<%BANNER%>

Prediction of Drive for Muscularity by Body Composition and Psychological Factors


PAGE 1

1 PREDICTION OF DRIVE FOR MUSCULARITY BY BODY COMPOSITION AND PSYCHOLOGICAL FACTORS By NICKLES I. CHITTESTER A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLOR IDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2007

PAGE 2

2 2007 Nickles I. Chittester

PAGE 3

3 Dedicated to my parents, Tom and Leanne Chittester.

PAGE 4

4 ACKNOWLEDGMENTS Several people provided their assistance on this project. I would like to give special thanks to Dr. Heather Hausenblas, not only for serving as the chair for this committee, but also for her guidance, assistance, and encouragement on this pr oject and others I have undertaken. I wish to thank the members of my committeeDr. Pete Giacobbi, Dr. Chris Janelle, and Dr. Sam Searsfor their suggestions at various stages of the study. In addition, I would like to thank the numerous class instructors who enabled me to recr uit participants for this study, as well as fellow graduate students Brian Cook, Jessica Doughty, and Anna Campbell for their friendship and support. My fiance, Mindy Mansour, has been a steady source of support during this project, and I wish to express my heartfelt thanks to her for he r love and understanding. Finally, I would like to express the sincerest of appreciation for my pa rents, Tom and Leanne Chittester, for their steadfast and unconditional l ove, support, and encourag ement throughout my life.

PAGE 5

5 TABLE OF CONTENTS page ACKNOWLEDGMENTS...............................................................................................................4 LIST OF TABLES................................................................................................................. ..........7 LIST OF FIGURES................................................................................................................ .........8 ABSTRACT....................................................................................................................... ..............9 CHAPTER 1 INTRODUCTION..................................................................................................................11 2 MATERIALS AND METHODS...........................................................................................22 Subjects....................................................................................................................... ............22 Measures....................................................................................................................... ..........22 Body Fat Percentage........................................................................................................23 FFMI........................................................................................................................... .....23 BMI............................................................................................................................ ......23 Demographic Information...............................................................................................24 Exercise Behavior............................................................................................................24 Eating Pathology.............................................................................................................25 Supplement Use...............................................................................................................25 Sociocultural Pressure.....................................................................................................26 Drive for Muscularity......................................................................................................26 Exercise Dependence.......................................................................................................27 Self-esteem.................................................................................................................... ..27 Procedure...................................................................................................................... ..........28 Data Analysis.................................................................................................................. ........29 3 LITERATURE REVIEW.......................................................................................................31 What Is It?.................................................................................................................... ...........31 Initial Identification......................................................................................................... .......33 Measurement.................................................................................................................... .......33 Heuristic Model of Male Body Change Strategies.................................................................34 Biological Factors............................................................................................................35 Body composition/BMI............................................................................................35 Pubertal growth........................................................................................................37 Pubertal timing.........................................................................................................38 Psychological Functioning..............................................................................................39 Negative affect.........................................................................................................39 Self-esteem...............................................................................................................39 Societal Factors...............................................................................................................40

PAGE 6

6 Media influence........................................................................................................40 Peer and parental influence......................................................................................41 Teasing.....................................................................................................................42 Peer popularity.........................................................................................................43 Social Body Comparison.................................................................................................43 Body-image Dissatisfaction.............................................................................................43 Muscularity...............................................................................................................44 Body fat....................................................................................................................45 Health Risk Behaviors.....................................................................................................46 Steroids.....................................................................................................................46 Steroid precursors.....................................................................................................47 Ephedrine.................................................................................................................49 Dieting to lose weight..............................................................................................50 Dieting to gain weight/increase muscularity............................................................50 Sports......................................................................................................................... ......52 Organized and informal team sports........................................................................53 Weightlifting............................................................................................................53 Other Factors Related to Ma le Body-Image Disturbance.......................................................54 Eating Disorders..............................................................................................................54 Anorexia nervosa......................................................................................................56 Bulimia nervosa........................................................................................................56 Binge-eating disorder...............................................................................................57 Exercise Dependence.......................................................................................................57 Romantic Partners...........................................................................................................59 Summary........................................................................................................................ .........60 4 RESULTS........................................................................................................................ .......63 Descriptive Statistics......................................................................................................... .....63 Multiple Regression Analyses................................................................................................63 5 DISCUSSION..................................................................................................................... ....69 Limitations.................................................................................................................... ..........75 Future Research................................................................................................................ ......78 APPENDIX A LIST OF MEASURES...........................................................................................................84 B RECRUITMENT FLYER......................................................................................................92 LIST OF REFERENCES............................................................................................................. ..93 BIOGRAPHICAL SKETCH.......................................................................................................106

PAGE 7

7 LIST OF TABLES Table page 4 Descriptive statistics for outcome variables.........................................................................65 4 Correlation matrix of outcome variables..............................................................................66 4 Stepwise regression predicting driv e for muscularity using subjective BMI.......................67 4 Stepwise regression predicting dr ive for muscularity using objective BMI.........................68

PAGE 8

8 LIST OF FIGURES Figure page 31 A heuristic model of male body change beha vior; solid arrows i ndicate relationships with greater support than broken arrows...........................................................................62 5 Proposed continua for male body-image disturbance........................................................83

PAGE 9

9 Abstract of Dissertation Pres ented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy PREDICTION OF DRIVE FOR MUSCULARITY BY BODY COMPOSITION AND PSYCHOLOGICAL FACTORS By Nickles I. Chittester May 2007 Chair: Heather A. Hausenblas Major: Health and Human Performance The ideal physique for men that is portra yed in the media is a lean and muscular physique, particularly upper body muscularity. The desire to obtain this ideal physique has resulted in increased body dissatisfaction with in men. High levels of body dissatisfaction may result in a specific drive for muscularity wherein a man holds attitudes that muscularity is crucial to attain; this attitude is often accompan ied by extreme body change behaviors aimed at increasing muscularity. Drive fo r muscularity is associated w ith low self-esteem, exercise dependence, eating pathology, and s ubstance abuse (e.g., anabolic st eroids, dietary supplements). Information on the psychological risk and maintena nce factors of drive for muscularity is sparse. Furthermore, body composition is believed to be an important factor in the drive for muscularity; body mass index (BMI), a simple height-to-weight ratio is most often used, followed by fat-free mass index (FFMI; e.g., the amount of body weight attributable to muscle), and finally body fat percentage. BMI has been associated with ge neral body-image disturbance in men, but this measure of body composition is limited because it doe s not account for weight attributable to musclea key factor in the drive for muscular ity. Thus, it is unclea r which measure of body composition (e.g., BMI, FFMI, body fat percentage ) is most useful in understanding the

PAGE 10

10 physique-related aspect of drive for muscularity. This is critical to understand because whether drive for muscularity is related to actual or perceived degree of musc ularity (similar to the question of actual vs. perceived th inness as it relates to the drive for thinness in women) remains equivocal. This studys objective was to identify the ps ychological and body composition predictors of drive for muscularity. To achieve this, 113 men completed psychological (e.g., self-esteem, exercise dependence, eating pathology, subs tance abuse) and body composition (e.g., BMI, body fat percentage, FFMI) measures. Multiple regression analysis was conducted to determine the psychological and body composition measures that were most predictive of drive for muscularity. The results indicated that drive for muscularity is predicted by weightlifting, supplement use, exercise dependence, and se lf-esteem; however, none of the body composition measures predicted drive for muscularity. Future research efforts should focus on clarifying the role of body composition in drive for muscularit y and on developing interventions that target behaviors (e.g., exercise, supplemen t use) that are associated w ith drive for muscularity.

PAGE 11

11 CHAPTER 1 INTRODUCTION Kostanski, Fisher, and Gullone (2004) argue d that body-image disturbance is so common that it is a normal part of a young womans life. Is it really that comm on? Consider the three following findings (Spitzer, Henderson, & Zivian, 1999): the body mass index (BMI) of Playboy centerfolds decreased from 18.12 in 1977 to 18.03 in 1996 (18.50 is considered the low end of th e normal range; Willett, Dietz, & Colditz, 1999); the BMI of Miss America beauty pageant winners decreased from 19.35 in 1953 to 18.06 in 1985; the BMI of American women has increased from 22.20 in the 1950s to 24.50 in 1990 (24.90 is considered the high end of the normal range; Willett et al., 1999). Based on these findings it is clear that the slimmer female ideal promoted through the media is being viewed by American wome n who are becoming progressively larger. Consequently, several researchers believe that this disparity betw een media representation of the female ideal and the female reality is a main factor in body-image disturbance (e.g., Cattarin, Thompson, Thomas, & Williams, 2000; Spitzer et al., 1999). Recent research, however, indicates that women have less body dissatisfaction than their cohorts from the mid-1990s (Cash, Morrow, Hrabosky, & Perry, 2004). While encouraging, the following caveat exists : Cash et al. (2004) drew these cohorts from the same university, therefore limiting the gene ralizability of this finding. In contrast to recent body-image research on women, body-image disturbance among men is on the rise, in part because of the now-prev alent portrayal of the male ideal in the mass media (Pope, Phillips, & Olivardia, 2000). For ex ample, Spitzer et al. (1999) analyzed the body size of Playgirl centerfolds a nd they found a sharp increase in BMI from 1986 to 1996, while

PAGE 12

12 simultaneously observing an increase in the aver age American mans BMI. At first this may seem congruent, however the increase in body size of the Playgirl centerfolds is attributable to muscle mass, whereas the increase in BMI for Ameri can men is attributable to fat. Indeed, Leit, Pope, and Gray (2001) confirmed this in a simila r study of Playgirl centerfolds. Furthermore, the action figures young boys play with are becoming more muscular. For example, assuming the 1998 Batman action figure stood 5, Pope, Olivardia, Gruber, and Borowiecki (1999) calculated that, given his physical proportions, he would have a 30.3 waist, a 57.2 chest, and 26.8 biceps. These measurements do not represent the typical man, for if Batman were to enter the Mr. Olympia bodybuilding competition he w ould pose a serious threat to usurping the reigning champion (arguably the most muscular ma n on earth), who at a height of 5 has a 58 chest and 24 biceps. Unfortunately, by play ing with extremely muscular action toys, boys are exposed to the muscular ide al at an increasingly younger age. Therefore, despite some limited evidence to the contrary (e.g., Rozin, Trachtenberg, & Cohen, 2001), it appears that a di sparity between the ideal p hysique and reality has also emerged for men. Identifying the time at which men began looking at their bodies with more dissatisfaction is difficult, but C hung (2001) argued that the rise to stardom in the 1980s of bodybuilders such as Arnold Schwarzenegger, who eventually became President George H.W. Bushs Fitness Council head, was one factor According to Chung ( 2001), Schwarzeneggers prominent role as the pinnacle of fitness ina dvertently set the bar higher for what acceptable muscularity is. Indeed, this drive for muscularity, along w ith a simultaneous dissatisfaction with degree of body fat, is the main source of body-image di sturbance in men (Pope, Phillips, et al., 2000). Moreover, some men who possess the ideal physi que nevertheless view themselves as either

PAGE 13

13 small or puny (Pope, Katz, & Hudson, 1993). For exampl e, the individual may adopt a strict diet, forego social engagements and other activities in favor of spending more time in the gym, and in some instances use anabolic steroids to add more muscle mass. In addition, some highly dissatisfied men may engage in other compulsi ve muscle-related behaviors such as mirrorchecking and weigh-ins several times a day (Pop e, Gruber, Choi, Olivardia, & Phillips, 1997). This unique form of male body-image dissatisfa ction, termed muscle dysmorphia, is also associated with mood disorders, anxiety, and di sturbed eating practices (Pope, Phillips, et al., 2000). As with women, body-image disturbance in men is a strong risk factor for eating disorders (Stice, 2002), and it is associated with low se lf-esteem in boys as young as 8 years old (Grilo & Masheb, 2005; McCabe & Ricciardelli, 2003; McCreary & Sasse, 2000). Also, male body-image disturbance is positively associ ated with depression (Kostanski & Gullone, 1998; McCreary & Sasse, 2000; Olivardia, Pope, & Hudson, 2000) which is a stro ng predictor of body dissatisfaction in high school boys (Presnell, Bearman, & Stice, 2004). Finally, some men may exercise excessively to achieve the ideal phys ique, which may lead to exercise dependence (Hausenblas & Symons Downs, 2002a, 2002b; Smith & Hale, 2004; Smith, Hale, & Collins, 1998); which is associated with physical a nd psychological difficulties (e.g., withdrawal symptoms, decreased time spent with family or friends, overuse injuries; Andersen, Cohn, & Holbrook, 2000; Pope, Phillips et al., 2000). Because male body-image disturbance is cente red on a preoccupation with muscularity, a key issue is that this preoccupation will lead to the adoption of unhealthy behaviors to gain muscle and decrease fat. For example, disturbe d eating practices are ofte n observed in men with body-image disturbance (Cafri, Thompson, Ricciarde lli, McCabe, Smolak, & Yesalis, 2005), and

PAGE 14

14 these eating practices have the following two goals: 1) to add muscle mass by eating high amounts of protein, and 2) to re strict foods high in fat conten t to decrease overall adiposity. However, one limitation to unde rstanding these eating behaviors is that they are typically assessed by the use of instruments designed to assess eating disorder pathology (e.g., Eating Disorder Inventory). These m easures do not capture the unique eating behaviors undertaken by individuals whose goal it is to increase muscle mass and shred body fat (e.g., paying close attention to the macronutrient breakdown of each meal consumed). Furthermore, these instruments have been validated in female ea ting disordered samples for whom eating pathology is qualitatively different (i.e., re stricting food intake to decrease body size) when compared to a man who has a high drive for muscularity (i.e ., eating large amounts of food to increase body size in the form of muscle). Therefore, a measure validated in men would add more understanding as to the specific na ture of the eating pathology s een in men attempting to gain muscle. The use of dietary supplements is comm on in men high in drive for muscularity (Kanayama, Pope, & Hudson, 2001). Although popul ar and expensive (Saper, Eisenberg, & Phillips, 2004), they generally show little imp act on muscle mass (Kreider, 1999), and they may promote dependence (Kanayama et al., 2001), and ha ve harmful side eff ects (Haller & Benowitz, 2000). The use of anabolic steroids is also a practice adopted by many me n in their pursuit for muscularity (Chng & Moore, 1990; Cole, Smit h, Halford, & Wagstaff, 2003; Wroblewska, 1997). This is alarming because of the health ri sks associated with anabolic steroid use (e.g., hypertension, disturbed lipid profiles, increase d irritability, increased aggression, body-image disturbance, and mood disturbances; Hartgens & Kuipers, 2004).

PAGE 15

15 Surprisingly, little research has examined body composition in relation to general bodyimage disturbance or drive for muscularity. Inde ed, satisfaction with body composition is critical in determining whether body-image disturbance will develop in men. For example, BMI is related to body-image disturbanc e in men (Kostanski et al., 2 004; Kostanski & Gullone, 1998; Presnell et al., 2004), and this re lationship is either positive or negative depending on whether the body-image disturbance reflects (1) a self-perception that one is too thin, which results in a drive for muscularity; or (2) a self-perception that one is too heavy, which results in simultaneous drives to lose body fat and add mu scle. Two studies (McC abe, Ricciardelli, & Banfield, 2001; McCreary, Karvinen, & Davis, 2006) have found that BMI was negatively correlated with body satisfaction in boys and men respectively. However, McCabe et al. (2001) also found that no correlation between BMI and a desire to increase musc le tone existed. This latter finding is consistent with the findings of McCreary and Sasse (2000) that BMI was uncorrelated with drive for muscularity. Taken to gether, these null findings indicate a need to clarify the relationship between BM I and drive for muscularity. Because BMI does not yield precise estimates of body fat percentage and muscle mass, direct assessment of these latter two meas ures of body composition is preferable when conducting male body-image research. Upon read ing the muscle dysmorphia literature one recognizes the importance of these assessments, yet only McCreary et al. (2006) used BMI, body fat percentage, and muscle mass (expressed as fa t-free mass index [FFMI]) to predict drive for muscularity. They found that BMI was significan tly correlated with both body fat percentage (r = .68) and FFMI (r = .93), and that a moderate yet significant corre lation existed between body fat and FFMI (r = .41; McCreary et al., 2006). Howe ver, the only anthropometric measure that significantly predicted behaviors re lated to drive for muscularity was flexed bicep circumference

PAGE 16

16 (McCreary et al., 2006). Thus, there exists a need to clarify which measure of the three main body composition measures is most informative wh en conducting drive for muscularity research. Cafri et al. (2005) attributed the lack of body composition assessment to factors such as time constraints on researchers, the need for pe rsonnel trained in body fat assessment, and cost associated with techniques such as hydrostatic weighing and Du al Energy X-ray Absorptiometry. The result is an absence of information pertai ning to the body fat percentages and extent of muscle mass possessed by persons with a high dr ive for muscularity. Id entifying and clarifying such relationships would be helpful in developi ng a precise model of th e drive for muscularity. The purpose of this study was to determine the psychological (e.g., self-esteem, exercise behavior, exercise dependence, eating pathol ogy) and body composition (e.g, BMI, body fat, fatfree mass index [FFMI]) predictors of drive for muscularity in college-a ged men. In accordance with this purpose, the follow ing hypotheses were advanced: Self-esteem. Similar to research in women (Stice, 2002), self-esteem is a predictor of negative body-image in men (Kostanski & Gull one, 1998). Self-esteem is also negatively correlated with body and muscle dissatisfacti on in men (Cafri, Strauss, & Thompson, 2002; Kostanski & Gullone, 1998; McCreary & Sasse, 2000). However, in contrast to women, men who are thin do not report greater self-esteem than normal weight men (Mazzeo, Slof, Tozzi, Kendler, & Bulik, 2004); it is believed that this is because a thin wo man is closer to the female ideal body whereas a thin man is farther from the ideal muscular male body. In addition, low self-esteem predicts problematic eating behavi or, increased dieting, and use of binge-purge cycles (McGee & Williams, 2000; Neumark-Sztainer & Hannan, 2000; Stice, 2002). In light of these findings, I hypothesized that self-esteem would be a negative predictor of drive for muscularity.

PAGE 17

17 Exercise. Although some studies indicate that exer cise is associated with greater body satisfaction in men (e.g., Davis & Cowles, 1991; Hausenblas & Fallon, 2002; Williams & Cash, 2001), other studies with men have found exerci se behavior to be associated with body dissatisfaction (Tiggemann & Williamson, 2000; Varnado-Sullivan, Horton, Savoy, 2006). Specifically, some studies have found that weightli fting is related to the drive for muscularity, greater physique dissat isfaction, and muscle dysmorphia (Lantz, Rhea, & Cornelius, 2002; McCreary & Sasse, 2000; Pope et al., 1997), but other research has found weightlifting to increase body satisfaction (Fisher & Thomps on, 1994; Williams & Cash, 2001). Part of the discrepancy in study findings may be related to the measure of exercise. That is, some exercise measures were general and asse ssed aerobic and anerobic exercise in a nonspecific context (e.g., Hausenblas & Fallon, 2002), whereas other studies have focused on weightlifting (e.g., Williams & Cash, 2001). It is conceivable th at exercise measures that fo cus on weightlifting may be more strongly related to drive for musc ularity than general exercise measures because theoretically weightlifting should be related to drive for muscularity. Thus, I a ssessed both general exercise as well as weightlifting measures to determine if there was a difference. I hypothesized that weightlifting would be a stronge r predictor of drive for muscul arity than general exercise behavior. Dietary supplements. A method many men use to achie ve greater muscularity while decreasing body fat is taking dietary supplemen ts (Kanayama et al., 2001). Men who have body dissatisfaction often use dietary supplements to increase muscularity (V arnado-Sullivan et al., 2006). Of importance, adolescent boys who repor t supplement use have lower body esteem than nonsupplement using adolescent boys (Smolak, Murnen, & Thom pson, 2005). The popularity of supplements for these purposes has led Kanayama et al. (2001) to refer to these supplements as

PAGE 18

18 body-image drugs. Therefore, I hypothesized that the use of dietary supplements would be a significant predictor of drive for muscularity. Eating pathology. McCreary and Sasse (2000) found th at drive for muscularity is significantly higher in ad olescent boys trying to gain weight (via unhealthy eating practices) than those who are not; and it is we ll established that body dissati sfaction and eating pathology are related (Olivardia et al., 2000; Olivardia, Pope, Mangweth, & Hudson, 1995). For example, in their study of 18-year-old men, Heywood and Mc Cabe (2006) found a significant correlation between dietary restraint and body dissatisfaction related to body parts such as the shoulders, chest, and arms. Furthermore, in their study of 83 bodybuilders, weightlifters, and athletically active controls, Hallsworth, Wade, and Tiggemann (2005) found that, after controlling for BMI, drive for muscularity was significantly related to the Bulimia subscale of the Eating Disorders Inventory. Therefore, I hypothesized that eating pathology would be a significant predictor of drive for muscularity. Sociocultural pressure. The etiology of drive for muscularity is multifactorial, and it is believed to include sociocultural sources such as peers, parents, and romantic partners. For example, during adolescence boys who mature ea rly (and thus move closer towards the male ideal physique) enjoy high popular ity, but also are more likely than boys who have not yet reached puberty to engage in body change strate gies (e.g., weightlifting, dieting to gain weight, supplement use; McCabe & Ricciardelli, 2004a). Other research indicates that experiencing teasing from peers is associated with decr eased body satisfaction (Paxton, Eisenberg, & Neumark-Sztainer, 2006); furthermore, encouragem ent from parents to lose weight has been associated with both decreased body satisfaction and use of muscle bu ilding strategies (e.g., steroid and supplement use; Smolak et al., 2005 ; Wertheim, Martin, Prior, Sanson, & Smart,

PAGE 19

19 2002). In addition, there is limited evidence that men told by a female dating partner to gain weight (presumably in the form of muscle) report low relationship satisfaction (Sheets & Ajmere, 2005), although other research indicates that men may be dissatisfied with their bodies despite a female dating partners satisfaction with it (Ogden & Taylor, 2000). Taken together, there is sufficient reason to believe that sociocul tural pressure does impact drive for muscularity; therefore, I hypothesized th at sociocultural pressure would be a significant predic tor of drive for muscularity. Exercise dependence. Exercise dependence is believed to be a key aspect of male bodyimage disturbance, especially muscle dysmor phia (Rhea et al., 2004). While moderate amounts of exercise are associated with greater body satisfaction (Williams & Cash, 2001), excessive amounts of exercise are associated with greater body-image disturbance (Pope et al., 1997; Rhea et al., 2004). Furthermore, exercise dependence is predicted by weight loss strategies (which is associated with male body-image disturbance) in adolescent boys (M cCabe & Ricciardelli, 2004a). Therefore, I hypothesized that exercise dependence would be a si gnificant predictor of drive for muscularity. BMI. Although there exists a relationship be tween BMI and male body-image disturbance wherein both high and low BMI are associated with greater dissatisfaction (Frederick, Peplau, & Lever, 2006; Gila, Castro, Cesena, & Toro, 2005) McCreary et al. (2006) recently found that BMI was not a predictor of drive fo r muscularity. A possible explana tion for this is in the nature of the BMI itself: because it is a height-to-wei ght ratio, it does not distinguish between weight attributable to body fat versus weight attributable to muscle. This distinction is critical because, by definition, the drive for muscularity is specifica lly associated with a de sire to have larger muscles. Therefore, in light of both the finding of McCreary et al. (2006) and the nonspecificity

PAGE 20

20 inherent in the BMI, I hypothesi zed that BMI would not be a si gnificant predictor of drive for muscularity. FFMI. While FFMI is significantly higher in men with muscle dysmorphia than normal comparison men (Olivardia et al., 2000), a recen t study found that FFMI did not emerge as a predictor of drive for muscular ity (McCreary et al., 2006). The au thors speculated that perhaps self-assessment of muscularity is compromised because a layer of body fat hides the true extent of a mans muscularity, a nd that the actual degree of musc ularity one possesses is most easily appraised in men who either have low body fat or have very well-developed muscles. Therefore, because the men in this study were expected to have normal levels of body fat (thereby concealing the degree of muscularity the men actually possessed), I hypothesized that FFMI would not be a significant pr edictor of drive for muscularity. Body fat percentage. Male body-image disturbance is centered around degree of muscularity; when given the opportunity to indi cate ideal body fat percentage, men generally do not report desiring body fat percentage that is a large departure fr om what they currently have (Cafri et al., 2002). Pickett, Lewis, and Cash (2005) found that although noncompetitive weight trainers score significantly hi gher than athletically active c ontrols on measures of body image such as appearance orientation, appearance evalua tion, and satisfaction with muscle tone, they have similar body fat percentage. Furthermore, O livardia et al. (2000) found similar levels of body fat percentage between men with musc le dysmorphia and normal comparison men. Although some research has found body-image sa tisfaction and body fat percentage to be inversely related (e.g., Huddy, Johnson, Stone, Proulx, & Pierce, 1997), the trend of most research on the topic is that body fat percentage is not the primary concern in male body-image, a point reinforced by McCreary et al. (2006) when they found th at body fat percentage did not

PAGE 21

21 emerge as a predictor of drive for muscul arity. Therefore, I hy pothesized that body fat percentage would not be a significant predictor of drive for muscularity. Self-report BMI vs. measured BMI. Although many studies rely on self-reported (as opposed to measured) values of height and weight to derive participants BMI, there is question as to how accurate such self-re ported values are. Specifically, several studies have found that subjective BMI is significantly lower than objective BMI (Brener, McManus, Galuska, Lowry, & Wechsler, 2003; Elgar, Roberts, Tudo r-Smith, & Moore, 2005; Hill & Roberts, 1998). Therefore, I hypothesized that subjective BMI (resulting from se lf-reported height and weight at pre-screening) would be si gnificantly lower than objectiv e BMI (resulting from objective measurement of height and weight as assessed at the testing session), as evidenced by a pairedsamples t-test.

PAGE 22

22 CHAPTER 2 MATERIALS AND METHODS Subjects Because multiple regression was to be used to examine the studys purposes, the power tables developed by Green (1991) for multiple re gression analyses were used to determine sample size. Based on the maximum number of pr edictors for the multiple regression analysis (9), to detect a medium effect with = .05, a sample of 113 was required for a power of .80 (Green, 1991); therefore, the target sample size for this study was N = 113. To be eligible for inclusion, participants had to be men between the ages of 18; th is age range was selected not only because other studies have used a sim ilar age range (e.g., Heywood & McCabe, 2006), but also to remove age as a potential confounding variab le in light of evidence that men of this age have different motivations for exercising than do older men (e.g., mid-30s and older; Davis & Cowles, 1991; Tiggemann & Williamson, 2000). The mean age of the 113 men in this study was 20.34 years ( SD = 1.52, Range = 18 years); most described their ethnicity as White ( n = 77), followed by Hispanic ( n = 14), Asian ( n = 9), Black ( n = 6) or Middle Eastern ( n = 2). In addition, each of the following descriptions of ethnicity was provided once: American, East Indian, Indian, Jewish, and Pacific Islander. Most of the men reported their sexual orientation as heterosexual ( n = 105). With respect to academic sta nding, juniors were most frequent ( n = 40), followed by seniors ( n = 33), sophomores ( n = 21), freshmen ( n = 18), and completion of a masters degree ( n = 1). Two participants reported current use of anabolic steroids, while one reported past but not current use of anabolic steroids. Measures The following variables were assess ed in the study (see Appendix A).

PAGE 23

23 Body Fat Percentage Body fat percentage was assessed by the re searcher using the 3site (chest, abdomen, thigh) skinfold method for men (American Colle ge of Sports Medicine, 2000). This method correlates strongly with the hydros tatic weighing method, and it ha s an error of 3.5% (ACSM, 2000). FFMI Each participants FFMI was determined to quantify degree of fat-free mass. The equation for FFMI (Kouri, Pope, Katz, & Oliva, 1995; Pope, Gruber, et al., 2000) is: {Wt x (100BF%) / Ht2 x 100} + 6.1 (1.8Ht) where Wt is weight in kilograms, BF% is body fat percentage, and Ht is height in meters. The FFMI of nonweightlifting men typically rang es from 18; nonsteroid using bodybuilders typically have a FFMI between 21, and ster oid using bodybuilders typically have a FFMI from 25 to the low 30s (Olivardia et al., 2000). The importance of ascerta ining FFMI in studies of body image is well-noted (e.g., Eston, 2002). BMI BMI assesses weight (kg) relative to height (m2). While BMI correlates significantly with body fat percentage (EPIETOOA, 1998), it is used mainly to determine overweight or obese status (Wei et al., 1999). People with a BMI between 18.5 to 24.9 kg/m2 are classified as normal; people with a BMI of 25.0 to 29.9 kg/m2 are classified as overweight and people with a BMI of 30.0 kg/m2 or greater are classified as obese (Will ett et al., 1999). BMI was calculated in two ways: a) subjectively via self-reported values of height and weight at pre-screening, and b) objectively via measurements of height and wei ght as assessed upon arrival at the Exercise Psychology laboratory. BMI was derived in these two ways because, while many epidemiological studies calculate BMI based on self-reported height and weight, there is

PAGE 24

24 mounting evidence that BMI based on objectively m easured height and weight is more accurate (e.g., Brener et al., 2003; England et al., 1998). Demographic Information The following demographic information was obta ined from each participant: age, ethnicity, sexual orientation, academic standing (if applicable ), past/current anabolic steroid use, and current duration/frequency of car diovascular and weightlifting se ssions (detailed in the next section). Author developed questi ons related to anabolic steroid use were the following: (1) Are you currently using anabolic steroi ds in order to build muscle mass?, which required either a yes or no response; (2) If you are not curren tly using anabolic steroids to build muscle mass, have you in the past?, which required either a yes, no, or not applicable response; similar methods have been employed to ascertai n anabolic steroid usag e (e.g., Neumark-Sztainer, Story, Falkner, Beuhring, & Resnick, 1999). Exercise Behavior Typical exercise behavior was assessed with the Leisure-Time Exercise Questionnaire (LTEQ; Godin & Shephard, 1985). The LTEQ asks pa rticipants to indicate how frequently during a typical week they enga ge in mild, moderate, and strenuous exercise for at least 15 minutes. An overall weekly ex ercise index is then derive d from the following formula: 3(frequency of participation in mild activities during the past week) + 5(frequency of moderate activities) +9(frequencies of strenuous activities) The LTEQ has adequate reliability and validity (Godin, Jobin, & Bouillon, 1986), and correlates moderately with VO2max, an index of cardiorespiratory fitness (Jacobs Ainsworth, Hartman, & Leon, 1993). Because the LTEQ does not specify the mode of exercise, participan ts were asked the following author-developed quest ions on the demographic survey : (1) How many sessions of cardiovascular activity do you engage in per we ek, and how long does a typical session run?

PAGE 25

25 and (2) How many sessions of weight training do you engage in per week, and how long does a typical session run? For this latter question, be cause no standardized measures of weightlifting frequency or session duration exis t, a weightlifting index (freque ncy x duration) was calculated. This was done because the LTEQ does not spec ify how much overall activity is due to weightlifting; this form of exercise is of critical interest in the present study because weightlifting is the primary ex ercise behavior that is responsible for muscular hypertrophy, which is what a man with high drive for muscularity strives to achieve. Eating Pathology Eating behavior specific to gaining muscle was assessed w ith the Diet subscale of the Muscle Dysmorphia Inventory (MDI ; Lantz et al., 2002; Rhea et al., 2004). This subscale asks participants to rate the extent (1 = Never to 6 = Always) to which certain statements (e.g., I regulate my caloric intake to maximize muscular development) apply to them. This subscale has good reliability in powerlifters ( = .84), bodybuilders ( = .87.94), and recr eational weight trainers ( = .88; Lantz et al., 2002; Rh ea et al., 2004), and has good construct validity (Rhea et al., 2004). A high score indicates greater eating pathology. The inte rnal consistency of the MDIDiet subscale in the present study was good ( = .82). Supplement Use Supplement use was assessed by the Supplement subscale of the MDI (Lantz et al., 2002; Rhea et al., 2004). This subscale asks participants to rate the extent (1 = Never to 6 = Always) to which certain statements (e.g., Before a workout I consume energy supplements.) apply to them. This subscale has excellent reliability in powerlifters ( = .91), good to exce llent reliability in bodybuilders ( = .80.94), and adequate reliability in recreational weight lifters ( = .75; Lantz et al., 2002; Rhea et al., 2004 ). Furthermore, it has good c onstruct validity (Rhea et al.,

PAGE 26

26 2004). A high score indicates greater use of suppl ements. The internal consistency of the MDISupplement subscale in the present study was good ( = .86). Sociocultural Pressure The Perceived Sociocultural Pressure Scale (Stice, Ziemba, Margolis, & Flick, 1996) was used to assess the extent (1 = Never to 5 = Al ways) to which participants perceived pressure from friends, family, dating partners, and the medi a to be lean and muscular. Because the scale was originally developed for use in eating disord er populations, the items we re adapted to reflect the nature of body image of releva nce to this study (the original scale is first in the appendix, followed by the adapted version used in this study). For example, the item, Ive felt pressure from my friends to lose weight was changed to read as follows: Ive felt pressure from my friends to lose body fat. An additional example would be the item, Ive noticed a strong message from my friends to have a thin body, which was changed to read as follows: Ive noticed a strong message from my friends to ha ve a muscular body. The adaptation of the items was derived after consulting with graduate students and a professor, all of whom have extensive experience in body image research. A high score indicates greater perc eived sociocultural pressure to conform to the male ideal. The in ternal consistency of th e Perceived Sociocultural Pressure Scale in the present study was acceptable ( = .75). Drive for Muscularity Drive for muscularity was assessed by the Dr ive for Muscularity Scale (DMS; McCreary & Sasse, 2000), which is considered to be the best available scale for assessing muscularityrelated concerns (Cafri & Thompson, 2004). Specifi cally, the DMS is a 15-it em likert-type scale with two subscales that assesses the extent (1 = Always to 6 = Never) to which the respondent holds attitudes (Muscle-oriented body image; MBI) and engages in behaviors (Muscularityrelated behavior; MB) indicative of the pursuit of a muscular physique. The DMS has good

PAGE 27

27 reliability ( = .81.91), and has been shown to have good face, convergent, and discriminant validity in men (Chittester, 2003; McCreary et al., 2006; McCreary & Sa sse, 2000; McCreary et al., 2004). In accordance with the recommendation by McCreary et al. (2004), one item (I think about taking anabolic steroids) was omitted from the survey because it does not load on either subscale of the DMS. All items are reverse coded so that high scores on the DMS indicate a high drive for muscularity. The internal consistency of the DMS-MBI ( = .88) and DMS-MB ( = .83) in the present study was good. Exercise Dependence Exercise dependence was assessed with the Exercise Dependence Scale (EDS; Hausenblas & Symons Downs, 2002b). The EDS is a 21-item likert-type scale that consists of seven subscales: withdrawal effects (I exercise to avoid feeling stressed.), tolera nce (I feel less of an effect/benefit with my current exercise.), continuance (I exercise despite recurring physical problems.), lack of control (I am unable to re duce how long I exercise.), reduction in other activities (My exercise interferes with work/sch ool responsibilities.), time (I organize my life around exercise.), and intention e ffects (I often exercise longer than I intend.). The EDS has acceptable reliability (Hausenblas & Fallon, 200 2; Hausenblas & Symons Downs, 2002b), and preliminary data indicate the EDS is valid (Hausenblas & Symons Downs, 2002b; Symons Downs, Hausenblas, & Nigg, 2004). Higher EDS scor es indicate greater exercise dependence. The internal consistency of the EDS in the present study was excellent ( = .91). Self-esteem The Rosenberg Self-esteem Scale (Rosenberg, 19 89) was used to assess global self-esteem. This 10-item scale asks particip ants to rate the ex tent (1 = Strongly agree to 4 = Strongly disagree) to which they agree with each questi on (e.g., At times I think I am no good at all). This scale is reliable and valid; recent research in dicates it may be superior to other measures of

PAGE 28

28 self-esteem (Griffiths et al., 1999). Some items ar e reverse coded; low scores on the Rosenberg Self-esteem Scale indicate poor self-esteem. The internal consistency of the Rosenberg Selfesteem Scale in the present study was good ( = .83). Procedure Participants were recruited with advertisemen ts to participate in a study on body image that would include body fat assessment (see Appendix B). These advertisements were disseminated by either being read aloud in college classes or by being posted in various locations. The advertisement was read aloud in select cour ses between August 2006 and January 2007 within the departments of Applied P hysiology & Kinesiology and Psyc hology at the University of Florida, and the department of Social and Behavioral Sciences at Santa Fe Community College. In addition, the advertisement was posted from late-June to December 2006 in the following three ways: The announcement was placed on a website, http://www.my.ufl.edu which is a secure website accessible only to university students; The announcement was placed in prominent area s within selected university parking structures; The announcement was placed in several privat e gyms and fitness centers within the Gainesville area. The advertisement directed intere sted men to an email address to write to if they wanted to participate. The advertisement asked interest ed men to include the following demographic information in their email: age, height, weight, and contact information. The researcher then contacted each respondent (via email, or if unsuc cessful, by phone call) to schedule an individual testing session (Note: a reminder email was se nt to each participant the day before his appointment) with the primary researcher at th e Exercise Psychology laboratory. Out of 159 men who either contacted the lab to indicate they we re interested in participating or signed up when

PAGE 29

29 the study announcement was made in their classe s, 113 men actually enro lled in the study. Once at the testing center, after providing informed c onsent, the participants height and weight was measured by using a Healthometer scale (Chicago, IL). Height without shoes was measured to the nearest 0.25 inch, and weight was measured to the nearest 0.25 lb. Each participant was then asked to complete several surveys (detailed in the previous section). After the participant had completed the surveys, body fat percentage was assessed via skinfold measurement. After all data had been collected, the participant was de briefed and excused from the testing center. Testing sessions were between 20 minutes in length. The protocol for this study was reviewed and approved by the Un iversity of Florida Instituti onal Review Board prior to participant recruitment. Data Analysis First, descriptive statistics for all variables were calculated, and the internal consistency of all surveys was ascertained. In addition, once data were entered, a search for outliers (e.g., 3 or more standard deviations from the mean) and missing data was initiated. When data were missing, the mean of the particular variable was in serted when less than 5% of the values for the variable were missing (Cohen & Cohen, 1983). In a ddition, a correlation matrix was derived that showed the correlations between the following va riables: objective BMI, self-report BMI, body fat percentage, FFMI, weightlifti ng index, exercise behavior (a s measured by the LTEQ), eating habits (as measured by the MDIDiet subscal e), supplement use (as measured by the MDI Supplement subscale), perceived sociocultura l pressure, muscle-oriented body-image (as measured by the DMSMBI) subscale), muscle -related behaviors (as measured by the DMS MB subscale), drive for muscularit y, exercise dependence, and se lf-esteem. A paired-samples ttest was used to determine whether differen ces between subjective and objective BMI were significant.

PAGE 30

30 Finally, to examine the main purposes, one stepwise multiple regression analysis was conducted. Stepwise regression was used because th ere exists no empirical data indicating which factor would be the best predicto r of drive for muscularity; were such data available hierarchical regression, where the resear cher specifies the orde ring of predictors, would have been conducted. The stepwise regression analysis determined which measures of body composition (Independent variables = BMI, body fat percentage, FFMI) and ps ychological factors (I ndependent variables = exercise behavior, weightlifting index, eating pat hology, supplement use, perceived sociocultural pressure, exercise dependence, and self-esteem) be st predicted drive for muscularity (Dependent variable). Because multicollinearity (e.g., high corre lations between independent variables) was a potential problem in this analysis, the tole rance values for the regression equation were determined.

PAGE 31

31 CHAPTER 3 LITERATURE REVIEW Although body-image disturbance has historically been viewed as occurring mostly in women (Pasman & Thompson, 1988; Rand & Wright, 2000) recent research has determined that men also experience body-image disturbance (S alusso-Deonier & Schwarzkopf, 1991; Pope et al., 1993; Pope, Gruber, et al., 2000). While in women body-image disturbance arises when one compares her body to the thin and toned female ideal physique often por trayed in the media, body-image disturbance in men arises when one compares his body to the lean and muscular male ideal physique often portrayed in the media (e.g., Leit et al., 2001). Body-image disturbance is a risk factor for eating disorder s (Phelps, Johnston, & Augustyniak, 1999; Stice, 2002), and the DSMIVTR lists preoccupation with body shape as a criterion for both anorexia and bulimia (APA, 2000). In addition, male body dissatisfaction is accompanied by a host of problematic behaviors (e.g., social avoidance, steroid use, dist urbed eating; Brower, Blow, & Hill, 1994; Olivardia et al, 2000; Cafri et al., 2005), poor self-est eem (Cafri et al., 2005), and negative affect (Olivardia, 2001; Presnell et al., 2004). Because of the myriad problems associated with body-image disturbance, and the fact it is being observed more frequently in boys (McCabe & Ricciardelli, 2003; Cohane & P ope, 2001), it is imperative that predisposing factors be identified. This review focuses on the following male body-image issues: 1) What body-image disturbance is, 2) init ial identification of body-image disturbance, 3) measurement of body-image disturbance, and 4) the Cafri et al. (2005) model of male body change strategies. What Is It? Body-image disturbance is a subjective negative evaluation of ones figure or body parts (Presnell et al., 2004, p. 389). While bodyimage disturbance occurs in both men and women, the aspect of the body from which this di sturbance stems varies between the sexes. In

PAGE 32

32 women, body-image dissatisfaction arises from evalua tion of ones overall wei ght (i.e., the belief that one is too fat), and this is coupled with c oncern specific to the shape of the lower torso (e.g., hips, thighs, and buttocks; Cash et al., 2004). However, the source of mens body-image disturbance arises from an evaluation of muscularity (Gokee-LaRose, Dunn, & Tantleff-Dunn, 2004). Knowledge of this concern was inadverten tly gained during a st udy on the psychiatric effects of anabolic steroids in bodybuilders (Pope et al., 1993). Th e researchers observed that, of 108 bodybuilders, two (both of whom had a hist ory of anorexia) reported such pronounced feelings of puniness and weakne ss that they would frequently decline social invitations and even wear heavy clothes on hot days to conceal th eir small size. Pope et al. (1993) coined the phrase reverse anorexia to explain this uniqu e body-image disturbance, which is now referred to as muscle dysmorphia (Pope et al., 1997). Although not explicitly stated in the diagnostic criteria a dvanced by Pope et al. (1997), a man with muscle dysmorphia would have to be muscular to the casual observer to warrant diagnosis. Because degree of muscularity can be s ubjective, Olivardia et al. (2000) proposed that ones fat-free mass index (FFMI), a function of height, weight, and body fat percentage, be calculated to determine muscularity su fficient enough for diagnosis. The FFMI of nonweightlifting men typically ranges from 18 ; nonsteroid using bodybuilders typically have a FFMI between 21, and steroid using bodybuilder s typically have a FFMI from 25 to the low 30s (Olivardia et al., 2000). Given the muscularity requirement, one could argue that only very muscular men would even qualify for muscle dysmorphia. Howe ver, many non weightlifting men experience bodyimage disturbance, which usually focuses on a la ck of muscularity. If these men do not have muscle dysmorphia (i.e., they do not possess the muscularity required fo r diagnosis), what do

PAGE 33

33 they have? One way to describe this body-image di sturbance is in relation to ones drive for muscularity and its accompanying behaviors an d attitudes (McCreary & Sasse, 2000). Because this is the most salient form of body-image disturbance in men, Cafri and Thompson (2004) advocated that its measurement be the cornerstone of future male body-image research. Initial Identification The first mention of body-image disturban ce is Arkoff and Weaver s (1966) article detailing the body-image of Japanese-Americans; ironic because body-image disturbance is more prevalent in Western society than in others (Yang, Gray, & Pope, 2005) Other early body-image research primarily dealt with dissatisfaction in relation to f acial surgery (e.g., Peterson & Topazian, 1976; Macgregor, 1981) and obesity (Guggenheim, Poznanski, & Kaufmann, 1977). However, by the mid-1980s researchers bega n to focus on the link between body-image disturbance and eating disorder s (e.g., Freeman, Beach, Davis, & Solyom, 1985); this is likely the reason why most body-image research up to the early 1990s focused on women. Measurement Several measures have been developed to assess body-image disturbance in men (see Stewart & Williamson, 2004, for a review), and th e focus of each measure varies depending on what aspect of body-image distur bance (i.e., concerns surroundi ng degree of muscularity or adiposity) is of primary intere st. The most widely used measures for assessing male body-image disturbance are the Drive for Muscularit y Scale (DMS; McCreary & Sasse, 2000), the Multidimensional Body Self-Relations Questionn aire (MBSRQ; Brown, Cash, & Mikulka, 1990) and the body dissatisfaction subscale of the Eating Disorders Inventory (EDIBD; Garner, Olmstead, & Polivy, 1983). Over the past five years several new indices of male body-image disturbance have been advanced, including the Muscle Appearance Sa tisfaction Scale (Mayville, Williamson, White,

PAGE 34

34 Netemeyer, & Drab, 2002), Muscle Dysmorphia Survey (Chittester, 2003), Muscle Dysmorphia Inventory (Rhea et al., 2004), and the Male Eating Behavior and Body Image Evaluation (Kaminski, Chapman, Haynes, & Own, 2005). These measures recognize that a major component of male body-image disturbance focu ses on ones simultaneous desire for more muscle mass and less body fat. Unfortunately, while these measures effectively assess preoccupations and behaviors characteristic of male body-image disturbance related to muscularity, they do not assess specific nutriti onal strategies employed to gain muscle mass while simultaneously stripping away body fat. Th is information is critical in completely understanding a multidimensional construct (i.e., how dietary practices, substance use, body composition, body-image dissatisfaction, and other psyc hological factors interact) such as male body-image disturbance. Heuristic Model of Male Body Change Strategies In an effort to organize the constructs associated with male body-image disturbance, Cafri et al. (2005) advanced a heuristic model that maps these constructs and provides an illustration of the strength of the various relationships that exist between the constructs (Figure 3). The model consists of seven main cons tructs, with six cons tructs consisting of subcomponents. The seven main construc ts (and their subcomponents) are: Biological Factors (body composition/BM I, pubertal growt h, pubertal timing); Psychological Functioning (negat ive affect, self-esteem); Societal Factors (media influence, peer a nd parental influence, teasing, peer popularity); Social Body Comparison; Body Image Dissatisfaction (muscularity, body fat); Health Risk Behaviors (steroid s, steroid precursors, ephedrin e, dieting to lose weight, dieting to gain weight, die ting to increase muscularity);

PAGE 35

35 Sports (organized team sports, info rmal team sports, weightlifting). The present study focuses on the following co mponents: Biological Factors, Psychological Functioning, Societal Factors, Body Image Di ssatisfaction, and Health Risk Behaviors. Accordingly, each of these constructs will be disc ussed in subsequent sections of this document. Because two constructs (Social Body Comparison and Sports) of the Cafri et al. (2005) model are not included in the present study, the reader is referred directly to the aforementioned article for a more in-depth review of those constructs. Biological Factors Body composition/BMI BMI is a ratio of body wei ght (kg) to height (m2) widely employed to ascertain overweight or obese status. According to the Expert Pane l on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (EPIETOOA; 1998), BMI co rrelates significantly with body fat percentage; it is for this reason that it is advisable to assess BMI as a routine procedure of a patients visit to see a physician (Man son, Skerrett, Greenland, & VanItallie, 2004). While BMI can be conveniently ascertained fr om self-reported height and weight, there is some evidence suggesting that BMI derived from se lf-report data is inaccu rate. For example, in their study of 6000 16-year-old males and female s in southwestern England, Hill and Roberts (1998) compared BMI based on self-reported he ight and weight to BMI based on measured height and weight. They found that, based on self-reported BM I, 49.7% of the males were classified as normal, whereas 37.3% were cl assified as overweight . However, based on objectively measured BMI, they found that the exact opposite was true: only 36.1% of the males had a normal BMI, while 46.7% were classified as overweight. Furthermore, similar patterns in the underestimation of BMI based on self -report data have been observed in 11th grade Welsh boys (Elgar et al., 2005) as well as high school-a ged boys in the United States (Brener et al.,

PAGE 36

36 2003). This underestimation of BMI based on self-repor t data is attributed to an overestimation of height and an underestimation of weight, alth ough some research suggests that only at-risk status (e.g., restrained eaters ) significantly predicts wei ght underestimation (Shapiro & Anderson, 2003). Taken together, these findings s uggest that BMI derived from self-reported height and weight is inaccurate and this poses a noteworthy pr oblem for researchers who have large sample sizes yet need this informati on from their participants. A common practice of studies on male body-im age disturbance involves the calculation of BMI to serve as an objec tive measure of body size, which c ould then be correlated with degree of body dissatisfaction. Re sults of such studies have consistently shown a strong curvilinear relationship between BMI and body dissatisfaction in males (Frederick et al., 2006; Gila et al., 2005; Grilo & Ma sheb, 2005; Kostanski et al., 2 004; Kostanski & Gullone, 1998; Presnell et al., 2004). However, a clear link between BMI and either the drive for muscularity or muscle dysmorphia, constructs that represent specific desc riptions of male body-image disturbance, has yet to be es tablished. In fact, only two st udies are known to have even investigated the link between BMI and any variable s related to either dr ive for muscularity or muscle dysmorphia (Cafri, van den Berg, & Th ompson, 2006; McCreary et al., 2006). In their study of 13-18-year old boys, Cafr i et al. (2006) observed sma ll but significant positive correlations between BMI and dieting to gain weight ( r = .16) and the use of performance enhancing drugs (e.g., anabolic st eroids, ephedrine, prohormones; r = .13), but did not observe correlations between BMI and either body dissatisf action or muscle dymorphia symptoms (Cafri et al., 2006). This latter findi ng is a surprising departure fr om the general male body-image disturbance literature. In addi tion, McCreary et al. (2006) found that BMI was not related to

PAGE 37

37 attitudes or behaviors related to drive for muscularity among co llege-aged men. The findings of these studies indicate a need to clarify the role of BMI in drive for muscularity. The most often cited reason why BMI is not us ed more often in driv e for muscularity or muscle dysmorphia research is the recognition that BMI is a poor measure of body composition for persons who have a high degree of muscul arity (McCabe & Ricciardelli, 2004b). For persons with a high amount of muscle mass, BMI could easily indicate a man was obese when he actually carried a significant amount of muscle. As a result, BMI is rarely (if ever) used as a primary outcome variable in research on either dr ive for muscularity or muscle dysmorphia. However, as has been established in this section, the decision whether to use objectively measured BMI vs. self-reported BMI should not be taken lightly because the available data suggest objectively measured BMI is superi or to BMI based on self-report. Pubertal growth Puberty is a time in which a males body cha nges from that of a child to a mature young adult. For males this means an increase in body mass; specifically, a marked increase in muscularity. Thus, this is the stage at which boys begin to ac quire the physique of a man and subsequently move closer towards the male i deal, which is often accompanied by increased body satisfaction (e.g., Rodriguez-Tom Bariaud, Cohen Zardi, Delmas, Jeanvoine, & Szylagyi, 1993). However, because puberty marks a period of body change it is possible that some adolescent males may seek even greater levels of muscularity through a variety of means; research on this topic is mixed. For example, ODea and Abraham (1999) found that trying to lose weight is significantly more likely in boys who have already reached puberty than in prepubescent boys, while McCabe et al. (2001) ob served that pubertal growth was associated with behavior aimed at increasing muscle tone and with increased use of food supplements designed to add muscle mass. These findings illustra te a pattern of behavior consistent with the

PAGE 38

38 simultaneous desire to decrease body fat and in crease muscle mass. However, in their study of 269 adolescent boys, Cafri et al. (2006) found no relationship between pubertal development and substance use (steroids and food supplements), muscle dysmorphia symptoms, or dieting to gain weight. Taken together, the role of pubertal growth on body change strategies and body-image disturbance is unclear and would be nefit from further study. Pubertal timing Although the precise role of pube rty in male body-image disturbance is unclear, there is more certainty in how the tim ing of puberty impacts body-image disturbance and body change strategies. Specifically, the availa ble research indicates that early maturation is associated with greater body-image satisfaction am ongst adolescent boys, and that late maturation is associated with greater body-image disturbance (McCab e & Ricciardelli, 2004a; Siegel, Yancey, Aneshensel, & Schuler, 1999). While this may suggest an advantage to early maturation, a closer look at the longitudinal data of McCabe and Ricciardelli (2004a ) reveals that early-maturating males are not devoid of problematic behaviors as sociated with their early jump into adulthood. Consistent with the findings of ODea and Abraham (1999), McCabe and Ricciardelli (2004a) found that early maturing males were more likely than on-time or late-maturing males to adopt weight loss strategies. Furthermore, weight loss strategies predicted exercise dependence and use of food supplements in these males eight months later. This troublesome pattern of behavior was not exclusive to early maturing males: common findings across early, on-time, and late-maturing males indicated that: 1) strategies to decrease weight predicted exercise dependence eight months later, and 2) use of food supplements predic ted disordered eating (M cCabe & Ricciardelli, 2004a). Indeed, with respect to body ch ange strategies, it seems that the early-maturing males are happy to have their increasingly masculine bodies, but they also engage in behaviors to make it

PAGE 39

39 even more masculine. Needless to say, late-matur ing males eventually catch-up to early and on-time maturers in regards to th e onset of body change behaviors, but there is a final caveat: the only group for whom steroid use was not part of th e final structural model at 8 months was the late-maturing males (McCabe & Ricciardelli, 2004a). Perhaps there is nothing wrong with maturing a little later after all. Psychological Functioning Negative affect Negative affect or depression is positively correlated with body dissatisfaction in boys (Kostanski & Gullone, 1998; Mc Creary & Sasse, 2000), and has been identified as a strong predictor of body-image disturbance in the same population (Presnell et al., 2004). In addition, the model proposed by Cafri et al. (2005) hypothesizes that negative affect is related to unhealthy behaviors (e.g., use of anabolic steroids, ephedrine, special di eting techniques to minimize body fat and maximize muscularity) often engage d in by men with body-image disturbance. Furthermore, Olivardia et al. (2000) found that men with muscle dysmorphia had significantly higher rates of past mood disorders (58%) than normal weightlifters (20%). With respect to body change behaviors, a recent st udy found negative affect in men to be significantly positively related to both efforts to increase muscle a nd dietary restraint (Heyw ood & McCabe, 2006). It is of note that some studies have assessed depres sion in anabolic steroi d users, a subgroup of weightlifting enthusiasts and bodybuilders that may present with body-image disturbance (Blouin & Goldfield, 1995). Self-esteem The relationship between self-esteem and body-image disturbance has received a fair amount of research. In an overview of the risk factors for drive for muscularity, Cafri et al. (2005) proposed a model in which self-esteem and the adoption of unhealthy behaviors (e.g., use

PAGE 40

40 of anabolic steroids, ephedrine, special die ting techniques to minimize body fat and maximize muscularity) are related. Simultane ously, Cafri et al. ( 2005) stated that body dissatisfaction leads one to adopt these unhealthy behaviors. What th e model does not propose, however, is a direct link between self-esteem and body di ssatisfaction, which is believed to be a stable relationship (Cohane & Pope, 2001). Indeed, poor self-est eem is often associated with body-image disturbance, and this has been found when meas uring the drive for muscularity in adolescent boys (McCreary & Sasse, 2000). In addition, Irvi ng, Wall, Neumark-Sztainer, and Story (2002) found that adolescent boys who used anabolic ster oids had significantly lower self-esteem than non-users, and tentative support fo r a relationship between low self-esteem and use of anabolic steroids in weightlifters has been identif ied (Kanayama, Pope, Cohane, & Hudson, 2003). Findings such as these lend support to the sentim ents of researchers who speculate that some men may enter bodybuilding, in part, to offset low self-esteem (Oliosi, Dalle Grave, & Burlini, 1999). Societal Factors Media influence One reason for the increase in male body-image di sturbance is the portrayal of an ideal male body in the mass media (e.g., mens magazine s; Labre, 2005), and there is evidence that viewing this ideal is negatively impacting high school boys (Presnell et al., 2004) and leading them to take measures to increase thei r muscularity (McCabe & Ricciardelli, 2005). Furthermore, not only are men from Playgirl cen terfolds (Leit et al., 2001) to professional football players (Kraemer et al ., 2005) becoming more muscular, the action figures preferred by many preadolescent boys are taking on superhum an physiques (Pope et al., 1999). To better understand the impact of viewing the ideal male body (as portrayed in the media) on body-image disturbance, Leit, Gray, and Pope (2002) showed slides depicting the ideal male physique to

PAGE 41

41 undergraduate men in a laboratory setting and then asked them to indicate via the somatomorphic matrix: a) their perceived body type, b) the ideal body type, c) the averag e mans body type, and d) the body type women preferred. Compared to men who had been shown neutral slides that did not depict the ideal male physique, men who saw slides of the ideal phy sique not only selected an ideal body type with a signi ficantly higher FFMI (Leit et al ., 2002), but also indicated they believed the average man had a si gnificantly higher FFMI. The drive for muscularity is not only pervas ive in American culturestudies in other Westernized cultures such as Australia, France, The Netherlands, Great Britain, Austria, and South Africa have shown a similar pattern of pr eference for increasingly muscular physiques. For example, in a study comparing Austrian, Fr ench, and American men, Pope, Gruber et al. (2000) found no difference in how much more musc le each group desired: the preference was for an additional 27 lbs. of muscle. Contrasting th ese findings with research in Taiwanese men, which shows that they prefer to have a physique with only about 4.5 lbs. more muscle (Yang et al., 2005), illustrates the disp arities between West and Ea st in male body-image ideals. Peer and parental influence Studies have examined the impact of both peers and parents on body-image and body change strategies in males. For example, body di ssatisfaction in boys is significantly related to the amount of weight-loss encouragement a parent provides (Wertheim et al., 2002). In light of this finding, some argue that there may be a diffe rence in what mode of weight loss mothers (dieting) and fathers (exercise) consider acceptable (Ricciardelli & McCabe, 2004). Furthermore, Smolak et al. (2005) found that both peer and pa rental comments were predictive of muscle building techniques; specificall y, boys who used either steroids or supplements reported significantly higher levels of parental comments regarding bo dy size than did non-using boys.

