The nature and extent of stigma towards individuals with anorexia nervosa and muscle dysmorphia remains underexplored. This study investigated attitudes and beliefs likely to be conducive to stigmatisation of individuals with these conditions. Male and female undergraduate students (N = 361) read one of four vignettes describing a fictional male or female character with anorexia nervosa or muscle dysmorphia, after which they responded to a series of questions addressing potentially stigmatising attitudes and beliefs towards each character. Characters with anorexia nervosa were more stigmatised than characters with muscle dysmorphia, female characters were more stigmatised than male characters, and male participants were more stigmatising than female participants. A very large effect of character diagnosis on masculinity was observed, such that characters with anorexia nervosa were perceived as less masculine than characters with muscle dysmorphia, and this effect was more pronounced amongst male participants. However, no significant corresponding effects were observed for femininity. Females with anorexia nervosa may be particularly susceptible to stigmatisation, especially by males. Anorexia nervosa and muscle dysmorphia are perceived as “female” and “male” disorders respectively, in line with societal gender role expectations, and this stigmatisation is tied more strongly to perceptions of sufferers’ masculinity than femininity.

1. STIGMATISATION OF ANOREXIA
NERVOSA AND MUSCLE
DYSMORPHIA
Griffiths, S., Mond, J. M., Murray, S. B., & Touyz, S. (In-press). Young
peoples’ stigmatizing attitudes and beliefs about anorexia and muscle
dysmorphia. International Journal of Eating Disorders.
doi:10.1002/eat.2222

2. Sex differences in eating disorder prevalence
100%
10%
50%
75%
70%
60%
50%
90%
50%
25%
30%
Anorexia
Nervosa
Bulimia
Nervosa
40%
0%
Binge Eating
Disorder
EDNOS
Muscle
Dysmorphia
MenWomen
(Hoek&Hueken, 2003; Hudson et al. 2007; Madden et al. 2009; Muise et al. 2003)
2

3. Two ends of a spectrum?
Anorexia nervosa
Muscle dysmorphia
3

4. Stigma and eating disorders
› Eating disorders are stigmatised
› People with anorexia = attention seekers who are personally
responsible for their illness (Crisafulli; Holle, &Bulik, 2008;
Crisp, Gelder, Rix, Meltzer, &Rowlands, 2000; Mond, RobertsonSmith, &Vetere, 2006; Roehrig& McLean, 2010)
› Stigma is assumed to be the reason why so few males are in treatment
› Eating disorders are a “girl's problem" (Robinson et al. 2012)
› However, studies examining stigma toward male and female eating
disorder sufferers have found few (if any) differences
(Wingfield, Kelly, Serdar, Shivy, &Mazzeo, 2011)
4

5. Masculinity, stigma and eating disorders
› Adherence to masculine norms is consistently negatively associated with
men’s willingness to seek professional help (Addis &Mahalik, 2003;
Courtenay, 2000; Levant & Richmond, 2007; Manfield, Addis
&Mahalik, 2003; O’Neil, 2008)
› Especially resistant to taking medication (Berger et al. 2013)
› Men prefer talk-therapy with a psychotherapist over other forms of
professional help-seeking (Berger et al. 2013)
› Men react more positively to seeking professional treatment at the
suggestion of a psychotherapist compared with a medical doctor or
romantic partner (Berger et al. 2013)
5

6. Exploring stigma toward anorexia and muscle
dysmorphia
Anorexia Nervosa
N = 343
Anorexia Nervosa
Muscle
Dysmorphia
Muscle
Dysmorphia

7. Main effects of participant sex (male or female)
Higher for female participants
Higher for male participants
Large Medium
Small
X
The character is…
Weird
X
X
X
X
Narcissistic
An attention-seeker
Less likely to be talked to
about their problem by
the participant
Less likely to be watched
or monitored by the
participant
X
Less likely to be watched
or monitored by others
Small
Medium
Large

8. Main effects of character sex (male or female)
Higher for female characters
Higher for male characters
Large Medium
Small
X
The character is…
Small
Medium
Large
Masculine
Feminine
X
More likely to be
watched/monitored
X
More uncomfortable to
talk to
X
More psychologically
fragile
Less likely to recover
easily
X
X
X
Less likely to be
discriminated against

9. Main effects of character diagnosis (anorexia or muscle dysmorphia)
Higher for muscle dysmorphia
Higher for anorexia nervosa
Large
Small
The character is…
X
Unintelligent
X
Medium
Less competent than their peers
X
Self-destructive
X
Will put strain on your
friendship
X
Likely to be watched or monitored
by the participant
X
Likely to be watched or monitored
by others
Likely to recover easily
X
Likely to be talked to about their
problem by the participant
X
X
Small
Going to require caution so as to
not upset them
Physically fragile
X
Medium
Large

10. Stigma and gender-role expectations
Mean perceived masculinity
5
Male
*p< .001
4
participants
n = 113
› To what extent do you agree
with the following statement:
Kelly/Michael is masculine
Female
participants
n = 230
3
- 5 = strongly agree
- 4 = agree
- 3 = neither agree nor disagree
- 2 = disagree
- 1 = strongly disagree
2
› Size of this effect size is very
large (η2 = .23)
1
Anorexia
Muscle
nervosa dysmorphia
Character diagnosis
- Even stronger for male
participants (interaction η2 =
.03, p = .002)

11. Gender-role stigmatisation in eating disorders
Mean frequency of stigmatisation
5
*p< .001
4
Males
n = 26
Females
n = 192
› How often are you subjected to
the attitude or belief that you are
“less of a man/woman”
because of your eating disorder?
- 5 = always
- 4 = often
3
- 3 = sometimes
- 2 = rarely
- 1 = never
2
1
› Size of this effect size is
moderate (η2 = .07)

12. Directions for future research
› Is stigma associated with more negative attitudes about seeking
psychological treatment in people with eating disorders?
- N = 173
Aspect of eating disorder
N = 173 stigmatisation
Alienation
Stereotype endorsement
Discrimination experience
Social withdrawal
Perceived devaluation&
discrimination
Negative attitudes about seeking
psychological treatment
r= .40***
r= .30***
r= .25**
r= .36***
r= .36***

13. Conclusions
› Anorexia nervosa is stigmatised more than muscle dysmorphia
› Undergraduate men in first-year psychology stigmatise people
with these conditions more than undergraduate women
› In broad terms, male characters with anorexia or muscle
dysmorphia are not stigmatised more than female characters
N = 173
› However, characters with anorexia nervosa are perceived as
much less masculine than people with muscle dysmorphia
- Even after accounting for the sex of the character
- Undergraduate men exhibit this stigma more than women
› Perception that people with anorexia nervosa are stigmatised as
less masculine is supported by emerging results from men with
anorexia nervosa