressors (fear of rejection, sexual orientation concealment, internalized homophobia, discrimination/prejudice) may be risk factors for BDD in this population. Thus, the purpose of the current study was to estimate the occurrence of BDD in a sample of sexual minority men and investigate associations between minority stressors and BDD. Participants were recruited via social media, and survey data were collected from 268 sexual minority adolescent boys and adult men (M = 24.59 years, SD = 5.37 years). Regression models included either positive BDD screen or levels of BDD symptoms as dependent variables and the four aforementioned minority stressors as explanatory variables. The occurrence rate of positive BDD screens was 49.3 %. Gay-related rejection sensitivity and sexual orientation concealment were uniquely associated with greater BDD symptoms, and sexual orientation concealment was uniquely associated with greater odds of positive BDD screens. Given the high occurrence of positive BDD screens in the current sample, compared to the national prevalence, sexual minority stressors may be worthy to explore in etiological models of BDD in this population.

Cognitive Behavioral Therapy for Body Image and Self-Care (CBT-BISC) among Sexual Minority Men Living with HIV: Skills-Based Treatment Mediators.

Individuals develop coping skills in response to body image distress; however, the degree to which body image improvements are mediated by skill acquisition is unknown. The current study assessed skills-based mediators of CBT-BISC (n = 22) versus enhanced treatment-as-usual (n = 22) for sexual minority men with HIV and body image disturbance. Skills-based mediators included avoidance, appearance fixing, and acceptance and cognitive reappraisal. Results revealed that CBT-BISC significantly reduced body image disturbance and improved coping skills. Latent difference score mediation indicated that changes in acceptance and cognitive reappraisal significantly predicted body image disturbance changes (b = -.96, p = .001). These strategies may, therefore, have a unique role in reducing body image disturbance in sexual minority men with HIV. Clinicians may wish to prioritize these strategies in CBT-BISC. Future treatment research, with methodologically rigorous mediation designs, is needed to assess mechanisms of change and consequently improve efficacy.

Psychosocial correlates of gap time to anabolic-androgenic steroid use.

OBJECTIVE: Theoretically, legal supplement use precedes and increases the risk for illicit appearance and performance enhancing drug (APED) use-also referred to as the gateway hypothesis. Little is known about associations between the speed of progression, or gap time, from legal to illicit APED use, and psychological risk factors, such as sociocultural influence, eating disorders, body image disturbance, and impulsivity. METHOD: The sample taken from two studies included 172 active steroid users (n = 143) and intense-exercising healthy controls (n = 29) between the ages of 18 and 60 (M = 34.16, SD = 10.43), the majority of whom were male (91.9%). Participants, retrospectively, reported APED use and completed measures assessing psychological and behavioral factors, including eating concern, muscle dysmorphia, and impulsivity. Participants had a gap time from initial APED use to anabolic-androgenic steroid (AAS) use that ranged from 0 to 38 years. RESULTS: Continuous survival analysis indicated that interactions between self- versus other sociocultural influence on APED onset and both higher eating concern and impulsivity are associated with a shorter gap time from initial legal to illicit APED use. DISCUSSION: The results indicate the potential value in developing different strategies for individuals with other sociocultural versus self-influence on illicit APED use, and among more impulsive and eating-concerned APED users. Future research is needed to assess different trajectories of APED use, such that eating-concerned and impulsive individuals who perceive less other sociocultural influence may be at greatest risk for a speedier progression to AAS use.

Thinness and muscularity internalization: Associations with disordered eating and muscle dysmorphia in men.

OBJECTIVE: The tripartite influence model of body image identifies internalization of societal body ideals as a risk factor for developing body dissatisfaction, and subsequent disordered eating behavior. In men, internalization of two dimensions of body image ideals, thinness and muscularity, is associated with body dissatisfaction and eating concerns. However, it is unknown how thinness and muscularity internalization interact in predicting muscle dysmorphia and disordered eating in men. METHOD: Data were collected online from 180 undergraduate men, with ages ranging from 18 to 33 years (19.6, SD = 2.6). Regression models were used to test the interactive effects of thinness and muscularity internalization on (a) muscle dysmorphia symptoms and (b) disordered eating. Subsequent simple slope analyses probed effects at the mean, and ±1 standard deviation of thinness internalization. RESULTS: Muscularity and thinness internalization were independently positively related to muscle dysmorphia symptoms and disordered eating. Additionally, a significant interaction revealed that muscularity internalization was increasingly related to muscle dysmorphia symptoms as thinness internalization decreased. DISCUSSION: Men who internalized the muscular ideal had higher levels of muscle dysmorphia when they did not highly internalize the thin ideal. However, greater internalization of both the muscularity and thin ideal independently may be most relevant in the development of disordered eating in men. Future research is needed to explore variability in experiences of muscle dysmorphia compared with disordered eating in males.

Current and ideal skin tone: Associations with tanning behavior among sexual minority men.

Sexual minority men have high rates of skin cancer, yet little is known about skin cancer risk behaviors in this population. It was hypothesized that current skin tone would moderate the association between darker ideals and tanning behaviors. Data were collected online from 231 sexual minority men in San Diego, United States of America, with a mean age of 24.66 (SD = 5.44). Ideal and current skin tone ratings and indoor and outdoor tanning behaviors were assessed. Darker ideals were significantly associated with increased indoor and outdoor tanning. The effect of darker ideals on tanning was strongest among individuals with lighter current skin tone, indicating a significant interaction. Sexual minority men whose perceived skin tone did not match their ideal were more likely to engage in skin cancer risk behaviors. Future skin cancer prevention programs aimed at sexual minority men may consider techniques that modify ideal skin tone internalization.

The eating disorder assessment for DSM-5 (EDA-5): Development and validation of a structured interview for feeding and eating disorders.

OBJECTIVE: Existing measures for DSM-IV eating disorder diagnoses have notable limitations, and there are important differences between DSM-IV and DSM-5 feeding and eating disorders. This study developed and validated a new semistructured interview, the Eating Disorders Assessment for DSM-5 (EDA-5). METHOD: Two studies evaluated the utility of the EDA-5. Study 1 compared the diagnostic validity of the EDA-5 with the Eating Disorder Examination (EDE) and evaluated the test-retest reliability of the new measure. Study 2 compared the diagnostic validity of an EDA-5 electronic application ("App") with clinician interview and self-reported assessments. RESULTS: In Study 1, the kappa for EDE and EDA-5 eating disorder diagnoses was 0.74 across all diagnoses (n = 64), with a range of κ = 0.65 for other specified feeding or eating disorder/unspecified feeding or eating disorder to κ = 0.90 for binge eating disorder. The EDA-5 test-retest kappa coefficient was 0.87 across diagnoses. For Study 2, clinical interview versus App conditions revealed a kappa of 0.83 for all eating disorder diagnoses (n = 71). Across individual diagnostic categories, kappas ranged from 0.56 for other specified feeding or eating disorder/unspecified feeding or eating disorder to 0.94 for BN. DISCUSSION: High rates of agreement were found between diagnoses by EDA-5 and the EDE, and EDA-5 and clinical interviews. Because this study supports the validity of the EDA-5 to generate DSM-5 eating disorders and the reliability of these diagnoses, the EDA-5 may be an option for the assessment of anorexia nervosa, bulimia nervosa, and binge eating disorder. Additional research is needed to evaluate the utility of the EDA-5 in assessing DSM-5 feeding disorders.