PAGE 42

42 Collectively, these studies suggest that peers a nd parents are quite infl uential in whether a boy decides to adopt body change behaviors ai med at increasing muscularity. Teasing One hallmark of muscle dysmorphia is that a very muscular male perceives that others will mock or ridicule his self-perceived small or wimpy physique. This belief can then lead to problems such as social avoidance and anxiet y. In a similar vein, several studies have investigated the impact of teas ing on the body-image of males. Fo r example, Cafri et al. (2006) found teasing to be significantly negatively correlated with dieting to gain weight and body dissatisfaction in adolescent males; the latter fi nding was believed to have occurred because of an indirect relationship between the two variables that is me diated via negative affect. In addition, teasing was significantly positiv ely correlated with muscle dysmorphia symptomatology, but did not emerge as a signific ant predictor of muscle dysmorphia symptoms. Again, Cafri et al. (2006) explaine d this latter finding as indicativ e of an indirect relationship between the two. Paxton et al. (2006) recently conducted a longitudinal study on adolescent boys over a 5year span in an effort to pr edict body dissatisfaction during mi ddle adolescence. They found that Time 1 weight-related teasing was a significan t predictor of Time 2 body dissatisfaction, but once the regression model was reduced and de pression was included, we ight-related teasing dropped out as a significan t predictor. This suggests, as di d Cafri et al. (2006), a relationship early in adolescence between teasing and body di ssatisfaction that is mediated by depression. Although the relationship between teasing and bo dy dissatisfaction must be teased apart by future research, what is already known of the relationship between the two has prompted the development of interventions ai med at decreasing teasing in th e elementary school setting (e.g., Haines, Neumark-Sztainer, Perr y, Hannan, & Levine, 2006).

PAGE 43

43 Peer popularity Little research has examin ed the relationship between popularity and male body change strategies, but it is known that a curvilinear relationship exists between popularity and physique in adolescent males. Specifically, in comparison to either thin or heavy adolescent males, adolescent males who have a muscular physique have greater body satisfaction and are more popular, but they are also more likely to be dieting (Graha m, Eich, Kephart, & Peterson, 2000; McCabe & Ricciardelli, 2004a ; Wang, Houshyar, & Prinstein, 2006). Furthermore, there is limited evidence of a weak associ ation between popularity and effo rts to increase muscularity amongst adolescent males (McCabe, Ri cciardelli, & Finemore, 2002). Social Body Comparison Social comparison is the process by which an individual evaluates hi s or her attributes, characteristics, or outcomes based on how they compare to the attributes, characteristics, or outcomes of another person. For example, if an individual scored a 75% on an exam he may be discouraged; however, after learning the class mean was 65% he may view his score more positively in light of what could have been. Sim ilar processes are believed to be at work when individuals evaluate their bodies ; opportunities for a male to compare his body to another males body are numerous, especially considering how much television adolescent boys watch (e.g., music videos) and how many other media outlets (e.g., magazines) routinel y produce content that emphasizes a lean and muscular physique (Lab re, 2005; Tiggemann, 2005). Specifically, studies have found that males report greater body dissatisf action after being exposed to images of the male ideal body (e.g., Leit et al., 2002; Strong, 2005). Body-image Dissatisfaction Unlike body-image disturbance in women, body-im age disturbance in men arises because men perceive themselves as either too heavy or too thin (Kostanski et al., 2004; Kostanski &

PAGE 44

44 Gullone, 1998; Presnell et al., 2004). This distinguishes the nature of body-image disturbance in men from that of women because it identifies a double-edged sword of risk in men not present in women. What has arisen from these findi ngs is twofold: (1) when a male reports dissatisfaction with being too small, the desire is to gain weight in the fo rm of muscle mass, and (2) when a male reports dissatisfac tion with being too large, the desi re is to lose weight in the form of body fat. Muscularity Recognizing the central role of muscularity in male bodyimage disturbance, several studies have derived FFMI as the objective meas ure of degree of muscul arity in participants (Pope, Gruber, et al., 2000). For example, Olivar dia et al. (2000) found that men with muscle dysmorphia had significantly higher FFMI than di d normal comparison weightlifters; this lends support to the argument that a key element of mu scle dysmorphia is that a quite muscular man perceives himself to be small or weak. Furt hermore, body composition is a hypothesized (yet poorly understood) precursor to body-image dist urbance in the Cafri et al. (2005) model, although some evidence indicates minimal muscul ature is a significant predictor of muscle dysmorphia symptoms (Chittester, 2003). There has been only one study to da te that has directly correlated FFMI with drive for muscularity (M cCreary et al., 2006), and it found no correlation between the two. Further research is clearly required because gain ing better insight into this relationship would greatly advance our knowle dge of the complexity of male body-image disturbance and actual muscularity; to this point such research has been a notable oversight in the literature because of the critical role actual (or perceived) musc ularity plays in male body-image disturbance.

PAGE 45

45 Body fat Because the BMI is unable to partial out we ight attributable to body fat from weight attributable to muscle, estimations of body fa t are preferred when assessing body composition. Not only is this practice more sc ientifically precise, it is also reflective of the recognition that body fat is one of two (degree of muscularity is the other) physique-relat ed factors that males evaluate when asked their degree of body satisfac tion. For example, Olivar dia et al. (2000) noted that men with muscle dysmorphia had a simila r amount of body fat than normal comparison weightlifters; this le nds support to the argument that one aspect of muscle dysmorphia is a disturbance in how one appraises his body comp osition. Most research, though, indicates that between body fat and muscularity, body fat is th e least consequential; perhaps this is why surprisingly little research has directly correlated body fat percen tage with body-image disturbance in men. One method of assessing satisfa ction with body fat percentage is by asking the participant to ascertain his body fat percentage by using th e somatomorphic matrix. This is a computerbased test in which the silhouette of a man is pres ented on the screen. The pa rticipants task is to simultaneously manipulate the degree of muscular ity and body fat of the silhouette in order to arrive at (1) the participants perceived actual body shape, (2) th e participants id eal body shape, and (3) the body shape he believes that mo st women find ideal. For example, using the somatomorphic matrix, Leit et al. (2002) found that undergraduate men perceived average men to have about 4% less body fat than the partic ipants perceived themse lves as having; this suggests a social comparison in which these pa rticipants believed th emselves to be chubby relative to an average man. Unfortunately, recent reliability assessment by Cafri, Roehrig, and Thompson (2004) has raised legitimate concerns that the somatomorphi c matrix is not reliable; clearly this assessment

PAGE 46

46 tool should be re-examined and properly adjust ed before being included in future body-image studies. This measurement problem underscores the need for direct assessment of body fat whenever it is an outcome of interest. Cafri et al. (2005) hypothesize th at body composition is a key precursor to body dissatisfactio n, yet there is little in the wa y of empirical data that can either confirm or falsify this proposed link. Ther efore, there is a need to better understand the relationship between body fat per centage and body-image disturban ce in men; such information could strengthen descriptive mode ls such as those presented by Ca fri et al. (2004) and Lantz et al. (2002). Health Risk Behaviors The pursuit of muscularity may potentially lead to the use of illegal substances or dietary supplements and products, most of which are ma rketed as weight-gai ner or weight loss supplements. These substances are attractive to someone with high body-image disturbance because of the belief that they offer a quick fix to ones body dissati sfaction that will require minimal lifestyle change on the part of the user In addition, many men a dopt rigid eating habits in an attempt to lose weight, gain weight, or add muscle mass. This section will detail these behaviors that increase the risk to health. Steroids Anabolic steroids, despite being illegal in th e United States, are attractive to persons who desire greater muscularity because these subs tances significantly enhance muscle mass in a relatively short period of time (H artgens & Kuipers, 2004). While st eroids offer these desirable effects, they also pose numerous risks to both physical and psychological health. Adverse physical symptoms include destabilization of lipid levels (which may increase risk of cardiovascular events), disturbances in liver function, testicular atr ophy, and acne (Hartgens & Kuipers, 2004; Pope & Katz, 1994; Tricker, ONeill, & Cook, 1989). In addition, psychological

PAGE 47

47 ramifications of steroid use include aggressive behavior, mood disorders, and psychotic symptoms (Lefavi, Reeve, & Newland, 1990; P ope & Katz, 1987; 1988; 1994; Tricker et al., 1989). Finally, beyond physical and ps ychological ramifications, steroi d use is both a financial (a user could expect to pay between $100$275 for a 100 count bottle; Kouri, Pope, & Katz, 1994) and legal risk (attempting to acquire steroids on the black market may be the pathway to jail for some users; e.g., Pope et al., 1993). Perhaps the most troublesome aspect of body-im age disturbance in men is its relationship to anabolic steroid use. Several studies have concluded that body dissa tisfaction is a primary predictor of steroid use in me n (Blouin & Goldfield, 1995; Brow er et al., 1994; Chng & Moore, 1990; Kanayama et al., 2003; Cole et al., 2003). Furt hermore, in a summation of interviews with 10 former steroid users, Olrich and Ewing (1999) alluded to body dissatisfaction as a precipitating factor. Specifically, these men reported steroid use, in part, because of (1) upward social comparisons (i.e., comparing oneself w ith more muscular men in the gym), and (2) perceived lack of gains in size and strength. In recognition of this unequiv ocal link, and the dire consequences of steroid use, it is prudent to develop interventions aimed at increasing body satisfaction in young men. Steroid precursors Adrenal hormones are substances designed to increase muscle mass because they are testosterone precursors. Some examples include growth hor mones (e.g., levodopa or L-DOPA) and testosterone stimulants such as HCG. Perhaps the best-known adrenal hormone is androstenedione, the substance admittedly used by former major league baseball star Mark McGwire during his quest for the single season home run record in 1998. In a review of these types of hormones, Ziegenfuss, Berardi, Lowe ry, and Antonio (2002) concluded that while physiological effects such as decreases in hi gh density lipoprotein ( good cholesterol) and

PAGE 48

48 increases in estrogen and testos terone levels are seen while taking these supplements, clear evidence that they positively increase either mu scle mass or performance (the primary claim made when they are marketed) is lacking. In fact, Ziegenfuss et al. (2002) argued that the theoretical risks of using these adrenal hormones outweigh any poten tial benefits they have to offer, while others (Kreider, 1999) have gone fu rther and said the use of these hormones should not be encouraged. Men with body-image disturbance often us e a variety of performance-enhancing substances (ranging from supplements found in hea lth food stores to ana bolic steroids obtained on the black market) in an attempt to attain the ideal physique. In addition, adolescent boys frequently consume these substances; this is alarming in light of McCabe and Ricciardellis (2004a) finding that disordered eating in adolescent boys is predicted by the use of food supplements. There are literally scores of different kinds of substances th at are used by men who want to simultaneously shred fat and gain muscle (Pope, Phillips, et al ., 2000). Because of their use primarily to alter body composition, which the user believes will facilitate greater body satisfaction, some researchers have begun referr ing to these as body image drugs (Kanayama et al., 2001). Two additional classes of supplements are described below. Protein supplements are designed to add muscularity; they typically come in the form of snack bars, shakes, or powder, and are often consumed pre-workout, post-workout, or between meals. For example, protein supplements such as Met-Rx and Power Bar are high in protein content, although there is little evidence that such supplements are more effective at promoting muscle growth than foods such as lean meat or skim milk (Pope, Phillips, et al., 2000). Creatine is a very popular supplement, and stud ies have shown it to increase muscle mass (e.g., Chilibeck, Stride, Farthing, & Burke, 2004; Kreider, 1999), but it is believed that a large

PAGE 49

49 portion of this gain may be attributable to water (Pope, Phillips, et. al, 2000). Creatine is regarded as relatively safe; a recen t review of its side effects noted that the greatest harm it poses is likely restricted to issues regarding the purity of the supplement itself as it is manufactured (Bizzarini & De Angelis, 2004). Perhaps concerns over water re tention explain the use of diuretics in some users (to eliminate water weig ht and increase the appearance of muscle mass). In addition, hydroxycitrate acid is a supplement frequently used as a compliment to musclepromoting supplements because of its reported ab ility to inhibit lipogene sis and thus promote weight loss and a leaner physique. These claims however, appear unfounded, as neither weight loss nor increased energy expenditure are faci litated by this supplement (Heymsfield, Allison, Vasselli, Pietrobelli, Greenfield, & Nunez, 1998; van Loon, van Rooijen, Niesen, Verhagen, Saris, & Wagenmakers, 2000). Ephedrine Ephedrine (ma huang) is a central nervous system stimulant often used in conjunction with caffeine to produce weight loss. The user will frequently combine the use of this supplement with exercise and strict dietar y practices aimed at shredding fa t and gaining muscle. In recent years there have been several reports of advers e effects associated w ith ephedrine, including mania-like episodes, acute myocardial infarction, stroke, and in especi ally vulnerable persons, death (Emmanuel, Jones, & Lydiard, 1998; Halle r & Benowitz, 2000; Saper et al., 2004; Traub, Hoyek, & Hoffman, 2001). While Hu tchins (2001) argued that t he implication of ephedrinetype alkaloids in deaths from a wide variety of conditions that o ccur in the general population is no more than idle speculation (p. 1096), the Food and Drug Administration found sufficient reason to ban in April 2004 the sale of ephedrine in the United States.

PAGE 50

50 Dieting to lose weight Although females are more likely to try to lo se weight than males (e.g., McCabe et al., 2002), males also adopt weight loss st rategies. It is troublesome to note that this starts early in life: evidence indicates that boys as young as 8y ears old already have th oughts of losing weight, or have already engaged in we ight loss behavior (McCabe & Ricciardelli, 2003). When males desire to lose weight the efforts are primarily aimed at decreasing body fat (as opposed to overall body size reduction, as is the goal when females atte mpt to lose weight). In some men the drive to lose weight may be so severe that it leads to problems such as exercise dependence or eating disorders (ODea & Abraham, 2002; Sharp, Clar k, Dunan, Blackwood, & Shapiro, 1994; Stice, 2002). It is well established that bodybuilders, esp ecially those who comp ete, closely monitor their dietary intake (Lantz et al., 2002) and display significantly greater eating dist urbed attitudes than athletically active cont rols (Goldfield, Blouin, & Woods ide, 2006; Pickett et al., 2005); however, it has been argued that careful attenti on to dietary intake is part of the competitive nature of the sport of bodybuilding, and, provided it harmed neither the health nor performance of the individual, could easily be viewed as drive or motivation (Chung, 2001). Of course, the problem arises when harm is being done to th e individual when distur bed eating behaviors are taken in context of an overall pa ttern of behavior designed to achie ve maximum muscularity. Dieting to gain weight/increase muscularity It is interesting to note that one of the first articles that obs erved a desire on the part of boys to increase weight attributed this desire to the tendency of boys to value change in shape or tallness (Andersen & Holman, 1997, p. 392); in retrospect, although they alluded to a desire to add muscle, it appears this did not occur to th e researchers at the time, and rightly so because there was little knowledge of or research on this relatively new phenomenon. Whereas for

PAGE 51

51 women the issue of dieting usually refers to weight loss efforts, a unique form of eating behavior is being observed more frequently in men. Speci fically, males with body-image disturbance not only restrict foods high in fat, they also consum e large amounts of food that are high in protein. Indeed, a study from Northern Ireland found th at the amount of protein consumed by males significantly increased between the ages of 15 and 22 (Boreham, Robson, Gallagher, Cran, Savage, & Murray, 2004), although the extent to which this was an intentional dietary practice was not determined. This dieting behavior is aimed at maximizing gains in muscle mass while simultaneously limiting calories from fat. This ma y result in continuous cycles of weight gain and loss of over 11 lbs. in the case of compe titive bodybuilders (Oliosi et al., 1999). If extreme eating practices produce such drastic weight fl uctuations in competitive bodybuilders, it is disturbing to note that adolescent boys are increasingly turning to su ch strategies to achieve the lean, muscular look. This is especially c oncerning due to the knowledge that body-image disturbance is an identified risk factor for su ch unhealthy eating behavi or (Cafri et al., 2005; Muris, Meesters, van de Blom, & Mayer, 2005). A major limitation of understand ing the role of dietary pr actices in the pursuit of muscularity has been the lack of a psychometri cally sound instrument. Previous studies have used measures that have been validated for use with eating disorder ed populations (e.g., Tiggemann, 2005), but even these are not without lim itation when being used in men. Recently a Muscle-Oriented behavior subscale has been identified on the Drive for Muscularity Scale (McCreary, Sasse, Saucier, & Dorsch, 2004); this contains some items that more precisely measure dietary practices aimed at building muscle (e.g., I try to consume as many calories as I can in a day). In addition, Kaminski et al (2005) have developed the MEBBIE, a scale specifically designed to assess ea ting, exercise, and body-image relate d attitudes and behaviors; a

PAGE 52

52 recent confirmatory factor analys is has determined the factor st ructure to be strong (Kaminski, personal communication, 2005) but it does not appear to contai n questions specific to eating practices undertaken to add muscle. However, the Diet subscale of the Muscle Dysmorphia Inventory (MDI; Lantz et al., 2002 ; Rhea et al., 2004), with very sp ecific items (e.g., I control the intake of proteins, carbohydrates, and fats to maximize my muscular development) and established psychometric propertie s, has emerged as a potential gold standard for assessing muscle-building dietary practices. Sports Millions of males worldwide participate in sports ranging from little league baseball and youth soccer to professional sports teams. In additi on to the pure enjoyment of the specific sport, males become involved in sports for a variety of reasons, including moral development, selfesteem enhancement, development of leadership qualities, and social in teractions (e.g., making friends, functioning within a group setting; Co akley, 2004; Tritschler, 2000). Considerable research over the past 30 years has been conducte d to determine precisely how sport involvement impacts males on these variables and a host of others, and the consensus is that sport involvement is generally a positive experience. Ho wever, for some males, sport involvement can be accompanied by hazardous behaviors aimed at increasing performance, such as disturbed eating practices, supplement use, and steroid use (Hausenblas & Carron, 1999; Irving et al., 2002; McCabe & Ricciardelli, 2004a). Interestingly, qualitative research s uggests that adolescent boys involved in sports report enga ging in such behaviors to increa se athletic performance, but nonetheless are fixated on their physiques for purel y aesthetic reasons (Ri cciardelli, McCabe, & Ridge, 2006). To further understand the role of spor ts in the adoption of body change strategies, Cafri et al. (2005) have drawn a distinction between organized and informal team sports; because no operational definitions were provided for what c onstitutes an organized or informal sport,

PAGE 53

53 the following section is a general discussion abou t sport involvement regardless of organization status. Organized and informal team sports Sports teams could theoreti cally include YMCA/YWCA a nd other locally organized recreational leagues, in addition to professional, intercollegiate, or high school varsity teams. Within the context of drive for muscularity a nd its correlates the most studied population of competitive athletes is bodybuilders; indeed, succe ss in this sport is comp letely reliant on unique diet and exercise behavior. Furt hermore, many of these athletes use substances to help achieve maximal muscularity. Beyond bodybuildi ng (which will be discussed in further detail below), the sports that are most associated with unhealthy beha vior related to diet, ex ercise, or substance use are those that are either (1) power or strength oriented (e.g., football, field ev ents such as shot put), or (2) weight oriented (e.g., wrestli ng, martial arts, horse jockey; Jonnalagadda, Rosenbloom, & Skinner, 2001; Moore, Timperi o, Crawford, Burns, & Cameron-Smith, 2002). However, competitive sport involvement (e.g., football, basketball, tennis, cricket) has been found to be a significant predictor of disord ered eating and steroid use in early maturing adolescent boys, but not in on-time or late-mat uring boys (McCabe & Ricciardelli, 2004a). This is consistent with the qualitat ive findings of Ricciardelli et al. (2006) in that part of the explanation for the increased like lihood of early maturing boys to engage in these behaviors lies in aesthetic concerns. Weightlifting The literature is equivocal when attempting to understand which groups of exercisers are most susceptible to experiencing body-image di sturbance. For example, athletically active exercisers have lower levels of body-image dist urbance than non-exercise rs (Schwerin et al., 1996), Also, exercise behavior is a strong predictor of body satisfa ction in physically active men

PAGE 54

54 (Hausenblas & Fallon, 2002), and Davis and Co wles (1991) found body dissatisfaction to be negatively correlated with physical activity. Furt hermore, there is evidence that men who regularly lift weights are satisfied with their bodies (Pickett et al., 2005), and that weightlifting interventions designed to improve body satisfa ction are efficacious (Williams & Cash, 2001). However, it is clear that for so me men weightlifting is taken to unhealthy levels to achieve the ultimate high muscularity/low body fat look (Hildebrandt, Schlundt, Langenbucher, & Chung, 2006). Collectively, these findings suggest that ex ercise may have a protective effect against body-image disturbance for most men, but may be associated with problematic psychopathology and behavior in others. Bodybuilders in particular report greater body-image disturbance than control men (Mangweth et al., 2001), martial artists (Blouin & Goldfield, 1995), and power lifters (Lantz et al., 2002). However, Boroughs and Thompson (2002) and Pickett et al. (2005) have recently found that bodybuilders are quite sa tisfied with their bodies. Th ese conflicting findings suggest that some persons may initiate weightlifting as a result of pre-existing body dissatisfaction (Kanayama et al., 2003), while othe rs become dissatisfied with th eir bodies only after initiating a weightlifting program; further research would help better understand this association. Other Factors Related to Male Body-Image Disturbance There are three additional factors that are notable when attempting to understand male body-image disturbance; what follows is a brief re view of eating disorders, exercise dependence, and the impact of romantic partners. Eating Disorders Eating disorders are often viewed as one of the consequences of body-image disturbance, and the interplay between these constructs in wome n has received a great deal of interest; indeed, body-image disturbance is an extremely salient and stable risk factor for eating pathology

PAGE 55

55 (Cooley & Toray, 2001; Stice, 2002). Although there is no difference between men and women in eating disorder presentation (Braun, Sunday, Huang, & Halmi, 1999), the relationship between eating disorders and body-image disturbance in men has received little attention. College men with eating disorders have grea ter levels of body-image disturba nce than non-eating disordered college men (Olivardia et al., 1995); this suggest s that more research should examine the relationship between these variable s in men. It is worthwhile to note, however, that body-image disturbance in men with eating disorders would likely center on dissati sfaction with overall weight, whereas body-image disturbance in non -eating disordered men would likely center around dissatisfaction with muscul arity. That being said, Mangweth et al. (2001) demonstrated the complexity of male body-image disturbance wh en they found that men with eating disorders and male bodybuilders were virtually simila r in their degree of dissatisfaction. Because most current male body-image resear ch addresses dissatisf action specific to muscularity, and because past body-image research has typically been done in women, there is little information available on the relationship between male body-image disturbance and eating disorders. In fact, preliminary evidence suggests that a history of eating disorders is associated with muscle dysmorphia. For example, Olivar dia et al. (2000) found a significantly higher incidence of past eating disord ers in men with muscle dysmo rphia (29%) than in normal comparison weightlifters (0%). Furthermore, Hitzeroth, Wessels, Zungu-Dirwayi, Oosthuizen, and Stein (2001) found that 6% (1 of 15) of amateur South African competitive bodybuilders with muscle dysmorphia had a past eating disord er. What follows is a brief overview of the research examining the relationship between male body-image disturbance and each eating disorder.

PAGE 56

56 Anorexia nervosa Although anorexia is seen less frequently in men than in women, evidence indicates that the disease presents with similar pathology for women and men (Woodside et al., 2001). Because body-image disturbance is a key componen t of anorexia, it is essential to understand body-image disturbance in men. For example, Gila et al. (2005) found that adolescent boys with anorexia had significantly higher body dissatisfaction than non-anor exic adolescent boys; this clearly indicates the presence of a relationship between the two, and sugge sts that if body-image disturbance is alleviated it w ould be accompanied by an allevi ation of other symptoms of anorexia. In some men anorexia may be a precursor to the development of muscle dysmorphia. For example, Pope et al. (1993) found that two out of three bodybuilders with muscle dysmorphia reported a history of anorexia. While the sample of muscle dysmorphic bodybuilders was small, this unique pairing of opposite diag noses at different times within the same individual suggests a complex clinical picture of male body-image disturbance. Bulimia nervosa The clinical presentation of bulimia in me n closely resembles that of bulimic women (Pope, Hudson, & Jonas, 1986). Furthermore, adol escent boys with eating patterns similar to bulimia and binge-eating disorder have expresse d greater body dissatisfaction than age-matched, non-eating disturbed controls (Keel, Klump, Leon, & Fulkerson, 1998). In addition, Blouin and Goldfield (1995) identified a subgroup of bodybuilders whose psychological make-up consisted of a disturbing mixture of body dissatisfaction, bulimic-like eati ng patterns, and steroid use. Unfortunately, bulimic tendencies appear frequen tly in bodybuilders, a population that, despite recent findings of Pickett et al. (2005), seems pr edisposed to body dissatisfaction (Lantz et al., 2002).

PAGE 57

57 Binge-eating disorder People with binge-eating disord er are typically obese, and previous sections of this manuscript have established the link between bodyweight and body-image disturbance in men. Specifically, several studies have found that body -image disturbance is significantly higher in women with binge-eating disorder than in me n (Barry, Grilo, & Masheb, 2002; Grilo & Masheb, 2005; Grilo, Masheb, Brody, Burke-Martindale, & Rothschild, 2005), and that body-image disturbance is correlated with body mass inde x (Grilo & Masheb, 2005) in men with bingeeating disorder. This is congruent with the finding that men often report body dissatisfaction when they perceive themselves as e ither not muscular enough or too fat. Exercise Dependence Regular exercise has positive physical and ps ychological benefits (Berger & Motl, 2000; Landers & Arent, 2001), a point underscored by a growing body of research that indicates exercise is an effective intervention for treating body-image distur bance (e.g., Fisher & Thompson, 1994; Williams & Cash, 2001). However, if taken to an unhealthy level exercise may be detrimental to health. Th e craving for leisure-time phys ical activity, resulting in uncontrollable excessive exerci se behavior, that manife sts in physiological (e.g., tolerance/withdrawal) and/or ps ychological (e.g., anxiety, depre ssion) symptoms (Hausenblas & Symons Downs, 2002a, p. 90) is called exerci se dependence. Based on ones motives for excessive exercise behavior, ex ercise dependence can be desc ribed as either primary or secondary. Primary exercise dependence is when the exercise behavior is the end in itself, whereas secondary exercise dependence is when th e exercise behavior is undertaken specifically to alter or control the desired body compositi on (Carron, Hausenblas, & Estabrooks, 2003). There is a subset of males who take exerci se to unhealthy levels to attain the ideal physique. Indeed, a person with exercise depend ence may experience withdrawal effects, and

PAGE 58

58 this may be reflected in the finding of ODea a nd Abraham (2002) that 34% of surveyed college men indicated they are distressed if unable to exercise as much as they desired, and that 20% displayed characteristics of di sordered eating. This unhealthy ove remphasis on exercise, and the simultaneous focus on disordered eating practic es, is concerning in light of McCabe and Ricciardellis (2004a) recent finding that exercise dependence in a dolescent boys is predicted by weight loss strategies over an 8month period. Taken together, th ese findings suggest that, as disruptive and harmful as exercise dependence may be, disordered eating habits may be a precursor to unhealthy exercise behavior. Research on drive for muscularity does not usually assess exercise dependence per se, but instead assesses body change strategies in wh ich exercise (e.g., McCabe & Ricciardelli, 2004a; Ricciardelli & McCabe, 2002) or specifically, weightlifting (e .g., Smolak et al., 2005) is a component. Contrast this approach with that undertaken in the muscle dysmorphia literature. According to the diagnostic crit eria proposed by Pope et al. ( 1997), exercise continuation that results in significant social, occ upational, or interpers onal impairment is a component of muscle dysmorphia. Therefore, because the exercise beha vior itself is implicit in the diagnosis, and because it is implied that weightlifting is the m ode of exercise, most assessment of exercise behavior is gained as part of a diagnostic interview (e.g., Hitzerot h et al., 2001; Olivardia et al., 2000). Attempts to circumvent an interview have led to the crea tion of measures such as the Bodybuilding Dependence Scale (Smith, et al., 1998) and the Muscle Appearance Satisfaction Scale (Mayville et al., 2002). Ho wever, these scales do not asse ss the actual mode, duration, and frequency of exercise; instead, their focus is on the respondents degree of persistence in exercising despite barriers (e.g., il lness, injury, demands of daily activities). Theref ore, the above

PAGE 59

59 findings indicate a need to quantify the mode, dur ation, and frequency of exercise behavior when conducting future research on male body-image disturbance. Romantic Partners If there is only one certaint y about how romantic partners (male-female dyads) view both their own and their partners body it is that the females body is more scrutinized than the males (Ogden & Taylor, 2000). In females, the scrutiny is related to the belief that the female should either lose (because she is seen as too heavy) or gain (because she is seen as too thin) weight. For example, Sheets and Ajmere (2005) found that an equal number (7%) of college women in their study had been told within the previous 3 months by a dating partner to either lose or gain weight; however, women who were told to gain weight had significan tly higher relationship satisfaction than women told to lose weight. Th is finding implies that thinner women perceive themselves as closer to the ideal female physique. In addition, Weller and Dziegielewskis (2004) study of 117 college-aged women found that romantic part ner support was significantly and inversely related to body-image disturbance, which is consiste nt with the finding of Befort, Robinson Kurpius, Hull-Blanks, Foley Nicpon, Huse r, and Sollenberger (2001) that college-aged women who receive weight-related criticism from romantic partne rs report greater body shame. Although Ogden and Taylor (2000) have argued that female body dissatisfaction stems from sources other than their romantic partners reactions to their b odies, the aforementioned findings make it difficult to dismiss the impact males can have on the body-image of their female romantic partners. Can females have a similar impact on the body-image of their male romantic partners? There has been little research done on this topic, but there is limited ev idence, both qualitative (e.g., Adams, Turner, & Bucks, 2005) and empirical, that the female partne rs evaluation of the males body does impact the males body satisfac tion. For example, in their study of college

PAGE 60

60 men, Sheets and Ajmere (2005) found that 24.4% of them had been told by a dating partner within the previous 3 months to either lose or gain weight. However, a disproportionate number of these men (19.7%) were told to gain weigh t; because the mean BMI of the sample men ( M = 24.70) was higher than the BMI of 88% of these men, their female partners presumably were expressing their desire for a male partner with more bulk on his frame. The message was not lost on these males, as relationship sa tisfaction in men told to gain weight was significantly lower than in other men (Sheets & Ajmere, 2005). Cons istent with this, Tantleff-Dunn and Thompson (1995) found that the only factor s that signifi cantly predicted appearan ce evaluation in men was what the men perceived their female partners thought of their bodies and what their female partners rated as their actual male body size pr eference. At the same time, other research indicates that although females view their male partners bodies, as well as specific body parts (e.g., shoulders, chest, arms), as closer to the i deal than the males believe they are, males still display a significant discrepancy between what th ey consider the actual and the ideal sizes (Ogden & Taylor, 2000). While the above findings indicate female romantic partners can influence male body-image, further research is required to clarify this relationship. Summary This chapter has described the main factor s relevant to the study of male body-image disturbance. Males do experience body-image disturbance, although the rates of disturbance are lower than in women. Another di stinguishing feature that separa tes male body-image disturbance from that experienced by women is the aspect of appearance that is dissatisfying: women primarily are dissatisfied with self-perceived he aviness, whereas men may be equally dissatisfied with either self-perceived heaviness or thinness. The Cafri et al. (2005) heuristic model of male body change strategies serves as a useful tool in attempting to understand the complexity of male body-image disturbance, especially because body-ima ge disturbance is a known risk factor for

PAGE 61

61 eating disorders, a health concern no longer restrict ed entirely to females, and is associated with low self-esteem and negative affect. Finally, it is believed that the drive for muscularity is also associated with (1) use of anabolic steroids to gain muscle mass, (2) misuse of dietary supplements designed to add muscle and strip aw ay fat, and (3) the adoption of strict eating behaviors that could lead to rapid weight fluctuation. In conclusion, the model offered by Cafri et al. (2005) serves as th e inspiration for the current study. While there are seven main construc ts in the model, for brevity the present study focuses primarily on the testing of hypothesized rela tionships that either have limited empirical support (e.g., biological factors and body-image dissatisfaction) or no proposed relationship (e.g., self-esteem and body-image dissatisfaction) wh ere one should be. Nota ble exclusions from this study are social body comparison and the im pact of sport. Social body comparison was omitted from the study because of the strength of support already existing for its inclusion; although weightlifting was included in the presen t study, the impact of organized and informal sports was omitted because the primary investigator elected to focus on general exercise behavior instead of sport involvement per se Additional research on model constructs not included in this study is warranted to furthe r our knowledge of drive for muscularity and associated body change behaviors.

PAGE 62

62 Health Risk Behaviors 1. Steroids 2. Steroid precursors 3. Ephedrine 4. Dieting to lose weight 5. Dieting to gain weight 6. Dietin g to increase muscularit y Body-image Dissatisfaction Psychological Functioning Social Body Comparison Societal Factors 1. Media influence 2. Peer/parental influence 3. Teasing 4. Peer popularity Biological Factors 1. Body composition/BMI 2. Pubertal growth 3. Pubertal timing Sports 1. Organized team sports 2. Informal team sports 3. Weightlifting Figure 3 A heuristic model of male body chan ge behavior; solid arrows indicate rela tionships with greater support than broken arrows. Reprinted from Clinical Psychology Review, Vol. 25, Cafri et al., Pursuit of the muscular ideal: Physical and psychological consequences and putative risk factors, pp. 215-239, Copyright (2005), with permission from Elsevier.

PAGE 63

63 CHAPTER 4 RESULTS Descriptive Statistics Body fat percentage was within the normal range for men of this age, and the FFMI indicated muscularity of nonsteroid using re creational weightlifters (Table 1 contains descriptive statistics). In a ddition, the mean objective BMI indi cated overweight status; it was also found that BMI based on objective measures of height and weight was significantly higher than BMI based on self-repor ted height and weight ( t(112) = 13.83, p < .001). The correlation matrix for study variables is located in Table 1. Among the more noteworthy correlations are the following: (1) Objective BMI and FFMI ( r = .77, p < .01), (2) self-report BMI and FFMI ( r = .75, p < .01), and (3) perceived sociocultural pr essure and the measures of body composition (objective BMI: r = .32, p < .01; self-report BMI: r = .29, p < .01; body fat: r = .24, p < .01; FFMI: r = .21, p < .05). Multiple Regression Analyses Because the correlation between objective BMI and self-reported BMI was so high ( r = .97), two separate regression analyses were run: one with objective BMI as an independent variable and the other with se lf-report BMI as an independent variable. Because the results across the analyses were consistent, only the regression analysis for the objective BMI is reported here (Table 1 contains the regression analysis using subjectiv e BMI); the decision to report the data for the objective BMI was due to the fact that this method of BMI calculation is more accurate than subjective BMI (Elgar et al., 2005). Examination of the tolerance values revealed that I did not have multicolinearity among the independent variables (Tolerance values range = .02 to .92; Mertler & Vannatta, 2002). Th e regression equation explained 51% of the variance in drive for muscularity, F (10,102) = 12.68, p < .001, with weightlifting index ( = .17,

PAGE 64

64 p = .05), supplement use ( = .37, p < .001), exercise dependence ( = .24, p < .01), and selfesteem ( = -.23, p < .01) emerging as significant predictors (Table 1).

PAGE 65

65 Table 4 Descriptive statis tics for outcome variables ______________________________________________________________________________ Variable M SD Range BMI Obj 25.05 3.63 17.79.08 BMI SR 23.82 3.31 17.01.14 Body fat percentage 15.96 7.01 4.70.70 FFMI 21.20 2.26 16.59.32 Cardio frequency 2.63 1.79 0.00.00 Cardio duration (mins.) 41.04 34.66 .00.00 Weightlifting frequency 2.24 1.80 .00.00 Weightlifting duration (mins.) 38.41 31.36 .00.00 Weightlifting index 127.57 134.90 .00.00 LTEQ 55.83 41.91 .00.00 MDI Diet 13.10 5.48 5.00.00 MDI Supplement 8.31 4.65 4.00.00 PSPS 16.63 5.07 8.00.00 DMS MBI 3.79 1.22 1.43.00 DMS MB 2.53 1.01 1.00.00 DMS Total 3.16 .94 1.36.07 EDS 45.51 14.33 21.00.00 RSES 33.73 4.37 23.00.00 ______________________________________________________________________________ Note: Obj = Measured; SR = Self-report; FFMI = Fat-free mass index; LTEQ = Leisure Time Exercise Questionnaire; MDIDiet = Muscle Dysmorphia InventoryDiet subscale; MDI Supplement = Muscle Dysmorphia InventorySupplement subscale; PSPS = Perceived Sociocultural Pressure Scale; DMSMBI = Drive for MuscularityMuscle-oriented body image subscale; DMSMB = Drive for Muscular ityMuscularity-related behaviors subscale; EDS = Exercise Dependence Scale; RS ES = Rosenberg Self-esteem Scale.

PAGE 66

66Table 4 Correlation matrix of outcome variables Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1. BMI OBJ .97** .65** .77** .06 -.02 .19* .01 .32** -.21* -.02 -.14 02 -.08 2. BMI SR .61** .75** .09 .00 .23* .01 .29** -.19* .00 -.12 .01 -.07 3. Body fat .03 -.23* -.05 .08 -.03 .24** -.17 -.17 -.20* -.16 -.10 4. FFMI .27** .04 .18 .02 .21* -.13 .11 -.03 .18 -.04 5. Weightlifting index .24* .35** .45** -.03 .11 .62** .40** .36** .11 6. LTEQ .10 .07 .02 -.01 .14 .06 .14 .06 7. MDI Diet .53** .08 .06 .55** .33** .33** .05 8. MDI -Supplement .12 .28** .77** .59** .40** -.02 9. PSPS .22* .14 .21* .20* -.34** 10. DMS MBI .44** .88** .35** -.37** 11. DMS -MB .81** .57** -.09 12. DMS Total -.53** -.29** 13. EDS -.20* 14. RSES ____________________________________________________________________________________________________________ Note: Obj = Measured; SR = Self-report; FFMI = Fat-free mass index; LTEQ = Leisure Time Exercise Questionnaire; MDIDiet = Muscle Dysmorphia InventoryDiet subsca le; MDISupplement = Muscle Dysmorphia InventorySupplement subscale; PSPS = Perceived Sociocultural Pressure Scale; DMSMBI = Drive for MuscularityMuscleoriented body image subscale; DMSMB = Drive for MuscularityMuscularity-related behaviors subscale; ED S = Exercise Dependence Scale; RSES = Rosenberg Self-esteem Scale. p < .05. ** p < .01.

PAGE 67

67Table 4 Stepwise regression predicting dr ive for muscularity using subjective BMI Predictor SE 95% Confidence interval Tolerance Subjective BMI .20 .07 -.07.19 .08 Body fat -.28 .02 -.08.00 .19 FFMI -.30 .08 -.28.02 .13 Weightlifting index .17* .00 .00 .61 LTEQ -.03 .00 .00 .93 MDI Diet .02 .01 -.03.03 .62 MDI Supplement .38*** .02 .04.11 .57 PSPS .12 .01 -.01.05 .77 EDS .25** .05 .01.03 .68 RSES -.24** .02 -.08(-.02) .83 ____________________________________________________________________________________________________________ Note: FFMI = Fat-free mass index; LTEQ = Leisure Time Exercise Qu estionnaire; MDIDiet = Mu scle Dysmorphia Inventory Diet subscale; MDISupplement = Muscle Dysmorphia InventorySup plement subscale; PSPS = Perc eived Sociocultural Pressure Scale; EDS = Exercise Dependence Scale; RSES = Rosenberg Self-esteem Scale. F (10,102) = 12.85, p < .001, Adj R2 = .51; p = .05. ** p < .01. *** p < .001.

PAGE 68

68Table 4 Stepwise regression predicting dr ive for muscularity using objective BMI Predictor SE 95% Confidence interval Tolerance Objective BMI .06 .12 -.22.25 .02 Body fat -.20 .04 -.11.05 .05 FFMI -.20 .15 -.38.21 .04 Weightlifting index .17* .00 .00 .61 LTEQ -.03 .00 .00 .92 MDI Diet .04 .01 -.02.04 .65 MDI Supplement .37*** .02 .04.11 .56 PSPS .12 .01 -.01.05 .76 EDS .24** .01 .01.03 .69 RSES -.24** .02 -.08(-.02) .81 ____________________________________________________________________________________________________________ Note: Obj = Measured; FFMI = Fat-free mass index; LTEQ = Le isure Time Exercise Questionnaire; MDIDiet = Muscle Dysmorphia InventoryDiet subscale; MDISupplement = Muscle Dysmorphia InventorySupplement subscale; PSPS = Perceived Sociocultural Pressure Scal e; EDS = Exercise Dependence Scale; RSES = Rosenberg Self-esteem Scale. p = .05. ** p < .01. *** p < .001.

PAGE 69

69 CHAPTER 5 DISCUSSION Drive for muscularity represents a form of ma le body dissatisfaction that is associated with substance use, eating pathology, and exercise dependence (McCreary et al., 2004). However, knowledge of the predictors of drive for muscul arity, including the role of body composition, is limited. Therefore, the purpose of my st udy was to identify the body composition and psychological predictors of drive for muscularity. Implica tions of my results, study limitations, and future research directions are discussed below. First, consistent with my hypotheses and the research of McCreary et al. (2006), the body composition measures of BMI, body fat percen tage, and FFMI did not predict drive for muscularity. It is possible that no effect emer ged because the men in my sample had average levels of body fat and FFMI, and were only slig htly overweight; if more men in the sample deviated from average values (e.g., had either higher body fat or FFMI) different results may have been attained. However, the fact that FFM I did not emerge as a predictor of drive for muscularity is noteworthy because theoretically one would expect to see higher drive for muscularity in less muscular men. In explaining their findings, McCreary et al. (2006) speculated that perhaps body fat hides the musculature that lies beneath, which w ould result in a mans inability to gauge his true level of muscular ity a similar effect may be at work here. Nevertheless, my findings sugge st that drive for muscularit y occurs independently of body composition. Further similarities with McCreary et al. (2006) emerged, as evidenced by the following significant correlations: (1) objective BMI and subjective BMI, (2) ob jective BMI and body fat percentage, (3) subjectiv e BMI and body fat percentage, (4) objective BMI and FFMI, and (5) subjective BMI and FFMI. However, in a depart ure from McCreary et al (2006), the correlation

PAGE 70

70 between body fat percentage and FFMI in my study was nonexistent. That these two measures of body composition are uncorrelated is to be expected because of the distinct difference between fat and muscle. Furthermore, all measures of body composition were weakly yet significantly related to perceived sociocultural pressure; alt hough the direction of caus ation is unclear, it is possible that either (1) men misi nterpret the messages coming from others and infer that their body does not fit the ideal male physique, or (2 ) the body composition of the men truly doesnt reflect the ideal male physique, which increases the likelihood that a man would hear messages confirming this. Among the measures of body composition, on ly objective and subjective BMI were significantly related to dietary habits consistent with drive for muscul arity. It is possible that this is due to the belief men have that eating more food, especially foods high in protein, will add muscle; while this may help, the extra calories gained from these foods will lead to more fat deposition as well, thus increasing BMI. Howe ver, while BMI was unrelated to muscularityrelated behaviors, it was inversel y related to muscle-oriented body image; this is an unexpected finding because it indicates that men with higher BMIs have less concern about their muscularity, although this may be clarified by the fact that BMI correlated significantly with FFMI. Second, in support of my hypotheses I found that supplement use, exercise dependence, and self-esteem significantly predicted drive for muscularity. The findings regarding supplement use indicate that it is predictive of drive for muscularity, as evidenced not only by the regression analysis but also by significant correlations with weightlifting, dietary practices, muscle-oriented body-image, and muscularity-related behaviors. Furthermore, supplement use was positively related to exercise dependence. Thus, the negativ e health behaviors of pa thological exercise and

PAGE 71

71 supplement use are related. Future research is need ed to determine the temporal course of these two behaviors because this information will aid in determining men who are at-risk for unhealthy exercise and eating. The collective picture these findings paint is one of an interconnected set of strategies simultaneously undertak en to increase muscularity. The results of my study also revealed that exercise de pendence predicts drive for muscularity. It is possible that, because men vi ew exercise as a critical means by which to increase muscularity, some men experience seve re frustration, negative mood, or anxiety when they are prevented from exercising or are un able to exercise. Further evidence of the ramifications of exercise dependence is found in its significant inverse relationship with selfesteem; this indicates that for some men, feelings of self-worth are closely tied to their ability to engage in exercise. Exercise dependence was si gnificantly related to perceived sociocultural pressure to be lean and muscular; thus it is po ssible that some men derive self-worth based on whether they possess a physique th at is deemed ideal by societ y, and exercise represents the best way to achieve that ideal. Exercise dependence was also si gnificantly related to weightlifting, dietary practices, muscle-oriented body-image, and mu scularity-related behaviors. This indicates that some men, because of their high drive for muscularity, become dependent on weightlifting as a specific form of exercise and that this dependence is accompanied by unhealthy eating aimed at increasing muscle. These conclusions are consistent with a host of research in weightlifters a nd bodybuilders showing that exer cise dependence and dietary practices are related (Lantz et al., 2002; Rhea et al., 2004); ind eed the Bodybuilding Dependence Scale (Smith & Hale, 2004) was developed spec ifically to assess this unhealthy exercise behavior.

PAGE 72

72 Self-esteem was a significant negative predictor of drive for muscularity, further supporting the notion that for some men, self-est eem is closely connected to possessing the ideal physique. This is consiste nt with research that has found an inverse relationship between self-esteem and both sa tisfaction with muscularity and problematic eating behaviors in preadolescent boys (McCabe & Ricciardelli, 20 03; McGee & Williams, 2000). The results also indicate that self-esteem is inversely related to both musc le-oriented body-image and perceived sociocultural pressure to be l ean and muscular. These findings not only underscore the impact of the media on self-esteem when it comes to how men evaluate their bodies, but also how physique-related comments from friends, parents, and dating partners impact self-esteem in general. Therefore, these persons could provide a protective effect ag ainst body dissatisfaction by building self-esteem in males vi a interpersonal support and refusa l to themselves internalize a body-image ideal. Third, consistent with my hypothesis, objectiv ely measured BMI was significantly higher than BMI derived from self-reported height and weight. Upon inspection of the data, this discrepancy in BMI was due to the tendency of men to overestimate their height. Thus, men appear to be accurate in self-reporting their weight. However, they may overestimate their height because of the self-presentational and social bene fits of being tall. That is, researchers have found that taller men typically at tain high social status, are ab le to exert greater social dominance, and enjoy the psyc hological upper hand in threaten ing situations (Cassidy, 1991; Bailey, Caffrey, & Hartnett, 1976). My data su pport the recommendations of Eston (2002) and suggest that when BMI is calculated in men, researchers should proceed cautiously when interpreting their results, especially if the BMI is for dia gnostic purposes (e.g., obesity, anorexia nervosa). Furthermore, my findings are consistent with those of others (e.g., Brener et al., 2003;

PAGE 73

73 Hill & Roberts, 1998) who have found that self-r eported height is overestimated relative to measured height. Fourth, consistent with my hypot hesis, weightlifting behavior was a significant predictor of drive for muscularity. For the man who desires gr eater muscularity weigh tlifting is a necessity because it results in strength and muscle gains. Th is is not to say that weightlifting is inherently pathological, maladaptive, or unhe althy; rather, my findings suggest that weightlifting may be a tool misused by those men highly fixated on attain ing a more muscular physique. It is a paradox, then, that while weightlifting was significantly re lated to dietary practices, supplement use, and muscularity-related behaviors, it was not significantly relate d to muscle-oriented body-image. Collectively, these results suggest that men w ith high drive for muscularity rely heavily upon weightlifting and other behavi ors (e.g., supplement use) in pu rsuit of the ideal physique, whereas men with moderate or low levels of dr ive for muscularity adopt these same behaviors independent of body-image concerns (e.g., for perc eived health benefits that supplements and high protein diets offer). Fifth, consistent with my hypothesis, genera l exercise behavior (as measured by the LTEQ) did not predict drive for muscul arity. It is possible that this is a reflection of the lack of specificity regarding exercise mode inhere nt in the LTEQ; this study has established weightlifting specifically as a pr edictor of drive for muscularit y. Although there was a weak yet significant relationship between th e LTEQ and weightlifting, my resu lts indicate that because the LTEQ does not specifically assess weightlifting it may not be th e best measure of exercise behavior for use in men. Instead, the LTEQ assesse s general leisure-time activity, and therefore is more appropriate for body-image research in women, where the primary emphasis on bodyimage is on weight reduction as opposed to muscular hypertrophy (McCabe et al., 2002).

PAGE 74

74 Contrary to my hypotheses, eat ing pathology and perceived soci ocultural pressure did not predict drive for muscularity. First, dietary behaviors were not predictive of drive for muscularity. This is interesting in light of th e finding that supplement use was predictive of drive for muscularity; this suggests that normal college-aged men do not adopt eating behaviors aimed at maximizing muscular growth (perhaps because it is too laborious), but they instead will readily turn to supplements to achieve greater muscularity. This is consistent with the larger societal trend towards quick fixes such as pi lls, powders, snack bars, ex ercise equipment, etc., that promise fast results with minimal effort. It is likely that dietary be haviors would have been predictive of drive for muscularity had the sample been comprised of advanced weightlifters or bodybuilders as such athletes are known to adopt stri ct dietary practices to achieve their goals of muscular hypertrophy (Lantz et al., 2002). Second, perceived sociocultural pressure di d not predict drive for muscularity. The Perceived Sociocultural Pressure Scale consists of eight items that ask the respondent how messages about body fat and muscularity from fr iends, family, dating partners, and the media impact them. It is possible that if these different influences were isolated then a more specific prediction would be available. For example, frie nds and family may serve as protective factors against developing drive for musc ularity, whereas dating partners and the media may contribute to drive for muscularity. It is noteworthy that fellow gym-goers or weightlifting partners were not included in the Perceived Sociocultural Pressure Scale; it is possible th at pressure to attain greater muscularity may stem from others in the gym environment. Further research would aid in clarifying this issue. My findings have several implications for the Cafri et al. (2005) m odel. Specifically, my results support their model of male body change strategies because weightlifting predicted drive

PAGE 75

75 for muscularity (body-image dissati sfaction in the model). My findi ngs also suggest that the link between health risk behaviors and body-image dissatisfaction should be bi-directional because use of supplements predicted drive for muscul arity. However, my findings do not support the hypothesized link between body composition (BMI, body fat percentage, FFMI) and body dissatisfaction; replication of this finding would suggest that this hypoth esized link be removed. Furthermore, my findings also indicate the need for two additions to the model: 1) self-esteem predicted drive for muscularity (body-image dissatisfaction in the model), therefore providing support for a directional arrow between ps ychological functioning and body-image dissatisfaction, and 2) exercise dependence pred icted drive for muscularity, therefore providing support for its inclusion as a health risk beha vior. Implementing these changes in the model would help refine the relationships betw een these constructs and male body-image dissatisfaction. Limitations Although this study advances our knowledge of how body composition and selected psychological factors relate to drive for muscul arity, there are several limitations. First, the participants were a convenient sample of colle ge-aged men, which limits the generalizability of the results. Future researchers ar e encouraged to examine predicto rs of drive for muscularity in other populations, including adol escent boys, older men, men who are not attending college, and athletically active women (e.g., body builders). For example, establis hing predictors of drive for muscularity in adolescent boys woul d aid in the identification of boys who are at highest risk of drive for muscularity and its asso ciated features. This is especi ally important because increasing numbers of boys as young as 8-years old report body-image dissatisfaction and disordered eating (Cohane & Pope, 2001; McCabe & Ri cciardelli, 2003). The generalizabl ility of the results is also limited to college-aged men in Florida; because Flor ida is a peninsula its ci tizens are able to visit

PAGE 76

76 beaches (where a greater proporti on of ones body will be exposed to others) frequently. It is therefore possible that men in Florida are more i nvested in their appearance than men who live in northern states where such bodily exposure o ccurs less frequently. T hus, further research examining drive for muscularity in other regions is needed. Second, while demographic variables such as sexual orientation and ethnicity were assessed, their low frequency precluded moderator anal ysis. It is possible that these variables, as well as other demographic variables that were not assessed (e.g., so cioeconomic status), moderate drive for muscularity. With respect to sexual orient ation, one participant reported homosexual orientation, but seven men reported Male as their se xual orientation. Because the question of sexual orientation was open-ended on the demographic questionnaire, it is unclear whether these participants meant to communicate their gender or if they were indeed homosexual. Most research indicates that homos exual men have greater body dissatisfaction and drive for muscularity than heterosexual me n (Kaminski et al., 2005; Yelland & Tiggemann, 2003), however other research has not supported this (e.g., Boroughs & Thompson, 2002). Therefore, it would be informative if future research on drive for muscularity included sexual orientation as a moderator. Ethnicity has been shown to moderate body dissatisfaction in women, whereby Whites report more body dissatisfaction than non White s (e.g., Wildes, Emery, & Simon, 2001). For example, when compared to Mexican women, Amer ican women have greater levels of concern about significant weight gain and fear of becoming fat (Crandall & Martinez, 1996). Although the topic has received little res earch attention in men, preliminar y evidence suggests that culture and ethnicity may also moderate male body dissa tisfaction as well as th e likelihood of adopting body change strategies (Ricci ardelli, McCabe, Williams, & Thompson, 2007). For example,

PAGE 77

77 there is evidence that Taiwanese men are more satisfied wi th their bodies than American and European men (Yang et al., 2005), and other research indicates that nonwhite men are less likely than white men to desire the V-shaped taper that is associated with a muscular physique (Fallon, DeBraganza, Chittester, & Hausenblas, 2005). Howeve r, some research indicates that nonwhite adolescent boys have greater ra tes of disordered eating than white adolescent boys (NeumarkSztainer & Hannan, 2000). Because this is counter to the available resear ch in men with eating disorders more research is needed. Third, although current and past steroid us e was ascertained, there were insufficient numbers of participants who an swered yes to these questio ns to conduct any meaningful analyses (two participants indica ted current steroid use, and one pa rticipant indicated past but not current steroid use). However, f our men who were not current st eroid users indicated that the question, If you are not currently us ing anabolic steroids to build muscle mass, have you in the past? did not apply to them. This response tech nically would indicate current usage; whether this was the case, or the response options provide d were confusing to the participant, cannot be determined. This also illustrates the final limitation of the study, which is the use of self-report measures. Although all self-report measures contained herein have adequate psychometric properties, it is possible that some information co llected from some participants on these types of measures contain inaccuracies because of (1) Norm al memory deficits, (2) inaccurate recall, or (3) intentionally providing inaccurate informati on. For example, the measurement of exercise behavior by the LTEQ was limited because the res pondent was asked to indicate the number of strenuous, moderate, and mild exercise sessions e ngaged in per week. In an attempt to help the respondent answer the items, th e LTEQ provides examples of activities that would qualify as

PAGE 78

78 strenuous, moderate, or mild in intensity, but th e only reference to weig htlifting is under the strenuous exercise heading. This begs the ques tion: Can a person have a light weightlifting session? Most people would say yes, but because such a session must be subjectively described as moderate or mild there is reason to suspect that the ability to accurately delineate between these intensities is diminished: one mans m oderate intensity weight lifting session may be another mans mild intensity weightlifting sessi on. In addition, while reliable and valid, the skinfold method of body fat estimation has a 3.5% margin of error (ACSM, 2000); another method of body fat estimation (e.g., DEXA) may yield a more precise estimate and thus strengthen the findings of subsequent research. Finally, out of 159 men who indicat ed they were interested in participating in the study by signing up when the study announcement was made in their classes, 113 men actually enrolled in the study. It is possible that th e lack of follow through on the pa rt of the 46 men who did not participate was attributable to factors such as lack of time, insuffici ent incentive (e.g., knowing their body fat percentage or earning extra credit toward their classes wa s not enticing enough to participate), reluctance to have their body fat esti mated (perhaps due to body-image concerns), or simply lack of interest. However, all men who re ported to the lab at thei r scheduled appointment time to participate in the study co mpleted all aspects of the study. Future Research Because body dissatisfaction in men has seve re psychological and physical ramifications further research is needed to examine its causes and consequences. First, there is a need for a psychometrically sound measure that a ssesses eating behaviors specific to adding muscle mass and decreasing b ody fat. Certain items of the DMS (McCreary & Sasse, 2000) and MEBBIE (Kaminski et al., 2005) asse ss such eating patterns in a general sense, but more precise items are required to fully unde rstand the specific eati ng patterns of persons

PAGE 79

79 attempting to add muscle mass while simultaneously limiting body fat accumulation. The MDI (Lantz et al., 2002; Rhea et al., 2004) shows promise. Second, while Cafri et al. (2005) have proposed a model of the risk factors for male bodyimage disturbance, they do not indicate a direct link between self-esteem and body image dissatisfactionwhy not? This is puzzling because there is sufficient evidence that there is a direct inverse relationship between body-image di sturbance and self-esteem, and this study has found that self-esteem is a negative predicto r of drive for muscularity in particular. Third, most male body dissatisfaction research has been conducted in adolescent boys; the only line of research that is a consistent exception to this is muscle dysmorphia. Indeed, it is logical to focus research on a popul ation that may be a target for intervention, but there is ample evidence indicating there is a need for better understanding of body-image disturbance in men. Specifically, information on drive for muscular ity across the life span would contribute to understanding how it is similar to, or different th an, other mens health issues (e.g., male pattern baldness, weight gain, impotence). For example, it is possible that dr ive for muscularity is especially salient in adolescence and young adult hood because this is a time when boys and young men gain a sense of what it means to be masc uline, and they therefor e derive self-identity from having a lean and muscular physique. In fact, some researchers have argued that, as traditional gender roles become increasingly blurre d and there exists greater parity between the sexes, men may focus on developing their physique s in an effort to assert their masculinity (Pope, Phillips et al., 2000). In light of this it would be informative to conduct prospective research to determine the course of drive for mu scularity as men age; at what point in a mans life does possessing a muscular physi que lose its appeal or percei ved benefits? For example, how do significant life events such as marriage and fa therhood impact a mans lif estyle, as well as his

PAGE 80

80 concept of what makes him masculine? Future re search that addresses th ese questions would be most enlightening. Fourth, the conceptualization of male body-image disturbance as two parallel continua may be beneficial (Figure 5). Together, these cont inua are able to encapsulate the finding that males are dissatisfied with being too small (with respect to musc ularity), not la rge enough (with respect to muscularity), or t oo large (with respect to body fat) At opposite ends of the body fat dimension is the dissatisfaction du e to perceiving oneself to be e ither too skinny or too fat; this reflects body-image disturbance relative to degree of body fat (e.g., the higher the body fat the higher the body-image dissatisfaction). However, because body fat is only half of the bodyimage equation for men, there is need for a musc le mass continuum that addresses dissatisfaction with degree of muscle; this refl ects the fact that body-image distur bance can also be a function of dissatisfaction with minimal muscularity (which would increase the chances of a drive for muscularity) or dissatisfaction th at ones actual high muscularity is not muscular enough (which would indicate muscle dysmorphia). Therefore, these two criteria may be used together to ascertain the likelihood of male body-image di ssatisfaction if both body fat and muscularity (expressed as FFMI) are known. For example, a man with little body fat and minimal musculature would have a higher chance of e xperiencing body-image disturbance than a man with little body fat but optimal musculature. Conversely, a man with high musculature and low body fat would likely have minimal body-image di ssatisfaction; the exce ption would be if, despite his considerable muscle mass, the ma n perceived himself as having a puny or scrawny body with minimal musculature this would be indicative of muscle dysmorphia. Fifth, more research is needed to determine the efficaciousness and safety of the myriad nutritional supplements that men with body-image di sturbance frequently use, especially given

PAGE 81

81 the findings of this study that supplement use is predictive of drive for muscularity. Current knowledge indicates that some supplements (e.g., cr eatine) are relatively in ert, whereas others (e.g., ephedrine) pose potentially life-threatening side effects if abused or used by at-risk persons. Sixth, weightlifting as a specific mode of exercise was found to predict drive for muscularity in this study, but the role of ex ercise in male body-image disturbance is still relatively unclear. Many studies report a positive corre lation between exercise behavior and body satisfaction in men, yet some studi es, especially in the muscle dysmorphia literature, indicate bodybuilders, whose preferred mode of exercise is weightlifting, are more likely to experience body-image disturbance than other groups of physi cally active men. This s uggests that some men involved in bodybuilding are more invested than others in their appear ance and are therefore more likely to be dissatisfied with perceived phys ique flaws; more research using samples of male weightlifters would clarify this relationship. Seventh, although the findings of this study and McCreary et al. (2006) indicate that there is no relationship between body composition and driv e for muscularity, there remains a lack of research describing the correlation between body composition (as assessed by BMI, body fat, and FFMI) and body-image disturbance in men. Most relevant would be further information correlating these measures with drive for musc ularity and muscle dysmorphia does a person need to have a certain combination of objec tive muscle mass and fat mass before becoming driven to attain muscularity? The findings pres ented herein indicate no, however establishing a dose-response-type relationship may improve understanding of how actual body composition is related to body-image disturbance; in turn, this information could be integrated into interventions (e.g., Cash & Hrabosky, 2004) aimed at decreasing body-image disturbance in males, or may aid

PAGE 82

82 researchers in determining which persons ar e most susceptible to experiencing body-image disturbance (this could facilitate the iden tification of at-risk persons based on body composition). In conclusion, this study has established a dditional support for the Cafri et al. (2005) model in that weightlifting was found to pr edict drive for muscul arity (e.g., body-image dissatisfaction in the model). Furthermore, whereas the model indicates that body-image dissatisfaction leads to health risk behaviors (e.g., supplem ent use), this study found that supplement use predicts drive for muscularity. In addition, this study also suggests two important components be considered for inclusion in the m odel: (1) Self-esteem as a negative predictor of drive for muscularity, and (2) exercise dependenc e, possibly under the Health Risk Behavior or Sports constructs, as a predictor of body-image dissatisf action. Finally, the finding that measures of body composition do not predict dr ive for muscularity call into question the proposed link between biological factors and bodyimage dissatisfaction in the model. Future research is required to determine if body-image di ssatisfaction in men truly is independent from actual body composition. Collectively, this studys fi ndings add to the understanding of drive for muscularity in men, and may potentially contribute to interventions designed to decrease drive for muscularity and its associated features.

PAGE 83

83 Body fat dimension Low Fat Optimal Excessive Fat Muscle mass dimension Minimal Optimal Excessive Muscularity Muscularity (Actual) (Actual) Figure 5. Proposed continua for male body-image disturbance.

PAGE 84

84 APPENDIX A LIST OF MEASURES General Information Age: _____ Ethnicity: ______________ Sexual orientation: ____________ (e.g., he tero-, homo-, bi-sexual) Academic standing: _____ Fr. _____ So. _____ Jr. _____ Sr. Are you currently using anabolic steroids in order to build muscle mass? _____ Yes _____ No If you are not currently using anabolic steroi ds to build muscle mass, have you in the past? _____ Yes _____ No _____ Not applicable How many sessions of cardiovascular ac tivity do you particip ate in per week? _____ How long (in minutes) does a typical session run? _______ How many weightlifting sessions do you participate in per week? _____ How long (in minutes) does a typical session run? _______

PAGE 85

85 Leisure-Time Exercise Questionnaire Instructions This is a scale which measures your leis ure-time exercise (i.e ., exercise that was done during your free time such as intramural sportsNOT your physical education class). Considering a typical week, please indicate how often (on average) you have engaged in strenuous, moderate, and mild exercise mo re than 15 minutes during your free time? 1. Strenuous exercise : heart beats rapidly (e.g., running, ba sketball, jogging, hockey, squash, judo, roller skating, vigorous swimming, vigorous long distance bicycling, vigorous aerobic dance classes, heavy weight training) How many times per typical week do you perform strenuous exercise for 15 minutes or longer? ______ 2. Moderate exercise : not exhausting, light sweating (e.g., fa st walking, baseball, tennis, easy bicycling, volleyball, badminton, easy swimming, popular and folk dancing) How many times per typical week do you perform moderate exercise for 15 minutes or longer? _______ 3. Mild exercise : minimal effort, no sweating (e.g., easy walking, yoga, archery, fishing, bowling, lawn bowling, shuffleboard, horseshoes, golf) How many times per typical week do you perfor m mild exercise for 15 minutes or longer? _______

PAGE 86

86 MDIDiet and Supplement Subscales Instructions Read each item (1-9) carefully and then indicate th e degree to which the item is characteristic or true of you by circling the appropriate number corresponding to each statement. There are no right or wrong answers so please respond as honestly as possible. The anonymity of your responses is guaranteed. 1. I regulate my caloric intake to maximize muscle development. 1 2 3 4 5 6 2. Before a workout, I consume energy supplements. 1 2 3 4 5 6 3. I monitor my diet closely to limit my fat intake. 1 2 3 4 5 6 4. I use supplements to help me recuperate from strenuous workouts. 1 2 3 4 5 6 5. I control the intake of proteins, carbohydrates, and fats to maximize my muscular development. 1 2 3 4 5 6 6. I use supplements to increase my lifting performance. 1 2 3 4 5 6 7. I use nutritional supplements to help me train through injuries. 1 2 3 4 5 6 8. My diet is regimented to th e point that I eat the same foods several days in a row. 1 2 3 4 5 6 9. I avoid foods high in sodium. 1 2 3 4 5 6 1 2 3 4 5 6 Never Rarely Sometimes Often Usually Always

PAGE 87

87 Perceived Sociocultural Pressure ScaleOriginal Using the following scale, please indicate the response that best captures your ow n experience. 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always 1. Ive felt pressure from my friends to lose weight.______ 2. Ive noticed a strong message from my friends to have a thin body._____ 3. Ive felt pressure from my family to lose weight.__ 4. Ive noticed a strong message from my family to have a thin body._____ 5. Ive felt pressure from people Ive dated to lose weight.______ 6. Ive noticed a strong message from peopl e I have dated to have a thin body.____ 7. Ive felt pressure from the media (e .g., TV, magazines) to lose weight._____ 8. Ive noticed a strong message from the media to have a thin body.___

PAGE 88

88 Perceived Sociocultural Pressure ScaleAdapted Using the following scale, please indicate the response that best captures your ow n experience. 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always 1. Ive felt pressure from my friends to lose body fat.______ 2. Ive noticed a strong message from my friends to have a muscular body._____ 3. Ive felt pressure from my family to lose body fat.__ 4. Ive noticed a strong message from my family to have a muscular body._____ 5. Ive felt pressure from people Ive dated to lose body fat.______ 6. Ive noticed a strong message from people I have dated to have a muscular body.____ 7. Ive felt pressure from the media (e .g., TV, magazines) to lose body fat._____ 8. Ive noticed a strong message from th e media to have a muscular body.___

PAGE 89

89 The Drive for Muscularity Scale Please read each item carefully, then, for each one, circle the number that best applies to you. 1. I wish that I were more muscular. 1 2 3 4 5 6 2. I lift weights to build up muscle. 1 2 3 4 5 6 3. I use protein or energy supplements. 1 2 3 4 5 6 4. I drink weight gain or protein shakes. 1 2 3 4 5 6 5. I try to consume as many calories as I can in a day. 1 2 3 4 5 6 6. I feel guilty if I miss a weight trai ning session. 1 2 3 4 5 6 7. I think I would feel more confident if I had more muscle mass. 1 2 3 4 5 6 8. Other people think I work out with we ights too often. 1 2 3 4 5 6 9. I think that I would look better if I gained 10 pounds in bulk. 1 2 3 4 5 6 10. I think that I would feel stronger if I gained a littl e more muscle mass. 1 2 3 4 5 6 11. I think that my weight training schedule interferes with other aspects of my life. 1 2 3 4 5 6 12. I think that my arms are not musc ular enough. 1 2 3 4 5 6 13. I think that my chest is not musc ular enough. 1 2 3 4 5 6 14. I think that my legs are not musc ular enough. 1 2 3 4 5 6 1 2 3 4 5 6 Never Rarely Sometimes Often Very often Always

PAGE 90

90 Exercise Dependence Scale Instructions. Using the scale provided below, pleas e complete the following questions as honestly as possible. The questions refer to cu rrent exercise beliefs a nd behaviors that have occurred in the past 3 months Please place your answer in th e blank space provided after each statement. 1 2 3 4 5 6 Never Always 1. I exercise to av oid feeling irritable._____ 2. I exercise despite recurring physical problems._____ 3. I continually increase my exerci se intensity to achieve the desired effects/benefits._____ 4. I am unable to re duce how long I exercise._____ 5. I would rather exercise th an spend time with family/friends._____ 6. I spend a lot of time exercising._____ 7. I exercise longer than I intend._____ 8. I exercise to avoid feeling anxious._____ 9. I exercise when injured._____ 10. I continually increase my exercise frequency to achieve the desired effects/benefits._____ 11. I am unable to redu ce how often I exercise._____ 12. I think about exercise when I sh ould be concentrating on school/work._____ 13. I spend most of my free time exercising._____ 14. I exercise longer than I expect._____ 15. I exercise to avoid feeling tense._____ 16. I exercise despite pers istent physical problems._____ 17. I continually increase my exerci se duration to achieve the desired effects/benefits._____ 18. I am unable to redu ce how intense I exercise._____ 19. I choose to exercise so that I can get out of spending time w ith family/friends._____ 20. A great deal of my time is spent exercising.____ 21. I exercise longer than I plan._____

PAGE 91

91 Rosenberg Self-Esteem Scale Directions: For each question, please indicate th e degree to which you strongly agree, agree, disagree, or str ongly disagree with each statement. Strongly Agree Agree Disagree Strongly Disagree 1 2 3 4 1. On the whole, I am satisfied with myself. 1 2 3 4 2. At times I think I am no good at all. 1 2 3 4 3. I feel that I have a number of good qualities. 1 2 3 4 4. I am able to do things as well as most other people. 1 2 3 4 5. I feel I do not have much to be proud of. 1 2 3 4 6. I certainly feel useless at times. 1 2 3 4 7. I feel that I am a person of worth, at least on an equal plane with others 1 2 3 4 8. I wish I could have more respect for myself. 1 2 3 4 9. All in all, I am inclined to feel that I am a failure. 1 2 3 4 10. I take a positive attitude toward myself. 1 2 3 4

PAGE 92

92 APPENDIX B RECRUITMENT FLYER ATTENTION MEN Have you ever wondered what your body fat percentage is? A study in the Department of Applied Physiology and Ki nesiology is currently exploring the relationship between exerci se habits, eating, body im age, and body composition. All you need to do to qualify for your FREE body fat estimation is to simply fill out a few surveys (which will take about 20 minutes) its that simple! To make an appointment please email the Exercise Psychology La boratory (located in FLG 143) at exer.psych.lab@hhp.ufl.edu and include the following information: Name Phone number Age Height Weight

PAGE 93

93 LIST OF REFERENCES Adams, G., Turner, H., & Bucks, R. (2005). The experience of body dissatisfaction in men. Body Image, 2, 271. American College of Sports Medicine (2000). Guidelines for exercise testing and prescription (6th Ed.). Philadelphia, PA: Lippincott Williams & Wilkins. American Psychiatri c Association (2000). Diagnostic and statistical manual of mental disorders (4th Ed.)Text revision. Washington, D.C.: Author. Andersen, A., Cohn, L., & Holbrook, T. (2000). Making weight: Mens conflicts with food, weight, shape & appearance. Carlsbad, CA: Gurze Books. Andersen, A. E., & Holman, J. E. (1997). Males w ith eating disorders: Challenges for treatment and research. Psychopharmacology Bulletin, 33, 391. Arkoff, A., & Weaver, H. B. (1966). Body image and body dissatisfaction in Japanese Americans. Journal of Social Psychology, 68, 323. Barry, D. T., Grilo, C. M., & Masheb, R. M. ( 2002). Gender differences in patients with binge eating disorder. International Journal of Eating Disorders, 31, 63. Befort, C., Robinson Kurpius, S. E., HullBlanks, E., Foley Nicpon, M., Huser, L., & Sollenberger, S. (2001). Body image, self-est eem, and weight-related criticism from romantic partners. Journal of College Student Development, 42, 407. Berger, B.G., & Motl, R. W. (2000). Exercise an d mood: A subjective revi ew and synthesis of research employing the Profile of Mood States. Journal of Applied Sport Psychology, 12, 69. Bizzarini, E., & De Angelis, L. (2004). Is th e use of oral creatine supplementation safe? Journal of Sports Medicine and Physical Fitness, 44, 411. Blouin, A. G., & Goldfield, G. S. (1995). Body image and steroid use in male bodybuilders. International Journal of Eating Disorders, 18, 159. Boreham, C., Robson, P. J., Gallagher, A. M., Cr an, G. W., Savage, J. M., & Murray, L. J. (2004). Tracking of physical activity, fitness, body composition and diet from adolescence to young adulthood: The young hearts project, Northern Ireland. International Journal of Behavioral Nutrition and Physical Activity, 1, 14. Boroughs, M., & Thompson, J. K. (2002). Exercise status and sexual orientation as moderators of body image disturbance and eating disorders in males. International Journal of Eating Disorders, 31, 307. Braun, D. L., Sunday, S. R., Huang, A., & Halmi, K. A. (1999). More males seek treatment for eating disorders. International Journal of Eating Disorders, 25, 415.

PAGE 94

94 Brener, N. D., McManus, T., Galuska, D. A., Lo wry, R., & Wechsler, H. (2003). Reliability and validity of self-reported height and weight amo ng high school students. Journal of Adolescent Health, 32, 281. Brewerton, T. D., Stellefson, E. J., Hibbs, N ., Hodges, E. L., & Cochrane, C. E. (1995). Comparison of eating disorder patients with and without compulsive exercising. International Journal of Eating Disorders, 17, 413. Brower, K. J., Blow, F. C., & Hill, E. M. (1994) Risk factors for anabolic-androgenic steroid use in men. Journal of Psychiatric Research, 28, 369. Brown, T.A., Cash, T.F., & Mikulka, P.J. ( 1990). Attitudinal body-image assessment: Factor analysis of the body self relations questionnaire. Journal of Personality Assessment, 55, 135. Cafri, G., Roehrig, M., & Thompson, J. K. (2004) Reliability assessment of the somatomorphic matrix. International Journal of Eating Disorders, 35, 597. Cafri, G., Strauss, J., & Thompson, J. K. (2002). Male body image: Satisfaction and its relationship to well-being using the somatomorphic matrix. International Journal of Mens Health, 1, 215. Cafri, G., & Thompson, J. K. (2004). Measuri ng male body image: A review of the current methodology. Psychology of Men & Masculinity, 5, 18. Cafri, G., Thompson, J. K., Ricciardelli, L., McCabe, M., Smolak, L., & Yesalis, C. (2005). Pursuit of the muscular ideal: Physical and psychological co nsequences and putative risk factors. Clinical Psychology Review, 25, 215. Cafri, G., van den Berg, P., & Thompson, J. K. (2006). Pursuit of muscularity in adolescent boys: Relations among biopsychosocial va riables and clinical outcomes. Journal of Clinical Child and Adolescent Psychology, 35, 283. Carron, A. V., Hausenblas, H. A., & Estabrooks, P. A. (2003). The psychology of physical activity. New York, NY: McGraw-Hill. Cash, T. F., & Hrabosky, J. I. (2004). Treatment of body image disturbances. In J. K. Thompson (Ed.), Handbook of Eating Disorders and Obesity (pp. 515-541). Hoboken, NJ: John Wiley & Sons, Inc. Cash, T. F., Morrow, J. A., Hrabosky, J. I., & Perry, A. A. (2004). How has body image changed? A cross-sectional investigation of college wo men and men from 1983 to 2001. Journal of Consulting and Clinical Psychology, 72, 1081. Cattarin, J. A., Thompson, J. K., Thomas, C ., & Williams, R. (2000). Body image, mood, and televised images of attractiveness: The role of social comparison. Journal of Social and Clinical Psychology, 19, 220.

PAGE 95

95 Chilibeck, P. D., Stride, D., Farthing, J. P., & Bu rke, D. G. (2004). Effect of creatine ingestion after exercise on muscle thickness in males and females. Medicine & Science in Sports & Exercise, 36, 1781. Chittester, N. I. (2003). Development and validation of the muscle dysmorphia survey (MDS). Unpublished masters thesis, Wa shington State University. Chng, C. L., & Moore, A. (1990). A study of st eroid use among athletes: Knowledge, attitude and use. Health Education, 21, 11. Chung, B. (2001). Muscle dysmorphia: A crit ical review of the proposed criteria. Perspectives in Biology and Medicine, 44, 565. Coakley, J. (2004). Sports in society: Issues & controversies (8th ed). New York, NY: McGrawHill. Cohane, G. H., & Pope, H. G., Jr. (2001). Body image in boys: A review of the literature. International Journal of Eating Disorders, 29, 373. Cohen, J., & Cohen, P. (1983). Applied multiple regression/correlation analysis for the behavioral sciences (2nd ed). Hillsdale, NJ: Lawrence Erlbaum Associates. Cole, J. C., Smith, R., Halford, J. C. G., & Wags taff, G. F. (2003). A preliminary investigation into the relationship between an abolic-androgenic steroid use and the symptoms of reverse anorexia in both current and ex-users. Psychopharmacology, 166, 424. Cooley, E., & Toray, T. (2001). Body image and personality predictors of eating disorder symptoms during the college years. International Journal of Eating Disorders, 30, 28. Davis, C., & Cowles, M. (1991). Body image and exercise: A study of relationships and comparisons between physica lly active men and women. Sex Roles, 25, 33. Elgar, F. J., Roberts, C., Tudor-Smith, C., & M oore, L. (2005). Validity of self-reported height and weight and predictors of bias in adolescents. Journal of Adolescent Health, 37, 371 375. Emmanuel, N. P., Jones, C., & Lydiard, R. B. (1998). Use of herbal products and symptoms of bipolar disorder. American Journal of Psychiatry, 155, 1627. Eston, R. G. (2002). Use of the body mass inde x (BMI) for individual counseling: The new section editor for kinanthropometry is Gra de 1 obese, overweight (BMI 27.3), but dense and distinctly muscular (FFMI 23.1)! Journal of Sports Sciences, 20, 515. Expert Panel on the Identifica tion, Evalation, and Treatment of Overweight and Obesity in Adults (1998). Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overw eight and obesity in adults. Archives of Internal Medicine, 158, 1855.

PAGE 96

96 Fisher, E., & Thompson, J. K. (1994). A comparat ive evaluation of cognitive-behavioral therapy (CBT) versus exercise therapy (ET) for the treatment of body image disturbance. Behavior Modification, 18, 171. Frederick, D. A., Peplau, L. A., & Lever, J. (2006). The swimsuit i ssue: Correlates of body image in a sample of 52,677 heterosexual adults. Body Image, 3, 413. Freeman, R. J., Beach, B., Davis, R., & Solyom, L. (1985). The prediction of relapse in bulimia nervosa. Journal of Psychiatric Research, 19, 349. Garner, D. M., Olmstead, M. P., & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2, 15. Gila, A., Castro, J., Cesena, J., & Toro, J. ( 2005). Anorexia nervosa in male adolescents: Body image, eating attitudes a nd psychological traits. Journal of Adolescent Health, 36, 221 226. Godin, G., Jobin, J., & Bouillon, J. (1986). Assessment of leisure ti me exercise behavior by selfreport: A concurrent validity study. Canadian Journal of Public Health, 77, 359. Godin, G., & Shephard, R. J. (1985). A simple method to assess exercise behavior in the community. Canadian Journal of Applied Sport Science, 10, 141. Gokee-LaRose, J., Dunn, M. E., & Tantleff-Dunn, S. (2004). An investigation of the cognitive organization of body comparison sites in rela tion to physical appear ance related anxiety and drive for thinness. Eating Behaviors, 5, 133. Goldfield, G. S., Blouin, A. G., & Woodside, D. B. (2006). Body image, binge eating, and bulimia nervosa in male bodybuilders. Canadian Journal of Psychiatry, 51, 160. Graham, M. A., Eich, C., Kephart, B., & Pete rson, D. (2000). Relationship among body image, sex, and popularity of high school students. Perceptual and Motor Skills, 90, 1187. Green, S. B. (1991). How many subjects doe s it take to do a regression analysis? Multivariate Behavioral Research, 20, 499. Griffiths, R. A., Beumont, P. J. V., Giannakopoul os, E., Russell, J., Schotte, D., Thornton, C., et al. (1999). Measuring self-esteem in dieting disordered patients: The validity of the Rosenberg and Coopersmith contrasted. International Journal of Eating Disorders, 25, 227. Grilo, C. M., & Masheb, R. M. (2005). Correla tes of body image dissati sfaction in treatmentseeking men and women with binge eating disorder. International Journal of Eating Disorders, 38, 162.

PAGE 97

97 Grilo, C. M., Masheb, R. M., Brody, M., Burke-Ma rtindale, C. H., & Rothschild, B. S. (2005). Binge eating and self-esteem predict body image dissatisfaction among obese men and women seeking bariatric surgery. International Journal of Eating Disorders, 37, 347. Guggenheim, K., Poznanski, R., & Kaufmann, N. A. (1977). Attitudes of adolescents to their body build and the problem of juvenile obesity. International Journal of Obesity, 1, 135 149. Haines, J., Neumark-Sztainer, D., Perry, C. L., Hannan, P. J., & Levine, M. P. (2006). V.I.K. (very important kids): A school-based progr am designed to reduce teasing and unhealthy weight-control behaviors. Health Education Research, 21, 884. Haller, C. A., & Benowitz, N. L. (2000). Advers e cardiovascular and cen tral nervous system events associated with dietary supp lements containing ephedra alkaloids. New England Journal of Medicine, 343, 1833. Hallsworth, L., Wade, T., & Tiggemann, M. (2005). Individual differences in male body-image: An examination of self-objectification in recreational body builders. British Journal of Health Psychology, 10, 453. Hartgens, F., & Kuipers, H. (2004). Effects of androgenic-anabolic st eroids in athletes. Sports Medicine, 34, 513. Hausenblas, H. A., & Carron, A. V. (1999). Eating disorder indices and at hletes: An integration. Journal of Sport & Exercise Psychology, 21, 230. Hausenblas, H. A., & Fallon, E. A. (2002). Rela tionship among body image, exercise behavior, and exercise dependence symptoms. International Journal of Eating Disorders, 32, 179 185. Hausenblas, H. A., & Symons Do wns, D. (2002a). Exercise depe ndence: A systematic review. Psychology of Sport and Exercise, 3, 89. Hausenblas, H. A., & Symons Downs, D. ( 2002b). How much is too much? The development and validation of the exercise dependence scale. Psychology and Health, 17, 387. Heymsfield, S. B., Allison, D. B., Vasselli, J. R. Pietrobelli, A., Greenfield, D., & Nunez, C. (1998). Garcinia cambogia (hydroxycitric ac id) as a potential antiobesity agent: A randomized controlled trial. JAMA, 280, 1596. Heywood, S., & McCabe, M. P. (2006). Nega tive affect as a mediator between body dissatisfaction and extreme weight loss and muscle gain behaviors. Journal of Health Psychology, 11, 833. Hildebrandt, T., Schlundt, D., Langenbucher, J., & Chung, T. (2006). Presence of muscle dysmorphia symptomology among male weightlifters. Comprehensive Psychiatry, 47, 127.

PAGE 98

98 Hill, A., & Roberts, J. (1998). Body mass inde x: a comparison between self-reported and measured height and weight. Journal of Public Health Medicine, 20, 206. Hitzeroth, V., Wessels, C., Zungu-Dirwayi, N., Oosthuizen, P., & Stein, D. J. (2001). Muscle dysmorphia: A South African sample. Psychiatry and Clinical Neurosciences, 55, 521 523. Huddy, D. C., Johnson, R. L., Stone, M. H., Proulx, C. M., & Pierce, K. A. (1997). Relationship between body image and percent body fat among male and female college students enrolled in an introductory 14week weight-training course. Perceptual and Motor Skills, 85, 1075. Hutchins, G. M. (2001). Letter to the editor. New England Journal of Medicine, 344, 1095. Irving, L. M., Wall, M., Neumark-Sztainer D., & Story, M. (2002). Steroid use among adolescents: Findings from project eat. Journal of Adolescent Health, 30, 243. Jacobs, D. R., Jr., Ainsworth, B. E., Hartma n, T. J., & Leon, A. S. (1993). A simultaneous evaluation of 10 commonly used physical activity questionnaires. Medicine and Science in Sports and Exercise, 25, 81. Jonnalagadda, S. S., Rosenbloom, C. A., & Skinne r, R. (2001). Dietary practices, attitudes, and physiological status of collegiat e freshman football players. Journal of Strength and Conditioning Research, 15, 507. Kaminski, P. L., Chapman, B. P., Haynes, S. D., & Own, L. (2005). Body image, eating behaviors, and attitudes toward ex ercise among gay and straight men. Eating Behaviors, 6, 179. Kanayama, G., Pope, H. G., Jr., Cohane, G., & H udson, J. I. (2003). Risk factors for anabolicandrogenic steroid use among wei ghtlifters: A case-control study. Drug and Alcohol Dependence, 71, 77. Kanayama, G., Pope, H. G., Jr., & Hudson, J. I. (2001). Body image drugs: A growing psychosomatic problem. Psychotherapy and Psychosomatics, 70, 61. Keel, P. K., Klump, K. L., Leon, G. R., & Fu lkerson, J. A. (1998). Disordered eating in adolescent males from a school-based sample. International Journal of Eating Disorders, 23, 125. Kostanski, M., Fisher, A., & Gullone, E. ( 2004). Current conceptualization of body image dissatisfaction: Have we got it wrong? Journal of Child Psychology and Psychiatry, 45, 1317. Kostanski, M., & Gullone, E. (1998). Adolescent body image dissatisfaction: Relationships with self-esteem, anxiety, and depr ession controlling for body mass. Journal of Child Psychology and Psychiatry, 39, 255.

PAGE 99

99 Kouri, E. M., Pope, H. G., Jr., & Katz D. L. (1994). Letter to the editor. JAMA, 271 347. Kouri, E. M., Pope, H. G., Jr., Katz, D. L., & O liva, P. (1995). Fat-free mass index in users and nonusers of anabolic-androgenic steroids. Clinical Journal of Sport Medicine, 5, 223. Kraemer, W. J., Torine, J. C., Silvestre, R., Frenc h, D. N., Ratamess, N. A., Spiering, B. A., et al. (2005). Body size and composition of na tional football league players. Journal of Strength and Conditioning Research, 19, 485. Kreider, R. B. (1999). Dietary supplements and th e promotion of muscle growth with resistance exercise. Sports Medicine, 27, 97. Labre, M. P. (2005). Burn fat, bu ild muscle: A content analysis of Mens Health and Mens Fitness. International Jo urnal of Mens Health, 4, 187. Landers, D. M., & Arent, S. M. (2001). Physical ac tivity and mental health. In R. N. Singer, H. A. Hausenblas, & C. M. Janelle (Eds.), Handbook of sport psychology (2nd Ed., pp 740765). New York, NY: Wiley. Lantz, C. D., Rhea, D. J., & Cornelius, A. E. (2002). Muscle dysmorphia in elite-level power lifters and bodybuilders: A test of diffe rences within a conceptual model. Journal of Strength and Conditioning Research, 16, 649. Lefavi, R. G., Reeve, T. G., & Newland, M. C. (1990). Relationship between anabolic steroid use and selected psychological parameters in male bodybuilders. Journal of Sport Behavior, 13, 157. Leit, R. A., Gray, J. J., & Pope, H. G., Jr. (2002 ). The medias representation of the ideal male body: A cause for muscle dysmorphia? International Journal of Eating Disorders, 31, 334. Leit, R. A., Pope, H. G., Jr., & Gray, J. J. (2001) Cultural expectations of muscularity in men: The evolution of playgirl centerfolds. International Journal of Eating Disorders, 29, 90 93. Macgregor, F. C. (1981). Patient dissatisfaction with results of technicall y satisfactory surgery. Aesthetic Plastic Surgery, 5, 27. Mangweth, B., Pope, H. G., Jr., Ke mmler, G., Ebenbichler, C., Hausmann, A., De Col, C., et al. (2001). Body image and psychopathology in male bodybuilders. Psychotherapy and Psychosomatics, 70, 38. Manson, J. E., Skerrett, P. J., Greenland, P., & VanItallie, T. B. (2004). The escalating pandemics of obesity and sedentary life style: A call to action for clinicians. Archives of Internal Medicine, 164, 249.

PAGE 100

100 Mayville, S. B., Williamson, D. A., White, M. A ., Netemeyer, R. G., & Drab, D. L. (2002). Development of the muscle appearance satisf action scale: A self-report measure for the assessment of muscle dysmorphia symptoms. Assessment, 9, 351. Mazzeo, S. E., Slof, R. M., Tozzi, F., Kendler, K. S., & Bulik, C. M. (2004). Characteristics of men with persistent thinness. Obesity Research, 12, 1367. McCabe, M. P., & Ricciardelli, L. A. (2003). B ody image and strategies to lose weight and increase muscle among boys and girls. Health Psychology, 22, 39. McCabe, M. P., & Ricciardelli, L. A. (2004a ). A longitudinal study of pubertal timing and extreme body change behaviors among adolescent boys and girls. Adolescence, 39, 145 166. McCabe, M. P., & Ricciardelli, L. A. (2004b) Body image dissatisfact ion among males across the lifespan: A review of past literature. Journal of Psychosomatic Research, 56, 675. McCabe, M. P., & Ricciardelli, L. A. (2005). A prospective study of pressures from parents, peers, and the media on extreme weight change behaviors among adolescent boys and girls. Behaviour Research and Therapy, 43, 653. McCabe, M. P., Ricciardelli, L. A., & Banfiel d, S. (2001). Body image, strategies to change muscles and weight, and puberty: Do they im pact on positive and ne gative affect among adolescent boys and girls? Eating Behaviours, 2, 129. McCabe, M. P., Ricciardelli, L. A., & Finemore J. (2002). The role of puberty, media, and popularity with peers as strategies to increase weight, decrease weight and increase muscle tone among adolescent boys and girls. Journal of Psychosomatic Research, 52, 145. McCreary, D. R., Karvinen, K., & Davis, C. (2006). The relationship between the drive for muscularity and anthropometric meas ures of muscularity and adiposity. Body Image, 3, 145. McCreary, D. R., & Sasse, D. K. (2000). An e xploration of the drive for muscularity in adolescent boys and girls. Journal of American College Health, 48, 297. McCreary, D. R., Sasse, D. K., Saucier, D. M., & Dorsch, K. D. (2004). Measuring the drive for muscularity: Factorial validit y of the drive for muscular ity scale in men and women. Psychology of Men & Masculinity, 5, 49. McGee, R., & Williams, S. (2000). Does low self-esteem predict health compromising behaviours among adolescents? Journal of Adolescence, 23, 569. Moore, J. M., Timperio, A. F., Crawford, D. A., Burns, C. M., & Cameron-Smith, D. (2002). Weight management and weight loss st rategies of professional jockeys. International Journal of Sport Nutrition and Exercise Metabolism, 12, 1.

PAGE 101

101 Muris, P., Meesters, C., van de Blom, W., & Ma yer, B. (2005). Biological, psychological, and sociocultural correlates of body change strategies and eating problems in adolescent boys and girls. Eating Behaviors, 6, 11. Neumark-Sztainer, D., & Hannan, P. J. (2000). Weight-related behavior s among adolescent girls and boys. Archives of Pediatrics & Adolescent Medicine, 154, 569. Neumark-Sztainer, D., Story, M., Falkner, N. H., Beuhring, T., & Resnick, M. D. (1999). Sociodemographic and personal characteristics of adolescents engaged in weight loss and weight/muscle gain behaviors: Who is doing what? Preventive Medicine, 28, 40. ODea, J. A., & Abraham, S. (1999). Onset of di sordered eating attitudes and behaviors in early adolescence: Interplay of pubertal status, gender, weight, and age. Adolescence, 34, 671 679. ODea, J. A., & Abraham, S. (2002). Eating and exercise disorders in young college men. Journal of American College of Health, 50, 273. Ogden, J., & Taylor, C. (2000). Body dissatisfaction within couples: Adding th e social context to perceptions of self. Journal of Health Psychology, 5, 25. Oliosi, M., Dalle Grave, R., & Burlini, S. (1999). Eating attitudes in noncompetitive male body builders. Eating Disorders, 7, 227. Olivardia, R. (2001). Mirror, mirror on the wall, w hos the largest of them all? The features and phenomenology of muscle dysmorphia. Harvard Review of Psychiatry, 9, 254. Olivardia, R., Pope, H. G., Jr., & Hudson, J. I. (2000). Muscle dysmorphia in male weightlifters: A case-control study. American Journal of Psychiatry, 157, 1291. Olivardia, R., Pope, H. G., Jr., Mangweth, B., & Hudson, J. I. (1995). Eati ng disorders in college men. American Journal of Psychiatry, 152, 1279. Olrich, T. W., & Ewing, M. E. (1999). Life on st eroids: Bodybuilders desc ribe their perceptions of the anabolic-androge nic steroid use period. The Sport Psychologist, 13, 299. Pasman, L., & Thompson, J. K. (1988). Body image and eating distur bance in obligatory runners, obligatory weightlifters, and sedentary individuals. International Journal of Eating Disorders, 7, 759. Paxton, S. J., Eisenberg, M. E., & Neumark-Sztain er, D. (2006). Prospective predictors of body dissatisfaction in adolescent girls an d boys: A five-year longitudinal study. Developmental Psychology, 42, 888. Peterson, L. J., & Topazian, R. G. (1976). Psycho logical considerations in corrective maxillary and midfacial surgery. Journal of Oral Surgery, 34, 157.

PAGE 102

102 Phelps, L., Johnston, L. S., & Augustyniak, K. (1999). Prevention of eating disorders: Identification of pr edictor variables. Eating Disorders, 7, 99. Phillips, K. A., OSullivan, R. L., & Pope, H. G., Jr. (1997). Muscle dysmorphia. Journal of Clinical Psychiatry, 58, 361. Pickett, T. C., Lewis, R. J., & Cash, T. F. (2005). Men, muscles, and body image: Comparisons of competitive bodybuilders, weight traine rs, and athletically active controls. British Journal of Sports Medicine, 39, 217. Pope, H. G., Jr., Gruber, A. J., Choi, P., Oliv ardia, R., & Phillips, K. A. (1997). Muscle dysmorphia: An underrecognized form of body dysmorphic disorder. Psychosomatics, 38, 548. Pope, H. G., Jr., Gruber, A. J., Mangweth, B., Bu reau, B., DeCol, C., Jouvent, R., et al. (2000). Body image perception among me n in three countries. American Journal of Psychiatry, 157, 1297. Pope, H. G., Jr., Hudson, J. I., & Jonas, J. M. (198 6). Bulimia in men: A series of fifteen cases. Journal of Nervous and Mental Disease, 174, 117. Pope, H. G., Jr., & Katz, D. L. (1987). Bodybuilders psychosis. The Lancet, 1, 863. Pope, H. G., Jr., & Katz, D. L. (1988). Affec tive and psychotic symptoms associated with anabolic steroid use. American Journal of Psychiatry, 145, 487. Pope, H. G., Jr., & Katz, D. L. (1994). Psychiat ric and medical effects of anabolic-androgenic steroid use. Archives of General Psychiatry, 51, 375. Pope, H. G., Jr., Katz, D. L., & Hudson, J. I. ( 1993). Anorexia nervosa and reverse anorexia among 108 male bodybuilders. Comprehensive Psychiatry, 34, 406. Pope, H. G., Jr., Olivardia, R., Gruber, A., & Borowiecki, J. (1999). Evolving ideals of male body image as seen through action toys. International Journal of Eating Disorders, 26, 65. Pope, H. G., Jr., Phillips, K. A., & Olivardia, R. (2000). The adonis complex: The secret crisis of male body obsession. New York, NY: The Free Press. Presnell, K., Bearman, S. K., & Stice, E. (2004). Risk factors fo r body dissatisfaction in adolescent boys and girls: A prospective study. International Journal of Eating Disorders, 36, 389. Rand, C. S. W., & Wright, B. A. (2000). Thi nner females and heavier males: Who says? A comparison of female to male ideal body sizes across a wide age span. International Journal of Eating Disorders, 29, 45.

PAGE 103

103 Rhea, D. J., Lantz, C. D., & Cornelius, A. E. (2004). Development of the muscle dysmorphia inventory (MDI). Journal of Sports Medicine and Physical Fitness, 44, 428. Ricciardelli, L. A., & McCabe, M. P. (2002) Psychometric evaluation of the body change inventory: An assessment instrument for adolescent boys and girls. Eating Behaviors, 3, 45. Ricciardelli, L. A., & McCabe, M. P. (2004). A biopsychosocial model of disordered eating and the pursuit of muscularity in adolescent boys. Psychological Bulletin, 130, 179. Ricciardelli, L. A., McCabe, M. P., & Ridge, D. (2006). The construction of the adolescent male body through sport. Journal of Health Psychology, 11, 577. Rodriguez-Tom H., Bariaud, F., Cohen Zardi, M. F., De lmas, C., Jeanvoine, B., & Szylagyi, P. (1993). The effects of pubertal changes on body image and relations with peers of the opposite sex in adolescence. Journal of Adolescence, 16, 421. Rosenberg, M. (1989). Society and the adolescent self-image (Rev. ed). Middletown, CT: Wesleyan University Press. Rozin, P., Trachtenberg, S., & Cohen, A. B. (2001). Stability of body image and body image dissatisfaction in American college st udents over about th e last 15 years. Appetite, 37, 245. Salusso-Deonier, C. J., & Schwar zkopf, R. J. (1991). Sex differen ces in body-cathexis associated with exercise involvement. Perceptual and Motor Skills, 73, 139. Saper, R. B., Eisenberg, D. M., & Phillips, R. S. (2004). Common dietary supplements for weight loss. American Family Physician, 70, 1731. Schwerin, M. J., Corcoran, K. J., Fisher, L., Pa tterson, D., Askew, W., Olrich, T., et al. (1996). Social physique anxiety, body esteem, and soci al anxiety in bodybuilders and self-reported anabolic steroid users. Addictive Behaviors, 21, 1. Shapiro, J. R., & Anderson, D. A. (2003). The e ffects of restraint, gender, and body mass index on the accuracy of self-reported weight. International Journal of Eating Disorders, 34, 177. Sharp, C. W., Clark, S. A., Dunan, J. R., Black wood, D. H., & Shapiro, C. M. (1994). Clinical presentation of anorexia ne rvosa in males: 24 new cases. International Journal of Eating Disorders, 15, 125. Sheets, V., & Ajmere, K. (2005). Are romantic pa rtners a source of coll ege students weight concern? Eating Behaviors, 6, 1. Siegel, J. M., Yancey, A. K., Aneshensel, C. S., & Schuler, R. (1999). Body image, perceived pubertal timing, and adolescent mental health. Journal of Adolescent Health, 25, 155.

PAGE 104

104 Smith, D., & Hale, B. (2004). Validity and fact or structure of the bodybuilding dependence scale. British Journal of Sports Medicine, 38, 177. Smith, D. K., Hale, B. D., & Collins, D. ( 1998). Measurement of exercise dependence in bodybuilders. Journal of Sports Medicine and Physical Activity, 38, 66. Smolak, L., Murnen, S. K., & Thompson, J. K. (2005). Sociocultural influences and muscle building in adolescent boys. Psychology of Men & Masculinity, 6, 227. Spitzer, B. L., Henderson, K. A., & Zivian, M. T. (1999). Gender differences in population versus media body sizes: A comparison over four decades. Sex Roles, 40, 545. Stewart, T. M., & Williamson, D. A. (2004). As sessment of body image disturbances. In J. K. Thompson (Ed.), Handbook of Eating Disorders and Obesity (pp. 495-514). Hoboken, NJ: John Wiley & Sons, Inc. Stice, E. (2002). Risk and ma intenance factors for eating path ology: A meta-analytic review. Psychological Bulletin, 128, 825. Strong, S. M. (2005). The role of exposure to media-idealized male physiques on mens body image (Doctoral dissertation, Univ ersity of Texas-Austin, 2005). Dissertation Abstracts International, 65, 4306. Symons Downs, D., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial validity and psychometric examination of the exercise dependence scale-revised. Measurement in Physical Education and Exercise Science, 8, 183. Tantleff-Dunn, S., & Thompson, J. K. (1995). Roma ntic partners and body image disturbance: Further evidence for the role of perceived-actual disparities. Sex Roles, 33, 589. Tiggemann, M. (2005). Television a nd adolescent body image: The role of program content and viewing motivation. Journal of Social and Clinical Psychology, 24, 361. Tiggemann, M., & Williamson, S. (2000). The effect of exercise on body satisfaction and selfesteem as a function of gender and age. Sex Roles, 43, 119. Traub, S. J., Hoyek, W., & Hoffman, R. S. (2001). Letter to the editor. New England Journal of Medicine, 344, 1096. Tricker, R., ONeill, M. R., & Cook, D. (1989). The incidence of anabolic steroid use among competitive bodybuilders. Journal of Drug Education, 19, 313. Tritschler, K. (2000). Practical measuremen t and assessment (5th ed). Baltimore, MD: Lippincott Williams & Wilkins.

PAGE 105

105 van Loon, L. J. C., van Rooijen, J. J. M., Ni esen, B., Verhagen, H., Saris, W. H. M., & Wagenmakers, A. J. M. (2000). Effects of acute (-)-hydroxycitrate supplementation on substrate metabolism at rest and during exercise in humans. American Journal of Clinical Nutrition, 72, 1445. Varnado-Sullivan, P. J., Horton, R., & Savoy, S. (2006). Differences for gender, weight and exercise in body image disturbance and eating disorder symptoms. Eating and Weight Disorders, 11, 118. Wang, S. S., Houshyar, S., & Prinstein, M. J. (2 006). Adolescent girls and boys weight-related health behaviors and cognitions: Associations with reputationand preference-based peer status. Health Psychology, 25, 658. Wei, M., Kampert, J. B., Barlow, C. E., Nicham an, M. Z., Gibbons, L. W., Paffenbarger, R. S., et al. (1999). Relationship between low cardiores piratory fitness and mortality in normalweight, overweight, and obese men. JAMA, 282, 1547. Weller, J. E., & Dziegielewski, S. F. (2004). The relationship between romantic partner support styles and body image disturbance. Journal of Human Behavior in the Social Environment, 10, 71. Wertheim, E. H., Martin, G., Prior, M., Sanson, A ., & Smart, D. (2002). Parent influences in the transmission of eating and weight related values and behaviors. Eating Disorders, 10, 321 334. Willett, W. C., Dietz, W. H., & Colditz, G. A. (1999). Guidelines for healthy weight. New England Journal of Medicine, 341, 427. Williams, P. A., & Cash, T. F. (2001). Effects of a circuit weight training program on the body images of college students. International Journal of Eating Disorders, 30, 75. Woodside, D. B., Garfinkel, P. E., Lin, E., Goer ing, P., Kaplan, A. S., Goldbloom, D. S., et al. (2001). Comparisons of men with full or pa rtial eating disorders, men without eating disorders, and women with eati ng disorders in the community. American Journal of Psychatry, 158, 570. Wroblewska, A.-M. (1997). Androgenic-anabol ic steroids and body dysmorphia in young men. Journal of Psychosomatic Research, 42, 225. Yang, C. F. J., Gray, P., & Pope, H. G., Jr. (2005 ). Male body image in Taiwan versus the west: Yanggang zhiqi meets the adonix complex. American Journal of Psychiatry, 162, 263 269. Ziegenfuss, T. N., Berardi, J. M., Lowery, L. M., & Antonio, J. (2002). Effects of prohormone supplementation in humans: A review. Canadian Journal of Applied Physiology, 27, 628 645.

PAGE 106

106 BIOGRAPHICAL SKETCH Nickles Irvin Chittester was born on 20 Novemb er 1976 in Mason City, Iowa. His parents moved him and his younger sister to Phoenix, Arizona, in 1980, and this is where he was raised. After graduating from Deer Valley High School in Glendale, Arizona, in June of 1995, Nick enrolled at Glendale Community College, where he earned an A. A. (major: psychology) in May of 1998. He enrolled at Arizona State Universi tys West campus in P hoenix in June of 1997, where he graduated with honors with a B.A. (m ajor: psychology) in May of 1999. In August of 1999, he moved to Pullman, Washington, to pursu e a Ph.D. in experimental psychology at Washington State University (WSU). However, in late April of 2001 his advisor, Dr. Lori Irving, passed away unexpectedly from a previously unk nown heart condition. He earned an M.S. in experimental psychology from WSU in Ma y of 2003; in August of 2003 he moved to Gainesville, Florida, to attend th e University of Florida, where in May of 2007 he earned a Ph.D. in Health and Human Performance with an emphasi s in Sport and Exercise Psychology. Upon completion of his Ph.D. he ma rried Mindy Mansour on 12 May 2007 in Gainesville, Florida. In August of 2007 he began his appointment as an assistant professor of psychology at Concordia University at Austin, Texas.


xml version 1.0 encoding UTF-8
REPORT xmlns http:www.fcla.edudlsmddaitss xmlns:xsi http:www.w3.org2001XMLSchema-instance xsi:schemaLocation http:www.fcla.edudlsmddaitssdaitssReport.xsd
INGEST IEID E20101112_AAAADQ INGEST_TIME 2010-11-12T18:49:49Z PACKAGE UFE0020125_00001
AGREEMENT_INFO ACCOUNT UF PROJECT UFDC
FILES
FILE SIZE 10009 DFID F20101112_AACHCU ORIGIN DEPOSITOR PATH chittester_n_Page_002.jpg GLOBAL false PRESERVATION BIT MESSAGE_DIGEST ALGORITHM MD5
e1484c742d3c62bbf020b9efe1857569
SHA-1
1639bbbe4119c0b79799a720f7b47d3ae579e3da
75734 F20101112_AACHDI chittester_n_Page_077.jpg
7f6de2ad17410488e8a36adf35f9bfe6
4fbacbb6e2fe5197bf23b21f7b305d1dfa4d7888
1012 F20101112_AACHCV chittester_n_Page_030.txt
cad196b866aabe40f8fd1beaa27b2161
68542aab69a99bf80b0bbe7ec2bf9b7d091c3f1b
12034 F20101112_AACHDJ chittester_n_Page_088.QC.jpg
70d4271c846292411c34f981887ba742
79e2dfc9a27e37cb5bc158fb5a1300385ec10e37
22563 F20101112_AACHCW chittester_n_Page_011.QC.jpg
835a0525051457429029fe6b4d7e9886
d8975f5144b7d3e6325b421f8f3d5f79f8507bae
1053954 F20101112_AACHDK chittester_n_Page_072.tif
9862a785d2f4acb5ac7f12950dd99dad
9912a5d1e5920d3694ec86f7ca6ff2c307a4131e
1408 F20101112_AACHCX chittester_n_Page_086.txt
0a1382076c470f43e890c976e946ebb1
5597c05a31cb8e27120d41c5ae89397cc75dd573
54337 F20101112_AACHEA chittester_n_Page_048.pro
58140539b7fadb02a0baab58014757d4
ab5a49407473ba0ea373e2ee878d5ddf27e05bb5
6897 F20101112_AACHDL chittester_n_Page_077thm.jpg
b391d27db32fe5a68eb82c792bc18c2d
667b6589b39544650cfd6982c8ef865a7f64f911
49975 F20101112_AACHCY chittester_n_Page_056.pro
06d4ad140de5ed367b8477e8a45a2f4c
6ed000570c33fd71d3f7b2a67d4323c5a5d182c0
71655 F20101112_AACHEB chittester_n_Page_034.jpg
04d45f770a2217cb45b80454584cd04e
a49d3f50d2e366f0b007b55bfc77bee8d7a090e0
27730 F20101112_AACHDM chittester_n_Page_103.QC.jpg
0f14d05cd1c4e107e0c3999c1dbfb179
1a00ca6c96f2f1bc9532917ef6451bd69f9ce615
94610 F20101112_AACHCZ chittester_n_Page_101.jpg
7a8317c320585c3e60b145a4f74d8c9d
e860fa971503761eda453aa1f779f57558e05075
F20101112_AACHEC chittester_n_Page_070.tif
5972d034603a38f2c4d078563754b477
731b59aa4e58c2b64c7c34d9d487a113ea597539
78175 F20101112_AACHDN chittester_n_Page_016.jpg
953b48bb90e1a804152acdcfa7aacd66
f157a4d9a01feb0241aa3baa7074602f2df69a71
105504 F20101112_AACHED chittester_n_Page_063.jp2
f30362ba4d0d6e1ffd05a3d0ef4aad9a
90434e1d7f6bd43bd7a00a6401bbae4629d0a0a0
14725 F20101112_AACHDO chittester_n_Page_086.QC.jpg
7a8ac50bd0483b9bc28c5cd1b2f46fbe
6c09e64cfe70785acf0d1cbd58c74db55e717a9a
2117 F20101112_AACHDP chittester_n_Page_032.txt
47aef2f25cac4694f6c941fd7934699f
3556a0728a43216054ce9a129042e495e1104a5f
119577 F20101112_AACHEE chittester_n_Page_078.jp2
8cb6e4e1ff3c47d48931b1444f043021
43726f91856098c1fbf5516b912595fb189a8685
46691 F20101112_AACHDQ chittester_n_Page_088.jp2
a8ea337a65dd7b75183e8c2f24e94f2b
bbd461ee89337489824035074ed54dac36b94f80
25974 F20101112_AACHEF chittester_n_Page_027.QC.jpg
8beaf28968a1a4b604549b5f4d75ff0c
b657b9bc2e548b677c85f1be9531d0434c508fa4
6803 F20101112_AACHDR chittester_n_Page_024thm.jpg
90fbd08a20a8c75ca301167d6602b62b
22c9469b5afa69ee76491a93c3416d5c005ffc8d
50624 F20101112_AACHEG chittester_n_Page_028.pro
62316fcd2ecc1f350a80ec29266b2065
f1ba5a4e7b7c6f1deb5ac4f6676520f8301e8c03
23587 F20101112_AACHDS chittester_n_Page_034.QC.jpg
94f907957e331444063a2a967bd5c9ac
efdc2de1d17a64b21465f0b9424b15e0196d7665
53869 F20101112_AACHEH chittester_n_Page_018.pro
9e72ae2cad73df4dccc2d6f24996f601
94a6bc20267fd01e9923329699a4b5ac468d278a
384035 F20101112_AACHDT chittester_n.pdf
89801f1622c0fd1fa617b2d4538b878e
be3adce5af1ce0063cd45af51c8e314927de6921
6790 F20101112_AACHEI chittester_n_Page_045thm.jpg
ff806319452a8fb7feab771f3291e973
9b8f5e4c83c508e6565ad3b216f1c95e1d1b3589
7299 F20101112_AACHDU chittester_n_Page_001.QC.jpg
5f505f62dbe60da7a459a78c47fadec2
377566b86acb17e9134f40e15209b6dfdcd12497
71441 F20101112_AACHEJ chittester_n_Page_011.jpg
2fb5c41916e40fd4ed2bb8e9d29e3b07
c6fa9f4616cf7d9876604421a3cb6c7dd81d57c7
862 F20101112_AACHDV chittester_n_Page_068.txt
a7bdd9f839a48b0b76a05c77875e8ca5
5d7817bd66166d0628ba2a2ab8c0b0b7ab2d2445
117501 F20101112_AACHEK chittester_n_Page_033.jp2
46b0654ba92718e97bfeab83fa65b163
deae75f5727f425165d0063597f01b89b897cab6
76684 F20101112_AACHDW chittester_n_Page_058.jpg
34e5dcb5b5dfb4fa537d44de95098214
32298a509b799293f02c42255aba210acbfbd287
2685 F20101112_AACHFA chittester_n_Page_094.txt
7b545dd7742a3e91af129738ce03aa36
23b3a5cb90a8b5db44a410ead3c3dc9efff9700b
26066 F20101112_AACHEL chittester_n_Page_059.QC.jpg
28bbfde6983671be99ff4517095e7f85
48baff6e381455db8baece71e045e4d08d32f9e4
121678 F20101112_AACHDX chittester_n_Page_038.jp2
230c98f51fe2f7bc84987f7c11355c4e
3b4a4f1597067fd0d3b1f730bb44722a9abc64ca
39743 F20101112_AACHFB chittester_n_Page_084.jp2
7d821f3df1c3083c812583ddd940e344
dfb1e708d3f2887dbc80495304253f0bcddac6e1
143026 F20101112_AACHEM chittester_n_Page_101.jp2
eb258d5aba61ab308221f25032f0f7fb
5bdcc7413e10f65f6f2637809cc0094ea9836650
F20101112_AACHDY chittester_n_Page_091.tif
af9893cd320d9bc66f1d59e48bcf98f7
3d1bd9419eefc32c9aef314157a9f3cb4de8de43
29678 F20101112_AACHFC chittester_n_Page_086.pro
0b73f71acacda3fb2ae87dacde257512
3a79f9ba8013e05c4fe3c5769c05db073bde8ba4
982 F20101112_AACHEN chittester_n_Page_088.txt
3e363d17005eee4d9215e8c0e2595783
3878a1bdfb6389b9d76b9b4870ae0c3815a9257e
6829 F20101112_AACHDZ chittester_n_Page_048thm.jpg
c07041cfea2bad3d0f1463fe97639d89
02670f41b41b481ce4ed029f7032eb0d3e2d518f
4673 F20101112_AACHFD chittester_n_Page_064.pro
361a623afe04622335c773ff304c10db
5e98bd392ccf89b07f0615e598558ae7c701ecbc
26327 F20101112_AACHEO chittester_n_Page_015.QC.jpg
dd92eef76a277130894b0fa9bb1d515b
3a95d286d7be6a27027c8d838c3333a6a96488b4
27984 F20101112_AACHFE chittester_n_Page_101.QC.jpg
192ecf5b7fa4d8536a05389d414a1c13
0732855050f887717240eec1931cf778a7eeaf88
76012 F20101112_AACHEP chittester_n_Page_047.jpg
0dc77444dc48202aa370f3c11592179d
52ca1e31d70d9b501cd67a92c59fc36894042760
75959 F20101112_AACHEQ chittester_n_Page_043.jpg
9df3723a6919caac1911f154e3b277e5
0607e7f6cae80f23a1df8fefd666fbb064e09eac
77465 F20101112_AACHFF chittester_n_Page_031.jpg
28da237dfdc04c8847579d51660b3761
8ee985dba29ad7694b80451a0f13bd3d5997a806
2050 F20101112_AACHER chittester_n_Page_025.txt
5b7365bd3c66b6e69c38f6c0775915fc
32aa4eb6a2d561c7689ca1c30f44a38b5b95b88e
6847 F20101112_AACHFG chittester_n_Page_019thm.jpg
f94c28b63519b7257b458bb1d8942d7f
f0fbe6fbc563a52fdfe9ea754041b5e92d8b56c1
141868 F20101112_AACHES chittester_n_Page_103.jp2
cdfb8a391c38a4df90be1971905af016
fc04707038229e2aa44953905376b4f4e82e0831
2223 F20101112_AACHFH chittester_n_Page_078.txt
bc2bf41ea1f58bbc26150f20ef2ae5da
f80a128a3298e1062d82b841de3e270e799d6b88
22915 F20101112_AACHET chittester_n_Page_022.QC.jpg
52293efc1a4728b73add000a8fbc4f96
c53e3b78ef8799de7e26d87017f191b747e91cfc
76164 F20101112_AACHFI chittester_n_Page_005.jpg
4d0340ab3db88477309f41b9be4feebc
8f74cce7255a960e47125cd91fc690719a5ba259
7352 F20101112_AACHEU chittester_n_Page_097thm.jpg
620a9ffb34eb5d82258af02c848174a0
062f4500f2d22d08f13620a8532d38539723e8d1
52355 F20101112_AACHFJ chittester_n_Page_046.pro
696f6e1f50ef5200e2eaaf7ac12c511f
41db186c4d59688278dc13b1658847dc590e9bca
118043 F20101112_AACHEV chittester_n_Page_013.jp2
55d1c078d7a58a4c8c3d333d2a0c8963
44557bc377d887614618a36ce55c2587fb1cb44f
4362 F20101112_AACHFK chittester_n_Page_004thm.jpg
28736f193059a02e44e52f9abdc31a5c
de31c3bf741d189ef1bb4a9f0867765626c6bc31
591 F20101112_AACHEW chittester_n_Page_007.txt
a038043746cb17a99ee7f73016eeb5d8
01ca6cc1123ffb31e0db31608647b34daed1c908
24139 F20101112_AACHFL chittester_n_Page_049.QC.jpg
f1ab2908e053696e092ebc369bd49f20
138aa6cd7b1501eadef3b37007be9372dab82efc
75701 F20101112_AACHEX chittester_n_Page_033.jpg
a0fc1ff37cbb3b3295222ca6dab4a7a5
5aa0b02e478eb7b626a02d71fe756bf285dcddd1
24982 F20101112_AACHGA chittester_n_Page_024.QC.jpg
f0b0ae49dffe4dde8f83ad52b7998af2
04ed7d660dc2c56984b8f6a325ee535ef745c921
51589 F20101112_AACHFM chittester_n_Page_068.jp2
e441a60e8e425cc71cfb26919bf8d874
ff82eda58f63938db5715a3fe66fccd055bfea90
113194 F20101112_AACHEY chittester_n_Page_053.jp2
f4ac43b47a74c554df21425cd96e52d1
0d456adc03820907fe1f6792fc9fd317ded6b500
32232 F20101112_AACHGB chittester_n_Page_010.pro
5d4a572bbf1ca2afab8286a1be61bca9
115c0facc67ec4829cd436bc8fc3e96a4f32f5a0
2022 F20101112_AACHFN chittester_n_Page_011.txt
135e107c94bf12087bad3b4f8de0a29c
588188e465f52d4895ff4c2c0c7b28e4ec914242
6837 F20101112_AACHEZ chittester_n_Page_083.QC.jpg
1ef6fc17345851899995258a787a97b4
438a399acdd5c3857367738a5764646c7904cc6f
F20101112_AACHGC chittester_n_Page_022.tif
0be5f037b43df45d6128e1534cc03033
359763bb73cd53dcfef66bcb94444f17d5ee1471
1076 F20101112_AACHFO chittester_n_Page_089.txt
588885bfa848240ebb02e0812c71aab5
b545049ded6abfc54f6a2f6a06466cc8484172bc
6428 F20101112_AACHGD chittester_n_Page_063thm.jpg
02afd7171a781d692f76074e53ef37f1
04e65b7c69bd8c415597f4d1f111b3b5490ff34c
3554 F20101112_AACHFP chittester_n_Page_084thm.jpg
4debb104fccef56e7debe08c1af6f17c
b4c3f8b8452d8726d19090d4973fa1aa726fcbe7
7216 F20101112_AACHGE chittester_n_Page_060thm.jpg
877113bc528fc8841800a3c93f5cba9c
044c3d2d7bd532a34ef14bdc921c134303e87ca5
F20101112_AACHFQ chittester_n_Page_039.tif
f72058549e13be4ebf0e910979ccb9a4
5b2f12f0fd7c62e19e89e35f78e5b60e78c492ae
117932 F20101112_AACHGF chittester_n_Page_018.jp2
82ceace5fa110234fc38c7368348fc6e
9e8767f2fb021387b3b5c736d6268d34c3bcd40f
2139 F20101112_AACHFR chittester_n_Page_048.txt
fc8cdf40756d42539ab26ea7ac2d0e83
a0dcea760e248efeebb17715b4a0933bdaceb880
2157 F20101112_AACHFS chittester_n_Page_080.txt
fc2c29ac6310225a1d3bf2a88c5795af
87f6fb78fe359aafa813263ee4af8064adcd1ffc
79652 F20101112_AACHGG chittester_n_Page_106.jp2
d5e6bc57167e3c11c6775c67650a29c4
75536387135c63f0e180f110aae7ef7fa0b6baaf
25300 F20101112_AACHGH chittester_n_Page_012.QC.jpg
ea53664f31f25a110825405aaf08e9ea
b303654a50a9f2ca55b7a1178c34347572aaf0cb
6273 F20101112_AACHFT chittester_n_Page_044thm.jpg
b0fd70865f8545badd84b7ce58eda279
72c274c1886a55cbe0be28a5a5a71031090bab96
77134 F20101112_AACHGI chittester_n_Page_020.jpg
bcc4d50194f6d4793c9330028b84efc5
059d94e9e1337eb9d31763e2573053de47d9939c
75247 F20101112_AACHFU chittester_n_Page_069.jpg
bea79045e18119a8e8d08c814d48bdc3
44c077f10e97fa56f698eea1b786620994b14d8c
53880 F20101112_AACHGJ chittester_n_Page_081.pro
6812b8ea6401076ca8ce04936b79f055
0b4aa969a8fbda132f08194f920de92a4cc7006b
6889 F20101112_AACHFV chittester_n_Page_003.jp2
64424f12a20a410106cbb0327e9fdd68
b0e2ed5a372196554cd058dd836ad1b87e091bd9
F20101112_AACHGK chittester_n_Page_083.tif
77caf4af15cdbb21ba038f0829bff8cf
437d51aa05436f40e3e7cbb42612d1386e899aa4
55146 F20101112_AACHFW chittester_n_Page_059.pro
8c4cf6144c62bcf3f4ea6c47690c0f44
d475621247860873f7043d495b2b3347fb0a31a5
2153 F20101112_AACHHA chittester_n_Page_038.txt
4ef2f202cf571e63c8e3947f67ddc9f7
2947ca88b47a6cfd07bbf9dd598e035a44757312
6075 F20101112_AACHGL chittester_n_Page_009thm.jpg
8642359fbf56bf95d147242b18b3a3ec
a1b91755b51d22f6f91457d5e220204c4ec245c2
116581 F20101112_AACHFX chittester_n_Page_040.jp2
87e2217880d4ca66eaa51c5972d0904e
61821fd40acebc61202a3bb60c983a657b4d4d68
1051961 F20101112_AACHHB chittester_n_Page_028.jp2
68be9172b0c1505f7374ecc03676534c
2c4b0db948ee8da929708f20ae06f1d5921f7577
F20101112_AACHGM chittester_n_Page_049.tif
74c9b733b936f4d54307b74459c27d75
5b319c8bd2d6445f42153c82fe75ba120136f269
7025 F20101112_AACHFY chittester_n_Page_054thm.jpg
300eb9e8eeb14d95a1508ebdfe76ff56
869b41bf43c64cee907ddfec813bf3ba415d9a58
2040 F20101112_AACHHC chittester_n_Page_009.txt
e7021c39f2ff80cc57eeb0f998ff3e32
bc0138c2d6972cb893e24fc6df908f896716eebf
14064 F20101112_AACHGN chittester_n_Page_007.pro
202fb0e32f8fb08d6e98d743d2b18b2a
fa2be8979fe009002d59a76de9232254d9e834af
51604 F20101112_AACHFZ chittester_n_Page_033.pro
62dea1fdc0f6d304f44856ad214e0f2a
326d86665348bdb86527741a3f56db5078393482
77864 F20101112_AACHHD chittester_n_Page_078.jpg
894d2d95bbe58efb2b3964da38b6e7b3
15ae47de8d3a679375936bd962686abc9ef44622
6942 F20101112_AACHGO chittester_n_Page_015thm.jpg
fc5ef7496f6e43d273abd475fb455d8f
971676193213b62a592b9fb84ed952ba73851c05
F20101112_AACHHE chittester_n_Page_040.tif
c80dd70497549949fc575e6a8ee54a06
5ed4e6b4259191c43dbaf0e9be97486d49cb70b4
53615 F20101112_AACHGP chittester_n_Page_016.pro
43832f52d57979d1040a284d31ca4108
cda8fea54fe825e2b9b8c72fc7d081b1f40d02ea
25375 F20101112_AACHHF chittester_n_Page_030.pro
911d46997cefd5d4f2b44c547ee252b1
12838badcbc7bcd540b85fa9cfa29f6143ff786e
76694 F20101112_AACHGQ chittester_n_Page_029.jpg
a026f5f277ff413c87ac356c6d2d2d66
53898aed437d920b525dd8b053750187daf4eef9
6840 F20101112_AACHHG chittester_n_Page_058thm.jpg
676647d3bc746e9f4c43341ff73f405b
1ff3eef9eca8f1f48899f05ca6a41603e24ce4ea
105229 F20101112_AACHGR chittester_n_Page_044.jp2
b85851cb2ac75c1a7d094624bcbce9c7
affba33dee491243eb03e7dde335933ee6a847a6
F20101112_AACHGS chittester_n_Page_096.tif
75ffdb4410d99ced866ae2d1ec882001
ea70fda04c89983901c0529918ae07e18054c91d
2118 F20101112_AACHHH chittester_n_Page_016.txt
b2ab4b593a0a1c2f28a897e4b5bdf2f4
c38c3a20068f2d47b2ee42426a418a46676f48d7
2174 F20101112_AACHGT chittester_n_Page_050.txt
64734d18c74750ead0d19c0bc5eb9ae5
37cd412c074fc4371b5e1aed904a9fe6f910b3aa
115362 F20101112_AACHHI chittester_n_Page_070.jp2
1a2361d9eeb39c4d898ec3ddf766ea05
b7ba60fb89ca11b97bdfac93e38190b8668916e2
3603 F20101112_AACHGU chittester_n_Page_087thm.jpg
b68a824f5b4b12f36b074b18da3ebcb5
8bedae1b362d6edce5791e1a20de9fcd3b8e857a
F20101112_AACHHJ chittester_n_Page_010.tif
1a81ec6332b137dfd837441616da40ba
9d3eb1cf7fa97bfede5457218240459e9a6c6d06
52721 F20101112_AACHGV chittester_n_Page_013.pro
27c107ff0929b01e771273c3b1c96d8c
47316adb5b9eb901dd42744c0d1f969a91b7306c
2106 F20101112_AACHHK chittester_n_Page_076.txt
e5d8e911cd7a5a54dbef46901241a88e
06a99eb34e9c2ba3205545662973c79a9c609450
25271604 F20101112_AACHGW chittester_n_Page_092.tif
d84f008c78b08e71f54b43bb9e9e616d
48f88e5d8dbef8f886d6c67477eca3813d3d2062
23940 F20101112_AACHHL chittester_n_Page_043.QC.jpg
1af2b77f272622fe3fc90ca08fb75919
7089079751fd4acad8c543d819a8a6406e31535f
25572 F20101112_AACHGX chittester_n_Page_041.QC.jpg
59aa786dba5c3bcadb0391455b73eaf8
d5fddd0966a687be390a034214bf94179c3f4167
2015 F20101112_AACHIA chittester_n_Page_055.txt
b7929b4ca9e9f003a0ea335c81be1483
c7028752c41ce9061aa74fbb10107ca676d2453a
117696 F20101112_AACHHM chittester_n_Page_042.jp2
d162ab7be4b167ce1661abf41d2eb6a5
64e53778ab3f5319e29a38016c785b1e2cb812db
74529 F20101112_AACHGY chittester_n_Page_055.jpg
dec89bbaa01ec2948ce35ab10da4e7a2
123f94ff60d3d1a898d4fca9883f263e7338f718
53623 F20101112_AACHIB chittester_n_Page_020.pro
be8c678f0b1e1349bbfbaa00a099fc2f
80db6780d42fe6d17699633a4852abbdb3868ce9
F20101112_AACHHN chittester_n_Page_031.txt
c96395770a2161363126bed3824434ec
d98e3ab070f7d79d0b6f900b68529e46b788b201
7345 F20101112_AACHGZ chittester_n_Page_103thm.jpg
36508d43c195b7b2626577b9234b4997
a29cf7bba19bee2ed77925f426efc067e35eb9db
78674 F20101112_AACHIC chittester_n_Page_038.jpg
7424c8621b69626ad63cc0379c780ac8
3b9d8c17730fd132f0d60392c96b31570ee72f39
56033 F20101112_AACHHO chittester_n_Page_106.jpg
bea725150e6d91386fcf2305f0d2efad
e3b9a004f092f45e2a0c954de0a54a4df4949843
2112 F20101112_AACHID chittester_n_Page_073.txt
2dc0c6f5c01dd33608577a1d4aa47055
145cbb9ef355ef2a625e3300090740669b419c0d
6933 F20101112_AACHHP chittester_n_Page_043thm.jpg
20a11513e8fe3dd5e7f8fe9fa3861e78
41565ec5897d2f430fe75cbe16a966417c79b2fd
14294 F20101112_AACHIE chittester_n_Page_064.jpg
ea57e43bbb96da71b3d0ae5a3a02d68f
c1fef1a65c3cf7bc32ef7255cd85410c46b4e1a5
760 F20101112_AACHHQ chittester_n_Page_092.txt
85804e70afd4b36f09d0bebc080f9ba4
264815682891affa86fea98c217dc5fe9fd05ead
75425 F20101112_AACHIF chittester_n_Page_054.jpg
11aae12bd0803390fcdc69f1d137abd7
aeaf21755ad49903c2738196384cd4e7f471b0cf
111406 F20101112_AACHHR chittester_n_Page_014.jp2
7ba5491eba66f03a52d20adf1f4db6e2
eb85cc2cccc0688f29bcbb98bf88f8105f7018a6
3329 F20101112_AACHIG chittester_n_Page_003.QC.jpg
c4e0ce2d46dfb0e910de196b79d6ec34
50251ea95d0ea4d2e550488a95f5d1978c37e578
49467 F20101112_AACHHS chittester_n_Page_034.pro
6886346ac6388408d0106ef641b117df
4078b19115cfc24a20729fe97935ddac4ff39480
2098 F20101112_AACHIH chittester_n_Page_063.txt
b2d3a7976aefa40046ca9d9f1aa688f5
91fa4d7e6c103666d9e15693bf3b44b7bae98be2
148391 F20101112_AACHHT chittester_n_Page_100.jp2
00d8a8c1ca024c5e84cdfdf616ca9910
3508fecbbaf18552f511a1da48a04981ff6e1ccc
F20101112_AACHHU chittester_n_Page_081.tif
55ca5d8331d15e21e09d18d61b79bdbd
4bfd0996254ac521e7eb138eae0d0e40691a2db7
49797 F20101112_AACHII chittester_n_Page_063.pro
73ab65b644dbd4d5f801bac75b072cd7
ffa3185cb37f4c6c4bafbd9f48a16237755cdf33
1228 F20101112_AACHHV chittester_n_Page_091.txt
23d8f5320cac263c9dfc6ab04791c8f4
c199a538d3740916c967265a9f623f749d00dfe7
F20101112_AACHIJ chittester_n_Page_085.tif
d936ae3e6b3d477340784cd0c49e180f
34d5eca662d1186aa0ac98d5d1898baedd6dcfaf
2289 F20101112_AACHHW chittester_n_Page_001thm.jpg
bb828bdd6ac05ae536fec923fc44d8e6
e1e71b9f99fc96aabcf36ed5cf25d36dbcacc4b8
54253 F20101112_AACHIK chittester_n_Page_026.pro
a41486ad096c9fee0a24b54e48cc0eb0
a842ca6def8107bcda7b4e893fd88bd185af025e
52254 F20101112_AACHHX chittester_n_Page_053.pro
f5933d6909cd96716daa33dcce0e3101
53818c4e9a6179f98dd7045d7004f8d377d3f76f
6525 F20101112_AACHJA chittester_n_Page_014thm.jpg
9c4361def0cf9b789ddb91a9a9c01628
22b1f2e5e632171e1a0a4e14ef438b861737db3b
10995 F20101112_AACHIL chittester_n_Page_003.jpg
87d39fa4a2093edf5551ba0716d92ea4
4e76ba064273118e55056eb203496fcd119bd8a7
24836 F20101112_AACHHY chittester_n_Page_073.QC.jpg
3242e2b81da40dbdf972bc4b0642762d
e7cf8ebdf0ed81d835285d10075a99c7e37675e2
111464 F20101112_AACHJB chittester_n_Page_071.jp2
d9fffccd8cc3ac54b06903156e065c4f
a3d40ad1888ce1bb2f88eeed498884b41a3bf653
25491 F20101112_AACHIM chittester_n_Page_050.QC.jpg
cb95249603c7107bbe3068428d75610e
ffa4de6312dedf6a551a4bc7a52397ac42b71fa6
26202 F20101112_AACHHZ chittester_n_Page_089.pro
edc380fa9a2259cdd407af8c3e94128c
d81b3fb06aa0afa7000569473d3fdece87f5050e
24325 F20101112_AACHJC chittester_n_Page_025.QC.jpg
a665c6cdba4328090e6e1537b2bd6d52
b09008ac732b1f85d58f76d779048843ff532b9a
48160 F20101112_AACHIN chittester_n_Page_044.pro
d1c4e3876b972f823464c2c9d9188617
42665a9abad36713417b3f97b7d8048bdacfab2f
91386 F20101112_AACHJD chittester_n_Page_098.jpg
b0960f2c410e62411fb21af9984f6686
38e83cd42d55657d315d00d371a7b3c6d2ab7546
104699 F20101112_AACHIO chittester_n_Page_023.jp2
00aa58fa903699b9b71404a90716363d
10d75ffc6d32f8eaeb81e038011316363cf175ef
85039 F20101112_AACHJE chittester_n_Page_082.jp2
a5b5e7e0c3d6854a6089552c90066e52
a239a3cbc9fb7440c2a821b09a73ad1f546ad1d7
515568 F20101112_AACHIP chittester_n_Page_092.jp2
33e35cc3f378d5787b478f469d08e6b5
4bcc3e56f4c8aad101d6dc55a7a0058654c19938
1054428 F20101112_AACHJF chittester_n_Page_062.tif
030a3e0f69d8995542bce8fd4c6a562b
64e93d0995af15f5e7069e68da5ea6bdf6281e2e
1989 F20101112_AACHIQ chittester_n_Page_034.txt
151744f1d1ceae29af71af376865151c
f24a75e57664df66fe2a28c0b6c2a4861f8aa162
6594 F20101112_AACHJG chittester_n_Page_034thm.jpg
bdd5ac36a1646d0bb8ca062c1f516edc
391aa2e4212cba52eb2bb0ab8b3ef25e2d6dd949
53240 F20101112_AACHIR chittester_n_Page_029.pro
2582b31df0329c2badfc3ca61fe586ff
a4e825480954bea113a75f86b5dd4a1fab3ff5ea
6945 F20101112_AACHJH chittester_n_Page_017thm.jpg
ffacda4bf7f88e4ddba04754b0617382
266ee4dd969f8c42cff28ce090d12031f0bfb6ae
25267 F20101112_AACHIS chittester_n_Page_040.QC.jpg
03cb0ba7d6e91a9a5345392beaa2b5ca
2c1b38d57573c3a3b4e221fae233c357a0acfa48
48877 F20101112_AACHJI chittester_n_Page_011.pro
60b092923aa451b580ff15754fc86b1f
935cf04951e5b8c73a8214e670eabf5b7c4ba5fb
53750 F20101112_AACHIT chittester_n_Page_047.pro
9b8643325790873d6883d05313a9ec26
3f12a2d94139b1727b4c089be72fca78c33204cf
19827 F20101112_AACHIU chittester_n_Page_083.jp2
39a13ca489ff41e5e3c3e127449760b3
66bc5f5428eaddff5bab35dd813a31febdd7ddc8
10680 F20101112_AACHJJ chittester_n_Page_091.QC.jpg
47b6ca73de8736513b7904031164ad24
899de37a076b7bdfa0a03492e172e63bd6fa148b
76794 F20101112_AACHIV chittester_n_Page_074.jpg
a627372f6b37b42ab850cad6bf7edd44
b482b7c8730399eddc7ab5fd7aec7430fd7e1137
F20101112_AACHJK chittester_n_Page_082.tif
9e04f7253d19a13a54e096938aeb4d59
c25f00a95248fade2083cfb32c263b8694518364
76605 F20101112_AACHIW chittester_n_Page_032.jpg
b9894f0eeba34c11670200909904c22f
3ff3c732a528ecbd050473d8bec19080b956c51b
95 F20101112_AACHKA chittester_n_Page_002.txt
18fb28c140a75fe26f095e7a37ab2960
753ef936a7fcfd86dd5c655ac5b60fa2c18a700b
2788 F20101112_AACHJL chittester_n_Page_100.txt
5c6b5ed9b379d2ef4d18ce4e5810e284
01f22fd95e8f44515c4831ab194407144721f841
24723 F20101112_AACHIX chittester_n_Page_046.QC.jpg
6175f146993e50621611feffe8cc4adc
596ddcf4c1addf543399ed5863306e26ae26be79
10386 F20101112_AACHKB chittester_n_Page_084.QC.jpg
b124453ef71cac78633f922c27374114
b0b378b5155502d84686b91b5b241ea0e945420d
40684 F20101112_AACHJM chittester_n_Page_090.pro
dc587b65a74971780b3cf98a70365aea
c30ad1655923824803cfcc6d557b2a29c0e50651
F20101112_AACHIY chittester_n_Page_012.txt
94eb337b98aeae23de4aaf5b40cd5841
9fb24552aea0bded4cbf30c869e1bc52d09268a2
53848 F20101112_AACHKC chittester_n_Page_032.pro
e8f39c73006de8be3f6e2ab7a1f0e7ba
391ac0b2d65e55c2bbc7a8f79e734a4a83da2401
834231 F20101112_AACHJN chittester_n_Page_090.jp2
ef4e32b6e49c44b205c3a708c002b9a3
cbb303d92db22a1702b7c59621f873593c159d36
F20101112_AACHIZ chittester_n_Page_007.tif
36d4b707b9c4618cba28b7da3ba6096a
69cd6be14f7839ea554b7dabac174ef046b6d48e
113150 F20101112_AACHKD chittester_n_Page_046.jp2
65c0f11a7a2125603cf74818482d9c16
3f2e5838d40c77247264f72660648acd37423760
46324 F20101112_AACHJO chittester_n_Page_091.jp2
e97212a6a92fbcc8f766452fec761e93
4e8c8abd0293a3bcfd296291b3c458a7937cde85
2056 F20101112_AACHKE chittester_n_Page_046.txt
f03e087c77fa397430feec70856b6c01
12447a485270ec72a831e55455a46c11c6ad8e38
130229 F20101112_AACHJP chittester_n_Page_102.jp2
6698401083110ff7ee5d3662f02d3c28
f20a40f57a02965957ceee2b6402d4206b87db1e
24437 F20101112_AACHKF chittester_n_Page_055.QC.jpg
027f7e9ad538f600b39d99ccad743f52
e70158e5a92eca4730c0c4aa997396fe0c45202b
17040 F20101112_AACHJQ chittester_n_Page_090.QC.jpg
be7927fb37b5980ee525fcd7d8a12b06
33a308f276ef8f1e941217020e8eab43564874f2
F20101112_AACHKG chittester_n_Page_014.tif
bf947f65011560a0da4630e82507aba9
ab8457b61683aa4b28c37e84d64ffa3758b10757
119191 F20101112_AACHJR chittester_n_Page_059.jp2
ad8e9c9a975ef05bdc115ceb85947dad
ad1b657bf9d56019fd0f44b9f5e5f13169341fdc
1331 F20101112_AACHKH chittester_n_Page_002thm.jpg
f76e1054104dd9a103f5bf4558974c6f
694436c68d4a29fe0f50762ba5add283b3945027
330548 F20101112_AACHJS chittester_n_Page_008.jp2
e5ab79b49a58092deb45c3a3778cd9aa
4507773812eb80c59a65173e65551030318e64d6
120515 F20101112_AACHKI chittester_n_Page_037.jp2
c15ff1f40959ca540f7d597d9320a8e7
191d3efa1a3667956cb128ce8833748bda9278ad
2978 F20101112_AACHJT chittester_n_Page_067thm.jpg
50248a44c78e5dfbaa7af205b569e88e
d1992275d369cc756899b8e0d731114cf7534773
25674 F20101112_AACHKJ chittester_n_Page_035.QC.jpg
347682bd823304c6c800bffb1d874115
5291dfd249cd7628de9e05a644d09e2f07611f1d
7132 F20101112_AACHJU chittester_n_Page_100thm.jpg
195363f6d66d23dcec3a62485b779b7b
51d52c54f23f8680cc0ea8cf837a553529163654
16512 F20101112_AACHJV chittester_n_Page_010.QC.jpg
d5e3e04b88835cca03e430038890f530
de651a66d6968f8909a9c9b5a826bc112c785dc4
6772 F20101112_AACHKK chittester_n_Page_031thm.jpg
4ad089e2a45a2ff862be16049c3b1a9a
2431633effe1b10ee3c2f9c854b45e3bfca401d3
8423998 F20101112_AACHJW chittester_n_Page_090.tif
9eb4b345bbcde72622f14491aae752b1
f404cd28db011f0ca8f8904569df035461f206ac
F20101112_AACHKL chittester_n_Page_067.tif
3cfdf63422c1f9a359e2004da0561796
b6c2d503957f1c9c35e69abbbd77c6abc30e1ab1
116998 F20101112_AACHJX chittester_n_Page_054.jp2
30403c1c6e4f6fbf0deeac005565f4ff
ca2a17c7e0e36783e4cbee687641300fe20fff8e
79880 F20101112_AACHLA chittester_n_Page_075.jpg
a70cfca9133aaeb9de58486351d71654
6b99b5e11ea1ff77a63690e79df8bf5facf1f545
2127 F20101112_AACHKM chittester_n_Page_029.txt
1cd9ecb697fc9ac72ba9500d3455f61a
fe1427468102e32d4259b8a1ed87070c434ba49b
7019 F20101112_AACHJY chittester_n_Page_102thm.jpg
27dd2d0ab4b30afc6ff937823c0a51e0
254289645ea256760e3e4b90003670ec0e6af324
26831 F20101112_AACHLB chittester_n_Page_095.QC.jpg
a3e204d3b75f2a4acb18ff9bc4e6ba2c
6b806a1d1df5cab06e5552318ea45955382407d1
24543 F20101112_AACHKN chittester_n_Page_053.QC.jpg
3aa67467b0fa44642a1f90e2c101c600
25ab56ca5c7dbddf1e0472d0a20028d52dfa7100
82806 F20101112_AACHJZ chittester_n_Page_102.jpg
0010d6e882526c68cb929ef9c99b6dbf
768d5a151f173cb4695ec87ac49958336fcf9f8c
2051 F20101112_AACHLC chittester_n_Page_043.txt
00c6f3396ec9fea25909f9069a1314a5
e9e08b2ead24bab6e823cb02c4402f9d7f229546
F20101112_AACHKO chittester_n_Page_070thm.jpg
a80bfc3d18ec279c44fb8b19974d19fb
b914506b498e64f3c80ba380a20b280574539d73
24902 F20101112_AACHLD chittester_n_Page_077.QC.jpg
4153c145f04fd7343855f903ba6e2e66
d410c43383801f4bfc600fbbcba4b013d19d0d13
25309 F20101112_AACHKP chittester_n_Page_080.QC.jpg
22f1906b45f9f067aeb9fd29d3dc8af1
e2d344b0faeacd9594c51942355497c07e3bf89e
1284 F20101112_AACHLE chittester_n_Page_010.txt
e667025162591501c5eac35fecc53f57
9b58e69040e2d0475429eb39165e811e07f3f28a
101847 F20101112_AACHLF chittester_n_Page_006.pro
7e27edf0e01e44bf00bf227ffe5e0e97
f3c7d237d6f61ad0707847ceb0161ee2b798336c
26318 F20101112_AACHKQ chittester_n_Page_075.QC.jpg
df765b565b2616860ccfab40f601a8a8
350b22e3ba907547e0013214125faee1f0634b89
2622 F20101112_AACHLG chittester_n_Page_093.txt
ebdc9fc93e0a51868cb8f82c515860b8
0e0f19c8d6b28be6c8fc7178fef4b73b259ecb2f
6936 F20101112_AACHKR chittester_n_Page_035thm.jpg
4c8ab5584a914e25a30e6454579315ca
5f0b54f8efe00fd6ca99745d47bf5487871ede00
73095 F20101112_AACHLH chittester_n_Page_039.jpg
256be44a40428eabdd126efb50eb0146
6e8777ee23f49ad9bff7bb223d6faacd5e0e32ab
25627 F20101112_AACHKS chittester_n_Page_072.QC.jpg
b5d1ff7cd73fdb30533d9415e1a1026f
f0454586ad6f6c4d257b6323f63f24e1dbd74c53
24673 F20101112_AACHLI chittester_n_Page_069.QC.jpg
dcf1299c1cf57810b3acaf80ff68f0d9
59e5ff3f49493d65e6eb2ba167317b5b0645d801
120185 F20101112_AACHKT chittester_n_Page_017.jp2
c23c2dafed6e40d0b74e3d7a9d1024d1
0b2cab0f6bb4207a3875a5087a98a8f27a42cc8c
53028 F20101112_AACHLJ chittester_n_Page_054.pro
4d3178e3a649538a729542571523a585
b274341c28b253cd746b7794b1539ef04ca62ac5
2689 F20101112_AACHKU chittester_n_Page_101.txt
da6e91c5edafe977d19f7a6bcfb7d6ef
1736e6f041a8b05292a645692bba4b74c2ef6a60
F20101112_AACHLK chittester_n_Page_027.tif
abd3cdcbcf94a2a0611bb91725b85f08
5336bf68663a52ee9f441f2c3a8a9f1476906281
25605 F20101112_AACHKV chittester_n_Page_099.QC.jpg
7c0a0425404ec8a3aeff09731566d1d3
901be17280d63399482c28726a2f00d4f566fbbc
78137 F20101112_AACHKW chittester_n_Page_027.jpg
3406aa978e911aa2390c0bdfc92ed6d9
9f1e17962a7a9bae79ecf6cc450016d8ac3d3a82
60613 F20101112_AACHMA chittester_n_Page_104.pro
beab8ca94de2e3567ad3b73a3b393fc8
e61572869d1fe8b1ce5a7ede7dd01091776a1c01
124148 F20101112_AACHLL chittester_n_Page_060.jp2
d87e17630e8acfbfeb3d161affbaec2f
fdb908a71cce107c2efbdff5346da1c07efd1a82
27254 F20101112_AACHKX chittester_n_Page_060.QC.jpg
43ba0a21798e6e4c5682195623925205
c0163b03af83d940e13531fd05a0f8cd6ca6cbf3
51857 F20101112_AACHMB chittester_n_Page_043.pro
914aa31a79f337fa3feff6f1b61fb84e
64f7e26646cbb4e7032a69a04f40aafcf3c7cc8e
45074 F20101112_AACHLM chittester_n_Page_004.jpg
fb168741a514c6ea979d9fbb117e9fe7
3f9a69856724df0f1d79b0fd6b9203621f0326b6
53709 F20101112_AACHKY chittester_n_Page_077.pro
4816ceec5a51f509822addf41f8dd5ac
3f04b687b540cb441bcb52b54dda8ad2bc2815ff
71724 F20101112_AACHMC chittester_n_Page_063.jpg
822d1410ff547c15c22386cf2c77db6b
96bb4f11ff9e4ddc991934dbadbc43b832c386f7
6786 F20101112_AACHLN chittester_n_Page_032thm.jpg
6d0ab9d7b3939daf2f8045f0f3c96f95
336de1d16e53e490460a17d33366bb6a03945f6e
26528 F20101112_AACHKZ chittester_n_Page_105.QC.jpg
cd474bd1668ba885c8e7f6feb189be3b
72a9cf2e67e90b09033b347dd82178c6177e891f
5873 F20101112_AACHMD chittester_n_Page_008.QC.jpg
bc6762dfa4e1bb5cdd577fa4b4ad0d23
dffe7b2f2a39a103c3b1c3e18984b3ca8f1a2256
77035 F20101112_AACHLO chittester_n_Page_013.jpg
60816b91a8b85608e1c40e37d5f7baaf
7beef4ee7536f677a083452f34ac0de629352f15
80193 F20101112_AACHME chittester_n_Page_037.jpg
406f3f36d9b72df11b7375b070050b63
4e120a1ce18fb7550858b18dd6050dd9afaf77aa
117877 F20101112_AACHLP chittester_n_Page_058.jp2
5a127b2d344682808a4c04f793774b73
60153073502e2e2e70ee06563945755db36ac7d8
118137 F20101112_AACHMF chittester_n_Page_026.jp2
437266f4762669f292c7342baf471c31
e2d6c41d0291a231bb146eb4a17ec3fb250abebf
F20101112_AACHLQ chittester_n_Page_006.tif
eed05f9b5002b9afddb39c3f3adef78d
bf2ecf1ca288ebf1be2318a6afd0714d3acbdb71
2115 F20101112_AACHMG chittester_n_Page_081.txt
04f1e6e430bdc52f0bca12673f712c4c
c33f8ccde1e4c4f2c4c46a1829c61eaaa0c288a6
86601 F20101112_AACHLR chittester_n_Page_095.jpg
06922f2ec1fc3872d97b86a613074c16
94282d2a321895a435e44f1ff82822a541f8e5c3
F20101112_AACHMH chittester_n_Page_074.txt
859b66b9aadff84bc47f90dea14058c4
6315cd20378d731daca57a91dd74f322812d5318
897 F20101112_AACHLS chittester_n_Page_067.txt
f48e31e7624f653131f5e965784142fb
9a5d890e61c0f638df09a211b201eef850749458
2019 F20101112_AACHMI chittester_n_Page_071.txt
68c711714d110e514e7ab3dc8e272a62
661e1079bdbe16c1587b977361f86792e24e11c3
23114 F20101112_AACHLT chittester_n_Page_063.QC.jpg
34dabe25940b1101e6eea37882bb0c96
0250d970e882412c58bc42f83e1e06ed7f34a248
2099 F20101112_AACHMJ chittester_n_Page_070.txt
37ae253f8821d1da14b8edb3342a7871
f7581cf066d7c56ebc217ef71e8af9322e370387
24805 F20101112_AACHLU chittester_n_Page_036.QC.jpg
4d0fb35deca9b44acdd9ced3e12974c3
dce6ed1a7d9cb3fdac01022dc74eaf0489661efa
F20101112_AACHMK chittester_n_Page_051.tif
e8bc56ba1144cc902cc1dd19dacd2947
bbf0f95ce401f7f8fc59f3a7f4defb92a69ae2e2
7241 F20101112_AACHLV chittester_n_Page_093thm.jpg
8b90aea9f8a8877d7a525b4541cb33ed
5dfaa34e5c654b597a88e7c38931b25afd8eb197
F20101112_AACHML chittester_n_Page_069.tif
81137f621b8717b82ce101f7d33c7e4d
9d9decbbcdb55234ad9883dbf1a0e3bad988c8d3
52215 F20101112_AACHLW chittester_n_Page_025.pro
5f1aeff9d519f3c628698459b3c75443
1caf93f15a0e47a61611035d5e3f5abad276fe70
27508 F20101112_AACHLX chittester_n_Page_067.jpg
206f6c7588e87a0d8aa8d2d3d98e66e0
3c64057f457812afc64cd9ce7a0383169ed89f24
F20101112_AACHNA chittester_n_Page_020.tif
a359f5a3fc01f88493cd882ac142ed5f
00692cbf7c29ce1fd8fb75a49366531c6984892b
F20101112_AACHMM chittester_n_Page_057.tif
ef1c47b9b16bfefb5fc42b8c554b4c80
a97fef0e30b9297d5174f302273b703daa67bf5c
14296 F20101112_AACHLY chittester_n_Page_004.QC.jpg
bf55e7db63d2bafd87f6de6202d3028a
3736174e12c9362f53c3b61a19e560a90ae45fd2
117915 F20101112_AACHNB chittester_n_Page_019.jp2
239d4a72c5473b7e16c91d66e0a1e7eb
c8674a54010c6af0aea093ef1776ba689ba909dc
2109 F20101112_AACHMN chittester_n_Page_057.txt
ced89a8e627f88bca22b9ebad571dfc1
bcb78de5ae5c582ad1d96384f8657734745f8cf7
25431 F20101112_AACHLZ chittester_n_Page_016.QC.jpg
0840722af1af7188a6496234747b08c8
af30f91fd0538f44afa2eee5f5f03e3d6fb2202b
7061 F20101112_AACHNC chittester_n_Page_059thm.jpg
38f07161ffe5d357c37b49489be784f8
8e248c8806ed98bb4a0251e5e678e8353b6df4c1
70536 F20101112_AACHMO chittester_n_Page_023.jpg
032cc28157b4d007e5588ea94d91e433
d94796208a043e211fd32d33d2c96605d6e9f2b4
2628 F20101112_AACHND chittester_n_Page_105.txt
b3f6f1af7af3f170361f266c041a4899
c0573aa08093f1ce0fe40fa9e3db67a5a6f72020
F20101112_AACHMP chittester_n_Page_011.tif
c65f72678244221fb924c6dc968c7d2f
e0125b0fb2f0707a6a7c3cb607594f87f45450dc
F20101112_AACHNE chittester_n_Page_094.tif
e9670e973d95d306a44a648296179939
531ffacf61b907f9e2f2f6b984ba855043d2f752
1020 F20101112_AACHMQ chittester_n_Page_002.pro
0151e0eac5aa06895bf6293d3850d0e7
35b31509f0b75a91e490accb0bc94d4e036c611f
35492 F20101112_AACHNF chittester_n_Page_066.jpg
13a79b1325fdf93a73c009e81d09164d
f30baa5db76bb084c375a33fa5ad9506ec68d5c6
961 F20101112_AACHMR chittester_n_Page_087.txt
0ee898d2bbe1e8e994062e32a7164bce
cd730caf38cb69fc376650a4b443f7c18e50f000
6982 F20101112_AACHNG chittester_n_Page_037thm.jpg
f6ceea70e0370ec6cf8c7d742a561f58
7ccd3aee100c8b9298699c0c382198dd9c4b5f71
19119 F20101112_AACHMS chittester_n_Page_061.QC.jpg
60b90a4577c2064819af33d2d53a0de7
d26b25f04364e5fded35f44384d95b62732de3b3
F20101112_AACHNH chittester_n_Page_033.tif
5f6312a6eeeef27d72e30a4294955d8a
7292048ecad5c8be0e6be3deb86f48c4efe0a99b
120940 F20101112_AACHMT chittester_n_Page_075.jp2
764532b9a361aca0bc995ef93694f6a4
59317a23d3a6db655901dc5fb96332c844313716
54283 F20101112_AACHNI chittester_n_Page_017.pro
913d7b0110117df2f54b593eca518a21
cd74688eec66c7e745680ad45fad79461ad414d0
119052 F20101112_AACHMU chittester_n_Page_050.jp2
d3e85de70728a250b98a1e59d8e66ff7
1c1e1c62f5693704d6debe126cd09e9347460e47
25363 F20101112_AACHNJ chittester_n_Page_070.QC.jpg
44acfeb7e775fe07d65f960b44df6814
06e83dde79ae496f20355fbcb8a2f021868e7e18
4163 F20101112_AACHMV chittester_n_Page_089thm.jpg
173224f1f178593299759af2afd67ca0
2ca64bf5cefa2abb8e9055d31a543f01f1261d1c
114603 F20101112_AACHNK chittester_n_Page_024.jp2
2c52b32a222f21a140507ba9719a3769
5761821c2af732f7e4bed497a872a269d6779c88
2664 F20101112_AACHMW chittester_n_Page_097.txt
19ac576d606d6ecc2fe66920b6b5536d
dce9a0c70c9535b5d4a0d7fdf298ab250b4b285e
F20101112_AACHNL chittester_n_Page_093.tif
591b40d76a49c8e302f3ac8c7501babd
a3505edce13f348ab33dc32e8b32ad5aa02252f0
7022 F20101112_AACHMX chittester_n_Page_026thm.jpg
8af240baf3729741184882657fcc5c9d
9940e03cb2a1ef2e0fb8ac2fe25939554e0e84b4
F20101112_AACHOA chittester_n_Page_047thm.jpg
895e83a5f0e181f5b716e7cdf616fadc
a3036976608a6b7641081fba325e35cf2f2f630c
16933 F20101112_AACHNM chittester_n_Page_092.pro
65fd319942453ccfb62b6435a5fef1ac
7a8214a4d8af4076fd8ddf20b829399b2ee33257
24996 F20101112_AACHMY chittester_n_Page_057.QC.jpg
bca02ae309ef00c12a692985f11a4638
8d013e397a2fae73569a37c7a68d413d92e5eb4f
F20101112_AACHOB chittester_n_Page_074.tif
7735d9045b1ec1bc14a8725a9938d898
6a6cb2185708dad1a177f237d189cd3661b8a387
101807 F20101112_AACHMZ chittester_n_Page_009.jp2
98ba6ba4fc6b0c1871d3c8460a100915
59bd3f808793aa06efe13297996f47a94f7c6433
4940 F20101112_AACHOC chittester_n_Page_005thm.jpg
73159245c4ebbb9cfe9be27bd595d888
4b147d5eb3197fedd87577d39df428ba5ce109dd
2201 F20101112_AACHNN chittester_n_Page_062thm.jpg
41c6d2569590967c558e88039e6c3319
5401a010bab21ce9a3450ff2100c36e9dd0eab4a
8414 F20101112_AACHOD chittester_n_Page_001.pro
1e766ff9f28d4c020f1bbf050ea09ef0
fc519bd405ce62559655e929a95fb5fff99a63b6
F20101112_AACHNO chittester_n_Page_030.tif
55c3d1c84477b181044d1bd1ed90373d
42af2342c47cc1c49e731b5587ecdbb96d99c6be
1051985 F20101112_AACHOE chittester_n_Page_006.jp2
5b3a4981b0d3fdbbd1a18df805b4fa7c
44a84053b8015dd725c8b4c784f8d35a79d5afdd
26555 F20101112_AACHNP chittester_n_Page_052.QC.jpg
0e51e7c5d34bfcd8322fd6fa75eb5546
af06bc2043cb1c309ac20cc03c7232675c66a656
24919 F20101112_AACHOF chittester_n_Page_045.QC.jpg
21c26ac6dde49549430d15fe8fafdd06
fa0300757e566882e2f5cf5e901b025b17f4a7b9
6493 F20101112_AACHNQ chittester_n_Page_049thm.jpg
d7577d70fa6fd18299e282b6df74c37a
d55116318fa82ccc5c7f37177cec72a18771c8da
55639 F20101112_AACHOG chittester_n_Page_078.pro
06a819ab68dfc98f84c470451976ace1
308849801aea912f02c9bbee12ecdad7e4f6e593
3486 F20101112_AACHNR chittester_n_Page_092thm.jpg
15f8a46b0fcdd65391bf88adfed9e203
eb16a5b1682b9a85bc8a78ac6992e2d273b17de1
57107 F20101112_AACHOH chittester_n_Page_082.jpg
06048b7bac2bc49b6605a0aa814d3a6f
2c0cccada99c5cb3413550764162ceb2c6b55f16
9385 F20101112_AACHNS chittester_n_Page_067.QC.jpg
cb3399b134f34becbc4dfb5bd2842f9f
e81f82688b3067541aeadea63452ca11cba73ca5
2447 F20101112_AACHOI chittester_n_Page_104.txt
0fc15ebe9a5817b0d5878e2d8be3f63f
7d1ede35776c59437331e3ac77719368eacb1b6c
77350 F20101112_AACHNT chittester_n_Page_080.jpg
51a8592f12a3d6d5664d456ad6e48558
031e126ce26d25372a8bb497a7c4d9e2152e55c3
6806 F20101112_AACHOJ chittester_n_Page_040thm.jpg
40f433bd604f8deffeeeffb157ae6b66
d15fcaec6eaf69ddf286b682c417d1740ec9a0b0
F20101112_AACHNU chittester_n_Page_076.tif
6a720fc1e75623fcea1f2b8c781e441c
90b4fad9d5e15526315489235f9b8f097c0113fb
F20101112_AACHOK chittester_n_Page_058.tif
fa776e184a7bf563d4b3c0cd1d937469
64414a8aacba82a47b37ba5fffe2a51af6ce710e
62073 F20101112_AACHNV chittester_n_Page_102.pro
9f2f757bdb9b684dcb0712bb57600b82
96747bd4639dc2d571d69349d52fe7467bf906d3
76701 F20101112_AACHOL chittester_n_Page_076.jpg
95e0d41b43cd12e438e10268bbeca5f7
4f022268415d998a3298e433cecbe527448fffd1
56545 F20101112_AACHNW chittester_n_Page_052.pro
c86547d11e8fa15dce3562a654618307
9be7c5f9a6f85264b6981cebddbec37eb3961c18
52160 F20101112_AACHPA chittester_n_Page_024.pro
b3c7d0dfa1e159122b60a40cd12fe5aa
ebb38aed0fe12eb26696911eeea28e31acf51371
117910 F20101112_AACHOM chittester_n_Page_035.jp2
e812b7940717ad8d1e8e4a53c1ab2222
dfe7db25bdb2e70d5dc6a13eb47e43a1ed83052a
7062 F20101112_AACHNX chittester_n_Page_028thm.jpg
fdbe3b86ad8606afad9568c5f2ada9e2
c7a1e243099d126074932090e4ebb2184b5e2ca0
F20101112_AACHPB chittester_n_Page_042.tif
28a84d8bc687bdbe1aa325fc5b18b8aa
137f4e73152fe7d60907082ff36f99aa906b48c5
2677 F20101112_AACHON chittester_n_Page_103.txt
02528cf96c8c3a920073d4c3dcd981e7
6a6b9d297abbf99d9ce067218876e589456a944c
24283 F20101112_AACHNY chittester_n_Page_021.pro
3ec8fe38f4337b2272c3bad0d3f371c7
cf72486411ffcb0a4c89786724e663816cb2450a
F20101112_AACHPC chittester_n_Page_054.tif
3285c47326e7f3fbee2128e5dcd475d9
99ebed888263b20f2f3ac1a228e9cd27c46430fe
23164 F20101112_AACHNZ chittester_n_Page_001.jpg
ec2d2327fe13c92d4601bd8186956468
453f75ef6da5ecfb8bcdef0b77b1b86a0dbdd7cf
89410 F20101112_AACHPD chittester_n_Page_097.jpg
e470f46212af99da0881eedda5c01b65
1ed9f4ef6b061de5f9dab66160cb40eebed69536
53835 F20101112_AACHOO chittester_n_Page_012.pro
652dad87812ad303dc1c382f87262417
d7e3689cdc6c6c3c4250d5168ac37cde72fda741
52419 F20101112_AACHPE chittester_n_Page_031.pro
0ada225e1b2d121b857290e48e31ea1c
d74818ac19fb0315ea480f7c8bbfdb79d3ff1ffe
2167 F20101112_AACHOP chittester_n_Page_059.txt
c29f2ebf637de8966832e25b428b71d5
555ce54a0286fab386791d67613f033bfb2662ac
F20101112_AACHPF chittester_n_Page_023.tif
2e3e4dcd3d4db889f19dbc5400d7ef2f
e67d17e31d5521000ead5dec50a77b1c916cd984
F20101112_AACHOQ chittester_n_Page_025.tif
fba55edcf77a92b3d469b3945dfe7e5e
77e12504f39be14bf819a84f2fe20cd7fb649285
74755 F20101112_AACHPG chittester_n_Page_024.jpg
2fbb678ba6c7bb314b16370908e7cc10
9cf6adc313fe036dfb0a2f95f0852444b94ace42
25521 F20101112_AACHOR chittester_n_Page_081.QC.jpg
8aff679183ea8bd064cd5afb3cbb1f34
d40c448ac25da23f4f5467bc17d14a9b505402ea
F20101112_AACHPH chittester_n_Page_024.tif
82a899475b1444fcc02c1d5812fcf21c
be52964f88da36e6fdaea876d883bc732a803bf4
2688 F20101112_AACHOS chittester_n_Page_095.txt
830f103afec4bb7613d6405f500177c8
4760a200dc5cbbbcd7de18102fe7d43a796433b4
55728 F20101112_AACHPI chittester_n_Page_037.pro
045f7b3af30568edd00f05066781fc21
5eb6572eced89a774dceeefef575dbeb03415467
44104 F20101112_AACHOT chittester_n_Page_092.jpg
5e8eda1e60f6d69460edda7601212dc5
0327908f7e44ff14f3d23953d010dda232b34194
9188 F20101112_AACHPJ chittester_n_Page_068.QC.jpg
a4c371d21957f6f2118fb99182775695
088d562b6142dc63548f176fa90565622ef0a775
F20101112_AACHOU chittester_n_Page_095.tif
5abad1d9e938b7003060de8631c47cba
753755fcd111409eeab3886ee23decb51404b143
25409 F20101112_AACHPK chittester_n_Page_076.QC.jpg
a73ed5dc6f8c0046987245eb2058b8ca
4df9394cdd096a19e820fa87a59f481e1bad3458
76373 F20101112_AACHOV chittester_n_Page_073.jpg
74f15a345873ef30a35de5adfdec0725
a0a7b4893a47957d0644ea8b5f4139b3afa4b1c5
F20101112_AACHPL chittester_n_Page_003.tif
e16386399f2f61591fd224e7144816e2
ab02c6077e04d758c6f5236a63a248bae7a03bf5
6599 F20101112_AACHOW chittester_n_Page_053thm.jpg
8ffa70e668cad05d13f5d496934dbd80
8678677ac45512f5a5e511e67883f874d8f80c2c
117612 F20101112_AACHPM chittester_n_Page_016.jp2
06973a921feb80c5fdc0ab2d0fd579f1
ca08fa2027ff31215f51064f18523f0a14a890ea
4703 F20101112_AACHOX chittester_n_Page_086thm.jpg
2d8a23d108945be52edb06ba9c726053
5117748a603f51f2e7111b453dd18df0efe514d7
F20101112_AACHQA chittester_n_Page_028.tif
53e807b6e8099da5598107c8c42f250d
adcd304082ba7cb3994eab7ce556f3cd045ec3d0
F20101112_AACHPN chittester_n_Page_106.tif
62e7337123e3a8f49cba9e51b2732fe6
fb738d1c7b82df0e8ee225627ea8743105325d13
25912 F20101112_AACHOY chittester_n_Page_051.QC.jpg
2135234f1f460f8fd88b27d136852b74
f2367a46bbcaf98254375cc86a3872519f7892f8
54056 F20101112_AACHQB chittester_n_Page_019.pro
dee72e68edd1b47ef3f6b25bc40b5f84
d0559e9a3acc5c2a902fcfe0068462213daea08f
F20101112_AACHOZ chittester_n_Page_078.tif
baaa392586afde12c3dd1072ef60b219
887295e3b13070dde4f77b077a2e22992e1b5ab2
55319 F20101112_AACHQC chittester_n_Page_050.pro
2e3e6cdb00ad43fa5e6129dbc5b4c67f
fd0c35198ee8095f7006921e407e3cab8c915cfb
F20101112_AACHPO chittester_n_Page_005.tif
d7b007014f00476f958aa6370711631b
3b2aeaa9d7ecc8161bd9481c215d80fe5964cca2
72770 F20101112_AACHQD chittester_n_Page_071.jpg
47854e912d104196becb26e6045a3b5e
f7d47ab5ebec6db49d128f4052af33d96b5efc23
F20101112_AACHQE chittester_n_Page_020.txt
b2fb23af723b76e0eccaa2a78ce63ad6
baf9b84991c7a277057b7460064352f25a005153
1900 F20101112_AACHPP chittester_n_Page_044.txt
58b6c1dbeb39d08a4b4ca799f3ae337e
4372f8928650712701877150f689de40f1d6b958
13433 F20101112_AACHQF chittester_n_Page_030.QC.jpg
1bbf02c4f6194e7227bca06ef8dfe5d2
7670f33ecba8f900c3c0d103b3dbb4c0c6d94c20
F20101112_AACHPQ chittester_n_Page_066.tif
d08f185a056f0c5bcc406551d61268bf
f57e72f3c66721b1f3574dad74c75798dde8378b
54566 F20101112_AACHQG chittester_n_Page_074.pro
ccda9408f041ef018bef27c51195f6ae
ff38e7f5ec10743698542f944c253052fe29c133
25952 F20101112_AACHPR chittester_n_Page_078.QC.jpg
e3ade29fe5eea7df9924733274cd7e70
e857e1799bb9a423623a0b43e651546af67671be
44602 F20101112_AACHQH chittester_n_Page_086.jpg
44b7139a63f8ae8a1203d775bba091cc
13e5a196e7ab75bcbdfc49af10545425ad11a022
6853 F20101112_AACHPS chittester_n_Page_099thm.jpg
e5e7f095ec1adcc32d1a393185f3f337
564d2a820a19ef1331fe9fc95554e0456ddfddbd
4429 F20101112_AACHQI chittester_n_Page_065thm.jpg
3fbac0a72da41f9a71dbb51180006cc2
b7b45bdb12163a36abe9714ec8ee225ea910df14
1524 F20101112_AACHPT chittester_n_Page_082.txt
45ecfc7194712d8401c52e31f0cb1f9f
6027cccf1db5d15905aa471870821f57a5a1ef9d
6888 F20101112_AACHQJ chittester_n_Page_041thm.jpg
65881d2134798b70aa3619111daf9bf4
f9413cec0b869b1002e284f64562f145e10f71c2
19879 F20101112_AACHPU chittester_n_Page_008.jpg
6b2ec769d95c94f2a0e356ad00a974d2
e0cadb7dea06be059c853838ebaac15c3d8183df
20292 F20101112_AACHQK chittester_n_Page_006.QC.jpg
107a84ba89d955fdc13d4832712e3391
88cf90f895e779884344ef10fa79449b5b9ce09a
F20101112_AACHPV chittester_n_Page_026.tif
eab7e0da137783cf0119f8478fba8d87
12e58933a02ea50c52d65e4a0b7523203b8a8494
34395 F20101112_AACHQL chittester_n_Page_091.jpg
39b090c7dc20084e40d23b893800be0e
3d6b7e67af92776351182f20ffe63bd8f0e26615
23950 F20101112_AACHPW chittester_n_Page_014.QC.jpg
be7e85842559f7038cc4bdff5b10847c
57728e844f3de68ac7a81997249b0b059523b77a
54938 F20101112_AACHRA chittester_n_Page_072.pro
6d69dd4341ac68b1e479f8c047c60238
1c29feb1c2cb2ed3f9602193dd9fceded0f2c5b3
25118 F20101112_AACHQM chittester_n_Page_032.QC.jpg
9cc843d0b614dd7a057af84064270c46
31ffff971cd3fc2a263488a465176a9f3cad57f7
F20101112_AACHPX chittester_n_Page_077.tif
d40069f09ba76d37daa9520d558516e9
9d3ba1e6767c6297acb887b0cc535df145fa0ed4
62581 F20101112_AACHRB chittester_n_Page_004.jp2
7f6a7b380d0c560069c50067746907a6
321b71d294aceba6c7f014304e444ca1bbea0a7e
117808 F20101112_AACHQN chittester_n_Page_041.jp2
3c9b619ac9ceb8c81be6924d691cec8f
4dfd8850998095e52cceb81ba7316b9b164f6713
16448 F20101112_AACHPY chittester_n_Page_084.pro
da7492591bf46685c5794393792b22c8
4573f1db42402b5e1f4861de2d7249471c3a59b7
F20101112_AACHRC chittester_n_Page_018.tif
30d32465daafe51631f4216cf774da86
ebdd3546a1e51ac563e464f0f5cd4f066c1cff4d
2635 F20101112_AACHQO chittester_n_Page_098.txt
a834715d6a4d995986b6e184ed506e3c
1871bfb152b8aec4420b92208ca9204ca93fcc13
F20101112_AACHPZ chittester_n_Page_063.tif
f596ae945ef63dfa6fba2f09464136ea
0d100fd995d57592f4335c72a019216da6765fce
F20101112_AACHRD chittester_n_Page_016.tif
240f083fb8a67297d36c305fb8ee1e44
9625e302e0ca2cf9a37b291a366ae641c3744647
6992 F20101112_AACHQP chittester_n_Page_052thm.jpg
8bd0eeeac349af48f5118f01818b297a
2eb07a4ff51927ef748c67156958d1420878abc3
6981 F20101112_AACHRE chittester_n_Page_050thm.jpg
409d388a437b9d4d03c8756d862dabb4
0679a5c38c9c776875fd076eedb0c4f03415f83f
37046 F20101112_AACHRF chittester_n_Page_066.pro
c6275ccb576123e13f15332a8e90c0a9
37858f3ee3fc4afe2e06b5ef6b1ab30cdc91ebfc
19295 F20101112_AACHQQ chittester_n_Page_005.QC.jpg
278eef7d82d297435423093926ccbb4f
e34e2aa5c9dc62ed45c966900ff8f948059179a0
25607 F20101112_AACHRG chittester_n_Page_001.jp2
68fe694fc77d82757a8d1b49655fde07
b7a7931c541253c7e88cd2870d0888229e76747d
13052 F20101112_AACHQR chittester_n_Page_064.jp2
b4838f17f736906bdc349a6c1b70f4ba
0f8056f5f6a7e459b53e22fc1225d35a91544f16
25398 F20101112_AACHRH chittester_n_Page_013.QC.jpg
c288c0ac3f69e70693f29924d0782583
45bcf297a0e9f20bc4773d442f758ef9b50a908e
132927 F20101112_AACHQS chittester_n_Page_104.jp2
e5d1800392549f5fe9408a66b93a8006
081226821bfb5056ae3ff2dd67317a322e547670
66518 F20101112_AACHRI chittester_n_Page_103.pro
0044cbe2a7b891d1d9b7538d8b0cb9ba
3f3eee3c0a6b73120429d52a8eb27582f3398530
116324 F20101112_AACHQT chittester_n_Page_045.jp2
36ada62ecb167ff5ed004785923182c6
969f05450d71024872f5e096bf31b99ca56d4cb2
76584 F20101112_AACHRJ chittester_n_Page_040.jpg
b465a823a152ebac90a3595d21a87d3f
af47979d0f54487a71dd604c4e43dd2c45bbc9d1
6736 F20101112_AACHQU chittester_n_Page_027thm.jpg
2a768c05605a47c44459b15223c79bbf
c00d77dfdaf9e4d093b147359d7a8915ddca0621
13186 F20101112_AACHRK chittester_n_Page_021.QC.jpg
2ee45ea3887f59b01dce424df99be9f9
7c1084a7d0711d66d6a95400affe3d2dbf08e75d
6535 F20101112_AACHQV chittester_n_Page_104thm.jpg
31dab3c237befd0674853c9729822421
471f6ac944be97c0f51babac9bbebbbedcc0ee47
27693 F20101112_AACHRL chittester_n_Page_004.pro
fef3ed10b203e9d90be3282f6b0e204b
d1f864f19a0a221f744f360d9917dfbf2e51b026
6859 F20101112_AACHQW chittester_n_Page_057thm.jpg
9d31d289a0b13c2ecb9d3a8385fb0aa0
356a1dffd596b3f20b4312b86d8091ec0444a739
39323 F20101112_AACHRM chittester_n_Page_061.pro
b7b72ec5e7a73e2eade4d697976451e1
c66b066e38f74dadaa6e24c227eb7af44f80dfa5
141535 F20101112_AACHQX chittester_n_Page_093.jp2
2faed08b24c52ff3e7eaeb986c796309
4e98d8aeecf4a0313344df8b3d7ba0b98b823129
56023 F20101112_AACHSA chittester_n_Page_075.pro
b4c609175199647be4b28c503749abf1
4b4aa7ae0ba8c4bbc61814b1c4634dbfe4ac5408
73217 F20101112_AACHRN chittester_n_Page_025.jpg
d189f4dc6a597784f5e9f9a078fc7383
7adf5b33b02c141fb675a95e93c44ee70edcb085
54797 F20101112_AACHQY chittester_n_Page_038.pro
ad12a118505ee42446586a9761eb4378
4febda624a0ed6734b845c49861319a91b072b22
55826 F20101112_AACHSB chittester_n_Page_015.pro
7b994e0ec699bb0441ae01d69beb92bf
f1f183bd2a2a7b191f4b2f44ed36ddbb5b7820b4
F20101112_AACHRO chittester_n_Page_055.tif
cc586ab87cb0dd371c40da9a6a715c59
3a8850d8e2e99405eb20f1c6f618a664a5a0a325
54124 F20101112_AACHQZ chittester_n_Page_041.pro
af73e7bcdb69e8170325b71831f8f085
4ad3a7929931cd656edf54b9ef4bee8d9a44a974
51224 F20101112_AACHSC chittester_n_Page_071.pro
9367b34224ebdc3c82e11aca9ed667f3
060e8d8b88fb37435d84e38574844ffb4716ab27
6796 F20101112_AACHRP chittester_n_Page_042thm.jpg
820b1b94425e8cc6461cbe425a2b7658
42d71535eba033323eb0b73c5858b01f87aca4d4
1977 F20101112_AACHSD chittester_n_Page_056.txt
c5a26102a4e63e186788792069355f39
0cbd4dfb57a429387164e123ffc4ce004d054807
2508 F20101112_AACHRQ chittester_n_Page_102.txt
8217fe0cb03bfe1e0e78044d92bab1a1
391b0fe34bcc85d3ee7047e80f4e799ce4269377
F20101112_AACHSE chittester_n_Page_079.tif
e04a71ab2c7597cb206c69f702e93595
973b44613e3ee3afc03ada09acb54f1bc0e32796
109654 F20101112_AACHSF chittester_n_Page_034.jp2
283ec911ffe5d7828e5cfa1a43b0c47d
fb3d2e9e0f62f18d12d4c66017471d7ea54a3bbb
3913 F20101112_AACHRR chittester_n_Page_021thm.jpg
96596166f85db9b88fff6a28bfae3cff
bb9026dbc7550b4309f4d05ec40dc80e73b72be3
20108 F20101112_AACHSG chittester_n_Page_083.jpg
b03d65440a73fb6f9dd9868048bb2ef7
077202d962dd1d035ee8677e16ef2aa019d14572
2128 F20101112_AACHRS chittester_n_Page_026.txt
9dd637989d549a52f8f3c3c44d145dca
01779337d9b47910acbe4ad338d1a3b79eb68066
7254 F20101112_AACHSH chittester_n_Page_094thm.jpg
78fac589aba48cc84f438a7fd45f6228
8ecbef8b538ff7b31bcae72ba93146f08d53d732
26271 F20101112_AACHRT chittester_n_Page_097.QC.jpg
d4facc4ebd362af63861971c7d61b748
dedea7e2e2ae1afd2f00aa62715877371bff591b
7101 F20101112_AACHSI chittester_n_Page_095thm.jpg
42788a9e754ef596f1bb4f846f586c6c
31a4cba29cdfd26a8027753f542de8e11b9f43ff
F20101112_AACHRU chittester_n_Page_035.tif
4c80e736ee44759e34937cfb29cbdc11
25017477d93b1e05bd3b838c531823d73602006c
2156 F20101112_AACHSJ chittester_n_Page_072.txt
ebccdaa407ae2b0ea27b5529daf620e3
0f911289cc3409dda513cde44ca87d440faeda12
1143 F20101112_AACHRV chittester_n_Page_004.txt
97f6e01d7143bb3acb9fbb778a135292
82db30f6c9ca6032959a82c705764b25cde637d4
6881 F20101112_AACHSK chittester_n_Page_016thm.jpg
0b74941605d89e27c1c53f705afab62b
3fa9075192b69e8f442dff4f775a028bc4583c13
71337 F20101112_AACHRW chittester_n_Page_066.jp2
8eff25306115c4a79a3472dda8d16f98
3d9724f98084d7b37b8d282aaee41943df36c033
2110 F20101112_AACHSL chittester_n_Page_033.txt
f3232559454a3c558922d67fd5d4f429
d04ffc80ddfe03f70c7358ce05639ffa46eac255
2186 F20101112_AACHRX chittester_n_Page_051.txt
8984e2f3c1e2860fd67e362aa7d83431
f536461e35432715f6281cfa282a497fecda9c61
62864 F20101112_AACHTA chittester_n_Page_099.pro
972854b8ac52c3f9c840414de190258c
ed0ff2deab99a982e6ad348bebd984f436577660
118365 F20101112_AACHSM chittester_n_Page_072.jp2
4688d6d2f678781ea1113ed311bdbeba
c219cacb2f77ada9d238869e59228436b616fff3
120327 F20101112_AACHRY chittester_n_Page_051.jp2
c6f12a6fc9c4943262b2f243111562be
dd3b0bf5ebdd6bc147d8e617120a0fec590b4f3d
26507 F20101112_AACHTB chittester_n_Page_098.QC.jpg
e5a52f283c7cf0e9acaa5731dfb5b20e
ab86ca95cb1e51a12dd9f9fedb77b8098bf06751
24050 F20101112_AACHSN chittester_n_Page_071.QC.jpg
66fbb0a7ddf3dc55ca271a95e4a5cd7b
94a05240e346f2e298d1c902599bda90bcde3c7c
F20101112_AACHRZ chittester_n_Page_027.txt
487097f377de60519c3d2607cf5488fd
4cbf1715a2594c7f2428530f2e134ea7e6a2a69d
2207 F20101112_AACHTC chittester_n_Page_052.txt
9773df85c9e0402ce8f37bbb9e9864ff
034f55a83f5a1bbfb00df4d0bf37c419eaa9e47f
81270 F20101112_AACHSO chittester_n_Page_060.jpg
a72f9f22c32327ad1158759e5f32674d
ec69a8758174c447a05cdbe6048c3dda2d336bab
66931 F20101112_AACHTD chittester_n_Page_095.pro
0a3de7273c4c7cd6ef005da5ca75ceed
d69850e0c5ea6a1c8c2848fa10e58f902c717c66
11691 F20101112_AACHSP chittester_n_Page_092.QC.jpg
775886046f870de60f554093101bb42e
b7c768d3183be5b0f106a4de25c75ff4d11a34c8
21049 F20101112_AACHTE chittester_n_Page_067.pro
e94d61073f0df2de044b221628a4317a
2cfe3e2732365cabbb87baba798f12692058feb8
66796 F20101112_AACHSQ chittester_n_Page_101.pro
a26c5cf530b3d8388835abd0292ec924
ab6694fe821adfc5540b3d79a1befa76f52ee939
F20101112_AACHTF chittester_n_Page_045.tif
1b45d687f888df2baa11cf112a25f3f6
5deabac45698905ab7e9752613d6da90d4eb5f15
F20101112_AACHSR chittester_n_Page_100.tif
7cf951e581c33c6fef4d929b1a58db60
4e961a130c7971f989a9f99a7d03b5329e995d5c
15142 F20101112_AACHTG chittester_n_Page_089.QC.jpg
b42828402f16800f7c259204280ca97a
0e2d95aaed17e4f1b09df14d6af69da80f4678d5
27835 F20101112_AACHTH chittester_n_Page_093.QC.jpg
cface3b946b6671e6aa92fdc6ca93e9d
f6007d3ae38ee665672f6e3675ff2e87b82545d8
23946 F20101112_AACHSS chittester_n_Page_039.QC.jpg
2f49bd1a26e7970041443d3c78c3bae4
6faab56e83c0650db72c04e229573135c63ae0ce
6815 F20101112_AACHTI chittester_n_Page_081thm.jpg
8dcc25e30f8886cbca9666a312b5c65b
99a336ccc01f106b1f5ad8f4e0713ce9661d63ac
66698 F20101112_AACHST chittester_n_Page_094.pro
42070663ece853dd426e61cfb4dc1f7f
bb5e882c5337043f9768db8b526dbf99eb15ee14
F20101112_AACHTJ chittester_n_Page_060.tif
036c27721ab3d7f4be39e7125319a3bb
6a655a2d4408142883158f45e9a78016d0f5bb24
25244 F20101112_AACHSU chittester_n_Page_020.QC.jpg
728bd935c3c2d3ed71434b1698372279
82ebe664c5fb8505d1f4e6b1efde393a259e06eb
F20101112_AACHTK chittester_n_Page_068.tif
c40e280faab9deface256c6fc90696fc
c05c96eeeaad34de5b7344f58ccb2fabeeaf9ad0
7107 F20101112_AACHSV chittester_n_Page_007.QC.jpg
f945b67e0eb6b9cd7c06ad13a0ce91eb
c77850b4288ed00a449fff909a2a444a7e871777
78351 F20101112_AACHTL chittester_n_Page_072.jpg
8fa8eaac78fa3ec18783d2cbbaa46758
8d28f052dd4cd94607fca4c6659fac37cd86bb3e
2057 F20101112_AACHSW chittester_n_Page_008thm.jpg
bdbf45d1408920e5a7132c66c029f368
36480a496d0aedfd471df3fa706aad5b1be95565
141243 F20101112_AACHUA chittester_n_Page_094.jp2
12fb1f84eebe314ffacbf0b88b48d818
9ad8b13da43872f0b81a5d2460134c4744288b1f
53195 F20101112_AACHTM chittester_n_Page_036.pro
b1552ecca6516e0361a4a35ba3116b5d
2b922abfb0de4f0fb7f1c79d6baf26269f44f9f5
93964 F20101112_AACHSX chittester_n_Page_094.jpg
4b7cabc17135889d62c5f1c8005cdb03
a35a0b8e8198144623256958d1a44a08171c4449
4002 F20101112_AACHUB chittester_n_Page_085thm.jpg
4ff4693b8ff6f60feaf603ec86425884
4b956f3984fddc0bb33a4cef3ab81a645973ab24
6845 F20101112_AACHTN chittester_n_Page_076thm.jpg
b98fe151a81b46a9490a202a67c43a96
38cbcf613ce4680edc50de587e364cefea05a25c
25316 F20101112_AACHSY chittester_n_Page_104.QC.jpg
ace16d25b7e3b5e91447f7bdc563f03e
a8fcbbda95e13f12dfa85cd77aa185a65efab89d
3250 F20101112_AACHUC chittester_n_Page_091thm.jpg
aa0c6bd8224bd1596d6c78f9011c9d2b
303cd658cce4d1f9301745c887cdfc17ac5bd1cd
188 F20101112_AACHTO chittester_n_Page_064.txt
47118bb154b286b3d1756179aaa61c28
96653cde619c84472eb44899ecea213a097660fc
F20101112_AACHSZ chittester_n_Page_032.tif
4549dcbc3391f812fae78cd2c5997d2a
438e18782ee43c159941c93f61277602f5602f77
93727 F20101112_AACHUD chittester_n_Page_093.jpg
8f9e1173185790c50ce56cbf5d2b14ac
cdfdcbfbfab0c872bcdb9df9c8c3434c0f80ebfc
46722 F20101112_AACHTP chittester_n_Page_009.pro
d6309e0ed07b359343596b836842c29a
49f6a2f0029ae350f8b84aa1a3deca537dce6de6
F20101112_AACHUE chittester_n_Page_050.tif
d8eaa05ffb4e4c759303bd3ef092faa5
fb6ad1df71ff9ce6ccf9e7cd829b0b59067a6dc9
73728 F20101112_AACHTQ chittester_n_Page_056.jpg
412c6433deade061801c41a0581dd5f4
c2ba9c4e413f05cf153453ce7d44005c0eba55ce
84184 F20101112_AACHUF chittester_n_Page_099.jpg
495bc41e91a5ca51b4c2ed1c6a3d8cf8
19bc66acc173b1465979b1c6896b1662439108ed
26447 F20101112_AACHTR chittester_n_Page_037.QC.jpg
95985a88ad0c61949cec52f326148435
10b96edaad9368b92f210aeaf653690bec547158
123191 F20101112_AACHUG chittester_n_Page_052.jp2
b916f603c45250a7a28937f866a9ac0b
8ee7a556f135ccd9dc1be50cb4b5f3e950014b05
78157 F20101112_AACHTS chittester_n_Page_059.jpg
1695bd4360be627f392637327a354e6e
c17684a138bafd811f52a1c7cda9a914c3dd2bff
F20101112_AACIAA chittester_n_Page_071.tif
bcc8a4e02e551371707afef8611417b1
0eb7d6067f72a2a36ecbeddc9d230bd5b9d4945f
1894 F20101112_AACHUH chittester_n_Page_065.txt
c79d25cf48081f6babae4175c7369dd1
85b2379f6676c4bcec6a3ec0bada5d9637d2638e
F20101112_AACIAB chittester_n_Page_073.tif
19a6861a3f42034aba900745ea8f486c
1c46cf993b14a85261cb75c86e1358c8138fb4b7
39852 F20101112_AACHUI chittester_n_Page_021.jpg
9742152014dfda83f17f42ebd041070e
0733134706a8af546c6868a05e55c9c7e42a54d5
98708 F20101112_AACHTT chittester_n_Page_005.pro
9c343eda8e416be7c81877dc4bb7321a
42dea57e64e2a93e1bc78abc061fc2518c36ef1b
F20101112_AACIAC chittester_n_Page_080.tif
cdfb657158b6127583ba357076cc1c95
aee509f1086845ccebca9724bad222c1a5692a97
53600 F20101112_AACHUJ chittester_n_Page_045.pro
c5db9135356ad1828237cd3501571c8c
799a174f4bb7a8ce23c860da4ec308e681f27709
6676 F20101112_AACHTU chittester_n_Page_013thm.jpg
d3fbd1d164d608afd7976bb7fef67285
f4b53aea3d605f636a51d48d1eb5bc145aa3bde1
F20101112_AACIAD chittester_n_Page_086.tif
ad9dd0d5d8da7d6247fa1712be978191
f3fd7dc69a7ee259f58ae7e4f79830894f932749
F20101112_AACHUK chittester_n_Page_012.tif
a68083f139857965e8d557638e841481
a979a86644892d0425609611470f31e45a17f306
64904 F20101112_AACHTV chittester_n_Page_105.pro
07952f90e8f37e48b8605f2e32da4385
07b16115b3c36315c68b897638a797dbace901ab
F20101112_AACIAE chittester_n_Page_087.tif
82273b916b81358fddd0f6f616b1bfac
aad2791923fd37b2fe20b10fc76ae18a451af07b
55844 F20101112_AACHTW chittester_n_Page_051.pro
933a4c50d921861773069534d0dcbb6e
f014b8040117ebf5f2a06676d4d440153541cb6d
F20101112_AACIAF chittester_n_Page_088.tif
928dfd9a552eb4b889cdddc0987b8537
5069c389ef8691d38989621f3a10148c4d2cc676
79348 F20101112_AACHUL chittester_n_Page_052.jpg
e894eabf21debce62ae078ce075dfd73
cca7debc46f912b6f4f58343416962d96f7834d7
2055 F20101112_AACHTX chittester_n_Page_024.txt
c1939bb7815a0a2b49c4623a9faaebda
e958a26f4f86c064f996b3d7ed0be89a5ec9e7e5
F20101112_AACIAG chittester_n_Page_089.tif
791bf35ef7775ef6c011197457d2d8fa
dfaf9db497e2983158c88c887e5541d37e2cb526
75053 F20101112_AACHVA chittester_n_Page_070.jpg
e770737cb9bfd3fa77b3d726b1eb5c1f
3ec7bdf5dbde9c4e8cc9a9577919d0260141378c
77233 F20101112_AACHUM chittester_n_Page_041.jpg
372fdbebf14252961ab7a290918e3a1f
31e48dd50b00d43b158130150e3978c204650c34
72632 F20101112_AACHTY chittester_n_Page_010.jp2
55227eff4d6ebd9eb179245043772d11
8ea27da8bf9909bef00c368a48552ed20286233d
F20101112_AACIAH chittester_n_Page_097.tif
b61fd6c09c733f42297adb312e2e6781
98dfef546118438f1f6939e43ea84c328c55d77e
F20101112_AACHVB chittester_n_Page_035.txt
0eb035d4aa46fe828a82e1b45603a779
713f413542425700914e634bc794a3cc2f1223c9
76188 F20101112_AACHUN chittester_n_Page_042.jpg
997ceb745d3bb35c6485a1c82f945ac5
5ddfe6e610df677d134442b74b32cf5710702dcd
27338 F20101112_AACHTZ chittester_n_Page_096.QC.jpg
e1f358792f734120a5b9c3043ef0757d
83cf3b36e9a80a183b0fc6ad3f45953ff2250977
F20101112_AACIAI chittester_n_Page_098.tif
83d6360f4e548c16744f6d4abaac7607
e7515dfc1e5dab4172bfdc0cf284b55381abf52d
69579 F20101112_AACHVC chittester_n_Page_085.jp2
e382192fd2752f6c5d8eda6d8e8c12d1
b72de3e1d70e3c0408c4a0a837a879b60c813ae8
11186 F20101112_AACHUO chittester_n_Page_066.QC.jpg
5163e1eeaeaab856233c82199d25285e
65dee02a5728969a25ad9367308b2119401b4966
F20101112_AACIAJ chittester_n_Page_101.tif
60acf3e665856d098f23cebd3015e153
53d7a3c46c8ffc66224d599dd1d3ac1f0e199405
F20101112_AACHVD chittester_n_Page_045.txt
63b162b117eaf7b0bc56cc9525af3595
a592b45d5765fa6c7b15bf71054b5ba78729ab3d
138305 F20101112_AACHUP chittester_n_Page_096.jp2
0d433f44c829dc7c8a64945ffd85cc97
f17799a22fa24d0758eae147e98754a101da0e69
F20101112_AACIAK chittester_n_Page_102.tif
65c751834760fdb211ec93a2b9f102ef
9aa82372385d72b9824c05c46704c80b9ab56043
22801 F20101112_AACHVE chittester_n_Page_044.QC.jpg
72026a67728393044ae11af18a6d1ff9
a123b52e339ab8cac35e2cd778aef4eb00ba30e0
1864 F20101112_AACHUQ chittester_n_Page_023.txt
dee2361559e50369f6a9cb87a3eb4764
b9d24396e79834003592ce57919a99facea72ba3
F20101112_AACIAL chittester_n_Page_103.tif
c67429ab828cdbce8b205ffe3f076715
a35a96910dcb268182df054153ceba590ca35afe
1426 F20101112_AACHVF chittester_n_Page_003thm.jpg
fbb3e31374298524abe85d57c4403a46
e01cf66ceb0d09f992aed23097fe990df9db855f
26065 F20101112_AACHUR chittester_n_Page_028.QC.jpg
4645530666d98c6c510dc17ca81681c0
12019c6c0b249c4a5c4654f52babd2c1d37fc22d
31894 F20101112_AACIBA chittester_n_Page_085.pro
14366ff81a5b18bfa74ebc5ef01d6acc
c864653e4980dc9549080c99d03ebf7c13e2482f
F20101112_AACIAM chittester_n_Page_104.tif
4777f6249584aa37ea1abe23be7e5762
0da93078b7d9be592a9988a7be3cc6572616f8c0
2512 F20101112_AACHVG chittester_n_Page_083thm.jpg
bbe0beb44f876bce1620144849850415
283030f5bdd14f73d390d6b64adbb4182d7931d2
25969 F20101112_AACHUS chittester_n_Page_054.QC.jpg
c665b183419009fb54ce52dc055fff98
b4615162b78faa46c975fd474d0bbda70e1ccc3e
19791 F20101112_AACIBB chittester_n_Page_087.pro
a13bd42b65db134e2fce4ef4562ac859
a4331d72520e812a4892653da62be43fe6253621
46598 F20101112_AACIAN chittester_n_Page_022.pro
b8d6f6341edbf6ed00a6e9e3d22fef76
a3f92d4570b9d6c70646c69a865b02dcd6ab8abd
116 F20101112_AACHVH chittester_n_Page_003.txt
206f0b85410373c6ca8c6cfe9623fcda
892997ce6582f2e42b0257e699c9d45487d8ed16
139304 F20101112_AACHUT chittester_n_Page_098.jp2
5de092718fa78ecc3bdf1494ac1a0f6a
f7bdad1fcbf0850d871e6881e769ad030bd21524
20389 F20101112_AACIBC chittester_n_Page_088.pro
32fbba06bc2588afce9df06ab468d39a
486f0ea892497617d22388d01364b2c88962933f
53922 F20101112_AACIAO chittester_n_Page_027.pro
70f9c7d4792a281ef0a99da1c97993c6
e96eafa545f883219e7b9f04367151eb63e4d0cb
6679 F20101112_AACHVI chittester_n_Page_073thm.jpg
9ab9f5decd81b0870586d0751a7e8f11
8cf4fc16e7b0f90a076b8922236d62d0a56c738b
25474 F20101112_AACIBD chittester_n_Page_091.pro
57fdf9c7b2f17bf4985b7b46c43c7635
7bd2ad1f9ef16cfbe82b4291c09ffa03b22ffef2
53842 F20101112_AACIAP chittester_n_Page_035.pro
72cc71674419d5da7b9471e41164863e
4df6ebc4401e8764c99324736fdbd3da169de462
116285 F20101112_AACHVJ chittester_n_Page_031.jp2
8ef07767bb13eaf7727d1793eaf3398d
ff7616bb5252e6158041f841209aaa72ea80a4ca
F20101112_AACHUU chittester_n_Page_040.pro
6cd767607b46a4932c4ff07376c005aa
5ef85f490109cccf1a4897887f844a4cb4f5c545
65225 F20101112_AACIBE chittester_n_Page_093.pro
0ccff47afe78c1db390ee64732af7a3b
9030fddc2615a4652b665a4dc99885071440361f
50489 F20101112_AACIAQ chittester_n_Page_049.pro
0b3f2592174eb12f9fe9396a96a6b16c
38166352856b310f77e93e8066ab4a1cda049949
31296 F20101112_AACHVK chittester_n_Page_084.jpg
ec127f71e21fcc19e959c32d269110ea
2a9b4240d3dfd97d22d05ab3c4ec7c2b110fa689
4928 F20101112_AACHUV chittester_n_Page_064.QC.jpg
a6d7b35eed547407204241609dd48cbc
d7fc4a67383482c2078874469538d2fd67f73452
65184 F20101112_AACIBF chittester_n_Page_096.pro
3eb4e4dd0625a57fe43ac8ab1f606118
edfe59ac2e77571dc8d7c8ce0dc9f0a0e4432bb5
53897 F20101112_AACIAR chittester_n_Page_058.pro
d98c1c934be90e8d0d792e8e9cf54ec8
093fee4cb38c4fa059bbb1007a1a5955ff733367
F20101112_AACHVL chittester_n_Page_105.tif
d742caee8208c22c3e1ee7958b27806e
1a75fe0986cc6bcf50050171e83ce4bf254a7e2a
2190 F20101112_AACHUW chittester_n_Page_015.txt
cd213062231c91beb7dc799b71930c9b
d3f5a48875418fc4d530d6da2206dc61f97c6fff
65938 F20101112_AACIBG chittester_n_Page_097.pro
2aec4e43eedc47e49acd240d06d35280
d15ec45fa9484736f086abe69c2df44e2ce0a248
14695 F20101112_AACHWA chittester_n_Page_085.QC.jpg
cbd14c33c20b86e128be28685b79b4bc
2ede5eca1163bbeb4951e028644cf143a043accc
57486 F20101112_AACIAS chittester_n_Page_060.pro
38f672882b32d945386e3dc82e679b18
6c8ee889ee486502b5f22463df89d772a37de2d4
F20101112_AACHVM chittester_n_Page_053.tif
41f500ab64426505bf5517e34a8e2b96
8240f279bb3ebe1cae24126e8b7dc9cdb3087933
F20101112_AACHUX chittester_n_Page_036.tif
84e891dd7745685b448ff4e447635e93
73edd52fe8195546ae65c7ad5416f25d7592272f
69339 F20101112_AACIBH chittester_n_Page_100.pro
346629914fe48d7da1b7cecdd7fc5279
a30cea91d6752052673e738da0df47b6b275be42
F20101112_AACHWB chittester_n_Page_099.tif
e40d7649dd4d42a91d7401da76556e76
9ed21cd3ed69f0facf4342f7acc852fbb33f8454
20591 F20101112_AACIAT chittester_n_Page_062.pro
6a097ef161d895cde28229f5a081ff42
900b8595af01276d56e7bb1397263903267cdce5
2633 F20101112_AACHVN chittester_n_Page_096.txt
b9947940ba5b89009b81337824099e31
a6c0afc7c14ba35ba62983563569dd8c8f6ccf5c
F20101112_AACHUY chittester_n_Page_017.tif
c85bcb6fec2948cb4dad37bb9620ab8d
9319eda04a6148500a5f165faf80ffa77f6d6349
6636 F20101112_AACHWC chittester_n_Page_039thm.jpg
29cba38213f1fbf4ccb0abf8cf696428
87a86d7bd0483ec1859996f79b510348acdce1df
40009 F20101112_AACIAU chittester_n_Page_065.pro
ae4fd488287f2bd723e5769b2b7db311
b3c6d5391478e51127067a153d6ab255145fde97
65230 F20101112_AACHVO chittester_n_Page_098.pro
865b2849fede491d954d9cb8938a0917
b5c501aed5271edd589592f3e480183c64a0945f
116384 F20101112_AACHUZ chittester_n_Page_020.jp2
31860a39976a727dcebc17f50b3fe946
f935c1d7d77d9f01df58dae9bf0757fbf5f28cf3
492 F20101112_AACIBI chittester_n_Page_001.txt
75c475182bcce88235e97d949748332d
b74c47d2d6961bac694a9c968c7452b8ac533539
78442 F20101112_AACHWD chittester_n_Page_050.jpg
14ea22ccc0afbf63b14abbb726293cd7
b11d27ca7525841098d12517809e7a289452d01a
20082 F20101112_AACIAV chittester_n_Page_068.pro
446138ec62cd8695c591d9bfbea05a3e
fabfec24336c4961c38ba6b3336c35fb3ecb0b17
7166 F20101112_AACHVP chittester_n_Page_101thm.jpg
105f6d965fba46f1a697d5e23a9c23a0
97ef909744cef9803608e46815620247dc3d0d60
1991 F20101112_AACIBJ chittester_n_Page_014.txt
0f1dd811421870d5b250c6ee7b0799da
ab25410f6a7279aa612eb03c2cf196bc33d659ce
7131 F20101112_AACHWE chittester_n_Page_038thm.jpg
68bd231ff97a3b3ac021dce39cf5f88f
872462dcebc499520a70b32e670420ad7f1bc79d
51321 F20101112_AACIAW chittester_n_Page_069.pro
5c7701b30becc741bb42054fb98b34c2
190c2fab9cb6671b708c1e199f2f221c9b261652
F20101112_AACHVQ chittester_n_Page_052.tif
b452798b73ed9c8f768ef48cd6b26f8f
0e9bfeb47faf601b6b57181257b8debb16f8a950
2131 F20101112_AACIBK chittester_n_Page_017.txt
417339704440abbc0f6d8eab8dc29b16
ee4cdb450311afa90b163948ad17253c0c99f0b5
25087 F20101112_AACHWF chittester_n_Page_058.QC.jpg
d914b31028d150630ad5592311ca0e08
0778f03097ff6c117e9eccc1e628f63f6a0b87b8
53480 F20101112_AACIAX chittester_n_Page_070.pro
394c2bbd4a350e3d93e676bed12f9803
4fa3b3863f5ddfc6055b24a5567eaa711effc6cb
6445 F20101112_AACHVR chittester_n_Page_083.pro
3862eff3050ee2f13a4e4860b24e96c5
23c6546c4f7a7589191b4b1cd932c3b687cf71ab
F20101112_AACICA chittester_n_Page_077.txt
ce546d83db462044718ec35859ddcbbb
45dce26a82c0216d7c1ca870772efa8ee1e2574c
2116 F20101112_AACIBL chittester_n_Page_018.txt
0cf4c199276528e6b6284849ddb1e174
f06267f9b003b694bc9917622aa9f27645bc7ea9
2108 F20101112_AACHWG chittester_n_Page_047.txt
d054c62ae44ee664fe108965a2f86812
57b3c721bcee3b58c050a3154871167fbdaf924a
56562 F20101112_AACIAY chittester_n_Page_079.pro
6d1c22caf9cc9e8c2059557a91329ebb
a19f714a2819559d5daaf52d344b94c2cc253a74
2226 F20101112_AACHVS chittester_n_Page_075.txt
87018a174e34e81d0f94e046a971f97f
e47679c66b28081de07798ea295ce8818e7b4f95
1998 F20101112_AACIBM chittester_n_Page_022.txt
4c89c311efb84d394480267e1d85bbe3
2c5097ccda2ece5e25d8dee320828a38905c86fc
48928 F20101112_AACHWH chittester_n_Page_010.jpg
3ad9e25df58474406b21bf17a5389ce8
49715826e274cf73ee1d05a5f6bd489bfd5323ea
54927 F20101112_AACIAZ chittester_n_Page_080.pro
78efb10d6cbd3aff746eff78e0d50801
a14c58169bc38e082e629f341967298addb04d05
F20101112_AACHVT chittester_n_Page_056.tif
d9c7b9ed2c6552e007c358bb41191f7e
6e9450ac389438094303636f42c1b570fb5063fe
2218 F20101112_AACICB chittester_n_Page_079.txt
73ebdb47a2516459fa03a5ccb4f764f3
a5fc47c7a3723b13505143fd9fe9ef07975fdc38
2053 F20101112_AACIBN chittester_n_Page_028.txt
be16a47c724bac4675f27325cb9c9b71
19c7446d722926beff0fe427ed1f23ac266fcaa0
117795 F20101112_AACHWI chittester_n_Page_047.jp2
c5cf44255763a53a2bd521b761b5183b
a26c642410d2634437836f6b0370a9e71d4e311c
25135 F20101112_AACHVU chittester_n_Page_048.QC.jpg
42b50ebed3aca43d2708e96070775b8d
50c7f53fb4eb958272572ebdf82671a56856b531
1250 F20101112_AACICC chittester_n_Page_085.txt
85fe6f3dfb00306862092432ef492c6a
113cf741e0a007aa65b16be293801f692b986535
2089 F20101112_AACIBO chittester_n_Page_036.txt
162f37175b469ea1bf75024c5194815d
b1097758a31b330edcf56e5aae1583c13e501fa7
F20101112_AACHWJ chittester_n_Page_048.tif
627fee7b9a561dd96f588b3a01cd5325
58f0390db54dbb8bd7c14cb9e14540b2b2b4d7f5
1680 F20101112_AACICD chittester_n_Page_090.txt
8c7162a2be44839db73c68b9cb286b4c
0f472c83090f5723588f3864e013cfabd585e41b
1980 F20101112_AACIBP chittester_n_Page_039.txt
d2c31b0798318c26e1993b8a14725ce0
fc9579ba179b915ee36d9782987fa98d56b5d35b
6800 F20101112_AACHWK chittester_n_Page_025thm.jpg
e88d11d9c2520c795807762de042f8b8
7b552ce1cb37f87f07fe737fd84cabbe1917b150
5339 F20101112_AACHVV chittester_n_Page_006thm.jpg
c2de02218493cda3e8cf58074a64a677
1a78456a26579cee2cdc7875bdb861afe9d5b7ee
1423 F20101112_AACICE chittester_n_Page_106.txt
548377335e48a95a8a3614848eb2d7cf
3ab9187f991965e1a7eef76141c8386013ac83e2
2081 F20101112_AACIBQ chittester_n_Page_040.txt
c18f61115fe266d59a2133e0d580990c
c52ce793162b97424f54f19ae1fb5e4d4623e0a6
6271 F20101112_AACHWL chittester_n_Page_011thm.jpg
dbf8be2e791beef93d0816b849eaae26
dee305d42ca45a450b36f0f64d4f147273a36774
2070 F20101112_AACHVW chittester_n_Page_013.txt
9587efb3b2ab5990613509f77f6e7e3d
4bfc965ffdb1ff37b648f72dc6061e7f83b430a6
6519 F20101112_AACICF chittester_n_Page_023thm.jpg
f07a692e4d2670a6c955c2ad8f148e9d
7acfdc3ea010d8c4e7144f6eed5f367f4d730346
2126 F20101112_AACIBR chittester_n_Page_041.txt
930eef2df5abc05f5d5bd19744174170
eb2bb10c6f6b6ca348c8d47c345c9b11af074ff2
F20101112_AACHWM chittester_n_Page_044.tif
ea331747ca89714099449d5d6ae7b8c6
c0d0d14d2ab4ddf9daabec25b327ccd399dd2233
F20101112_AACHVX chittester_n_Page_042.txt
ccdf9ce4bd4d99da2b0df08574dd1b0e
7d781c369481b9d92889a5e8fd4de00f012c9025
27988 F20101112_AACICG chittester_n_Page_100.QC.jpg
894cd08d412485603406f1d2aba3e801
fcca3f84a538e4b86b3e1119cd6a015945006e49
1986 F20101112_AACIBS chittester_n_Page_049.txt
5fb610fbf81f04e2cf7f5070902050e0
2d2ffd6e84af84c04d835479a52e19af68538512
38309 F20101112_AACHWN chittester_n_Page_082.pro
6ca93dea37ec631f95168edf79d899d7
947a3db416c16ce29cae2325d2be42134b1fa75c
2542 F20101112_AACHVY chittester_n_Page_099.txt
124185e9c1128dcd9784b9ab08647c69
d8741eee131864801d7262ee76a3b0117e5a6533
6911 F20101112_AACICH chittester_n_Page_096thm.jpg
a2516b3f19665b6d61cd727302e9a864
15d9b2a5c6436cf842a7769ff834b1bdd39b29ec
76602 F20101112_AACHXB chittester_n_Page_006.jpg
f52e29134b00cc20934a799a3b13ac5e
a7ecb5c42023d478549f17662ea310f875e122ce
2054 F20101112_AACIBT chittester_n_Page_053.txt
d7cdcdc6a21cfba58aa2f36b7af5dc0d
c9e0820fb30bba91d24215f426c70ee1c895c4c6
277 F20101112_AACHWO chittester_n_Page_083.txt
a2b677f727b486dfe60cbe04bc4f0d0e
f7bf73c4935a0ecc214de941c60d39a8e6b72a7d
16237 F20101112_AACHVZ chittester_n_Page_065.QC.jpg
a8505e6de236161b5c5cd5057fe23b3e
d03b2aac5b0b106dee6048ad1796563bcf346524
11739 F20101112_AACICI chittester_n_Page_087.QC.jpg
138281175ac2696bd8f1499a9b190421
8388b92685fa8d27e2dd039ce902f57436c3337f
23413 F20101112_AACHXC chittester_n_Page_007.jpg
1a18139695a3543ba4a3ca8da0265360
fd8bf3f60823944e8c108b5978bf0e9ddbad454c
2114 F20101112_AACIBU chittester_n_Page_054.txt
7efba6f87a0b3014e74b912b5af200c6
608259b208420d6a6df8491a163dd2b2599bce65
3539 F20101112_AACHWP chittester_n_Page_088thm.jpg
073a69f6b062c7afe0c0b5771631f178
83ee4855b429bbb0f5300c7003f4945a4a066c90
25883 F20101112_AACICJ chittester_n_Page_102.QC.jpg
8c3b22e63ee2cb7d327d1a066795d781
95c1f409eb7d3f209cea87753d6c61cbeadc8194
70079 F20101112_AACHXD chittester_n_Page_009.jpg
08e25d3a8c319357b69dea051dcbbd99
b110555aed896215319bfad042284336b58c26a4
F20101112_AACIBV chittester_n_Page_058.txt
2570ac363f6b3d73d07e77618af66e9b
7ff18470f7deb065312c35146eeeac015f725eec
118364 F20101112_AACHWQ chittester_n_Page_080.jp2
87f9b496d13e54b32f9f855b12516adc
7e1fc8608df2c459679a34fa2df3ddc1e4f7c851
162462 F20101112_AACICK UFE0020125_00001.xml FULL
af49ef859eef5740340cf236068fad16
2ebdd7781fbe1ba0c8effdeb8c66a66f992adb0b
76661 F20101112_AACHXE chittester_n_Page_012.jpg
45481c02b7d63b59e993c58ffcb5a827
9ac8a626280cbfc5c26df020b6773e4bd4e7073b
1563 F20101112_AACIBW chittester_n_Page_061.txt
1399445c130cac34ed1d8a5bd91c75cd
02ccdf1ae0ac862b9f3b9f4063a417d31168c496
72964 F20101112_AACHWR chittester_n_Page_014.jpg
9c255b0c783182b660eebcf8e0ff26cd
a52907a9c75e040a4c03556cbe53e447708ca30b
6910 F20101112_AACIDA chittester_n_Page_046thm.jpg
0f483de10f41d2a0475b55d4a1e1231b
71bf02d1e723094b4f5f3d53e4953db6fbd3adf7
3095 F20101112_AACICL chittester_n_Page_002.QC.jpg
10a8c1fb375056666c9ae9ee225b4465
36c6a4044a2f5a6e3ef87c43fe7cd288c2943142
79856 F20101112_AACHXF chittester_n_Page_015.jpg
ceaa6592dc4d94a59bbaf4339f2db171
c0464bede2b9f5ca6e62fe05649970a7ddea86f1
1241 F20101112_AACIBX chittester_n_Page_062.txt
3970ec8f8fdb01227889c554236074dc
b70bb9822a99acd08df6b3d156b9edc6d1b0677e
3971 F20101112_AACHWS chittester_n_Page_005.txt
0029354c3c2ce46e7d3ba0c88fe118e0
bcf94855f9be2e6ad068aa2de2bc69ca886c26c1
25589 F20101112_AACIDB chittester_n_Page_047.QC.jpg
2a5352051cc9fb722cd7f1ebf89be588
e96027eddfed0b18f70e2d80f3e9f9a00162e6f1
2234 F20101112_AACICM chittester_n_Page_007thm.jpg
976c0dd5b25102ebb718e1f52f8f252f
f6e6732880bbfea26df0767fd85ba69592d6a424
77548 F20101112_AACHXG chittester_n_Page_017.jpg
4915a0a2e8aa244bdff9e306d5f4b310
92c81661beb732eae3ec977f729a85ffe3d67ab1
1583 F20101112_AACIBY chittester_n_Page_066.txt
d08995a455f42b81abb2634334353a1e
1585fb9dcb87132d2f6a8e248a2b5bda82bb9f9b
27207 F20101112_AACHWT chittester_n_Page_094.QC.jpg
33936bf6a6f82b3f73cb461c7c59935e
ff80b6afeb70a5230fe91cde44275c22c738c6f1
4763 F20101112_AACICN chittester_n_Page_010thm.jpg
98ad0e5b79b4d15ddf8df8725e056a65
e24d0c0294de41eabcc7811be047c1aa63a1f22a
76997 F20101112_AACHXH chittester_n_Page_019.jpg
1ba30cd6ca747aa14ef99b1969d8515d
bb88e10b7a50c6e976b013bbc25c1099f714285b
F20101112_AACIBZ chittester_n_Page_069.txt
e3a0aab4b4da98fa69f9b664f071d634
7b6c9886b0dbf65c68bf27c194df3e29fe2dc7d2
34758 F20101112_AACHWU chittester_n_Page_106.pro
68535297af1cf36c7ca8d74703bf4649
d75d0c1997483a9ab713faca5c10e1215dc2130f
7046 F20101112_AACIDC chittester_n_Page_051thm.jpg
c722921c571750c63c3d317f0ce75880
c83ceab9ff191f8eb5d83d41983e7fa95a6f0cde
25773 F20101112_AACICO chittester_n_Page_017.QC.jpg
67b1d915cc53d87963b8a6ba43930603
e8513f6e14d3dc912eb1442481b6d7fdcb4e13a1
69781 F20101112_AACHXI chittester_n_Page_022.jpg
8500197e39460b9b6379039ca378d187
48a0f4879bcab51c8227f8088dce0dc15b7238a1
50615 F20101112_AACHWV chittester_n_Page_014.pro
f5abf91b3364aed115e3524417609fd5
9cbb57baa66d086ebfc3c7ba0a32214a509f4942
F20101112_AACIDD chittester_n_Page_055thm.jpg
3720be4589ae9781bd0358ed4e08b297
eea4a0db8782338e8c0ee2de230f60d5a027232b
25346 F20101112_AACICP chittester_n_Page_018.QC.jpg
16779d50fa5a4c58e7af067232760360
67df50bf3e45c5a4e79202d6192d1e8a5546c07b
77449 F20101112_AACHXJ chittester_n_Page_026.jpg
03183764911017e4b8922b13132c6455
7506eb2c05576e8fed3d9b216934695b3ff21555
6667 F20101112_AACIDE chittester_n_Page_056thm.jpg
78690fc5dab647301478d64f6302776a
b811b1e68c91d0e653f479e561b68dba3ee2060e
6696 F20101112_AACICQ chittester_n_Page_018thm.jpg
044ad955eec13b2445ec8776213d2781
a4e9d8d70365d2443d2b463ee30a3de6b1bd14e6
79638 F20101112_AACHXK chittester_n_Page_028.jpg
75fe992813a3cd80d6542173eb9f573b
f413578e07a85f81981cc406f8caa39b454f51b5
1616 F20101112_AACHWW chittester_n_Page_003.pro
a3896fa8633664b28a7d5832c6b06061
77cbfe4e72727e5626b012e1d9bb6bfad74b1ccf
5368 F20101112_AACIDF chittester_n_Page_061thm.jpg
689c8c0eb88c33c8d45aee33ddc7071d
3503159313839123b0ab32832c3080b297516ac9
25293 F20101112_AACICR chittester_n_Page_019.QC.jpg
6a4e8706efc0947f527a80bee24d64d8
e96ae25feec19a99057934adffda67125645875e
41195 F20101112_AACHXL chittester_n_Page_030.jpg
e80032b704c2f9feaf1855f05cd6ea93
1bd38557e377891613d023d999f668a7936e6ba0
117573 F20101112_AACHWX chittester_n_Page_048.jp2
9c6e6d7c037887849604e664538f1097
59fc21676602570836d8dfa083578e2b09d87921
6522 F20101112_AACIDG chittester_n_Page_062.QC.jpg
8939008177fe5443f2c23e99db039555
fd7465158b3bb4f3f4f06ba48a1762c26c3b484d
49426 F20101112_AACHYA chittester_n_Page_085.jpg
0d6658edf88db25e9409ff5fbb867000
38f496b71492b9605869eaa304628186d4e72c8b
6087 F20101112_AACICS chittester_n_Page_022thm.jpg
181ff8ff5701f6614d04025fb47b9b88
8c02ad070242dea66e652e65008054397b9eaa71
77640 F20101112_AACHXM chittester_n_Page_035.jpg
0f75bd36c8839e6294509832eea289bd
47541f830c3158b75f1e6bb4929397bd96075a3f
125373 F20101112_AACHWY UFE0020125_00001.mets
ac70c8a0aa9671a0011aca06d791fb01
52ce531dd65d917ce0588c0435133e3a98478570
1747 F20101112_AACIDH chittester_n_Page_064thm.jpg
7451b4e5d97b65e9339d0cfc2ff24da9
abfed67731d5d5847ae914f8fd1fb6dc07a9a8a0
35361 F20101112_AACHYB chittester_n_Page_087.jpg
4939bcdadf96dc475ccff773beae912c
277b1d6e1009020f9a0aa4e969e4e1d3d411f6bf
22561 F20101112_AACICT chittester_n_Page_023.QC.jpg
fe977d37ea3dd29bfdb3d259c3d67c88
7b1a058f0487f73edca3126d6b73f6ba3df6ffa8
76327 F20101112_AACHXN chittester_n_Page_036.jpg
d15e12b13a11b034d424f6dcce30a4a8
bc1296c26c06877eb45022655558b18fd659e32f
2892 F20101112_AACIDI chittester_n_Page_068thm.jpg
39cc1b0444d13e0f15da4d7f204faad1
2d9a50fdad210b7c74d08a5e8ee450f47a8194b6
61174 F20101112_AACHYC chittester_n_Page_090.jpg
e7cec79cfb7ac121c284ca7455377917
524f9db7b9b392a124f1e084b7fd1fe80091018c
25092 F20101112_AACICU chittester_n_Page_029.QC.jpg
df0b06f508571f6deaf65a899479f5e9
1a880792c3bcbd8cabd272cf29762eca2c29e572
69754 F20101112_AACHXO chittester_n_Page_044.jpg
b83ad41e26d02c846a322f6af552c275
cb69cc84e6032e7dc949d8d152ac38ce41a52ebd
6576 F20101112_AACIDJ chittester_n_Page_071thm.jpg
10b06ee3bbd1d51eeaed7b5e47ba1458
f74214f892a86a136ff1a5ba491117b37fee2baa
95545 F20101112_AACHYD chittester_n_Page_096.jpg
f22061a0d0d16fc3293084f628770489
fbd2deb67ad51d5119407d84d92ccbe080ddffdf
6904 F20101112_AACICV chittester_n_Page_029thm.jpg
f4fd8662554e723c1f7fc9ece519a946
fb0928a7279dcc4d0b235744cf5df2163575e422
76771 F20101112_AACHXP chittester_n_Page_045.jpg
254000be4fe3d2b8448137ecbf26373b
6e597daceb44c6d3c8662ebfae591c5f32a166d0
6750 F20101112_AACIDK chittester_n_Page_072thm.jpg
182fbdc2a6ccc69f596c98d8430fa4ba
2c3be3707691739ccdeb899605cd3478a4d30e9e
94993 F20101112_AACHYE chittester_n_Page_103.jpg
9e9f4c2be880cce5ee830acfbd2c1364
f6a5e2928ffa6041119873617d9b057e3f265e9b
3962 F20101112_AACICW chittester_n_Page_030thm.jpg
027972915c8dc13374667482f9c470a2
fcdf4e8af5a00f572f12813b0bb16e84b1891788
75265 F20101112_AACHXQ chittester_n_Page_046.jpg
03eb056495c50531ee8a1d25fab3a58c
166c90754076468b9fe1e7f782faa86ae514ce3f
6814 F20101112_AACIDL chittester_n_Page_075thm.jpg
a564c3a6f6991f25c911c15549ed0592
aa932be1b3802795c38032f3265954e7a296a6c1
80561 F20101112_AACHYF chittester_n_Page_104.jpg
b2cb2ebc92e8f632d1c5fcdfaa2e344e
601cefeaecc8448561ee5046ebff194784d5bd66
6795 F20101112_AACICX chittester_n_Page_036thm.jpg
a5d42d8263b9ddcbf025ee84af23906a
3cfb0f4560f8802fd119556a2e2db6535f1eb831
77229 F20101112_AACHXR chittester_n_Page_048.jpg
0a346d599162de33654a5d88b21faee2
62aa3fbc1b04de58ff2824f29f0e0ca76f84056b
7024 F20101112_AACIDM chittester_n_Page_078thm.jpg
8859d7e6938d2bd1a9ea164f6f418a04
aced07d3b1c128790494141a5770d641beaadb7b
91671 F20101112_AACHYG chittester_n_Page_105.jpg
92fdfd3935129eddcc78b43d38bb1f63
8dfa5bf620de549d80f50bb3b05759c8a6d25133
25901 F20101112_AACICY chittester_n_Page_038.QC.jpg
3d909e8d30f2a281a0ac6204f8e2289a
87a18b49c71ff977c5555de4a3205a8bc478ba69
78760 F20101112_AACHXS chittester_n_Page_051.jpg
2c0d6ad47009e10a44e341b0261fc5e5
1b90c5d659844245c6396fa2ed37aedf126b27d0
25932 F20101112_AACIDN chittester_n_Page_079.QC.jpg
c4e64829c93044f622825bf20a0ef3a5
3ab5a537d7da3273fce9be8cdc7c08fb5248a72e
1051946 F20101112_AACHYH chittester_n_Page_005.jp2
2f9d176d438f8d2e6ea5edf253ecdbbe
da03b0a7a8002a000edd397b5aa7ff0a80ba1360
25139 F20101112_AACICZ chittester_n_Page_042.QC.jpg
1c6000cee030b51778582707c87a2d8c
c393a6d64cff636d811ee5d9389ffc780365edeb
73502 F20101112_AACHXT chittester_n_Page_053.jpg
c6b6bcf62a706031adfb37d212910d98
e95f488b46d55b1a09c748f64c57473100021288
6934 F20101112_AACIDO chittester_n_Page_079thm.jpg
08a0c6d40956caff5e1be52538afb8f8
e3941f27342d6e802ba283c42a3e58cf2049f502
450478 F20101112_AACHYI chittester_n_Page_007.jp2
d125a810584ebf1bd2f541d92d7dd12e
b2aeb67a4599c9ed8561d0d5bc1a67b5f2139299
77511 F20101112_AACHXU chittester_n_Page_057.jpg
9a045a59614e9e077399782f47e77393
47b33b6f9692de281bb66f4da406a56f1057656a
6824 F20101112_AACIDP chittester_n_Page_080thm.jpg
fc7f89c8da97aef77c24fde70f468194
8dccc580b449e0e0697e83408b345444148afbea
106343 F20101112_AACHYJ chittester_n_Page_011.jp2
9a773d5e56de0c595fdb87c92c6dfbb0
80d9d8fe61595963747e72f7b2d5ca340fe2ac7a
57878 F20101112_AACHXV chittester_n_Page_061.jpg
c02c12bc21a6853837bee0f937c5143b
66d61b4c7d797935e6b20ba9a98ace7d95f24be7
18869 F20101112_AACIDQ chittester_n_Page_082.QC.jpg
3f679d2977a724dd95f16648b2255c50
94a244024d07223eda42206adb9d067968408ab6
120979 F20101112_AACHYK chittester_n_Page_015.jp2
240d43d7467e6bc4fc43cf66ce162648
fed9ebceb1d07eaee0f54e3b8c3828869600824b
21588 F20101112_AACHXW chittester_n_Page_062.jpg
eca184dc548f7317c57b192625a4057b
5368bc58c9796341fa45c98b34c26afacb9e2e89
5133 F20101112_AACHBC chittester_n_Page_106thm.jpg
c0f725cfe5d8fa3089fee6afc316233d
401a08fb0aa98580114c39d9c3dc678039fcc03f
5320 F20101112_AACIDR chittester_n_Page_082thm.jpg
01df6e4d3a5eed33d75758a5f067baa4
edb96b1fa175bfad1575b9f5226621f91d3ac9a5
55892 F20101112_AACHYL chittester_n_Page_021.jp2
19b397532f4127aba617687117c1ddb8
50a5d8c285a177d3d979dec169cd8cde4203c64f
F20101112_AACHBD chittester_n_Page_041.tif
8aa6476f6cb9e2691c5d6f312e2f4efd
e186b2ba88d63e6568bd3137cc67e9cc39a34faa
116857 F20101112_AACHZA chittester_n_Page_081.jp2
f7e0758df62a4536c3fcb47a0478e79f
4b2e9a92734cdbee726c6fd603c306a1cac5fec8
4543 F20101112_AACIDS chittester_n_Page_090thm.jpg
1632e4eb4a13984c7a0d8434018e13c1
75efd74b57e961cf57ec5035efe78c22e7a32af7
102246 F20101112_AACHYM chittester_n_Page_022.jp2
e039334197caaf9cdb6ec91253c9da4e
fc2ca4d8a01613a95b8c941ca2624e683f503ec2
54071 F20101112_AACHXX chittester_n_Page_065.jpg
5d3cc9b2a5aee9b553efdd710389f39a
f191b67f9b6fefb56ce7860f74ce22d0f00142bd
116913 F20101112_AACHBE chittester_n_Page_012.jp2
3251520def964c079f4f9bed0b44da34
887f7055276e268d965694dd509edc291d7eb005
60353 F20101112_AACHZB chittester_n_Page_086.jp2
59003f1628506505ae7674683d384be0
2eb66f81a64eee40b99dc3d96e661efd742f171f
F20101112_AACIDT chittester_n_Page_105thm.jpg
b0eccea4fd21b9de3d4faddd71d6b4ec
d365a6ada5b460ef849bae22ff044f19108b0cb2
111550 F20101112_AACHYN chittester_n_Page_025.jp2
95a78067b7834f7896565545ac6971b7
fce946804ddd566ea872eaf8f135a1a0d64f51a6
26747 F20101112_AACHXY chittester_n_Page_068.jpg
8a095e65b5620ef1628e9279e861c43d
a3dec3d1212143c362c797070c8c31c503851f1b
110790 F20101112_AACHBF chittester_n_Page_056.jp2
db45bf2460c6bc76faa84d12b318a551
a779d064196a035bdab706013f4e8b954348c8a9
45697 F20101112_AACHZC chittester_n_Page_087.jp2
76b36a0142655724ba86df25955431e8
6b42b89fb2de522ad4e6799db026d7307577e9f4
18255 F20101112_AACIDU chittester_n_Page_106.QC.jpg
c9fee1da5936e26d67a6d814ab0d3ebf
6794a74d3b8bf91e267dd67e1f545a17359a8a78
116909 F20101112_AACHYO chittester_n_Page_032.jp2
af1f98f37a763262c747922e3b1056e2
0fd386b4e2401e14450dc649345e30eccaff3b56
78805 F20101112_AACHXZ chittester_n_Page_079.jpg
c2bc6d577c994c16dbdc12e1063d90b7
3400785a5fe6d36ac1cda8c3fe8ce50b24ecadca
4272 F20101112_AACHBG chittester_n_Page_006.txt
d81f6ac643d3b6881ab0131c2675488d
166136b129066155cc9465a4b8393ee323beff6f
142329 F20101112_AACHZD chittester_n_Page_095.jp2
22f9de64f09070f4d973dafbc30fc291
293f65197888f17677aeba41198d7643562bab6c
115666 F20101112_AACHYP chittester_n_Page_036.jp2
b9e36925bc691cfc525e60e9fbd42ffb
fa18002169d4be066d7aaffe89aebce08bd3d782
2121 F20101112_AACHBH chittester_n_Page_019.txt
1c25ab754c1e8ad04bdff0c00b1291b6
b724535b5edd038461ec0cfffbd7f45e3189f074
142748 F20101112_AACHZE chittester_n_Page_097.jp2
3bea0d1fb14c65b51d66c29e4a047d92
69301e7cc0bfc1db0c95ce8aaa7986a09904dfd6
110740 F20101112_AACHYQ chittester_n_Page_039.jp2
0ebb80cbb5d4b3540d675533ae17ab62
54390af68755ae6c467e74bf68db9b741d187492
53627 F20101112_AACHBI chittester_n_Page_076.pro
f809f437f23533299401886aef5ee752
8230a462f46aeedc36a5c4cf6e0a77f9bc96dd8e
131723 F20101112_AACHZF chittester_n_Page_099.jp2
fb0ad898f5372574c32bd4290ab1b930
186da2ee754ad40383c82d579281e16f598db2cc
115114 F20101112_AACHYR chittester_n_Page_043.jp2
34b79fbaf3c9e8790c9c8647ff9ebd29
416ed5be597fcde82b5ac82eaf20e5f100f2b83a
F20101112_AACHBJ chittester_n_Page_074thm.jpg
0c8f04e5a799ec921734178b5c770ecc
25b2a0ebe5a6a38e290447db1bf954a8fbe54ff0
138048 F20101112_AACHZG chittester_n_Page_105.jp2
3424b6bca4cd711916f7ddfaadbd4678
b6db321cb1302a5705d6f43a6dadb84d856518ba
109663 F20101112_AACHYS chittester_n_Page_049.jp2
65276ef2ab247caa4ed8f21cad6039fd
c7a728b2d664fe9da2294660ed4d7110c527c2cc
22167 F20101112_AACHBK chittester_n_Page_009.QC.jpg
bc9f49354579cb765ffd32c4f586fc53
a34a4e65122799c00992d82ba70fb71b062b8e10
F20101112_AACHZH chittester_n_Page_001.tif
b965f1455f1f3893c5e6de4e0bc05bd3
26e9bb689b48fa4bfdc23139c703a8eefcf866c1
118984 F20101112_AACHYT chittester_n_Page_057.jp2
3325064c4e3755b9142ff4c9b465fcdd
0539928abdafd1036f88d50b05f71289f98a332b
F20101112_AACHCA chittester_n_Page_064.tif
abdbd6807931125fad3ab071a52eabe1
525b670ba7044f7dcb14a1de94431b1a1e8bbec1
72762 F20101112_AACHBL chittester_n_Page_049.jpg
01abe21ca961c2f64ad833e04774bdc0
6622e6b2b737d02611590e222ab1e5d4c67535cc
86831 F20101112_AACHYU chittester_n_Page_061.jp2
20e8ec140474a2369481c28797d2d925
fbeb7739563354c18923d28125dd6f451a609a69
F20101112_AACHCB chittester_n_Page_075.tif
5efbe1a85a16f1d23470f2235013420c
6bffc1d7754059f6b005a41942eda2c502b14b19
24578 F20101112_AACHBM chittester_n_Page_033.QC.jpg
6076cf8ad088f391cc19766b92b76032
606525c9a07caa52d0959d38dfdc3f7631a52a8d
F20101112_AACHZI chittester_n_Page_002.tif
822a8a945150208115a70bbbef66ce8d
559b2f624a88519074451ae10ee6268bfb4e3a59
111856 F20101112_AACHYV chittester_n_Page_069.jp2
5af348bf34a6a08b94d6837407234b8e
0f0607ccbe367104bd1f4450ea2d70d3e9b8509c
7064 F20101112_AACHBN chittester_n_Page_033thm.jpg
d13863c87a31213072a9248c425e4e07
257e21352674a1b325fa6503e8d55549016b98a9
F20101112_AACHZJ chittester_n_Page_004.tif
150fcdd884fbc932fc2449624b24535f
a401be3d11e24f8a1c09d01038b979371d1284a1
115829 F20101112_AACHYW chittester_n_Page_073.jp2
990abf4c0b77a9e5392e955923e20bd6
58f704d742b0eaef4fb73bd8da6aa9d707feadb9
F20101112_AACHCC chittester_n_Page_046.tif
f181e0c312716f01ede6d4a7bf9d4ed1
e307ac958aa81ada5a1877d1306a10d696887a32
51111 F20101112_AACHBO chittester_n_Page_055.pro
38806a4c20e4d45a813bd9b7a660bdd6
285f654b1e909561a57ccf5d7be00f06a8744e4d
F20101112_AACHZK chittester_n_Page_008.tif
3eadd651b778cb65b0866adff4638f5b
71116f46313103fc0154d58e13bb47668db2b12b
116620 F20101112_AACHYX chittester_n_Page_074.jp2
797a0fbdc11a17147c5a15f8467cfb90
de908abdb023fc01ae4f00f121196edb1acf099a
6838 F20101112_AACHCD chittester_n_Page_069thm.jpg
beddaab32ec8ca569be2452bf6ff9f4f
412dc41020a6caab869939f92c522139962ed442
23835 F20101112_AACHBP chittester_n_Page_056.QC.jpg
ca4ca67493a72bc3e07ce2c68a3007a9
e8988182b8c6e1fe2d646e6fc2aef37f660ad07b
F20101112_AACHZL chittester_n_Page_009.tif
9a00547359e33f9d408cd443518d128f
2f3f5a5202a23b9007c7a129426a0dd4fb63cc5e
35958 F20101112_AACHCE chittester_n_Page_088.jpg
8cb5a604104ed485f5ac12cee163a5f8
ee03ef3588cd85b26b457977cad688f127598eaa
48622 F20101112_AACHBQ chittester_n_Page_089.jpg
0cc7c0f132e6afec045be24a684231a9
c82b4802b072bbaa2b403e014e189c0834fb983d
F20101112_AACHZM chittester_n_Page_013.tif
9086554baed0c873609df915e83f04f6
53b039291237ee851705763ae6a6e9816ce72e8a
117423 F20101112_AACHYY chittester_n_Page_076.jp2
feb0162281c078fd8f5a7bc54387a41c
bb0bb3d954b5e13df168d290f7ce7fd90e4803c9
53821 F20101112_AACHCF chittester_n_Page_042.pro
7cba8cf3ac3a0c9093b3b5343c4a0492
de4ace4cec76ac841d5d0d2376cf27fb1df2807a
50175 F20101112_AACHBR chittester_n_Page_039.pro
660dad15511789b5f0eac862d0e558f0
e03aa5170b2e7c6fddc33a7946b74af66c1f6b5b
F20101112_AACHZN chittester_n_Page_015.tif
2f4786b29db7db0f09489020329b0a18
af0317412382ec319c80608d2fda6898187596fc
119734 F20101112_AACHYZ chittester_n_Page_079.jp2
2669acac75ed003167824358939d4495
5848550a4e2f12945c25d611b9998b5455187449
10253 F20101112_AACHCG chittester_n_Page_008.pro
d9f743515bbb0434f67f1f676fb3f5bf
b0f5a28d9714ae5a1b4af0698564ccce3bdb7a11
6682 F20101112_AACHBS chittester_n_Page_012thm.jpg
7d98ff51485a8022b15b5f913b1b1bc0
f3e6928e1071cd8d5e798049bc3fe0a7f40abb97
F20101112_AACHZO chittester_n_Page_019.tif
08f4c118d7dd9942bf49ba0414b4018d
4f7b774d005bb0f4cd0e2f49925e41f97ef2b6b6
76494 F20101112_AACHCH chittester_n_Page_081.jpg
cea9986366f0fa461c88c166e81e6ce8
62d77f008ac0735f42103b93b41ad0d5a5f4e05a
5539 F20101112_AACHBT chittester_n_Page_002.jp2
598c93f7df264050f3c042a425941afc
572a1ce186e07ec02c0701dd1089d66c661f9308
F20101112_AACHZP chittester_n_Page_021.tif
50c7b4b32649e7d18ecc89df7bc26dc1
9b8d08c265e73360180a0cc8df15b4d96de42a25
451 F20101112_AACHCI chittester_n_Page_008.txt
bfd7eb4c08b5b5e3916bff56456eca23
3cd08aaf32fe6c0e4da5d74067d1df41e8d6a48f
117816 F20101112_AACHBU chittester_n_Page_027.jp2
7cf87787ee2e1db9432a1d5e396ac566
3a39bfdb8bca3fa59e767961c5967880b9c0b95c
F20101112_AACHZQ chittester_n_Page_029.tif
6a7a69a15802c7210b70282270a8f9d2
a20749c651eafa565f8dfb6efa4a4d90bea2f12e
865 F20101112_AACHCJ chittester_n_Page_084.txt
7056bb7665002dee621f83901c11bab5
b248c5dba932995f761def17e4bb24543835b75c
2283 F20101112_AACHBV chittester_n_Page_060.txt
2a3e1d5fd8cda12b0ceb0546257330be
f2fe70d1e30e9b9dd8eb4ca35490e8ebf531d993
F20101112_AACHZR chittester_n_Page_031.tif
d4a7a0ae76f29650003ef22fe1817ff4
861ea1a6f5b9f81bdb340ee7c8b3b53788c5347a
77011 F20101112_AACHCK chittester_n_Page_018.jpg
9bd4b0713fddcea3abe2786c5f75d720
eade5246c2c7ad065bfd474685a1bdd9557c7588
F20101112_AACHBW chittester_n_Page_029.jp2
445b017d39fa967a5bcb9e09af9d296e
857c4daeacec886757ad1cfca3ab565ef3bbb201
F20101112_AACHZS chittester_n_Page_034.tif
18a297bce4c28db7f34e4f1eb727f306
84d56fce20db808c8f72e8a80b6572b7adb78ced
45794 F20101112_AACHCL chittester_n_Page_062.jp2
ada5a671e8af074a06290927bb2bec96
75ad554ff596c7b88ebe14d534fa3524e40e1ec4
25349 F20101112_AACHBX chittester_n_Page_026.QC.jpg
cf44759bee7bd555586832f88d11220f
63ec407330145866257c7751d4548e8719b0d3d0
F20101112_AACHZT chittester_n_Page_037.tif
e4e68a0741f9f8006e80711c67228076
f87dad778e37e9a69a57b568ea6bcf94430f2037
970 F20101112_AACHDA chittester_n_Page_021.txt
c5b8b70cb1026cffd4b0c57bb25f7b15
cf9ff7fc41f059a1ac101b56c81fdfaeb2179b74
F20101112_AACHCM chittester_n_Page_074.QC.jpg
951b472ecb8b2a5e3c98d8aa72ab6418
d629e9dec21062e4e789279b54a70a9b88b29339
98260 F20101112_AACHBY chittester_n_Page_100.jpg
47e3ea3d34f7581ddc2973d0397cb28b
49d46c338e75d25ca9f6e45bced0e4ced7c00541
F20101112_AACHZU chittester_n_Page_038.tif
8b972a202ec824744677a7ad262d7c4d
36d29c7fb3591d430a13f3e1ac07190c70893d82
2183 F20101112_AACHDB chittester_n_Page_037.txt
f4a3eab714eb8374a294996e1b3286bd
4fd90431661c8a64cbb1b79e4cbf48d8792f638b
53512 F20101112_AACHCN chittester_n_Page_057.pro
54bcb2d7000fc28ecdec220fbf0a1e34
83a0d0bdc7b96aad4af4961d5602df624159a4c1
F20101112_AACHBZ chittester_n_Page_084.tif
67289f315703ffff05e2cfe5160d72bf
9a0053c5a1e5cd6c1f11f3576dc59b06595ab1c8
F20101112_AACHZV chittester_n_Page_043.tif
dc6a9f282e2e5567487cf804a8b5d985
deed6092083bb7a6d05b3b6c2c7f260ddd08c66e
74130 F20101112_AACHDC chittester_n_Page_065.jp2
63468e3df9ce155161bb7fb31f1c0269
566e8477a55ce9a17fc9df68247ed0de8b88b6c0
25305 F20101112_AACHCO chittester_n_Page_031.QC.jpg
5d7796ce2958b49880059896938bda30
9ce7dcc9368a5ce0d876d98f968d6d8d1df2977b
F20101112_AACHZW chittester_n_Page_047.tif
25125023b83edaa5b039dec95eae00d2
77480f75f78dbbbd06c2d79d0f0e8b1277cace11
61123 F20101112_AACHCP chittester_n_Page_089.jp2
641f3626947c2e0dcc7dd3e52396a3c5
9dc9d834cef021979875b9888166f08fab02611a
F20101112_AACHZX chittester_n_Page_059.tif
e1ee674e77e1ee1b56be650af4e47176
1739f8e0958159c310c4f55d6da246e2a5312d78
46887 F20101112_AACHDD chittester_n_Page_023.pro
f042e702da0de91b76ac598c0d69196c
99eedf33dd2da2903d828a54a56afa3f6958a6c3
7359 F20101112_AACHCQ chittester_n_Page_098thm.jpg
0289622d18c01f0ae9d35f4a767471cc
3ced02ca85414d6c86c03e962996444d44b7c12f
F20101112_AACHZY chittester_n_Page_061.tif
775e0faeaa4d0dfb7c817d42c83c4fba
9fc1c578be997eeb967d9f08eeae13f1023b9c91
58819 F20101112_AACHDE chittester_n_Page_030.jp2
7c2502a405a509b128868cd5139c4b6f
0cc4f9485692ebf0b56b17450ed76e79e0aa4a36
3195 F20101112_AACHCR chittester_n_Page_066thm.jpg
97cef5df6e6942436d338365880d077b
30021007322038b925ab6b9a2280209d0f8814b1
113907 F20101112_AACHDF chittester_n_Page_055.jp2
4cf5675a20cd9317b53425125d918df1
031638daf7b534835dfb3a75f51a76d3e31db50e
53769 F20101112_AACHCS chittester_n_Page_073.pro
d515b72fc22735351846c36c33ea9e67
3d3cd5e90c8ce51167d73a1b8557cd75d0d7902d
F20101112_AACHZZ chittester_n_Page_065.tif
94d945e76db1a23e14a59544c5214644
d28f32ebb552554016a7df54e1991c8c87f436c2
115785 F20101112_AACHDG chittester_n_Page_077.jp2
4b241b187a2935ac45c0e19613253df5
0c0563ead0b86afbe6d115c667fc0f4351fb2034
6728 F20101112_AACHCT chittester_n_Page_020thm.jpg
e279e36537665f6665174957de649b05
0855653e291c371df90e854000e6b24ec2430d86
53280 F20101112_AACHDH chittester_n_Page_067.jp2
4bea77181f76e9940dc26ba28411473b
4d9cc6b8965dfca2c4529d98f640cff4305d4e44


Permanent Link: http://ufdc.ufl.edu/UFE0020125/00001

Material Information

Title: Prediction of Drive for Muscularity by Body Composition and Psychological Factors
Physical Description: Mixed Material
Copyright Date: 2008

Record Information

Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
System ID: UFE0020125:00001

Permanent Link: http://ufdc.ufl.edu/UFE0020125/00001

Material Information

Title: Prediction of Drive for Muscularity by Body Composition and Psychological Factors
Physical Description: Mixed Material
Copyright Date: 2008

Record Information

Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
System ID: UFE0020125:00001


This item has the following downloads:


Full Text





PREDICTION OF DRIVE FOR MUSCULARITY BY BODY COMPOSITION AND
PSYCHOLOGICAL FACTORS
























By

NICKLES I. CHITTESTER


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA

2007

































2007 Nickles I. Chittester

































Dedicated to my parents, Tom and Leanne Chittester.









ACKNOWLEDGMENTS

Several people provided their assistance on this project. I would like to give special thanks

to Dr. Heather Hausenblas, not only for serving as the chair for this committee, but also for her

guidance, assistance, and encouragement on this project and others I have undertaken. I wish to

thank the members of my committee-Dr. Pete Giacobbi, Dr. Chris Janelle, and Dr. Sam

Sears-for their suggestions at various stages of the study. In addition, I would like to thank the

numerous class instructors who enabled me to recruit participants for this study, as well as fellow

graduate students Brian Cook, Jessica Doughty, and Anna Campbell for their friendship and

support.

My fiancee, Mindy Mansour, has been a steady source of support during this project, and I

wish to express my heartfelt thanks to her for her love and understanding. Finally, I would like to

express the sincerest of appreciation for my parents, Tom and Leanne Chittester, for their

steadfast and unconditional love, support, and encouragement throughout my life.










TABLE OF CONTENTS

page

A C K N O W L ED G M EN T S ............................................................ ..................................... .....

L IS T O F T A B L E S ................................................................................. 7

LIST OF FIGURES .................................. .. .... ... ...............8

ABSTRAC T ........................................................................ 9

CHAPTER

1 IN TR O D U C TIO N ............... .............................. ..................... ........ .. 11

2 M A TER IA L S A N D M ETH O D S ........................................... ...........................................22

S u b j e c ts ................................................................................................................2 2
M easu res ................... ...................2...................2..........
B o dy F at P ercen tag e ................................................................................................... 2 3
F F M I ................... ...................2...................3..........
B M I..... . ................................................23
D em graphic Inform action .......................................................................................... 24
Exercise B ehavior.................................................. 24
E eating P anthology ....................................................... 25
S u p p lem e n t U se .......................................................................................................... 2 5
S o cio cu ltu ral P ressu re ................................................................................................ 2 6
D rive for M uscularity .........................................................................26
E x ercise D ep en d en ce .................................................................................................. 2 7
S elf-e steem ................................................................2 7
P ro c e d u re .............. .... ...............................................................2 8
D ata A analysis .................................................. 29

3 L IT E R A T U R E R E V IE W ................................................................ ............................... 3 1

W h at Is It? ............. ..... ............................................................ 3 1
Initial Identification ................................................................33
M easurem ent ................................................................................ ............... 33
Heuristic Model of Male Body Change Strategies ..............................................................34
B io lo g ic al F a cto rs ....................................................................................................... 3 5
Body composition/BMI...................... .......... ......... 35
P ub ertal grow th ................................................................37
P u b e rta l tim in g .................................................................................................... 3 8
P psychological Functioning ...........................................................39
N eg ativ e affe ct .................................................................................................... 3 9
S e lf-e ste e m .....................................................................................................3 9
Societal Factors ....................... ...... ... .. ... .. .. ......... ........ 40









M edia influence .................. ...................................................... .. 40
P eer and parental influence ........................................................... .....................4 1
T e a sin g ..............................................................................4 2
P e e r p o p u la rity ................................................................................................... 4 3
Social B ody Com prison ........................................................... .. ............... 43
B ody-im age D issatisfaction.................................................. ............................... 43
M uscularity ................................................................................................... .......44
B o d y fat ........................................................................................4 5
Health Risk Behaviors ............... ......................................... ............ 46
S te ro id s ............................................................................................................... 4 6
Steroid precursors.......... ..... .......................................................... .......... ...... 47
E p h e d rin e ........................................................................................................... 4 9
D ieting to lose w eight .............. ........ ...... .................. .. ............ ............. 50
Dieting to gain weight/increase muscularity .........................................................50
S p o rts .................. ....................... .............................................................................. 5 2
Organized and inform al team sports ............................................. ............... 53
Weightlifting ........................................53................53
Other Factors Related to Male Body-Image Disturbance.....................................................54
E eating D disorders ................................................................... 54
A n orex ia n erv o sa ........... ..... ....................................................................... .. ....... .. 56
B ulim ia nervosa.................................................... 56
Binge-eating disorder .................. .......................... ........ ................. 57
E exercise D ependence........... ..................................................................... ....... .. .... 57
Rom antic Partners ..................................... .. .......... .. ............59
S u m m ary ................... ...................6...................0..........

4 R E SU L T S .............. ... ................................................................63

D descriptive Statistics ................................................................... 63
M multiple R egression A naly ses .......................................................................................... 63

5 D IS C U S S IO N ........................................................................................................6 9

L im itatio n s ................... ...................7...................5..........
F utu re R research ................................................................7 8

APPENDIX

A L IST O F M E A SU R E S ..................................................................................................... 84

B R E C R U IT M E N T FL Y E R ................................................................................................ 92

LIST OF REFERENCES ..................................................................... .........93

BIOGRAPHICAL SKETCH .................. .................. ...................................... 106





6









LIST OF TABLES


Table page

4-1 D escriptive statistics for outcome e variables .............................................. ............... 65

4-2 Correlation m atrix of outcome e variables ........................................ ......................... 66

4-3 Stepwise regression predicting drive for muscularity using subjective BMI .......................67

4-4 Stepwise regression predicting drive for muscularity using objective BMI .........................68









LIST OF FIGURES


Figure pe

3-1 A heuristic model of male body change behavior; solid arrows indicate relationships
w ith greater support than broken arrow s ........................................ ....................... 62

5-1 Proposed continue for male body-image disturbance....................................... .......... 83









Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

PREDICTION OF DRIVE FOR MUSCULARITY BY BODY COMPOSITION AND
PSYCHOLOGICAL FACTORS

By

Nickles I. Chittester

May 2007

Chair: Heather A. Hausenblas
Major: Health and Human Performance

The ideal physique for men that is portrayed in the media is a lean and muscular

physique, particularly upper body muscularity. The desire to obtain this ideal physique has

resulted in increased body dissatisfaction within men. High levels of body dissatisfaction may

result in a specific drive for muscularity wherein a man holds attitudes that muscularity is crucial

to attain; this attitude is often accompanied by extreme body change behaviors aimed at

increasing muscularity. Drive for muscularity is associated with low self-esteem, exercise

dependence, eating pathology, and substance abuse (e.g., anabolic steroids, dietary supplements).

Information on the psychological risk and maintenance factors of drive for muscularity is sparse.

Furthermore, body composition is believed to be an important factor in the drive for muscularity;

body mass index (BMI), a simple height-to-weight ratio is most often used, followed by fat-free

mass index (FFMI; e.g., the amount of body weight attributable to muscle), and finally body fat

percentage. BMI has been associated with general body-image disturbance in men, but this

measure of body composition is limited because it does not account for weight attributable to

muscle-a key factor in the drive for muscularity. Thus, it is unclear which measure of body

composition (e.g., BMI, FFMI, body fat percentage) is most useful in understanding the









physique-related aspect of drive for muscularity. This is critical to understand because whether

drive for muscularity is related to actual or perceived degree of muscularity (similar to the

question of actual vs. perceived thinness as it relates to the drive for thinness in women) remains

equivocal.

This study's objective was to identify the psychological and body composition predictors

of drive for muscularity. To achieve this, 113 men completed psychological (e.g., self-esteem,

exercise dependence, eating pathology, substance abuse) and body composition (e.g., BMI, body

fat percentage, FFMI) measures. Multiple regression analysis was conducted to determine the

psychological and body composition measures that were most predictive of drive for

muscularity. The results indicated that drive for muscularity is predicted by weightlifting,

supplement use, exercise dependence, and self-esteem; however, none of the body composition

measures predicted drive for muscularity. Future research efforts should focus on clarifying the

role of body composition in drive for muscularity and on developing interventions that target

behaviors (e.g., exercise, supplement use) that are associated with drive for muscularity.









CHAPTER 1
INTRODUCTION


Kostanski, Fisher, and Gullone (2004) argued that body-image disturbance is so common

that it is a normal part of a young woman's life. Is it really that common? Consider the three

following findings (Spitzer, Henderson, & Zivian, 1999):

* the body mass index (BMI) of Playboy centerfolds decreased from 18.12 in 1977 to 18.03
in 1996 (18.50 is considered the low end of the "normal" range; Willett, Dietz, & Colditz,
1999);

* the BMI of Miss America beauty pageant winners decreased from 19.35 in 1953 to 18.06
in 1985;

* the BMI of American women has increased from 22.20 in the 1950s to 24.50 in 1990
(24.90 is considered the high end of the "normal" range; Willett et al., 1999).

Based on these findings it is clear that the slimmer female ideal promoted through the

media is being viewed by American women who are becoming progressively larger.

Consequently, several researchers believe that this disparity between media representation of the

female "ideal" and the female reality is a main factor in body-image disturbance (e.g., Cattarin,

Thompson, Thomas, & Williams, 2000; Spitzer et al., 1999). Recent research, however, indicates

that women have less body dissatisfaction than their cohorts from the mid-1990s (Cash, Morrow,

Hrabosky, & Perry, 2004). While encouraging, the following caveat exists: Cash et al. (2004)

drew these cohorts from the same university, therefore limiting the generalizability of this

finding.

In contrast to recent body-image research on women, body-image disturbance among men

is on the rise, in part because of the now-prevalent portrayal of the male "ideal" in the mass

media (Pope, Phillips, & Olivardia, 2000). For example, Spitzer et al. (1999) analyzed the body

size of Playgirl centerfolds and they found a sharp increase in BMI from 1986 to 1996, while









simultaneously observing an increase in the average American man's BMI. At first this may

seem congruent, however the increase in body size of the Playgirl centerfolds is attributable to

muscle mass, whereas the increase in BMI for American men is attributable to fat. Indeed, Leit,

Pope, and Gray (2001) confirmed this in a similar study of Playgirl centerfolds. Furthermore, the

action figures young boys play with are becoming more muscular. For example, assuming the

1998 Batman action figure stood 5'10", Pope, Olivardia, Gruber, and Borowiecki (1999)

calculated that, given his physical proportions, he would have a 30.3" waist, a 57.2" chest, and

26.8" biceps. These measurements do not represent the typical man, for if Batman were to enter

the Mr. Olympia bodybuilding competition he would pose a serious threat to usurping the

reigning champion (arguably the most muscular man on earth), who at a height of 5' 11" has a

58" chest and 24" biceps. Unfortunately, by playing with extremely muscular action toys, boys

are exposed to the muscular "ideal" at an increasingly younger age.

Therefore, despite some limited evidence to the contrary (e.g., Rozin, Trachtenberg, &

Cohen, 2001), it appears that a disparity between the "ideal" physique and reality has also

emerged for men. Identifying the time at which men began looking at their bodies with more

dissatisfaction is difficult, but Chung (2001) argued that the rise to stardom in the 1980s of

bodybuilders such as Arnold Schwarzenegger, who eventually became President George H.W.

Bush's Fitness Council head, was one factor. According to Chung (2001), Schwarzenegger's

prominent role as the pinnacle of fitness inadvertently set the bar higher for what acceptable

muscularity is.

Indeed, this "drive for muscularity," along with a simultaneous dissatisfaction with degree

of body fat, is the main source of body-image disturbance in men (Pope, Phillips, et al., 2000).

Moreover, some men who possess the "ideal" physique nevertheless view themselves as either









small or puny (Pope, Katz, & Hudson, 1993). For example, the individual may adopt a strict diet,

forego social engagements and other activities in favor of spending more time in the gym, and in

some instances use anabolic steroids to add more muscle mass. In addition, some highly

dissatisfied men may engage in other compulsive muscle-related behaviors such as mirror-

checking and weigh-ins several times a day (Pope, Gruber, Choi, Olivardia, & Phillips, 1997).

This unique form of male body-image dissatisfaction, termed muscle dysmorphia, is also

associated with mood disorders, anxiety, and disturbed eating practices (Pope, Phillips, et al.,

2000).

As with women, body-image disturbance in men is a strong risk factor for eating disorders

(Stice, 2002), and it is associated with low self-esteem in boys as young as 8 years old (Grilo &

Masheb, 2005; McCabe & Ricciardelli, 2003; McCreary & Sasse, 2000). Also, male body-image

disturbance is positively associated with depression (Kostanski & Gullone, 1998; McCreary &

Sasse, 2000; Olivardia, Pope, & Hudson, 2000), which is a strong predictor of body

dissatisfaction in high school boys (Presnell, Bearman, & Stice, 2004). Finally, some men may

exercise excessively to achieve the "ideal" physique, which may lead to exercise dependence

(Hausenblas & Symons Downs, 2002a, 2002b; Smith & Hale, 2004; Smith, Hale, & Collins,

1998); which is associated with physical and psychological difficulties (e.g., withdrawal

symptoms, decreased time spent with family or friends, overuse injuries; Andersen, Cohn, &

Holbrook, 2000; Pope, Phillips et al., 2000).

Because male body-image disturbance is centered on a preoccupation with muscularity, a

key issue is that this preoccupation will lead to the adoption of unhealthy behaviors to gain

muscle and decrease fat. For example, disturbed eating practices are often observed in men with

body-image disturbance (Cafri, Thompson, Ricciardelli, McCabe, Smolak, & Yesalis, 2005), and









these eating practices have the following two goals: 1) to add muscle mass by eating high

amounts of protein, and 2) to restrict foods high in fat content to decrease overall adiposity.

However, one limitation to understanding these eating behaviors is that they are typically

assessed by the use of instruments designed to assess eating disorder pathology (e.g., Eating

Disorder Inventory-2). These measures do not capture the unique eating behaviors undertaken

by individuals whose goal it is to increase muscle mass and shred body fat (e.g., paying close

attention to the macronutrient breakdown of each meal consumed). Furthermore, these

instruments have been validated in female eating disordered samples for whom eating pathology

is qualitatively different (i.e., restricting food intake to decrease body size) when compared to a

man who has a high drive for muscularity (i.e., eating large amounts of food to increase body

size in the form of muscle). Therefore, a measure validated in men would add more

understanding as to the specific nature of the eating pathology seen in men attempting to gain

muscle.

The use of dietary supplements is common in men high in drive for muscularity

(Kanayama, Pope, & Hudson, 2001). Although popular and expensive (Saper, Eisenberg, &

Phillips, 2004), they generally show little impact on muscle mass (Kreider, 1999), and they may

promote dependence (Kanayama et al., 2001), and have harmful side effects (Haller & Benowitz,

2000). The use of anabolic steroids is also a practice adopted by many men in their pursuit for

muscularity (Chng & Moore, 1990; Cole, Smith, Halford, & Wagstaff, 2003; Wroblewska,

1997). This is alarming because of the health risks associated with anabolic steroid use (e.g.,

hypertension, disturbed lipid profiles, increased irritability, increased aggression, body-image

disturbance, and mood disturbances; Hartgens & Kuipers, 2004).









Surprisingly, little research has examined body composition in relation to general body-

image disturbance or drive for muscularity. Indeed, satisfaction with body composition is critical

in determining whether body-image disturbance will develop in men. For example, BMI is

related to body-image disturbance in men (Kostanski et al., 2004; Kostanski & Gullone, 1998;

Presnell et al., 2004), and this relationship is either positive or negative depending on whether

the body-image disturbance reflects (1) a self-perception that one is too thin, which results in a

drive for muscularity; or (2) a self-perception that one is too heavy, which results in

simultaneous drives to lose body fat and add muscle. Two studies (McCabe, Ricciardelli, &

Banfield, 2001; McCreary, Karvinen, & Davis, 2006) have found that BMI was negatively

correlated with body satisfaction in boys and men respectively. However, McCabe et al. (2001)

also found that no correlation between BMI and a desire to increase muscle tone existed. This

latter finding is consistent with the findings of McCreary and Sasse (2000) that BMI was

uncorrelated with drive for muscularity. Taken together, these null findings indicate a need to

clarify the relationship between BMI and drive for muscularity.

Because BMI does not yield precise estimates of body fat percentage and muscle mass,

direct assessment of these latter two measures of body composition is preferable when

conducting male body-image research. Upon reading the muscle dysmorphia literature one

recognizes the importance of these assessments, yet only McCreary et al. (2006) used BMI, body

fat percentage, and muscle mass (expressed as fat-free mass index [FFMI]) to predict drive for

muscularity. They found that BMI was significantly correlated with both body fat percentage (r =

.68) and FFMI (r = .93), and that a moderate yet significant correlation existed between body fat

and FFMI (r = .41; McCreary et al., 2006). However, the only anthropometric measure that

significantly predicted behaviors related to drive for muscularity was flexed bicep circumference









(McCreary et al., 2006). Thus, there exists a need to clarify which measure of the three main

body composition measures is most informative when conducting drive for muscularity research.

Cafri et al. (2005) attributed the lack of body composition assessment to factors such as

time constraints on researchers, the need for personnel trained in body fat assessment, and cost

associated with techniques such as hydrostatic weighing and Dual Energy X-ray Absorptiometry.

The result is an absence of information pertaining to the body fat percentages and extent of

muscle mass possessed by persons with a high drive for muscularity. Identifying and clarifying

such relationships would be helpful in developing a precise model of the drive for muscularity.

The purpose of this study was to determine the psychological (e.g., self-esteem, exercise

behavior, exercise dependence, eating pathology) and body composition (e.g, BMI, body fat, fat-

free mass index [FFMI]) predictors of drive for muscularity in college-aged men. In accordance

with this purpose, the following hypotheses were advanced:

Self-esteem. Similar to research in women (Stice, 2002), self-esteem is a predictor of

negative body-image in men (Kostanski & Gullone, 1998). Self-esteem is also negatively

correlated with body and muscle dissatisfaction in men (Cafri, Strauss, & Thompson, 2002;

Kostanski & Gullone, 1998; McCreary & Sasse, 2000). However, in contrast to women, men

who are thin do not report greater self-esteem than normal weight men (Mazzeo, Slof, Tozzi,

Kendler, & Bulik, 2004); it is believed that this is because a thin woman is closer to the female

"ideal" body whereas a thin man is farther from the "ideal" muscular male body. In addition, low

self-esteem predicts problematic eating behavior, increased dieting, and use of binge-purge

cycles (McGee & Williams, 2000; Neumark-Sztainer & Hannan, 2000; Stice, 2002). In light of

these findings, I hypothesized that self-esteem would be a negative predictor of drive for

muscularity.









Exercise. Although some studies indicate that exercise is associated with greater body

satisfaction in men (e.g., Davis & Cowles, 1991; Hausenblas & Fallon, 2002; Williams & Cash,

2001), other studies with men have found exercise behavior to be associated with body

dissatisfaction (Tiggemann & Williamson, 2000; Varnado-Sullivan, Horton, Savoy, 2006).

Specifically, some studies have found that weightlifting is related to the drive for muscularity,

greater physique dissatisfaction, and muscle dysmorphia (Lantz, Rhea, & Cornelius, 2002;

McCreary & Sasse, 2000; Pope et al., 1997), but other research has found weightlifting to

increase body satisfaction (Fisher & Thompson, 1994; Williams & Cash, 2001). Part of the

discrepancy in study findings may be related to the measure of exercise. That is, some exercise

measures were general and assessed aerobic and anerobic exercise in a nonspecific context (e.g.,

Hausenblas & Fallon, 2002), whereas other studies have focused on weightlifting (e.g., Williams

& Cash, 2001). It is conceivable that exercise measures that focus on weightlifting may be more

strongly related to drive for muscularity than general exercise measures because theoretically

weightlifting should be related to drive for muscularity. Thus, I assessed both general exercise as

well as weightlifting measures to determine if there was a difference. I hypothesized that

weightlifting would be a stronger predictor of drive for muscularity than general exercise

behavior.

Dietary supplements. A method many men use to achieve greater muscularity while

decreasing body fat is taking dietary supplements (Kanayama et al., 2001). Men who have body

dissatisfaction often use dietary supplements to increase muscularity (Varnado-Sullivan et al.,

2006). Of importance, adolescent boys who report supplement use have lower body esteem than

nonsupplement using adolescent boys (Smolak, Murnen, & Thompson, 2005). The popularity of

supplements for these purposes has led Kanayama et al. (2001) to refer to these supplements as









"body-image drugs." Therefore, I hypothesized that the use of dietary supplements would be a

significant predictor of drive for muscularity.

Eating pathology. McCreary and Sasse (2000) found that drive for muscularity is

significantly higher in adolescent boys trying to gain weight (via unhealthy eating practices) than

those who are not; and it is well established that body dissatisfaction and eating pathology are

related (Olivardia et al., 2000; Olivardia, Pope, Mangweth, & Hudson, 1995). For example, in

their study of 18-25-year-old men, Heywood and McCabe (2006) found a significant correlation

between dietary restraint and body dissatisfaction related to body parts such as the shoulders,

chest, and arms. Furthermore, in their study of 83 bodybuilders, weightlifters, and athletically

active controls, Hallsworth, Wade, and Tiggemann (2005) found that, after controlling for BMI,

drive for muscularity was significantly related to the Bulimia subscale of the Eating Disorders

Inventory. Therefore, I hypothesized that eating pathology would be a significant predictor of

drive for muscularity.

Sociocultural pressure. The etiology of drive for muscularity is multifactorial, and it is

believed to include sociocultural sources such as peers, parents, and romantic partners. For

example, during adolescence boys who mature early (and thus move closer towards the male

"ideal" physique) enjoy high popularity, but also are more likely than boys who have not yet

reached puberty to engage in body change strategies (e.g., weightlifting, dieting to gain weight,

supplement use; McCabe & Ricciardelli, 2004a). Other research indicates that experiencing

teasing from peers is associated with decreased body satisfaction (Paxton, Eisenberg, &

Neumark-Sztainer, 2006); furthermore, encouragement from parents to lose weight has been

associated with both decreased body satisfaction and use of muscle building strategies (e.g.,

steroid and supplement use; Smolak et al., 2005; Wertheim, Martin, Prior, Sanson, & Smart,









2002). In addition, there is limited evidence that men told by a female dating partner to gain

weight (presumably in the form of muscle) report low relationship satisfaction (Sheets &

Ajmere, 2005), although other research indicates that men may be dissatisfied with their bodies

despite a female dating partner's satisfaction with it (Ogden & Taylor, 2000). Taken together,

there is sufficient reason to believe that sociocultural pressure does impact drive for muscularity;

therefore, I hypothesized that sociocultural pressure would be a significant predictor of drive for

muscularity.

Exercise dependence. Exercise dependence is believed to be a key aspect of male body-

image disturbance, especially muscle dysmorphia (Rhea et al., 2004). While moderate amounts

of exercise are associated with greater body satisfaction (Williams & Cash, 2001), excessive

amounts of exercise are associated with greater body-image disturbance (Pope et al., 1997; Rhea

et al., 2004). Furthermore, exercise dependence is predicted by weight loss strategies (which is

associated with male body-image disturbance) in adolescent boys (McCabe & Ricciardelli,

2004a). Therefore, I hypothesized that exercise dependence would be a significant predictor of

drive for muscularity.

BMI. Although there exists a relationship between BMI and male body-image disturbance

wherein both high and low BMI are associated with greater dissatisfaction (Frederick, Peplau, &

Lever, 2006; Gila, Castro, Cesena, & Toro, 2005), McCreary et al. (2006) recently found that

BMI was not a predictor of drive for muscularity. A possible explanation for this is in the nature

of the BMI itself: because it is a height-to-weight ratio, it does not distinguish between weight

attributable to body fat versus weight attributable to muscle. This distinction is critical because,

by definition, the drive for muscularity is specifically associated with a desire to have larger

muscles. Therefore, in light of both the finding of McCreary et al. (2006) and the nonspecificity









inherent in the BMI, I hypothesized that BMI would not be a significant predictor of drive for

muscularity.

FFMI. While FFMI is significantly higher in men with muscle dysmorphia than normal

comparison men (Olivardia et al., 2000), a recent study found that FFMI did not emerge as a

predictor of drive for muscularity (McCreary et al., 2006). The authors speculated that perhaps

self-assessment of muscularity is compromised because a layer of body fat "hides" the true

extent of a man's muscularity, and that the actual degree of muscularity one possesses is most

easily appraised in men who either have low body fat or have very well-developed muscles.

Therefore, because the men in this study were expected to have normal levels of body fat

(thereby "concealing" the degree of muscularity the men actually possessed), I hypothesized that

FFMI would not be a significant predictor of drive for muscularity.

Body fat percentage. Male body-image disturbance is centered around degree of

muscularity; when given the opportunity to indicate ideal body fat percentage, men generally do

not report desiring body fat percentage that is a large departure from what they currently have

(Cafri et al., 2002). Pickett, Lewis, and Cash (2005) found that although noncompetitive weight

trainers score significantly higher than athletically active controls on measures of body image

such as appearance orientation, appearance evaluation, and satisfaction with muscle tone, they

have similar body fat percentage. Furthermore, Olivardia et al. (2000) found similar levels of

body fat percentage between men with muscle dysmorphia and normal comparison men.

Although some research has found body-image satisfaction and body fat percentage to be

inversely related (e.g., Huddy, Johnson, Stone, Proulx, & Pierce, 1997), the trend of most

research on the topic is that body fat percentage is not the primary concern in male body-image,

a point reinforced by McCreary et al. (2006) when they found that body fat percentage did not









emerge as a predictor of drive for muscularity. Therefore, I hypothesized that body fat

percentage would not be a significant predictor of drive for muscularity.

Self-report BMI vs. measured BMI. Although many studies rely on self-reported (as

opposed to measured) values of height and weight to derive participants' BMI, there is question

as to how accurate such self-reported values are. Specifically, several studies have found that

"subjective" BMI is significantly lower than "objective" BMI (Brener, McManus, Galuska,

Lowry, & Wechsler, 2003; Elgar, Roberts, Tudor-Smith, & Moore, 2005; Hill & Roberts, 1998).

Therefore, I hypothesized that "subjective" BMI (resulting from self-reported height and weight

at pre-screening) would be significantly lower than "objective" BMI (resulting from objective

measurement of height and weight as assessed at the testing session), as evidenced by a paired-

samples t-test.









CHAPTER 2
MATERIALS AND METHODS

Subjects

Because multiple regression was to be used to examine the study's purposes, the power

tables developed by Green (1991) for multiple regression analyses were used to determine

sample size. Based on the maximum number of predictors for the multiple regression analysis

(9), to detect a medium effect with c = .05, a sample of 113 was required for a power of .80

(Green, 1991); therefore, the target sample size for this study was N= 113. To be eligible for

inclusion, participants had to be men between the ages of 18-24; this age range was selected not

only because other studies have used a similar age range (e.g., Heywood & McCabe, 2006), but

also to remove age as a potential confounding variable in light of evidence that men of this age

have different motivations for exercising than do older men (e.g., mid-30s and older; Davis &

Cowles, 1991; Tiggemann & Williamson, 2000). The mean age of the 113 men in this study was

20.34 years (SD = 1.52, Range = 18-24 years); most described their ethnicity as White (n = 77),

followed by Hispanic (n = 14), Asian (n = 9), Black (n = 6) or Middle Eastern (n = 2). In

addition, each of the following descriptions of ethnicity was provided once: American, East

Indian, Indian, Jewish, and Pacific Islander. Most of the men reported their sexual orientation as

heterosexual (n = 105). With respect to academic standing, juniors were most frequent (n = 40),

followed by seniors (n = 33), sophomores (n = 21), freshmen (n = 18), and completion of a

masters degree (n = 1). Two participants reported current use of anabolic steroids, while one

reported past but not current use of anabolic steroids.

Measures

The following variables were assessed in the study (see Appendix A).









Body Fat Percentage

Body fat percentage was assessed by the researcher using the 3-site (chest, abdomen,

thigh) skinfold method for men (American College of Sports Medicine, 2000). This method

correlates strongly with the hydrostatic weighing method, and it has an error of 3.5% (ACSM,

2000).

FFMI

Each participant's FFMI was determined to quantify degree of fat-free mass. The equation

for FFMI (Kouri, Pope, Katz, & Oliva, 1995; Pope, Gruber, et al., 2000) is:

{Wt x (100-BF%) / Ht2 x 100} + 6.1 (1.8-Ht)

where "Wt" is weight in kilograms, BF% is body fat percentage, and "Ht" is height in meters.

The FFMI of nonweightlifting men typically ranges from 18-21; nonsteroid using bodybuilders

typically have a FFMI between 21-25, and steroid using bodybuilders typically have a FFMI

from 25 to the low 30s (Olivardia et al., 2000). The importance of ascertaining FFMI in studies

of body image is well-noted (e.g., Eston, 2002).

BMI

BMI assesses weight (kg) relative to height (m2). While BMI correlates significantly with

body fat percentage (EPIETOOA, 1998), it is used mainly to determine overweight or obese

status (Wei et al., 1999). People with a BMI between 18.5 to 24.9 kg/m2 are classified as normal;

people with a BMI of 25.0 to 29.9 kg/m2 are classified as overweight, and people with a BMI of

30.0 kg/m2 or greater are classified as obese (Willett et al., 1999). BMI was calculated in two

ways: a) subjectively via self-reported values of height and weight at pre-screening, and b)

objectively via measurements of height and weight as assessed upon arrival at the Exercise

Psychology laboratory. BMI was derived in these two ways because, while many

epidemiological studies calculate BMI based on self-reported height and weight, there is









mounting evidence that BMI based on objectively measured height and weight is more accurate

(e.g., Brener et al., 2003; England et al., 1998).

Demographic Information

The following demographic information was obtained from each participant: age, ethnicity,

sexual orientation, academic standing (if applicable), past/current anabolic steroid use, and

current duration/frequency of cardiovascular and weightlifting sessions (detailed in the next

section). Author developed questions related to anabolic steroid use were the following: (1) "Are

you currently using anabolic steroids in order to build muscle mass?", which required either a

"yes" or "no" response; (2) "If you are not currently using anabolic steroids to build muscle

mass, have you in the past?", which required either a "yes," "no," or "not applicable" response;

similar methods have been employed to ascertain anabolic steroid usage (e.g., Neumark-Sztainer,

Story, Falkner, Beuhring, & Resnick, 1999).

Exercise Behavior

Typical exercise behavior was assessed with the Leisure-Time Exercise Questionnaire

(LTEQ; Godin & Shephard, 1985). The LTEQ asks participants to indicate how frequently

during a typical week they engage in mild, moderate, and strenuous exercise for at least 15

minutes. An overall weekly exercise index is then derived from the following formula:

3(frequency of participation in mild activities during the past week) + 5(frequency of moderate

activities) +9(frequencies of strenuous activities). The LTEQ has adequate reliability and validity

(Godin, Jobin, & Bouillon, 1986), and correlates moderately with VO2max, an index of

cardiorespiratory fitness (Jacobs, Ainsworth, Hartman, & Leon, 1993).

Because the LTEQ does not specify the mode of exercise, participants were asked the

following author-developed questions on the demographic survey: (1) "How many sessions of

cardiovascular activity do you engage in per week, and how long does a typical session run?"









and (2) "How many sessions of weight training do you engage in per week, and how long does a

typical session run?" For this latter question, because no standardized measures of weightlifting

frequency or session duration exist, a weightlifting index (frequency x duration) was calculated.

This was done because the LTEQ does not specify how much overall activity is due to

weightlifting; this form of exercise is of critical interest in the present study because

weightlifting is the primary exercise behavior that is responsible for muscular hypertrophy,

which is what a man with high drive for muscularity strives to achieve.

Eating Pathology

Eating behavior specific to gaining muscle was assessed with the Diet subscale of the

Muscle Dysmorphia Inventory (MDI; Lantz et al., 2002; Rhea et al., 2004). This subscale asks

participants to rate the extent (1 = Never to 6 = Always) to which certain statements (e.g., "I

regulate my caloric intake to maximize muscular development") apply to them. This subscale has

good reliability in powerlifters (a = .84), bodybuilders (a = .87-.94), and recreational weight

trainers (a = .88; Lantz et al., 2002; Rhea et al., 2004), and has good construct validity (Rhea et

al., 2004). A high score indicates greater eating pathology. The internal consistency of the MDI-

Diet subscale in the present study was good (a = .82).

Supplement Use

Supplement use was assessed by the Supplement subscale of the MDI (Lantz et al., 2002;

Rhea et al., 2004). This subscale asks participants to rate the extent (1 = Never to 6 = Always) to

which certain statements (e.g., "Before a workout, I consume energy supplements.") apply to

them. This subscale has excellent reliability in powerlifters (c = .91), good to excellent reliability

in bodybuilders (a = .80-.94), and adequate reliability in recreational weight lifters (a = .75;

Lantz et al., 2002; Rhea et al., 2004). Furthermore, it has good construct validity (Rhea et al.,









2004). A high score indicates greater use of supplements. The internal consistency of the MDI-

Supplement subscale in the present study was good (a = .86).

Sociocultural Pressure

The Perceived Sociocultural Pressure Scale (Stice, Ziemba, Margolis, & Flick, 1996) was

used to assess the extent (1 = Never to 5 = Always) to which participants perceived pressure

from friends, family, dating partners, and the media to be lean and muscular. Because the scale

was originally developed for use in eating disorder populations, the items were adapted to reflect

the nature of body image of relevance to this study (the original scale is first in the appendix,

followed by the adapted version used in this study). For example, the item, "I've felt pressure

from my friends to lose weight" was changed to read as follows: "I've felt pressure from my

friends to lose body fat." An additional example would be the item, "I've noticed a strong

message from my friends to have a thin body", which was changed to read as follows: "I've

noticed a strong message from my friends to have a muscular body." The adaptation of the items

was derived after consulting with graduate students and a professor, all of whom have extensive

experience in body image research. A high score indicates greater perceived sociocultural

pressure to conform to the male "ideal." The internal consistency of the Perceived Sociocultural

Pressure Scale in the present study was acceptable (a = .75).

Drive for Muscularity

Drive for muscularity was assessed by the Drive for Muscularity Scale (DMS; McCreary

& Sasse, 2000), which is considered to be the best available scale for assessing muscularity-

related concerns (Cafri & Thompson, 2004). Specifically, the DMS is a 15-item likert-type scale

with two subscales that assesses the extent (1 = Always to 6 = Never) to which the respondent

holds attitudes (Muscle-oriented body image; MBI) and engages in behaviors (Muscularity-

related behavior; MB) indicative of the pursuit of a muscular physique. The DMS has good









reliability (c = .81-.91), and has been shown to have good face, convergent, and discriminant

validity in men (Chittester, 2003; McCreary et al., 2006; McCreary & Sasse, 2000; McCreary et

al., 2004). In accordance with the recommendation by McCreary et al. (2004), one item ("I think

about taking anabolic steroids") was omitted from the survey because it does not load on either

subscale of the DMS. All items are reverse coded so that high scores on the DMS indicate a high

drive for muscularity. The internal consistency of the DMS-MBI (a = .88) and DMS-MB ( =

.83) in the present study was good.

Exercise Dependence

Exercise dependence was assessed with the Exercise Dependence Scale (EDS; Hausenblas

& Symons Downs, 2002b). The EDS is a 21-item likert-type scale that consists of seven

subscales: withdrawal effects ("I exercise to avoid feeling stressed."), tolerance ("I feel less of an

effect/benefit with my current exercise."), continuance ("I exercise despite recurring physical

problems."), lack of control ("I am unable to reduce how long I exercise."), reduction in other

activities ("My exercise interferes with work/school responsibilities."), time ("I organize my life

around exercise."), and intention effects ("I often exercise longer than I intend."). The EDS has

acceptable reliability (Hausenblas & Fallon, 2002; Hausenblas & Symons Downs, 2002b), and

preliminary data indicate the EDS is valid (Hausenblas & Symons Downs, 2002b; Symons

Downs, Hausenblas, & Nigg, 2004). Higher EDS scores indicate greater exercise dependence.

The internal consistency of the EDS in the present study was excellent (a = .91).

Self-esteem

The Rosenberg Self-esteem Scale (Rosenberg, 1989) was used to assess global self-esteem.

This 10-item scale asks participants to rate the extent (1 = Strongly agree to 4 = Strongly

disagree) to which they agree with each question (e.g., "At times I think I am no good at all").

This scale is reliable and valid; recent research indicates it may be superior to other measures of









self-esteem (Griffiths et al., 1999). Some items are reverse coded; low scores on the Rosenberg

Self-esteem Scale indicate poor self-esteem. The internal consistency of the Rosenberg Self-

esteem Scale in the present study was good (a = .83).

Procedure

Participants were recruited with advertisements to participate in a study on body image that

would include body fat assessment (see Appendix B). These advertisements were disseminated

by either being read aloud in college classes or by being posted in various locations. The

advertisement was read aloud in select courses between August 2006 and January 2007 within

the departments of Applied Physiology & Kinesiology and Psychology at the University of

Florida, and the department of Social and Behavioral Sciences at Santa Fe Community College.

In addition, the advertisement was posted from late-June to December 2006 in the following

three ways:

* The announcement was placed on a website, http://www.my.ufl.edu, which is a secure
website accessible only to university students;

* The announcement was placed in prominent areas within selected university parking
structures;

* The announcement was placed in several private gyms and fitness centers within the
Gainesville area.

The advertisement directed interested men to an email address to write to if they wanted to

participate. The advertisement asked interested men to include the following demographic

information in their email: age, height, weight, and contact information. The researcher then

contacted each respondent (via email, or if unsuccessful, by phone call) to schedule an individual

testing session (Note: a reminder email was sent to each participant the day before his

appointment) with the primary researcher at the Exercise Psychology laboratory. Out of 159 men

who either contacted the lab to indicate they were interested in participating or signed up when









the study announcement was made in their classes, 113 men actually enrolled in the study. Once

at the testing center, after providing informed consent, the participant's height and weight was

measured by using a Healthometer scale (Chicago, IL). Height without shoes was measured to

the nearest 0.25 inch, and weight was measured to the nearest 0.25 lb. Each participant was then

asked to complete several surveys (detailed in the previous section). After the participant had

completed the surveys, body fat percentage was assessed via skinfold measurement. After all

data had been collected, the participant was debriefed and excused from the testing center.

Testing sessions were between 20-30 minutes in length. The protocol for this study was

reviewed and approved by the University of Florida Institutional Review Board prior to

participant recruitment.

Data Analysis

First, descriptive statistics for all variables were calculated, and the internal consistency

of all surveys was ascertained. In addition, once data were entered, a search for outliers (e.g., 3

or more standard deviations from the mean) and missing data was initiated. When data were

missing, the mean of the particular variable was inserted when less than 5% of the values for the

variable were missing (Cohen & Cohen, 1983). In addition, a correlation matrix was derived that

showed the correlations between the following variables: objective BMI, self-report BMI, body

fat percentage, FFMI, weightlifting index, exercise behavior (as measured by the LTEQ), eating

habits (as measured by the MDI-Diet subscale), supplement use (as measured by the MDI-

Supplement subscale), perceived sociocultural pressure, muscle-oriented body-image (as

measured by the DMS-MBI) subscale), muscle-related behaviors (as measured by the DMS-

MB subscale), drive for muscularity, exercise dependence, and self-esteem. A paired-samples t-

test was used to determine whether differences between subjective and objective BMI were

significant.









Finally, to examine the main purposes, one stepwise multiple regression analysis was

conducted. Stepwise regression was used because there exists no empirical data indicating which

factor would be the best predictor of drive for muscularity; were such data available hierarchical

regression, where the researcher specifies the ordering of predictors, would have been conducted.

The stepwise regression analysis determined which measures of body composition (Independent

variables = BMI, body fat percentage, FFMI) and psychological factors (Independent variables =

exercise behavior, weightlifting index, eating pathology, supplement use, perceived sociocultural

pressure, exercise dependence, and self-esteem) best predicted drive for muscularity (Dependent

variable). Because multicollinearity (e.g., high correlations between independent variables) was a

potential problem in this analysis, the tolerance values for the regression equation were

determined.









CHAPTER 3
LITERATURE REVIEW

Although body-image disturbance has historically been viewed as occurring mostly in

women (Pasman & Thompson, 1988; Rand & Wright, 2000), recent research has determined that

men also experience body-image disturbance (Salusso-Deonier & Schwarzkopf, 1991; Pope et

al., 1993; Pope, Gruber, et al., 2000). While in women body-image disturbance arises when one

compares her body to the thin and toned female "ideal" physique often portrayed in the media,

body-image disturbance in men arises when one compares his body to the lean and muscular

male "ideal" physique often portrayed in the media (e.g., Leit et al., 2001). Body-image

disturbance is a risk factor for eating disorders (Phelps, Johnston, & Augustyniak, 1999; Stice,

2002), and the DSM-IV-TR lists preoccupation with body shape as a criterion for both anorexia

and bulimia (APA, 2000). In addition, male body dissatisfaction is accompanied by a host of

problematic behaviors (e.g., social avoidance, steroid use, disturbed eating; Brower, Blow, &

Hill, 1994; Olivardia et al, 2000; Cafri et al., 2005), poor self-esteem (Cafri et al., 2005), and

negative affect (Olivardia, 2001; Presnell et al., 2004). Because of the myriad problems

associated with body-image disturbance, and the fact it is being observed more frequently in

boys (McCabe & Ricciardelli, 2003; Cohane & Pope, 2001), it is imperative that predisposing

factors be identified. This review focuses on the following male body-image issues: 1) What

body-image disturbance is, 2) initial identification of body-image disturbance, 3) measurement

of body-image disturbance, and 4) the Cafri et al. (2005) model of male body change strategies.

What Is It?

Body-image disturbance is a "subjective negative evaluation of one's figure or body

parts" (Presnell et al., 2004, p. 389). While body-image disturbance occurs in both men and

women, the aspect of the body from which this disturbance stems varies between the sexes. In









women, body-image dissatisfaction arises from evaluation of one's overall weight (i.e., the belief

that one is too fat), and this is coupled with concern specific to the shape of the lower torso (e.g.,

hips, thighs, and buttocks; Cash et al., 2004). However, the source of men's body-image

disturbance arises from an evaluation of muscularity (Gokee-LaRose, Dunn, & Tantleff-Dunn,

2004). Knowledge of this concern was inadvertently gained during a study on the psychiatric

effects of anabolic steroids in bodybuilders (Pope et al., 1993). The researchers observed that, of

108 bodybuilders, two (both of whom had a history of anorexia) reported such pronounced

feelings of "puniness" and weakness that they would frequently decline social invitations and

even wear heavy clothes on hot days to conceal their "small" size. Pope et al. (1993) coined the

phrase "reverse anorexia" to explain this unique body-image disturbance, which is now referred

to as muscle dysmorphia (Pope et al., 1997).

Although not explicitly stated in the diagnostic criteria advanced by Pope et al. (1997), a

man with muscle dysmorphia would have to be muscular to the casual observer to warrant

diagnosis. Because degree of muscularity can be subjective, Olivardia et al. (2000) proposed that

one's fat-free mass index (FFMI), a function of height, weight, and body fat percentage, be

calculated to determine muscularity sufficient enough for diagnosis. The FFMI of

nonweightlifting men typically ranges from 18-21; nonsteroid using bodybuilders typically have

a FFMI between 21-25, and steroid using bodybuilders typically have a FFMI from 25 to the

low 30s (Olivardia et al., 2000).

Given the muscularity requirement, one could argue that only very muscular men would

even qualify for muscle dysmorphia. However, many non weightlifting men experience body-

image disturbance, which usually focuses on a lack of muscularity. If these men do not have

muscle dysmorphia (i.e., they do not possess the muscularity required for diagnosis), what do









they have? One way to describe this body-image disturbance is in relation to one's "drive for

muscularity" and its accompanying behaviors and attitudes (McCreary & Sasse, 2000). Because

this is the most salient form of body-image disturbance in men, Cafri and Thompson (2004)

advocated that its measurement be the cornerstone of future male body-image research.

Initial Identification

The first mention of body-image disturbance is Arkoff and Weaver's (1966) article

detailing the body-image of Japanese-Americans; ironic because body-image disturbance is more

prevalent in Western society than in others (Yang, Gray, & Pope, 2005). Other early body-image

research primarily dealt with dissatisfaction in relation to facial surgery (e.g., Peterson &

Topazian, 1976; Macgregor, 1981) and obesity (Guggenheim, Poznanski, & Kaufmann, 1977).

However, by the mid-1980s researchers began to focus on the link between body-image

disturbance and eating disorders (e.g., Freeman, Beach, Davis, & Solyom, 1985); this is likely

the reason why most body-image research up to the early 1990s focused on women.

Measurement

Several measures have been developed to assess body-image disturbance in men (see

Stewart & Williamson, 2004, for a review), and the focus of each measure varies depending on

what aspect of body-image disturbance (i.e., concerns surrounding degree of muscularity or

adiposity) is of primary interest. The most widely used measures for assessing male body-image

disturbance are the Drive for Muscularity Scale (DMS; McCreary & Sasse, 2000), the

Multidimensional Body Self-Relations Questionnaire (MBSRQ; Brown, Cash, & Mikulka, 1990)

and the body dissatisfaction subscale of the Eating Disorders Inventory (EDI-BD; Garner,

Olmstead, & Polivy, 1983).

Over the past five years several new indices of male body-image disturbance have been

advanced, including the Muscle Appearance Satisfaction Scale (Mayville, Williamson, White,









Netemeyer, & Drab, 2002), Muscle Dysmorphia Survey (Chittester, 2003), Muscle Dysmorphia

Inventory (Rhea et al., 2004), and the Male Eating Behavior and Body Image Evaluation

(Kaminski, Chapman, Haynes, & Own, 2005). These measures recognize that a major

component of male body-image disturbance focuses on one's simultaneous desire for more

muscle mass and less body fat. Unfortunately, while these measures effectively assess

preoccupations and behaviors characteristic of male body-image disturbance related to

muscularity, they do not assess specific nutritional strategies employed to gain muscle mass

while simultaneously stripping away body fat. This information is critical in completely

understanding a multidimensional construct (i.e., how dietary practices, substance use, body

composition, body-image dissatisfaction, and other psychological factors interact) such as male

body-image disturbance.

Heuristic Model of Male Body Change Strategies

In an effort to organize the constructs associated with male body-image disturbance,

Cafri et al. (2005) advanced a heuristic model that maps these constructs and provides an

illustration of the strength of the various relationships that exist between the constructs (Figure

3-1). The model consists of seven main constructs, with six constructs consisting of

subcomponents. The seven main constructs (and their subcomponents) are:

* Biological Factors (body composition/BMI, pubertal growth, pubertal timing);

* Psychological Functioning (negative affect, self-esteem);

* Societal Factors (media influence, peer and parental influence, teasing, peer popularity);

* Social Body Comparison;

* Body Image Dissatisfaction muscularityy, body fat);

* Health Risk Behaviors (steroids, steroid precursors, ephedrine, dieting to lose weight,
dieting to gain weight, dieting to increase muscularity);









* Sports (organized team sports, informal team sports, weightlifting).

The present study focuses on the following components: Biological Factors, Psychological

Functioning, Societal Factors, Body Image Dissatisfaction, and Health Risk Behaviors.

Accordingly, each of these constructs will be discussed in subsequent sections of this document.

Because two constructs (Social Body Comparison and Sports) of the Cafri et al. (2005) model

are not included in the present study, the reader is referred directly to the aforementioned article

for a more in-depth review of those constructs.

Biological Factors

Body composition/BMI

BMI is a ratio of body weight (kg) to height (m2) widely employed to ascertain overweight

or obese status. According to the Expert Panel on the Identification, Evaluation, and Treatment

of Overweight and Obesity in Adults (EPIETOOA; 1998), BMI correlates significantly with

body fat percentage; it is for this reason that it is advisable to assess BMI as a routine procedure

of a patient's visit to see a physician (Manson, Skerrett, Greenland, & VanItallie, 2004).

While BMI can be conveniently ascertained from self-reported height and weight, there is

some evidence suggesting that BMI derived from self-report data is inaccurate. For example, in

their study of 6000 16-64-year-old males and females in southwestern England, Hill and Roberts

(1998) compared BMI based on self-reported height and weight to BMI based on measured

height and weight. They found that, based on self-reported BMI, 49.7% of the males were

classified as "normal," whereas 37.3% were classified as "overweight." However, based on

objectively measured BMI, they found that the exact opposite was true: only 36.1% of the males

had a "normal" BMI, while 46.7% were classified as "overweight." Furthermore, similar patterns

in the underestimation of BMI based on self-report data have been observed in 11th grade Welsh

boys (Elgar et al., 2005) as well as high school-aged boys in the United States (Brener et al.,









2003). This underestimation of BMI based on self-report data is attributed to an overestimation

of height and an underestimation of weight, although some research suggests that only at-risk

status (e.g., restrained eaters) significantly predicts weight underestimation (Shapiro &

Anderson, 2003). Taken together, these findings suggest that BMI derived from self-reported

height and weight is inaccurate, and this poses a noteworthy problem for researchers who have

large sample sizes yet need this information from their participants.

A common practice of studies on male body-image disturbance involves the calculation

of BMI to serve as an objective measure of body size, which could then be correlated with

degree of body dissatisfaction. Results of such studies have consistently shown a strong

curvilinear relationship between BMI and body dissatisfaction in males (Frederick et al., 2006;

Gila et al., 2005; Grilo & Masheb, 2005; Kostanski et al., 2004; Kostanski & Gullone, 1998;

Presnell et al., 2004). However, a clear link between BMI and either the drive for muscularity or

muscle dysmorphia, constructs that represent specific descriptions of male body-image

disturbance, has yet to be established. In fact, only two studies are known to have even

investigated the link between BMI and any variables related to either drive for muscularity or

muscle dysmorphia (Cafri, van den Berg, & Thompson, 2006; McCreary et al., 2006). In their

study of 13-18-year old boys, Cafri et al. (2006) observed small but significant positive

correlations between BMI and dieting to gain weight (r = .16) and the use of performance

enhancing drugs (e.g., anabolic steroids, ephedrine, prohormones; r = .13), but did not observe

correlations between BMI and either body dissatisfaction or muscle dymorphia symptoms (Cafri

et al., 2006). This latter finding is a surprising departure from the general male body-image

disturbance literature. In addition, McCreary et al. (2006) found that BMI was not related to









attitudes or behaviors related to drive for muscularity among college-aged men. The findings of

these studies indicate a need to clarify the role of BMI in drive for muscularity.

The most often cited reason why BMI is not used more often in drive for muscularity or

muscle dysmorphia research is the recognition that BMI is a poor measure of body composition

for persons who have a high degree of muscularity (McCabe & Ricciardelli, 2004b). For persons

with a high amount of muscle mass, BMI could easily indicate a man was obese when he

actually carried a significant amount of muscle. As a result, BMI is rarely (if ever) used as a

primary outcome variable in research on either drive for muscularity or muscle dysmorphia.

However, as has been established in this section, the decision whether to use objectively

measured BMI vs. self-reported BMI should not be taken lightly because the available data

suggest objectively measured BMI is superior to BMI based on self-report.

Pubertal growth

Puberty is a time in which a male's body changes from that of a child to a mature young

adult. For males this means an increase in body mass; specifically, a marked increase in

muscularity. Thus, this is the stage at which boys begin to acquire the physique of a man and

subsequently move closer towards the male "ideal," which is often accompanied by increased

body satisfaction (e.g., Rodriguez-Tomb, Bariaud, Cohen Zardi, Delmas, Jeanvoine, & Szylagyi,

1993). However, because puberty marks a period of body change it is possible that some

adolescent males may seek even greater levels of muscularity through a variety of means;

research on this topic is mixed. For example, O'Dea and Abraham (1999) found that trying to

lose weight is significantly more likely in boys who have already reached puberty than in

prepubescent boys, while McCabe et al. (2001) observed that pubertal growth was associated

with behavior aimed at increasing muscle tone and with increased use of food supplements

designed to add muscle mass. These findings illustrate a pattern of behavior consistent with the









simultaneous desire to decrease body fat and increase muscle mass. However, in their study of

269 adolescent boys, Cafri et al. (2006) found no relationship between pubertal development and

substance use (steroids and food supplements), muscle dysmorphia symptoms, or dieting to gain

weight. Taken together, the role of pubertal growth on body change strategies and body-image

disturbance is unclear and would benefit from further study.

Pubertal timing

Although the precise role of puberty in male body-image disturbance is unclear, there is

more certainty in how the timing of puberty impacts body-image disturbance and body change

strategies. Specifically, the available research indicates that early maturation is associated with

greater body-image satisfaction amongst adolescent boys, and that late maturation is associated

with greater body-image disturbance (McCabe & Ricciardelli, 2004a; Siegel, Yancey,

Aneshensel, & Schuler, 1999). While this may suggest an advantage to early maturation, a closer

look at the longitudinal data of McCabe and Ricciardelli (2004a) reveals that early-maturating

males are not devoid of problematic behaviors associated with their early jump into adulthood.

Consistent with the findings of O'Dea and Abraham (1999), McCabe and Ricciardelli (2004a)

found that early maturing males were more likely than on-time or late-maturing males to adopt

weight loss strategies. Furthermore, weight loss strategies predicted exercise dependence and use

of food supplements in these males eight months later. This troublesome pattern of behavior was

not exclusive to early maturing males: common findings across early, on-time, and late-maturing

males indicated that: 1) strategies to decrease weight predicted exercise dependence eight months

later, and 2) use of food supplements predicted disordered eating (McCabe & Ricciardelli,

2004a).

Indeed, with respect to body change strategies, it seems that the early-maturing males are

happy to have their increasingly masculine bodies, but they also engage in behaviors to make it









even more masculine. Needless to say, late-maturing males eventually "catch-up" to early and

on-time maturers in regards to the onset of body change behaviors, but there is a final caveat: the

only group for whom steroid use was not part of the final structural model at 8 months was the

late-maturing males (McCabe & Ricciardelli, 2004a). Perhaps there is nothing wrong with

maturing a little later after all.

Psychological Functioning

Negative affect

Negative affect or depression is positively correlated with body dissatisfaction in boys

(Kostanski & Gullone, 1998; McCreary & Sasse, 2000), and has been identified as a strong

predictor of body-image disturbance in the same population (Presnell et al., 2004). In addition,

the model proposed by Cafri et al. (2005) hypothesizes that negative affect is related to unhealthy

behaviors (e.g., use of anabolic steroids, ephedrine, special dieting techniques to minimize body

fat and maximize muscularity) often engaged in by men with body-image disturbance.

Furthermore, Olivardia et al. (2000) found that men with muscle dysmorphia had significantly

higher rates of past mood disorders (58%) than normal weightlifters (20%). With respect to body

change behaviors, a recent study found negative affect in men to be significantly positively

related to both efforts to increase muscle and dietary restraint (Heywood & McCabe, 2006). It is

of note that some studies have assessed depression in anabolic steroid users, a subgroup of

weightlifting enthusiasts and bodybuilders that may present with body-image disturbance

(Blouin & Goldfield, 1995).

Self-esteem

The relationship between self-esteem and body-image disturbance has received a fair

amount of research. In an overview of the risk factors for drive for muscularity, Cafri et al.

(2005) proposed a model in which self-esteem and the adoption of unhealthy behaviors (e.g., use









of anabolic steroids, ephedrine, special dieting techniques to minimize body fat and maximize

muscularity) are related. Simultaneously, Cafri et al. (2005) stated that body dissatisfaction leads

one to adopt these unhealthy behaviors. What the model does not propose, however, is a direct

link between self-esteem and body dissatisfaction, which is believed to be a stable relationship

(Cohane & Pope, 2001). Indeed, poor self-esteem is often associated with body-image

disturbance, and this has been found when measuring the drive for muscularity in adolescent

boys (McCreary & Sasse, 2000). In addition, Irving, Wall, Neumark-Sztainer, and Story (2002)

found that adolescent boys who used anabolic steroids had significantly lower self-esteem than

non-users, and tentative support for a relationship between low self-esteem and use of anabolic

steroids in weightlifters has been identified (Kanayama, Pope, Cohane, & Hudson, 2003).

Findings such as these lend support to the sentiments of researchers who speculate that some

men may enter bodybuilding, in part, to offset low self-esteem (Oliosi, Dalle Grave, & Burlini,

1999).

Societal Factors

Media influence

One reason for the increase in male body-image disturbance is the portrayal of an "ideal"

male body in the mass media (e.g., men's magazines; Labre, 2005), and there is evidence that

viewing this ideal is negatively impacting high school boys (Presnell et al., 2004) and leading

them to take measures to increase their muscularity (McCabe & Ricciardelli, 2005).

Furthermore, not only are men from Playgirl centerfolds (Leit et al., 2001) to professional

football players (Kraemer et al., 2005) becoming more muscular, the action figures preferred by

many preadolescent boys are taking on superhuman physiques (Pope et al., 1999). To better

understand the impact of viewing the ideal male body (as portrayed in the media) on body-image

disturbance, Leit, Gray, and Pope (2002) showed slides depicting the ideal male physique to









undergraduate men in a laboratory setting and then asked them to indicate via the somatomorphic

matrix: a) their perceived body type, b) the ideal body type, c) the average man's body type, and

d) the body type women preferred. Compared to men who had been shown neutral slides that did

not depict the ideal male physique, men who saw slides of the ideal physique not only selected

an ideal body type with a significantly higher FFMI (Leit et al., 2002), but also indicated they

believed the average man had a significantly higher FFMI.

The drive for muscularity is not only pervasive in American culture-studies in other

Westernized cultures such as Australia, France, The Netherlands, Great Britain, Austria, and

South Africa have shown a similar pattern of preference for increasingly muscular physiques.

For example, in a study comparing Austrian, French, and American men, Pope, Gruber et al.

(2000) found no difference in how much more muscle each group desired: the preference was for

an additional 27 lbs. of muscle. Contrasting these findings with research in Taiwanese men,

which shows that they prefer to have a physique with only about 4.5 lbs. more muscle (Yang et

al., 2005), illustrates the disparities between West and East in male body-image ideals.

Peer and parental influence

Studies have examined the impact of both peers and parents on body-image and body

change strategies in males. For example, body dissatisfaction in boys is significantly related to

the amount of weight-loss encouragement a parent provides (Wertheim et al., 2002). In light of

this finding, some argue that there may be a difference in what mode of weight loss mothers

(dieting) and fathers (exercise) consider acceptable (Ricciardelli & McCabe, 2004). Furthermore,

Smolak et al. (2005) found that both peer and parental comments were predictive of muscle

building techniques; specifically, boys who used either steroids or supplements reported

significantly higher levels of parental comments regarding body size than did non-using boys.









Collectively, these studies suggest that peers and parents are quite influential in whether a boy

decides to adopt body change behaviors aimed at increasing muscularity.

Teasing

One hallmark of muscle dysmorphia is that a very muscular male perceives that others will

mock or ridicule his self-perceived small or wimpy physique. This belief can then lead to

problems such as social avoidance and anxiety. In a similar vein, several studies have

investigated the impact of teasing on the body-image of males. For example, Cafri et al. (2006)

found teasing to be significantly negatively correlated with dieting to gain weight and body

dissatisfaction in adolescent males; the latter finding was believed to have occurred because of

an indirect relationship between the two variables that is mediated via negative affect. In

addition, teasing was significantly positively correlated with muscle dysmorphia

symptomatology, but did not emerge as a significant predictor of muscle dysmorphia symptoms.

Again, Cafri et al. (2006) explained this latter finding as indicative of an indirect relationship

between the two.

Paxton et al. (2006) recently conducted a longitudinal study on adolescent boys over a 5-

year span in an effort to predict body dissatisfaction during middle adolescence. They found that

Time 1 weight-related teasing was a significant predictor of Time 2 body dissatisfaction, but

once the regression model was reduced and depression was included, weight-related teasing

dropped out as a significant predictor. This suggests, as did Cafri et al. (2006), a relationship

early in adolescence between teasing and body dissatisfaction that is mediated by depression.

Although the relationship between teasing and body dissatisfaction must be teased apart by

future research, what is already known of the relationship between the two has prompted the

development of interventions aimed at decreasing teasing in the elementary school setting (e.g.,

Haines, Neumark-Sztainer, Perry, Hannan, & Levine, 2006).









Peer popularity

Little research has examined the relationship between popularity and male body change

strategies, but it is known that a curvilinear relationship exists between popularity and physique

in adolescent males. Specifically, in comparison to either thin or heavy adolescent males,

adolescent males who have a muscular physique have greater body satisfaction and are more

popular, but they are also more likely to be dieting (Graham, Eich, Kephart, & Peterson, 2000;

McCabe & Ricciardelli, 2004a ; Wang, Houshyar, & Prinstein, 2006). Furthermore, there is

limited evidence of a weak association between popularity and efforts to increase muscularity

amongst adolescent males (McCabe, Ricciardelli, & Finemore, 2002).

Social Body Comparison

Social comparison is the process by which an individual evaluates his or her attributes,

characteristics, or outcomes based on how they compare to the attributes, characteristics, or

outcomes of another person. For example, if an individual scored a 75% on an exam he may be

discouraged; however, after learning the class mean was 65% he may view his score more

positively in light of what "could have been." Similar processes are believed to be at work when

individuals evaluate their bodies; opportunities for a male to compare his body to another male's

body are numerous, especially considering how much television adolescent boys watch (e.g.,

music videos) and how many other media outlets (e.g., magazines) routinely produce content that

emphasizes a lean and muscular physique (Labre, 2005; Tiggemann, 2005). Specifically, studies

have found that males report greater body dissatisfaction after being exposed to images of the

male "ideal" body (e.g., Leit et al., 2002; Strong, 2005).

Body-image Dissatisfaction

Unlike body-image disturbance in women, body-image disturbance in men arises because

men perceive themselves as either too heavy or too thin (Kostanski et al., 2004; Kostanski &









Gullone, 1998; Presnell et al., 2004). This distinguishes the nature of body-image disturbance in

men from that of women because it identifies a "double-edged sword" of risk in men not present

in women. What has arisen from these findings is twofold: (1) when a male reports

dissatisfaction with being too small, the desire is to gain weight in the form of muscle mass, and

(2) when a male reports dissatisfaction with being too large, the desire is to lose weight in the

form of body fat.

Muscularity

Recognizing the central role of muscularity in male body-image disturbance, several

studies have derived FFMI as the objective measure of degree of muscularity in participants

(Pope, Gruber, et al., 2000). For example, Olivardia et al. (2000) found that men with muscle

dysmorphia had significantly higher FFMI than did normal comparison weightlifters; this lends

support to the argument that a key element of muscle dysmorphia is that a quite muscular man

perceives himself to be small or weak. Furthermore, body composition is a hypothesized (yet

poorly understood) precursor to body-image disturbance in the Cafri et al. (2005) model,

although some evidence indicates minimal musculature is a significant predictor of muscle

dysmorphia symptoms (Chittester, 2003). There has been only one study to date that has directly

correlated FFMI with drive for muscularity (McCreary et al., 2006), and it found no correlation

between the two. Further research is clearly required because gaining better insight into this

relationship would greatly advance our knowledge of the complexity of male body-image

disturbance and actual muscularity; to this point such research has been a notable oversight in the

literature because of the critical role actual (or perceived) muscularity plays in male body-image

disturbance.









Body fat

Because the BMI is unable to partial out weight attributable to body fat from weight

attributable to muscle, estimations of body fat are preferred when assessing body composition.

Not only is this practice more scientifically precise, it is also reflective of the recognition that

body fat is one of two (degree of muscularity is the other) physique-related factors that males

evaluate when asked their degree of body satisfaction. For example, Olivardia et al. (2000) noted

that men with muscle dysmorphia had a similar amount of body fat than normal comparison

weightlifters; this lends support to the argument that one aspect of muscle dysmorphia is a

disturbance in how one appraises his body composition. Most research, though, indicates that

between body fat and muscularity, body fat is the least consequential; perhaps this is why

surprisingly little research has directly correlated body fat percentage with body-image

disturbance in men.

One method of assessing satisfaction with body fat percentage is by asking the participant

to ascertain his body fat percentage by using the somatomorphic matrix. This is a computer-

based test in which the silhouette of a man is presented on the screen. The participant's task is to

simultaneously manipulate the degree of muscularity and body fat of the silhouette in order to

arrive at (1) the participant's perceived actual body shape, (2) the participant's ideal body shape,

and (3) the body shape he believes that most women find ideal. For example, using the

somatomorphic matrix, Leit et al. (2002) found that undergraduate men perceived average men

to have about 4% less body fat than the participants perceived themselves as having; this

suggests a social comparison in which these participants believed themselves to be chubby

relative to an average man.

Unfortunately, recent reliability assessment by Cafri, Roehrig, and Thompson (2004) has

raised legitimate concerns that the somatomorphic matrix is not reliable; clearly this assessment









tool should be re-examined and properly adjusted before being included in future body-image

studies. This measurement problem underscores the need for direct assessment of body fat

whenever it is an outcome of interest. Cafri et al. (2005) hypothesize that body composition is a

key precursor to body dissatisfaction, yet there is little in the way of empirical data that can

either confirm or falsify this proposed link. Therefore, there is a need to better understand the

relationship between body fat percentage and body-image disturbance in men; such information

could strengthen descriptive models such as those presented by Cafri et al. (2004) and Lantz et

al. (2002).

Health Risk Behaviors

The pursuit of muscularity may potentially lead to the use of illegal substances or dietary

supplements and products, most of which are marketed as "weight-gainer" or weight loss

supplements. These substances are attractive to someone with high body-image disturbance

because of the belief that they offer a "quick fix" to one's body dissatisfaction that will require

minimal lifestyle change on the part of the user. In addition, many men adopt rigid eating habits

in an attempt to lose weight, gain weight, or add muscle mass. This section will detail these

behaviors that increase the risk to health.

Steroids

Anabolic steroids, despite being illegal in the United States, are attractive to persons who

desire greater muscularity because these substances significantly enhance muscle mass in a

relatively short period of time (Hartgens & Kuipers, 2004). While steroids offer these desirable

effects, they also pose numerous risks to both physical and psychological health. Adverse

physical symptoms include destabilization of lipid levels (which may increase risk of

cardiovascular events), disturbances in liver function, testicular atrophy, and acne (Hartgens &

Kuipers, 2004; Pope & Katz, 1994; Tricker, O'Neill, & Cook, 1989). In addition, psychological









ramifications of steroid use include aggressive behavior, mood disorders, and psychotic

symptoms (Lefavi, Reeve, & Newland, 1990; Pope & Katz, 1987; 1988; 1994; Tricker et al.,

1989). Finally, beyond physical and psychological ramifications, steroid use is both a financial (a

user could expect to pay between $100-$275 for a 100 count bottle; Kouri, Pope, & Katz, 1994)

and legal risk (attempting to acquire steroids on the black market may be the pathway to jail for

some users; e.g., Pope et al., 1993).

Perhaps the most troublesome aspect of body-image disturbance in men is its relationship

to anabolic steroid use. Several studies have concluded that body dissatisfaction is a primary

predictor of steroid use in men (Blouin & Goldfield, 1995; Brower et al., 1994; Chng & Moore,

1990; Kanayama et al., 2003; Cole et al., 2003). Furthermore, in a summation of interviews with

10 former steroid users, Olrich and Ewing (1999) alluded to body dissatisfaction as a

precipitating factor. Specifically, these men reported steroid use, in part, because of (1) upward

social comparisons (i.e., comparing oneself with more muscular men in the gym), and (2)

perceived lack of gains in size and strength. In recognition of this unequivocal link, and the dire

consequences of steroid use, it is prudent to develop interventions aimed at increasing body

satisfaction in young men.

Steroid precursors

Adrenal hormones are substances designed to increase muscle mass because they are

testosterone precursors. Some examples include growth hormones (e.g., levodopa or L-DOPA)

and testosterone stimulants such as HCG. Perhaps the best-known adrenal hormone is

androstenedione, the substance admittedly used by former major league baseball star Mark

McGwire during his quest for the single season home run record in 1998. In a review of these

types of hormones, Ziegenfuss, Berardi, Lowery, and Antonio (2002) concluded that while

physiological effects such as decreases in high density lipoprotein ("good" cholesterol) and









increases in estrogen and testosterone levels are seen while taking these supplements, clear

evidence that they positively increase either muscle mass or performance (the primary claim

made when they are marketed) is lacking. In fact, Ziegenfuss et al. (2002) argued that the

theoretical risks of using these adrenal hormones outweigh any potential benefits they have to

offer, while others (Kreider, 1999) have gone further and said the use of these hormones should

not be encouraged.

Men with body-image disturbance often use a variety of performance-enhancing

substances (ranging from supplements found in health food stores to anabolic steroids obtained

on the black market) in an attempt to attain the "ideal" physique. In addition, adolescent boys

frequently consume these substances; this is alarming in light of McCabe and Ricciardelli's

(2004a) finding that disordered eating in adolescent boys is predicted by the use of food

supplements. There are literally scores of different kinds of substances that are used by men who

want to simultaneously shred fat and gain muscle (Pope, Phillips, et al., 2000). Because of their

use primarily to alter body composition, which the user believes will facilitate greater body

satisfaction, some researchers have begun referring to these as "body image drugs" (Kanayama

et al., 2001). Two additional classes of supplements are described below.

Protein supplements are designed to add muscularity; they typically come in the form of

snack bars, shakes, or powder, and are often consumed pre-workout, post-workout, or between

meals. For example, protein supplements such as "Met-Rx" and "Power Bar" are high in protein

content, although there is little evidence that such supplements are more effective at promoting

muscle growth than foods such as lean meat or skim milk (Pope, Phillips, et al., 2000).

Creatine is a very popular supplement, and studies have shown it to increase muscle mass

(e.g., Chilibeck, Stride, Farthing, & Burke, 2004; Kreider, 1999), but it is believed that a large









portion of this gain may be attributable to water (Pope, Phillips, et. al, 2000). Creatine is

regarded as relatively safe; a recent review of its side effects noted that the greatest harm it poses

is likely restricted to issues regarding the purity of the supplement itself as it is manufactured

(Bizzarini & De Angelis, 2004). Perhaps concerns over water retention explain the use of

diuretics in some users (to eliminate water weight and increase the appearance of muscle mass).

In addition, hydroxycitrate acid is a supplement frequently used as a compliment to muscle-

promoting supplements because of its reported ability to inhibit lipogenesis and thus promote

weight loss and a leaner physique. These claims, however, appear unfounded, as neither weight

loss nor increased energy expenditure are facilitated by this supplement (Heymsfield, Allison,

Vasselli, Pietrobelli, Greenfield, & Nunez, 1998; van Loon, van Rooijen, Niesen, Verhagen,

Saris, & Wagenmakers, 2000).

Ephedrine

Ephedrine (ma huang) is a central nervous system stimulant often used in conjunction with

caffeine to produce weight loss. The user will frequently combine the use of this supplement

with exercise and strict dietary practices aimed at shredding fat and gaining muscle. In recent

years there have been several reports of adverse effects associated with ephedrine, including

mania-like episodes, acute myocardial infarction, stroke, and in especially vulnerable persons,

death (Emmanuel, Jones, & Lydiard, 1998; Haller & Benowitz, 2000; Saper et al., 2004; Traub,

Hoyek, & Hoffman, 2001). While Hutchins (2001) argued that "the implication of ephedrine-

type alkaloids in deaths from a wide variety of conditions that occur in the general population is

no more than idle speculation" (p. 1096), the Food and Drug Administration found sufficient

reason to ban in April 2004 the sale of ephedrine in the United States.









Dieting to lose weight

Although females are more likely to try to lose weight than males (e.g., McCabe et al.,

2002), males also adopt weight loss strategies. It is troublesome to note that this starts early in

life: evidence indicates that boys as young as 8-years old already have thoughts of losing weight,

or have already engaged in weight loss behavior (McCabe & Ricciardelli, 2003). When males

desire to lose weight the efforts are primarily aimed at decreasing body fat (as opposed to overall

body size reduction, as is the goal when females attempt to lose weight). In some men the drive

to lose weight may be so severe that it leads to problems such as exercise dependence or eating

disorders (O'Dea & Abraham, 2002; Sharp, Clark, Dunan, Blackwood, & Shapiro, 1994; Stice,

2002).

It is well established that bodybuilders, especially those who compete, closely monitor

their dietary intake (Lantz et al., 2002) and display significantly greater eating disturbed attitudes

than athletically active controls (Goldfield, Blouin, & Woodside, 2006; Pickett et al., 2005);

however, it has been argued that careful attention to dietary intake is part of the competitive

nature of the sport of bodybuilding, and, provided it harmed neither the health nor performance

of the individual, could easily be viewed as "drive" or motivation (Chung, 2001). Of course, the

problem arises when harm is being done to the individual when disturbed eating behaviors are

taken in context of an overall pattern of behavior designed to achieve maximum muscularity.

Dieting to gain weight/increase muscularity

It is interesting to note that one of the first articles that observed a desire on the part of

boys to increase weight attributed this desire to the tendency of boys to "value change in shape

or tallness" (Andersen & Holman, 1997, p. 392); in retrospect, although they alluded to a desire

to add muscle, it appears this did not occur to the researchers at the time, and rightly so because

there was little knowledge of or research on this relatively new phenomenon. Whereas for









women the issue of dieting usually refers to weight loss efforts, a unique form of eating behavior

is being observed more frequently in men. Specifically, males with body-image disturbance not

only restrict foods high in fat, they also consume large amounts of food that are high in protein.

Indeed, a study from Northern Ireland found that the amount of protein consumed by males

significantly increased between the ages of 15 and 22 (Boreham, Robson, Gallagher, Cran,

Savage, & Murray, 2004), although the extent to which this was an intentional dietary practice

was not determined. This dieting behavior is aimed at maximizing gains in muscle mass while

simultaneously limiting calories from fat. This may result in continuous cycles of weight gain

and loss of over 11 lbs. in the case of competitive bodybuilders (Oliosi et al., 1999). If extreme

eating practices produce such drastic weight fluctuations in competitive bodybuilders, it is

disturbing to note that adolescent boys are increasingly turning to such strategies to achieve the

lean, muscular look. This is especially concerning due to the knowledge that body-image

disturbance is an identified risk factor for such unhealthy eating behavior (Cafri et al., 2005;

Muris, Meesters, van de Blom, & Mayer, 2005).

A major limitation of understanding the role of dietary practices in the pursuit of

muscularity has been the lack of a psychometrically sound instrument. Previous studies have

used measures that have been validated for use with eating disordered populations (e.g.,

Tiggemann, 2005), but even these are not without limitation when being used in men. Recently a

Muscle-Oriented behavior subscale has been identified on the Drive for Muscularity Scale

(McCreary, Sasse, Saucier, & Dorsch, 2004); this contains some items that more precisely

measure dietary practices aimed at building muscle (e.g., "I try to consume as many calories as I

can in a day"). In addition, Kaminski et al. (2005) have developed the MEBBIE, a scale

specifically designed to assess eating, exercise, and body-image related attitudes and behaviors; a









recent confirmatory factor analysis has determined the factor structure to be strong (Kaminski,

personal communication, 2005), but it does not appear to contain questions specific to eating

practices undertaken to add muscle. However, the Diet subscale of the Muscle Dysmorphia

Inventory (MDI; Lantz et al., 2002; Rhea et al., 2004), with very specific items (e.g., "I control

the intake of proteins, carbohydrates, and fats to maximize my muscular development") and

established psychometric properties, has emerged as a potential gold standard for assessing

muscle-building dietary practices.

Sports

Millions of males worldwide participate in sports ranging from little league baseball and

youth soccer to professional sports teams. In addition to the pure enjoyment of the specific sport,

males become involved in sports for a variety of reasons, including moral development, self-

esteem enhancement, development of leadership qualities, and social interactions (e.g., making

friends, functioning within a group setting; Coakley, 2004; Tritschler, 2000). Considerable

research over the past 30 years has been conducted to determine precisely how sport involvement

impacts males on these variables and a host of others, and the consensus is that sport

involvement is generally a positive experience. However, for some males, sport involvement can

be accompanied by hazardous behaviors aimed at increasing performance, such as disturbed

eating practices, supplement use, and steroid use (Hausenblas & Carron, 1999; Irving et al.,

2002; McCabe & Ricciardelli, 2004a). Interestingly, qualitative research suggests that adolescent

boys involved in sports report engaging in such behaviors to increase athletic performance, but

nonetheless are fixated on their physiques for purely aesthetic reasons (Ricciardelli, McCabe, &

Ridge, 2006). To further understand the role of sports in the adoption of body change strategies,

Cafri et al. (2005) have drawn a distinction between organized and informal team sports; because

no operational definitions were provided for what constitutes an "organized" or "informal" sport,









the following section is a general discussion about sport involvement regardless of organization

status.

Organized and informal team sports

Sports teams could theoretically include YMCA/YWCA and other locally organized

recreational leagues, in addition to professional, intercollegiate, or high school varsity teams.

Within the context of drive for muscularity and its correlates the most studied population of

competitive athletes is bodybuilders; indeed, success in this sport is completely reliant on unique

diet and exercise behavior. Furthermore, many of these athletes use substances to help achieve

maximal muscularity. Beyond bodybuilding (which will be discussed in further detail below), the

sports that are most associated with unhealthy behavior related to diet, exercise, or substance use

are those that are either (1) power or strength oriented (e.g., football, field events such as shot

put), or (2) weight oriented (e.g., wrestling, martial arts, horse jockey; Jonnalagadda,

Rosenbloom, & Skinner, 2001; Moore, Timperio, Crawford, Bums, & Cameron-Smith, 2002).

However, competitive sport involvement (e.g., football, basketball, tennis, cricket) has been

found to be a significant predictor of disordered eating and steroid use in early maturing

adolescent boys, but not in on-time or late-maturing boys (McCabe & Ricciardelli, 2004a). This

is consistent with the qualitative findings of Ricciardelli et al. (2006) in that part of the

explanation for the increased likelihood of early maturing boys to engage in these behaviors lies

in aesthetic concerns.

Weightlifting

The literature is equivocal when attempting to understand which groups of exercisers are

most susceptible to experiencing body-image disturbance. For example, athletically active

exercisers have lower levels of body-image disturbance than non-exercisers (Schwerin et al.,

1996), Also, exercise behavior is a strong predictor of body satisfaction in physically active men









(Hausenblas & Fallon, 2002), and Davis and Cowles (1991) found body dissatisfaction to be

negatively correlated with physical activity. Furthermore, there is evidence that men who

regularly lift weights are satisfied with their bodies (Pickett et al., 2005), and that weightlifting

interventions designed to improve body satisfaction are efficacious (Williams & Cash, 2001).

However, it is clear that for some men weightlifting is taken to unhealthy levels to achieve the

ultimate high muscularity/low body fat look (Hildebrandt, Schlundt, Langenbucher, & Chung,

2006). Collectively, these findings suggest that exercise may have a protective effect against

body-image disturbance for most men, but may be associated with problematic psychopathology

and behavior in others.

Bodybuilders in particular report greater body-image disturbance than control men

(Mangweth et al., 2001), martial artists (Blouin & Goldfield, 1995), and power lifters (Lantz et

al., 2002). However, Boroughs and Thompson (2002) and Pickett et al. (2005) have recently

found that bodybuilders are quite satisfied with their bodies. These conflicting findings suggest

that some persons may initiate weightlifting as a result of pre-existing body dissatisfaction

(Kanayama et al., 2003), while others become dissatisfied with their bodies only after initiating a

weightlifting program; further research would help better understand this association.

Other Factors Related to Male Body-Image Disturbance

There are three additional factors that are notable when attempting to understand male

body-image disturbance; what follows is a brief review of eating disorders, exercise dependence,

and the impact of romantic partners.

Eating Disorders

Eating disorders are often viewed as one of the consequences of body-image disturbance,

and the interplay between these constructs in women has received a great deal of interest; indeed,

body-image disturbance is an extremely salient and stable risk factor for eating pathology









(Cooley & Toray, 2001; Stice, 2002). Although there is no difference between men and women

in eating disorder presentation (Braun, Sunday, Huang, & Halmi, 1999), the relationship between

eating disorders and body-image disturbance in men has received little attention. College men

with eating disorders have greater levels of body-image disturbance than non-eating disordered

college men (Olivardia et al., 1995); this suggests that more research should examine the

relationship between these variables in men. It is worthwhile to note, however, that body-image

disturbance in men with eating disorders would likely center on dissatisfaction with overall

weight, whereas body-image disturbance in non-eating disordered men would likely center

around dissatisfaction with muscularity. That being said, Mangweth et al. (2001) demonstrated

the complexity of male body-image disturbance when they found that men with eating disorders

and male bodybuilders were virtually similar in their degree of dissatisfaction.

Because most current male body-image research addresses dissatisfaction specific to

muscularity, and because past body-image research has typically been done in women, there is

little information available on the relationship between male body-image disturbance and eating

disorders. In fact, preliminary evidence suggests that a history of eating disorders is associated

with muscle dysmorphia. For example, Olivardia et al. (2000) found a significantly higher

incidence of past eating disorders in men with muscle dysmorphia (29%) than in normal

comparison weightlifters (0%). Furthermore, Hitzeroth, Wessels, Zungu-Dirwayi, Oosthuizen,

and Stein (2001) found that 6% (1 of 15) of amateur South African competitive bodybuilders

with muscle dysmorphia had a past eating disorder. What follows is a brief overview of the

research examining the relationship between male body-image disturbance and each eating

disorder.









Anorexia nervosa

Although anorexia is seen less frequently in men than in women, evidence indicates that

the disease presents with similar pathology for women and men (Woodside et al., 2001).

Because body-image disturbance is a key component of anorexia, it is essential to understand

body-image disturbance in men. For example, Gila et al. (2005) found that adolescent boys with

anorexia had significantly higher body dissatisfaction than non-anorexic adolescent boys; this

clearly indicates the presence of a relationship between the two, and suggests that if body-image

disturbance is alleviated it would be accompanied by an alleviation of other symptoms of

anorexia.

In some men anorexia may be a precursor to the development of muscle dysmorphia. For

example, Pope et al. (1993) found that two out of three bodybuilders with muscle dysmorphia

reported a history of anorexia. While the sample of muscle dysmorphic bodybuilders was small,

this unique pairing of opposite diagnoses at different times within the same individual suggests a

complex clinical picture of male body-image disturbance.

Bulimia nervosa

The clinical presentation of bulimia in men closely resembles that of bulimic women

(Pope, Hudson, & Jonas, 1986). Furthermore, adolescent boys with eating patterns similar to

bulimia and binge-eating disorder have expressed greater body dissatisfaction than age-matched,

non-eating disturbed controls (Keel, Klump, Leon, & Fulkerson, 1998). In addition, Blouin and

Goldfield (1995) identified a subgroup of bodybuilders whose psychological make-up consisted

of a disturbing mixture of body dissatisfaction, bulimic-like eating patterns, and steroid use.

Unfortunately, bulimic tendencies appear frequently in bodybuilders, a population that, despite

recent findings of Pickett et al. (2005), seems predisposed to body dissatisfaction (Lantz et al.,

2002).









Binge-eating disorder

People with binge-eating disorder are typically obese, and previous sections of this

manuscript have established the link between bodyweight and body-image disturbance in men.

Specifically, several studies have found that body-image disturbance is significantly higher in

women with binge-eating disorder than in men (Barry, Grilo, & Masheb, 2002; Grilo & Masheb,

2005; Grilo, Masheb, Brody, Burke-Martindale, & Rothschild, 2005), and that body-image

disturbance is correlated with body mass index (Grilo & Masheb, 2005) in men with binge-

eating disorder. This is congruent with the finding that men often report body dissatisfaction

when they perceive themselves as either not muscular enough or too fat.

Exercise Dependence

Regular exercise has positive physical and psychological benefits (Berger & Motl, 2000;

Landers & Arent, 2001), a point underscored by a growing body of research that indicates

exercise is an effective intervention for treating body-image disturbance (e.g., Fisher &

Thompson, 1994; Williams & Cash, 2001). However, if taken to an unhealthy level exercise may

be detrimental to health. The "craving for leisure-time physical activity, resulting in

uncontrollable excessive exercise behavior, that manifests in physiological (e.g.,

tolerance/withdrawal) and/or psychological (e.g., anxiety, depression) symptoms" (Hausenblas &

Symons Downs, 2002a, p. 90) is called exercise dependence. Based on one's motives for

excessive exercise behavior, exercise dependence can be described as either primary or

secondary. Primary exercise dependence is when the exercise behavior is the end in itself,

whereas secondary exercise dependence is when the exercise behavior is undertaken specifically

to alter or control the desired body composition (Carron, Hausenblas, & Estabrooks, 2003).

There is a subset of males who take exercise to unhealthy levels to attain the "ideal"

physique. Indeed, a person with exercise dependence may experience withdrawal effects, and









this may be reflected in the finding of O'Dea and Abraham (2002) that 34% of surveyed college

men indicated they are distressed if unable to exercise as much as they desired, and that 20%

displayed characteristics of disordered eating. This unhealthy overemphasis on exercise, and the

simultaneous focus on disordered eating practices, is concerning in light of McCabe and

Ricciardelli's (2004a) recent finding that exercise dependence in adolescent boys is predicted by

weight loss strategies over an 8-month period. Taken together, these findings suggest that, as

disruptive and harmful as exercise dependence may be, disordered eating habits may be a

precursor to unhealthy exercise behavior.

Research on drive for muscularity does not usually assess exercise dependence per se, but

instead assesses "body change strategies" in which exercise (e.g., McCabe & Ricciardelli, 2004a;

Ricciardelli & McCabe, 2002) or, specifically, weightlifting (e.g., Smolak et al., 2005) is a

component. Contrast this approach with that undertaken in the muscle dysmorphia literature.

According to the diagnostic criteria proposed by Pope et al. (1997), exercise continuation that

results in significant social, occupational, or interpersonal impairment is a component of muscle

dysmorphia. Therefore, because the exercise behavior itself is implicit in the diagnosis, and

because it is implied that weightlifting is the mode of exercise, most assessment of exercise

behavior is gained as part of a diagnostic interview (e.g., Hitzeroth et al., 2001; Olivardia et al.,

2000). Attempts to circumvent an interview have led to the creation of measures such as the

Bodybuilding Dependence Scale (Smith, et al., 1998) and the Muscle Appearance Satisfaction

Scale (Mayville et al., 2002). However, these scales do not assess the actual mode, duration, and

frequency of exercise; instead, their focus is on the respondent's degree of persistence in

exercising despite barriers (e.g., illness, injury, demands of daily activities). Therefore, the above









findings indicate a need to quantify the mode, duration, and frequency of exercise behavior when

conducting future research on male body-image disturbance.

Romantic Partners

If there is only one certainty about how romantic partners (male-female dyads) view both

their own and their partner's body it is that the female's body is more scrutinized than the male's

(Ogden & Taylor, 2000). In females, the scrutiny is related to the belief that the female should

either lose (because she is seen as too heavy) or gain (because she is seen as too thin) weight. For

example, Sheets and Ajmere (2005) found that an equal number (7%) of college women in their

study had been told within the previous 3 months by a dating partner to either lose or gain

weight; however, women who were told to gain weight had significantly higher relationship

satisfaction than women told to lose weight. This finding implies that thinner women perceive

themselves as closer to the "ideal" female physique. In addition, Weller and Dziegielewski's

(2004) study of 117 college-aged women found that romantic partner support was significantly

and inversely related to body-image disturbance, which is consistent with the finding of Befort,

Robinson Kurpius, Hull-Blanks, Foley Nicpon, Huser, and Sollenberger (2001) that college-aged

women who receive weight-related criticism from romantic partners report greater body shame.

Although Ogden and Taylor (2000) have argued that female body dissatisfaction stems from

sources other than their romantic partner's reactions to their bodies, the aforementioned findings

make it difficult to dismiss the impact males can have on the body-image of their female

romantic partners.

Can females have a similar impact on the body-image of their male romantic partners?

There has been little research done on this topic, but there is limited evidence, both qualitative

(e.g., Adams, Turner, & Bucks, 2005) and empirical, that the female partner's evaluation of the

male's body does impact the male's body satisfaction. For example, in their study of college









men, Sheets and Ajmere (2005) found that 24.4% of them had been told by a dating partner

within the previous 3 months to either lose or gain weight. However, a disproportionate number

of these men (19.7%) were told to gain weight; because the mean BMI of the sample men (M=

24.70) was higher than the BMI of 88% of these men, their female partners presumably were

expressing their desire for a male partner with more bulk on his frame. The message was not lost

on these males, as relationship satisfaction in men told to gain weight was significantly lower

than in other men (Sheets & Ajmere, 2005). Consistent with this, Tantleff-Dunn and Thompson

(1995) found that the only factors that significantly predicted appearance evaluation in men was

what the men perceived their female partners thought of their bodies and what their female

partners rated as their actual male body size preference. At the same time, other research

indicates that although females view their male partners' bodies, as well as specific body parts

(e.g., shoulders, chest, arms), as closer to the "ideal" than the males believe they are, males still

display a significant discrepancy between what they consider the actual and the "ideal" sizes

(Ogden & Taylor, 2000). While the above findings indicate female romantic partners can

influence male body-image, further research is required to clarify this relationship.

Summary

This chapter has described the main factors relevant to the study of male body-image

disturbance. Males do experience body-image disturbance, although the rates of disturbance are

lower than in women. Another distinguishing feature that separates male body-image disturbance

from that experienced by women is the aspect of appearance that is dissatisfying: women

primarily are dissatisfied with self-perceived heaviness, whereas men may be equally dissatisfied

with either self-perceived heaviness or thinness. The Cafri et al. (2005) heuristic model of male

body change strategies serves as a useful tool in attempting to understand the complexity of male

body-image disturbance, especially because body-image disturbance is a known risk factor for









eating disorders, a health concern no longer restricted entirely to females, and is associated with

low self-esteem and negative affect. Finally, it is believed that the drive for muscularity is also

associated with (1) use of anabolic steroids to gain muscle mass, (2) misuse of dietary

supplements designed to add muscle and strip away fat, and (3) the adoption of strict eating

behaviors that could lead to rapid weight fluctuation.

In conclusion, the model offered by Cafri et al. (2005) serves as the inspiration for the

current study. While there are seven main constructs in the model, for brevity the present study

focuses primarily on the testing of hypothesized relationships that either have limited empirical

support (e.g., biological factors and body-image dissatisfaction) or no proposed relationship

(e.g., self-esteem and body-image dissatisfaction) where one should be. Notable exclusions from

this study are social body comparison and the impact of sport. Social body comparison was

omitted from the study because of the strength of support already existing for its inclusion;

although weightlifting was included in the present study, the impact of organized and informal

sports was omitted because the primary investigator elected to focus on general exercise

behavior instead of sport involvement per se. Additional research on model constructs not

included in this study is warranted to further our knowledge of drive for muscularity and

associated body change behaviors.













Psychological
Biological Factors Psychologi
1 Body compositon/BMI Functioning
Functioning
2 Pubertal growth
3 Pubertal timing ".... .....




I N'.,
"**
-^ ~-A


Societal Factors
1. Media influence
2. Peer/parental influence
3. Teasing
4. Peer popularity


\ %


Sports
1. Organized team sports
2. Informal team sports
3. Weightlifting


Figure 3-1 A heuristic model of male body change behavior; solid arrows indicate relationships with greater support than broken
arrows. Reprinted from Clinical Psychology Review, Vol. 25, Cafri et al., Pursuit of the muscular ideal: Physical and
psychological consequences and putative risk factors, pp. 215-239, Copyright (2005), with permission from Elsevier.


al










CHAPTER 4
RESULTS

Descriptive Statistics

Body fat percentage was within the normal range for men of this age, and the FFMI

indicated muscularity of nonsteroid using recreational weightlifters (Table 1-1 contains

descriptive statistics). In addition, the mean objective BMI indicated "overweight" status; it was

also found that BMI based on objective measures of height and weight was significantly higher

than BMI based on self-reported height and weight (t(112) = 13.83, p < .001). The correlation

matrix for study variables is located in Table 1-2. Among the more noteworthy correlations are

the following: (1) Objective BMI and FFMI (r = .77, p < .01), (2) self-report BMI and FFMI (r =

.75, p < .01), and (3) perceived sociocultural pressure and the measures of body composition

(objective BMI: r= .32,p < .01; self-report BMI: r = .29,p < .01; body fat: r = .24,p < .01;

FFMI: r = .21,p <.05).

Multiple Regression Analyses

Because the correlation between objective BMI and self-reported BMI was so high (r =

.97), two separate regression analyses were run: one with objective BMI as an independent

variable and the other with self-report BMI as an independent variable. Because the results

across the analyses were consistent, only the regression analysis for the objective BMI is

reported here (Table 1-3 contains the regression analysis using subjective BMI); the decision to

report the data for the objective BMI was due to the fact that this method of BMI calculation is

more accurate than subjective BMI (Elgar et al., 2005). Examination of the tolerance values

revealed that I did not have multicolinearity among the independent variables (Tolerance values

range = .02 to .92; Mertler & Vannatta, 2002). The regression equation explained 51% of the

variance in drive for muscularity, F(10,102) = 12.68, p < .001, with weightlifting index (P = .17,









p = .05), supplement use (3 = .37,p < .001), exercise dependence (P = .24,p < .01), and self-

esteem (3 = -.23, p < .01) emerging as significant predictors (Table 1-4).









Table 4-1 Descriptive statistics for outcome variables


Variable M SD Range


BMI- Obj 25.05 3.63 17.79-42.08
BMI- SR 23.82 3.31 17.01-39.14
Body fat percentage 15.96 7.01 4.70-32.70
FFMI 21.20 2.26 16.59-29.32
Cardio frequency 2.63 1.79 0.00-10.00
Cardio duration (mins.) 41.04 34.66 .00-180.00
Weightlifting frequency 2.24 1.80 .00-6.00
Weightlifting duration (mins.) 38.41 31.36 .00-150.00
Weightlifting index 127.57 134.90 .00-750.00
LTEQ 55.83 41.91 .00-333.00
MDI Diet 13.10 5.48 5.00-25.00
MDI Supplement 8.31 4.65 4.00-22.00
PSPS 16.63 5.07 8.00-33.00
DMS MBI 3.79 1.22 1.43-6.00
DMS MB 2.53 1.01 1.00-5.00
DMS Total 3.16 .94 1.36-5.07
EDS 45.51 14.33 21.00-86.00
RSES 33.73 4.37 23.00-40.00

Note: Obj = Measured; SR= Self-report; FFMI = Fat-free mass index; LTEQ = Leisure Time
Exercise Questionnaire; MDI-Diet = Muscle Dysmorphia Inventory-Diet subscale; MDI-
Supplement = Muscle Dysmorphia Inventory-Supplement subscale; PSPS = Perceived
Sociocultural Pressure Scale; DMS-MBI = Drive for Muscularity-Muscle-oriented body
image subscale; DMS-MB = Drive for Muscularity-Muscularity-related behaviors subscale;
EDS = Exercise Dependence Scale; RSES = Rosenberg Self-esteem Scale.










Table 4-2 Correlation matrix of outcome variables


Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14


1. BMI- OBJ
2. BMI- SR
3. Body fat
4. FFMI
5. Weightlifting index
6. LTEQ
7. MDI Diet
8. MDI -- Supplement
9. PSPS
10. DMS MBI
11. DMS --MB
S12. DMS Total
13. EDS
14. RSES


.97** .65**
.61**


.77**
.75**
.03


.06
.09
-.23*
.27**


-.02 .19* .01
.00 .23* .01
-.05 .08 -.03
.04 .18 .02
.24* .35** .45**
- .10 .07
.53**


.32** -.21* -.02
.29** -.19* .00
.24** -.17 -.17
.21* -.13 .11
-.03 .11 .62**
.02 -.01 .14
.08 .06 .55**
.12 .28** .77**
.22* .14
.44**


-.14
-.12
-.20* -.
-.03
.40** .
.06
.33**
.59**
.21*
.88**
.81**


02 -.08
01 -.07
16 -.10
18 -.04
36** .11
.14 .06
.33** .05
.40** -.02
.20* -.34**
.35** -.37**
.57** -.09
.53** -.29**
- -.20*


Note: Obj = Measured; SR = Self-report; FFMI = Fat-free mass index; LTEQ = Leisure Time Exercise Questionnaire; MDI-Diet =
Muscle Dysmorphia Inventory-Diet subscale; MDI-Supplement = Muscle Dysmorphia Inventory-Supplement subscale; PSPS =
Perceived Sociocultural Pressure Scale; DMS-MBI = Drive for Muscularity-Muscle-oriented body image subscale; DMS-MB =
Drive for Muscularity-Muscularity-related behaviors subscale; EDS = Exercise Dependence Scale; RSES = Rosenberg Self-esteem
Scale.


*p< .05. **p < .01.










Table 4-3 Stepwise regression predicting drive for muscularity using subjective BMI


Predictor 0 SE 95% Confidence interval Tolerance


Subjective BMI

Body fat

FFMI

Weightlifting index

LTEQ

MDI Diet

MDI Supplement


PSPS

EDS

RSES


.20

-.28

-.30

.17*


-.07-.19

-.08-.00

-.28-.02


-.03


.38***


.25**


-.03-.03

.04-.11

-.01-.05

.01-.03

-.08-(-.02)


Note: FFMI = Fat-free mass index; LTEQ = Leisure Time Exercise Questionnaire; MDI-Diet = Muscle Dysmorphia Inventory-
Diet subscale; MDI-Supplement = Muscle Dysmorphia Inventory-Supplement subscale; PSPS = Perceived Sociocultural Pressure
Scale; EDS = Exercise Dependence Scale; RSES = Rosenberg Self-esteem Scale.
F(10,102) = 12.85, p <.001, Adj R2 = .51; *p= .05. **p < .01. ***p< .001.










Table 4-4 Stepwise regression predicting drive for muscularity using objective BMI


Predictor 0 SE 95% Confidence interval Tolerance


Objective BMI

Body fat

FFMI

Weightlifting index

LTEQ

MDI Diet

MDI Supplement

PSPS

EDS

RSES


.06

-.20

-.20

.17*


-.22-.25

-.11-.05

-.38-.21


-.03


-.02-.04

.04-.11

-.01-.05

.01-.03

-.08-(-.02)


Note: Obj = Measured; FFMI = Fat-free mass
Dysmorphia Inventory-Diet subscale; MDI-
Perceived Sociocultural Pressure Scale; EDS
*p = .05. **p< .01. ***p< .001.


index; LTEQ = Leisure Time Exercise Questionnaire; MDI-Diet = Muscle
-Supplement = Muscle Dysmorphia Inventory-Supplement subscale; PSPS
= Exercise Dependence Scale; RSES = Rosenberg Self-esteem Scale.


.37***









CHAPTER 5
DISCUSSION

Drive for muscularity represents a form of male body dissatisfaction that is associated with

substance use, eating pathology, and exercise dependence (McCreary et al., 2004). However,

knowledge of the predictors of drive for muscularity, including the role of body composition, is

limited. Therefore, the purpose of my study was to identify the body composition and

psychological predictors of drive for muscularity. Implications of my results, study limitations,

and future research directions are discussed below.

First, consistent with my hypotheses and the research of McCreary et al. (2006), the body

composition measures of BMI, body fat percentage, and FFMI did not predict drive for

muscularity. It is possible that no effect emerged because the men in my sample had average

levels of body fat and FFMI, and were only slightly overweight; if more men in the sample

deviated from average values (e.g., had either higher body fat or FFMI) different results may

have been attained. However, the fact that FFMI did not emerge as a predictor of drive for

muscularity is noteworthy because theoretically one would expect to see higher drive for

muscularity in less muscular men. In explaining their findings, McCreary et al. (2006) speculated

that perhaps body fat "hides" the musculature that lies beneath, which would result in a man's

inability to gauge his true level of muscularity a similar effect may be at work here.

Nevertheless, my findings suggest that drive for muscularity occurs independently of body

composition.

Further similarities with McCreary et al. (2006) emerged, as evidenced by the following

significant correlations: (1) objective BMI and subjective BMI, (2) objective BMI and body fat

percentage, (3) subjective BMI and body fat percentage, (4) objective BMI and FFMI, and (5)

subjective BMI and FFMI. However, in a departure from McCreary et al. (2006), the correlation









between body fat percentage and FFMI in my study was nonexistent. That these two measures of

body composition are uncorrelated is to be expected because of the distinct difference between

fat and muscle. Furthermore, all measures of body composition were weakly yet significantly

related to perceived sociocultural pressure; although the direction of causation is unclear, it is

possible that either (1) men misinterpret the messages coming from others and infer that their

body does not fit the "ideal" male physique, or (2) the body composition of the men truly doesn't

reflect the "ideal" male physique, which increases the likelihood that a man would hear messages

confirming this.

Among the measures of body composition, only objective and subjective BMI were

significantly related to dietary habits consistent with drive for muscularity. It is possible that this

is due to the belief men have that eating more food, especially foods high in protein, will add

muscle; while this may help, the extra calories gained from these foods will lead to more fat

deposition as well, thus increasing BMI. However, while BMI was unrelated to muscularity-

related behaviors, it was inversely related to muscle-oriented body image; this is an unexpected

finding because it indicates that men with higher BMI's have less concern about their

muscularity, although this may be clarified by the fact that BMI correlated significantly with

FFMI.

Second, in support of my hypotheses I found that supplement use, exercise dependence,

and self-esteem significantly predicted drive for muscularity. The findings regarding supplement

use indicate that it is predictive of drive for muscularity, as evidenced not only by the regression

analysis but also by significant correlations with weightlifting, dietary practices, muscle-oriented

body-image, and muscularity-related behaviors. Furthermore, supplement use was positively

related to exercise dependence. Thus, the negative health behaviors of pathological exercise and









supplement use are related. Future research is needed to determine the temporal course of these

two behaviors because this information will aid in determining men who are at-risk for unhealthy

exercise and eating. The collective picture these findings paint is one of an interconnected set of

strategies simultaneously undertaken to increase muscularity.

The results of my study also revealed that exercise dependence predicts drive for

muscularity. It is possible that, because men view exercise as a critical means by which to

increase muscularity, some men experience severe frustration, negative mood, or anxiety when

they are prevented from exercising or are unable to exercise. Further evidence of the

ramifications of exercise dependence is found in its significant inverse relationship with self-

esteem; this indicates that for some men, feelings of self-worth are closely tied to their ability to

engage in exercise. Exercise dependence was significantly related to perceived sociocultural

pressure to be lean and muscular; thus it is possible that some men derive self-worth based on

whether they possess a physique that is deemed "ideal" by society, and exercise represents the

best way to achieve that ideal. Exercise dependence was also significantly related to

weightlifting, dietary practices, muscle-oriented body-image, and muscularity-related behaviors.

This indicates that some men, because of their high drive for muscularity, become dependent on

weightlifting as a specific form of exercise, and that this dependence is accompanied by

unhealthy eating aimed at increasing muscle. These conclusions are consistent with a host of

research in weightlifters and bodybuilders showing that exercise dependence and dietary

practices are related (Lantz et al., 2002; Rhea et al., 2004); indeed the Bodybuilding Dependence

Scale (Smith & Hale, 2004) was developed specifically to assess this unhealthy exercise

behavior.









Self-esteem was a significant negative predictor of drive for muscularity, further

supporting the notion that for some men, self-esteem is closely connected to possessing the

"ideal" physique. This is consistent with research that has found an inverse relationship between

self-esteem and both satisfaction with muscularity and problematic eating behaviors in

preadolescent boys (McCabe & Ricciardelli, 2003; McGee & Williams, 2000). The results also

indicate that self-esteem is inversely related to both muscle-oriented body-image and perceived

sociocultural pressure to be lean and muscular. These findings not only underscore the impact of

the media on self-esteem when it comes to how men evaluate their bodies, but also how

physique-related comments from friends, parents, and dating partners impact self-esteem in

general. Therefore, these persons could provide a protective effect against body dissatisfaction

by building self-esteem in males via interpersonal support and refusal to themselves internalize a

body-image "ideal."

Third, consistent with my hypothesis, objectively measured BMI was significantly higher

than BMI derived from self-reported height and weight. Upon inspection of the data, this

discrepancy in BMI was due to the tendency of men to overestimate their height. Thus, men

appear to be accurate in self-reporting their weight. However, they may overestimate their height

because of the self-presentational and social benefits of being tall. That is, researchers have

found that taller men typically attain high social status, are able to exert greater social

dominance, and enjoy the psychological upper hand in threatening situations (Cassidy, 1991;

Bailey, Caffrey, & Hartnett, 1976). My data support the recommendations of Eston (2002) and

suggest that when BMI is calculated in men, researchers should proceed cautiously when

interpreting their results, especially if the BMI is for diagnostic purposes (e.g., obesity, anorexia

nervosa). Furthermore, my findings are consistent with those of others (e.g., Brener et al., 2003;









Hill & Roberts, 1998) who have found that self-reported height is overestimated relative to

measured height.

Fourth, consistent with my hypothesis, weightlifting behavior was a significant predictor of

drive for muscularity. For the man who desires greater muscularity weightlifting is a necessity

because it results in strength and muscle gains. This is not to say that weightlifting is inherently

pathological, maladaptive, or unhealthy; rather, my findings suggest that weightlifting may be a

tool misused by those men highly fixated on attaining a more muscular physique. It is a paradox,

then, that while weightlifting was significantly related to dietary practices, supplement use, and

muscularity-related behaviors, it was not significantly related to muscle-oriented body-image.

Collectively, these results suggest that men with high drive for muscularity rely heavily upon

weightlifting and other behaviors (e.g., supplement use) in pursuit of the "ideal" physique,

whereas men with moderate or low levels of drive for muscularity adopt these same behaviors

independent of body-image concerns (e.g., for perceived health benefits that supplements and

high protein diets offer).

Fifth, consistent with my hypothesis, general exercise behavior (as measured by the

LTEQ) did not predict drive for muscularity. It is possible that this is a reflection of the lack of

specificity regarding exercise mode inherent in the LTEQ; this study has established

weightlifting specifically as a predictor of drive for muscularity. Although there was a weak yet

significant relationship between the LTEQ and weightlifting, my results indicate that because the

LTEQ does not specifically assess weightlifting it may not be the best measure of exercise

behavior for use in men. Instead, the LTEQ assesses general leisure-time activity, and therefore

is more appropriate for body-image research in women, where the primary emphasis on body-

image is on weight reduction as opposed to muscular hypertrophy (McCabe et al., 2002).









Contrary to my hypotheses, eating pathology and perceived sociocultural pressure did not

predict drive for muscularity. First, dietary behaviors were not predictive of drive for

muscularity. This is interesting in light of the finding that supplement use was predictive of drive

for muscularity; this suggests that normal college-aged men do not adopt eating behaviors aimed

at maximizing muscular growth (perhaps because it is too laborious), but they instead will

readily turn to supplements to achieve greater muscularity. This is consistent with the larger

societal trend towards "quick fixes" such as pills, powders, snack bars, exercise equipment, etc.,

that promise fast results with minimal effort. It is likely that dietary behaviors would have been

predictive of drive for muscularity had the sample been comprised of advanced weightlifters or

bodybuilders as such athletes are known to adopt strict dietary practices to achieve their goals of

muscular hypertrophy (Lantz et al., 2002).

Second, perceived sociocultural pressure did not predict drive for muscularity. The

Perceived Sociocultural Pressure Scale consists of eight items that ask the respondent how

messages about body fat and muscularity from friends, family, dating partners, and the media

impact them. It is possible that if these different influences were isolated then a more specific

prediction would be available. For example, friends and family may serve as protective factors

against developing drive for muscularity, whereas dating partners and the media may contribute

to drive for muscularity. It is noteworthy that fellow gym-goers or weightlifting partners were

not included in the Perceived Sociocultural Pressure Scale; it is possible that pressure to attain

greater muscularity may stem from others in the gym environment. Further research would aid in

clarifying this issue.

My findings have several implications for the Cafri et al. (2005) model. Specifically, my

results support their model of male body change strategies because weightlifting predicted drive









for muscularity (body-image dissatisfaction in the model). My findings also suggest that the link

between health risk behaviors and body-image dissatisfaction should be bi-directional because

use of supplements predicted drive for muscularity. However, my findings do not support the

hypothesized link between body composition (BMI, body fat percentage, FFMI) and body

dissatisfaction; replication of this finding would suggest that this hypothesized link be removed.

Furthermore, my findings also indicate the need for two additions to the model: 1) self-esteem

predicted drive for muscularity (body-image dissatisfaction in the model), therefore providing

support for a directional arrow between psychological functioning and body-image

dissatisfaction, and 2) exercise dependence predicted drive for muscularity, therefore providing

support for its inclusion as a health risk behavior. Implementing these changes in the model

would help refine the relationships between these constructs and male body-image

dissatisfaction.

Limitations

Although this study advances our knowledge of how body composition and selected

psychological factors relate to drive for muscularity, there are several limitations. First, the

participants were a convenient sample of college-aged men, which limits the generalizability of

the results. Future researchers are encouraged to examine predictors of drive for muscularity in

other populations, including adolescent boys, older men, men who are not attending college, and

athletically active women (e.g., bodybuilders). For example, establishing predictors of drive for

muscularity in adolescent boys would aid in the identification of boys who are at highest risk of

drive for muscularity and its associated features. This is especially important because increasing

numbers of boys as young as 8-years old report body-image dissatisfaction and disordered eating

(Cohane & Pope, 2001; McCabe & Ricciardelli, 2003). The generalizablility of the results is also

limited to college-aged men in Florida; because Florida is a peninsula its citizens are able to visit









beaches (where a greater proportion of one's body will be exposed to others) frequently. It is

therefore possible that men in Florida are more invested in their appearance than men who live in

northern states where such bodily exposure occurs less frequently. Thus, further research

examining drive for muscularity in other regions is needed.

Second, while demographic variables such as sexual orientation and ethnicity were

assessed, their low frequency precluded moderator analysis. It is possible that these variables, as

well as other demographic variables that were not assessed (e.g., socioeconomic status),

moderate drive for muscularity. With respect to sexual orientation, one participant reported

homosexual orientation, but seven men reported "Male" as their sexual orientation. Because the

question of sexual orientation was open-ended on the demographic questionnaire, it is unclear

whether these participants meant to communicate their gender or if they were indeed

homosexual. Most research indicates that homosexual men have greater body dissatisfaction and

drive for muscularity than heterosexual men (Kaminski et al., 2005; Yelland & Tiggemann,

2003), however other research has not supported this (e.g., Boroughs & Thompson, 2002).

Therefore, it would be informative if future research on drive for muscularity included sexual

orientation as a moderator.

Ethnicity has been shown to moderate body dissatisfaction in women, whereby Whites

report more body dissatisfaction than non Whites (e.g., Wildes, Emery, & Simon, 2001). For

example, when compared to Mexican women, American women have greater levels of concern

about significant weight gain and fear of becoming fat (Crandall & Martinez, 1996). Although

the topic has received little research attention in men, preliminary evidence suggests that culture

and ethnicity may also moderate male body dissatisfaction as well as the likelihood of adopting

body change strategies (Ricciardelli, McCabe, Williams, & Thompson, 2007). For example,









there is evidence that Taiwanese men are more satisfied with their bodies than American and

European men (Yang et al., 2005), and other research indicates that nonwhite men are less likely

than white men to desire the V-shaped taper that is associated with a muscular physique (Fallon,

DeBraganza, Chittester, & Hausenblas, 2005). However, some research indicates that nonwhite

adolescent boys have greater rates of disordered eating than white adolescent boys (Neumark-

Sztainer & Hannan, 2000). Because this is counter to the available research in men with eating

disorders more research is needed.

Third, although current and past steroid use was ascertained, there were insufficient

numbers of participants who answered "yes" to these questions to conduct any meaningful

analyses (two participants indicated current steroid use, and one participant indicated past but not

current steroid use). However, four men who were not current steroid users indicated that the

question, "If you are not currently using anabolic steroids to build muscle mass, have you in the

past?" did not apply to them. This response technically would indicate current usage; whether

this was the case, or the response options provided were confusing to the participant, cannot be

determined.

This also illustrates the final limitation of the study, which is the use of self-report

measures. Although all self-report measures contained herein have adequate psychometric

properties, it is possible that some information collected from some participants on these types of

measures contain inaccuracies because of (1) Normal memory deficits, (2) inaccurate recall, or

(3) intentionally providing inaccurate information. For example, the measurement of exercise

behavior by the LTEQ was limited because the respondent was asked to indicate the number of

strenuous, moderate, and mild exercise sessions engaged in per week. In an attempt to help the

respondent answer the items, the LTEQ provides examples of activities that would qualify as









strenuous, moderate, or mild in intensity, but the only reference to weightlifting is under the

strenuous exercise heading. This begs the question: Can a person have a "light" weightlifting

session? Most people would say yes, but because such a session must be subjectively described

as moderate or mild there is reason to suspect that the ability to accurately delineate between

these intensities is diminished: one man's moderate intensity weightlifting session may be

another man's mild intensity weightlifting session. In addition, while reliable and valid, the

skinfold method of body fat estimation has a + 3.5% margin of error (ACSM, 2000); another

method of body fat estimation (e.g., DEXA) may yield a more precise estimate and thus

strengthen the findings of subsequent research.

Finally, out of 159 men who indicated they were interested in participating in the study by

signing up when the study announcement was made in their classes, 113 men actually enrolled in

the study. It is possible that the lack of follow through on the part of the 46 men who did not

participate was attributable to factors such as lack of time, insufficient incentive (e.g., knowing

their body fat percentage or earning extra credit toward their classes was not enticing enough to

participate), reluctance to have their body fat estimated (perhaps due to body-image concerns), or

simply lack of interest. However, all men who reported to the lab at their scheduled appointment

time to participate in the study completed all aspects of the study.

Future Research

Because body dissatisfaction in men has severe psychological and physical ramifications

further research is needed to examine its causes and consequences.

First, there is a need for a psychometrically sound measure that assesses eating behaviors

specific to adding muscle mass and decreasing body fat. Certain items of the DMS (McCreary &

Sasse, 2000) and MEBBIE (Kaminski et al., 2005) assess such eating patterns in a general sense,

but more precise items are required to fully understand the specific eating patterns of persons









attempting to add muscle mass while simultaneously limiting body fat accumulation. The MDI

(Lantz et al., 2002; Rhea et al., 2004) shows promise.

Second, while Cafri et al. (2005) have proposed a model of the risk factors for male body-

image disturbance, they do not indicate a direct link between self-esteem and body image

dissatisfaction-why not? This is puzzling because there is sufficient evidence that there is a

direct inverse relationship between body-image disturbance and self-esteem, and this study has

found that self-esteem is a negative predictor of drive for muscularity in particular.

Third, most male body dissatisfaction research has been conducted in adolescent boys; the

only line of research that is a consistent exception to this is muscle dysmorphia. Indeed, it is

logical to focus research on a population that may be a target for intervention, but there is ample

evidence indicating there is a need for better understanding of body-image disturbance in men.

Specifically, information on drive for muscularity across the life span would contribute to

understanding how it is similar to, or different than, other men's health issues (e.g., male pattern

baldness, weight gain, impotence). For example, it is possible that drive for muscularity is

especially salient in adolescence and young adulthood because this is a time when boys and

young men gain a sense of what it means to be masculine, and they therefore derive self-identity

from having a lean and muscular physique. In fact, some researchers have argued that, as

traditional gender roles become increasingly blurred and there exists greater parity between the

sexes, men may focus on developing their physiques in an effort to assert their masculinity

(Pope, Phillips et al., 2000). In light of this it would be informative to conduct prospective

research to determine the course of drive for muscularity as men age; at what point in a man's

life does possessing a muscular physique lose its appeal or perceived benefits? For example, how

do significant life events such as marriage and fatherhood impact a man's lifestyle, as well as his









concept of what makes him masculine? Future research that addresses these questions would be

most enlightening.

Fourth, the conceptualization of male body-image disturbance as two parallel continue may

be beneficial (Figure 5-1). Together, these continue are able to encapsulate the finding that

males are dissatisfied with being too small (with respect to muscularity), not large enough (with

respect to muscularity), or too large (with respect to body fat). At opposite ends of the body fat

dimension is the dissatisfaction due to perceiving oneself to be either too skinny or too fat; this

reflects body-image disturbance relative to degree of body fat (e.g., the higher the body fat the

higher the body-image dissatisfaction). However, because body fat is only half of the body-

image equation for men, there is need for a muscle mass continuum that addresses dissatisfaction

with degree of muscle; this reflects the fact that body-image disturbance can also be a function of

dissatisfaction with minimal muscularity (which would increase the chances of a drive for

muscularity) or dissatisfaction that one's actual high muscularity is not muscular enough (which

would indicate muscle dysmorphia). Therefore, these two criteria may be used together to

ascertain the likelihood of male body-image dissatisfaction if both body fat and muscularity

(expressed as FFMI) are known. For example, a man with little body fat and minimal

musculature would have a higher chance of experiencing body-image disturbance than a man

with little body fat but optimal musculature. Conversely, a man with high musculature and low

body fat would likely have minimal body-image dissatisfaction; the exception would be if,

despite his considerable muscle mass, the man perceived himself as having a "puny" or

"scrawny" body with minimal musculature this would be indicative of muscle dysmorphia.

Fifth, more research is needed to determine the efficaciousness and safety of the myriad

nutritional supplements that men with body-image disturbance frequently use, especially given









the findings of this study that supplement use is predictive of drive for muscularity. Current

knowledge indicates that some supplements (e.g., creatine) are relatively inert, whereas others

(e.g., ephedrine) pose potentially life-threatening side effects if abused or used by at-risk

persons.

Sixth, weightlifting as a specific mode of exercise was found to predict drive for

muscularity in this study, but the role of exercise in male body-image disturbance is still

relatively unclear. Many studies report a positive correlation between exercise behavior and body

satisfaction in men, yet some studies, especially in the muscle dysmorphia literature, indicate

bodybuilders, whose preferred mode of exercise is weightlifting, are more likely to experience

body-image disturbance than other groups of physically active men. This suggests that some men

involved in bodybuilding are more invested than others in their appearance and are therefore

more likely to be dissatisfied with perceived physique flaws; more research using samples of

male weightlifters would clarify this relationship.

Seventh, although the findings of this study and McCreary et al. (2006) indicate that there

is no relationship between body composition and drive for muscularity, there remains a lack of

research describing the correlation between body composition (as assessed by BMI, body fat,

and FFMI) and body-image disturbance in men. Most relevant would be further information

correlating these measures with drive for muscularity and muscle dysmorphia does a person

need to have a certain combination of objective muscle mass and fat mass before becoming

driven to attain muscularity? The findings presented herein indicate no, however establishing a

dose-response-type relationship may improve understanding of how actual body composition is

related to body-image disturbance; in turn, this information could be integrated into interventions

(e.g., Cash & Hrabosky, 2004) aimed at decreasing body-image disturbance in males, or may aid









researchers in determining which persons are most susceptible to experiencing body-image

disturbance (this could facilitate the identification of "at-risk" persons based on body

composition).

In conclusion, this study has established additional support for the Cafri et al. (2005)

model in that weightlifting was found to predict drive for muscularity (e.g., body-image

dissatisfaction in the model). Furthermore, whereas the model indicates that body-image

dissatisfaction leads to health risk behaviors (e.g., supplement use), this study found that

supplement use predicts drive for muscularity. In addition, this study also suggests two important

components be considered for inclusion in the model: (1) Self-esteem as a negative predictor of

drive for muscularity, and (2) exercise dependence, possibly under the "Health Risk Behavior"

or "Sports" constructs, as a predictor of body-image dissatisfaction. Finally, the finding that

measures of body composition do not predict drive for muscularity call into question the

proposed link between biological factors and body-image dissatisfaction in the model. Future

research is required to determine if body-image dissatisfaction in men truly is independent from

actual body composition. Collectively, this study's findings add to the understanding of drive for

muscularity in men, and may potentially contribute to interventions designed to decrease drive

for muscularity and its associated features.










Body fat dimension


Excessive Fat


Muscle mass dimension


Minimal
Muscularity
(Actual)


Optimal


Excessive
Muscularity
(Actual)


Figure 5-1. Proposed continue for male body-image disturbance.


Low Fat


Optimal


I I









APPENDIX A
LIST OF MEASURES

General Information


Age:

Ethnicity:

Sexual orientation: (e.g., hetero-, homo-, bi-sexual)

Academic standing: Fr. So. Jr. Sr.

Are you currently using anabolic steroids in order to build muscle mass?

Yes No

If you are not currently using anabolic steroids to build muscle mass, have you in the
past?

Yes No Not applicable

How many sessions of cardiovascular activity do you participate in per week?



How long (in minutes) does a typical session run?

How many weightlifting sessions do you participate in per week?



How long (in minutes) does a typical session run?









Leisure-Time Exercise Questionnaire


Instructions. This is a scale which measures your leisure-time exercise (i.e., exercise that was
done during your free time such as intramural sports-NOT your physical education class).
Considering a typical week, please indicate how often (on average) you have engaged in
strenuous, moderate, and mild exercise more than 15 minutes during your free time?

1. Strenuous exercise: heart beats rapidly (e.g., running, basketball, jogging, hockey, squash,
judo, roller skating, vigorous swimming, vigorous long distance bicycling, vigorous aerobic
dance classes, heavy weight training)
How many times per typical week do you perform strenuous exercise for 15 minutes or longer?


2. Moderate exercise: not exhausting, light sweating (e.g., fast walking, baseball, tennis, easy
bicycling, volleyball, badminton, easy swimming, popular and folk dancing)
How many times per typical week do you perform moderate exercise for 15 minutes or longer?


3. Mild exercise: minimal effort, no sweating (e.g., easy walking, yoga, archery, fishing,
bowling, lawn bowling, shuffleboard, horseshoes, golf)
How many times per typical week do you perform mild exercise for 15 minutes or longer?










MDI-Diet and Supplement Subscales



Instructions


Read each item (1-9) carefully and then indicate the degree to which the item is characteristic or
true of you by circling the appropriate number corresponding to each statement. There are no
right or wrong answers so please respond as honestly as possible. The anonymity of your
responses is guaranteed.


1. I regulate my caloric intake to maximize muscle
development.


2. Before a workout, I consume energy supplements.


3. I monitor my diet closely to limit my fat intake.


4. I use supplements to help me recuperate from
strenuous workouts.


5. I control the intake of proteins, carbohydrates, and
fats to maximize my muscular development.


6. I use supplements to increase my lifting performance.


7. I use nutritional supplements to help me train through
injuries.


8. My diet is regimented to the point that I eat the same
foods several days in a row.


9. I avoid foods high in sodium.


1 2 3 4 5 6


1 2 3 4 5 6


1 2 3 4 5 6



1 2 3 4 5 6



1 2 3 4 5 6


1 2 3 4 5 6



1 2 3 4 5 6



1 2 3 4 5 6


1 2 3 4 5 6










Perceived Sociocultural Pressure Scale-Original

Using the following scale, please indicate the response that best captures your own experience.


1 = Never
2 = Rarely
3 = Sometimes
4 = Often
5 = Always

1. I've felt pressure from my friends to lose weight.

2. I've noticed a strong message from my friends to have a thin body.

3. I've felt pressure from my family to lose weight.

4. I've noticed a strong message from my family to have a thin body.

5. I've felt pressure from people I've dated to lose weight.

6. I've noticed a strong message from people I have dated to have a thin body.

7. I've felt pressure from the media (e.g., TV, magazines) to lose weight.

8. I've noticed a strong message from the media to have a thin body.









Perceived Sociocultural Pressure Scale-Adapted

Using the following scale, please indicate the response that best captures your own experience.


1 = Never
2 = Rarely
3 = Sometimes
4 = Often
5 = Always

1. I've felt pressure from my friends to lose body fat.

2. I've noticed a strong message from my friends to have a muscular body.

3. I've felt pressure from my family to lose body fat.

4. I've noticed a strong message from my family to have a muscular body.

5. I've felt pressure from people I've dated to lose body fat.

6. I've noticed a strong message from people I have dated to have a muscular body.

7. I've felt pressure from the media (e.g., TV, magazines) to lose body fat.

8. I've noticed a strong message from the media to have a muscular body.









The Drive for Muscularity Scale


Please read each item carefully, then, for each one, circle the number that best applies to you.


1. I wish that I were more muscular.
2. I lift weights to build up muscle.
3. I use protein or energy supplements.
4. I drink weight gain or protein shakes.
5. I try to consume as many calories as I can in a day.
6. I feel guilty if I miss a weight training session.
7. I think I would feel more confident if I had more muscle mass.
8. Other people think I work out with weights too often.
9. I think that I would look better if I gained 10 pounds in bulk.
10. I think that I would feel stronger if I gained a little more muscle
mass.
11. I think that my weight training schedule interferes with other
aspects of my life.
12. I think that my arms are not muscular enough.
13. I think that my chest is not muscular enough.
14. I think that my legs are not muscular enough.


1 2 3 4 5 6


1 2 3
1 2 3
1 2 3
1 2 3
123
123
123
123









Exercise Dependence Scale


Instructions. Using the scale provided below, please complete the following questions as
honestly as possible. The questions refer to current exercise beliefs and behaviors that have
occurred in the past 3 months. Please place your answer in the blank space provided after each
statement.

1 2 3 4 5 6
Never Always

1. I exercise to avoid feeling irritable.
2. I exercise despite recurring physical problems.
3. I continually increase my exercise intensity to achieve the desired
effects/benefits.
4. I am unable to reduce how long I exercise.
5. I would rather exercise than spend time with family/friends.
6. I spend a lot of time exercising.
7. I exercise longer than I intend.
8. I exercise to avoid feeling anxious.
9. I exercise when injured.
10. I continually increase my exercise frequency to achieve the desired
effects/benefits.
11. I am unable to reduce how often I exercise.
12. I think about exercise when I should be concentrating on school/work.
13. I spend most of my free time exercising.
14. I exercise longer than I expect.
15. I exercise to avoid feeling tense.
16. I exercise despite persistent physical problems.
17. I continually increase my exercise duration to achieve the desired
effects/benefits.
18. I am unable to reduce how intense I exercise.
19. I choose to exercise so that I can get out of spending time with family/friends.
20. A great deal of my time is spent exercising.
21. I exercise longer than I plan.









Rosenberg Self-Esteem Scale

Directions: For each question, please indicate the degree to which you strongly agree, agree,
disagree, or strongly disagree with each statement.


Strongly Agree Agree Disagree Strongly Disagree
1 2 3 4




1. On the whole, I am satisfied with myself. 1 2 3 4
2. At times I think I am no good at all. 1 2 3 4
3. I feel that I have a number of good qualities. 1 2 3 4
4. I am able to do things as well as most other people. 1 2 3 4
5. I feel I do not have much to be proud of. 1 2 3 4
6. I certainly feel useless at times. 1 2 3 4
7. I feel that I am a person of worth,
at least on an equal plane with others 1 2 3 4
8. I wish I could have more respect for myself. 1 2 3 4
9. All in all, I am inclined to feel that I am a failure. 1 2 3 4
10. I take a positive attitude toward myself. 1 2 3 4








APPENDIX B
RECRUITMENT FLYER

ATTENTION MEN


Have you ever wondered what your body fat percentage is? A study in the
Department of Applied Physiology and Kinesiology is currently exploring the
relationship between exercise habits, eating, body image, and body composition.
All you need to do to qualify for your FREE body fat estimation is to simply fill
out a few surveys (which will take about 20 minutes) it's that simple! To make
an appointment please email the Exercise Psychology Laboratory (located in FLG
143) at exer.psych.lab@hhp.ufl.edu and include the following information:

Name
Phone number
Age
Height
Weight









LIST OF REFERENCES


Adams, G., Turner, H., & Bucks, R. (2005). The experience of body dissatisfaction in men. Body
Image, 2, 271-283.

American College of Sports Medicine (2000). Guidelinesfor exercise testing and prescription
(6th Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders
(4 Ed.)Text revision. Washington, D.C.: Author.

Andersen, A., Cohn, L., & Holbrook, T. (2000). Making weight: Men's conflicts n i/thfood,
weight, shape & appearance. Carlsbad, CA: Gurze Books.

Andersen, A. E., & Holman, J. E. (1997). Males with eating disorders: Challenges for treatment
and research. Psychopharmacology Bulletin, 33, 391-397.

Arkoff, A., & Weaver, H. B. (1966). Body image and body dissatisfaction in Japanese
Americans. Journal of Social Psychology, 68, 323-330.

Barry, D. T., Grilo, C. M., & Masheb, R. M. (2002). Gender differences in patients with binge
eating disorder. International Journal ofEating Disorders, 31, 63-70.

Befort, C., Robinson Kurpius, S. E., Hull-Blanks, E., Foley Nicpon, M., Huser, L., &
Sollenberger, S. (2001). Body image, self-esteem, and weight-related criticism from
romantic partners. Journal of College Student Development, 42, 407-419.

Berger, B.G., & Motl, R. W. (2000). Exercise and mood: A subjective review and synthesis of
research employing the Profile of Mood States. Journal ofApplied Sport Psychology, 12,
69-92.

Bizzarini, E., & De Angelis, L. (2004). Is the use of oral creatine supplementation safe? Journal
of Sports Medicine and Physical Fitness, 44, 411-416.

Blouin, A. G., & Goldfield, G. S. (1995). Body image and steroid use in male bodybuilders.
International Journal of Eating Disorders, 18, 159-165.

Boreham, C., Robson, P. J., Gallagher, A. M., Cran, G. W., Savage, J. M., & Murray, L. J.
(2004). Tracking of physical activity, fitness, body composition and diet from adolescence
to young adulthood: The young hearts project, Northern Ireland. International Journal of
Behavioral Nutrition and Physical Activity, 1, 14.

Boroughs, M., & Thompson, J. K. (2002). Exercise status and sexual orientation as moderators
of body image disturbance and eating disorders in males. International Journal ofEating
Disorders, 31, 307-311.

Braun, D. L., Sunday, S. R., Huang, A., & Halmi, K. A. (1999). More males seek treatment for
eating disorders. International Journal ofEating Disorders, 25, 415-424.









Brener, N. D., McManus, T., Galuska, D. A., Lowry, R., & Wechsler, H. (2003). Reliability and
validity of self-reported height and weight among high school students. Journal of
Adolescent Health, 32, 281-287.

Brewerton, T. D., Stellefson, E. J., Hibbs, N., Hodges, E. L., & Cochrane, C. E. (1995).
Comparison of eating disorder patients with and without compulsive exercising.
International Journal ofEating Disorders, 17, 413-416.

Brower, K. J., Blow, F. C., & Hill, E. M. (1994). Risk factors for anabolic-androgenic steroid use
in men. Journal of Psychiatric Research, 28, 369-380.

Brown, T.A., Cash, T.F., & Mikulka, P.J. (1990). Attitudinal body-image assessment: Factor
analysis of the body self relations questionnaire. Journal ofPersonality Assessment, 55,
135-144.

Cafri, G., Roehrig, M., & Thompson, J. K. (2004). Reliability assessment of the somatomorphic
matrix. International Journal ofEating Disorders, 35, 597-600.

Cafri, G., Strauss, J., & Thompson, J. K. (2002). Male body image: Satisfaction and its
relationship to well-being using the somatomorphic matrix. International Journal of Men's
Health, 1, 215-231.

Cafri, G., & Thompson, J. K. (2004). Measuring male body image: A review of the current
methodology. Psychology of Men & Masculinity, 5, 18-29.

Cafri, G., Thompson, J. K., Ricciardelli, L., McCabe, M., Smolak, L., & Yesalis, C. (2005).
Pursuit of the muscular ideal: Physical and psychological consequences and putative risk
factors. Clinical Psychology Review, 25, 215-239.

Cafri, G., van den Berg, P., & Thompson, J. K. (2006). Pursuit of muscularity in adolescent
boys: Relations among biopsychosocial variables and clinical outcomes. Journal of
Clinical Child and Adolescent Psychology, 35, 283-291.

Carron, A. V., Hausenblas, H. A., & Estabrooks, P. A. (2003). The psychology ofphysical
activity. New York, NY: McGraw-Hill.

Cash, T. F., & Hrabosky, J. I. (2004). Treatment of body image disturbances. In J. K. Thompson
(Ed.), Handbook of Eating Disorders and Obesity (pp. 515-541). Hoboken, NJ: John Wiley
& Sons, Inc.

Cash, T. F., Morrow, J. A., Hrabosky, J. I., & Perry, A. A. (2004). How has body image
changed? A cross-sectional investigation of college women and men from 1983 to 2001.
Journal of Consulting and Clinical Psychology, 72, 1081-1089.

Cattarin, J. A., Thompson, J. K., Thomas, C., & Williams, R. (2000). Body image, mood, and
televised images of attractiveness: The role of social comparison. Journal of Social and
Clinical Psychology, 19, 220-239.









Chilibeck, P. D., Stride, D., Farthing, J. P., & Burke, D. G. (2004). Effect of creatine ingestion
after exercise on muscle thickness in males and females. Medicine & Science in Sports &
Exercise, 36, 1781-1788.

Chittester, N. I. (2003). Development and validation of the muscle dysmorphia survey (MDS).
Unpublished masters thesis, Washington State University.

Chng, C. L., & Moore, A. (1990). A study of steroid use among athletes: Knowledge, attitude
and use. Health Education, 21, 11-17.

Chung, B. (2001). Muscle dysmorphia: A critical review of the proposed criteria. Perspectives in
Biology and Medicine, 44, 565-574.

Coakley, J. (2004). Sports in society: Issues & controversies (8th ed). New York, NY: McGraw-
Hill.

Cohane, G. H., & Pope, H. G., Jr. (2001). Body image in boys: A review of the literature.
International Journal ofEating Disorders, 29, 373-379.

Cohen, J., & Cohen, P. (1983). Applied multiple regression/correlation analysis for the
behavioral sciences (2nd ed). Hillsdale, NJ: Lawrence Erlbaum Associates.

Cole, J. C., Smith, R., Halford, J. C. G., & Wagstaff, G. F. (2003). A preliminary investigation
into the relationship between anabolic-androgenic steroid use and the symptoms of reverse
anorexia in both current and ex-users. Psychopharmacology, 166, 424-429.

Cooley, E., & Toray, T. (2001). Body image and personality predictors of eating disorder
symptoms during the college years. International Journal ofEating Disorders, 30, 28-36.

Davis, C., & Cowles, M. (1991). Body image and exercise: A study of relationships and
comparisons between physically active men and women. Sex Roles, 25, 33-44.

Elgar, F. J., Roberts, C., Tudor-Smith, C., & Moore, L. (2005). Validity of self-reported height
and weight and predictors of bias in adolescents. Journal ofAdolescent Health, 37, 371-
375.

Emmanuel, N. P., Jones, C., & Lydiard, R. B. (1998). Use of herbal products and symptoms of
bipolar disorder. American Journal ofPsychiatry, 155, 1627.

Eston, R. G. (2002). Use of the body mass index (BMI) for individual counseling: The new
section editor for kinanthropometry is "Grade 1 obese, overweight" (BMI 27.3), but dense
and "distinctly muscular" (FFMI 23.1)! Journal of Sports Sciences, 20, 515-518.

Expert Panel on the Identification, Evalation, and Treatment of Overweight and Obesity in
Adults (1998). Executive summary of the clinical guidelines on the identification,
evaluation, and treatment of overweight and obesity in adults. Archives ofInternal
Medicine, 158, 1855-1867.









Fisher, E., & Thompson, J. K. (1994). A comparative evaluation of cognitive-behavioral therapy
(CBT) versus exercise therapy (ET) for the treatment of body image disturbance. Behavior
Modification, 18, 171-185.

Frederick, D. A., Peplau, L. A., & Lever, J. (2006). The swimsuit issue: Correlates of body
image in a sample of 52,677 heterosexual adults. Body Image, 3, 413-419.

Freeman, R. J., Beach, B., Davis, R., & Solyom, L. (1985). The prediction of relapse in bulimia
nervosa. Journal ofPsychiatric Research, 19, 349-353.

Garner, D. M., Olmstead, M. P., & Polivy, J. (1983). Development and validation of a
multidimensional eating disorder inventory for anorexia nervosa and bulimia. International
Journal ofEating Disorders, 2, 15-34.

Gila, A., Castro, J., Cesena, J., & Toro, J. (2005). Anorexia nervosa in male adolescents: Body
image, eating attitudes and psychological traits. Journal ofAdolescent Health, 36, 221-
226.

Godin, G., Jobin, J., & Bouillon, J. (1986). Assessment of leisure time exercise behavior by self-
report: A concurrent validity study. Canadian Journal of Public Health, 77, 359-362.

Godin, G., & Shephard, R. J. (1985). A simple method to assess exercise behavior in the
community. Canadian Journal ofApplied Sport Science, 10, 141-146.

Gokee-LaRose, J., Dunn, M. E., & Tantleff-Dunn, S. (2004). An investigation of the cognitive
organization of body comparison sites in relation to physical appearance related anxiety
and drive for thinness. Eating Behaviors, 5, 133-145.

Goldfield, G. S., Blouin, A. G., & Woodside, D. B. (2006). Body image, binge eating, and
bulimia nervosa in male bodybuilders. Canadian Journal ofPsychiatry, 51, 160-168.

Graham, M. A., Eich, C., Kephart, B., & Peterson, D. (2000). Relationship among body image,
sex, and popularity of high school students. Perceptual andMotor .\k//1, 90, 1187-1193.

Green, S. B. (1991). How many subjects does it take to do a regression analysis? Multivariate
Behavioral Research, 20, 499-510.

Griffiths, R. A., Beumont, P. J. V., Giannakopoulos, E., Russell, J., Schotte, D., Thornton, C., et
al. (1999). Measuring self-esteem in dieting disordered patients: The validity of the
Rosenberg and Coopersmith contrasted. International Journal ofEating Disorders, 25,
227-231.

Grilo, C. M., & Masheb, R. M. (2005). Correlates of body image dissatisfaction in treatment-
seeking men and women with binge eating disorder. International Journal ofEating
Disorders, 38, 162-166.









Grilo, C. M., Masheb, R. M., Brody, M., Burke-Martindale, C. H., & Rothschild, B. S. (2005).
Binge eating and self-esteem predict body image dissatisfaction among obese men and
women seeking bariatric surgery. International Journal ofEating Disorders, 37, 347-351.

Guggenheim, K., Poznanski, R., & Kaufmann, N. A. (1977). Attitudes of adolescents to their
body build and the problem of juvenile obesity. International Journal of Obesity, 1, 135-
149.

Haines, J., Neumark-Sztainer, D., Perry, C. L., Hannan, P. J., & Levine, M. P. (2006). V.I.K.
(very important kids): A school-based program designed to reduce teasing and unhealthy
weight-control behaviors. Health Education Research, 21, 884-895.

Haller, C. A., & Benowitz, N. L. (2000). Adverse cardiovascular and central nervous system
events associated with dietary supplements containing ephedra alkaloids. New England
Journal of Medicine, 343, 1833-1838.

Hallsworth, L., Wade, T., & Tiggemann, M. (2005). Individual differences in male body-image:
An examination of self-objectification in recreational body builders. British Journal of
Health Psychology, 10, 453-465.

Hartgens, F., & Kuipers, H. (2004). Effects of androgenic-anabolic steroids in athletes. Sports
Medicine, 34, 513-554.

Hausenblas, H. A., & Carron, A. V. (1999). Eating disorder indices and athletes: An integration.
Journal of Sport & Exercise Psychology, 21, 230-258.

Hausenblas, H. A., & Fallon, E. A. (2002). Relationship among body image, exercise behavior,
and exercise dependence symptoms. International Journal ofEating Disorders, 32, 179-
185.

Hausenblas, H. A., & Symons Downs, D. (2002a). Exercise dependence: A systematic review.
Psychology of Sport and Exercise, 3, 89-123.

Hausenblas, H. A., & Symons Downs, D. (2002b). How much is too much? The development
and validation of the exercise dependence scale. Psychology andHealth, 17, 387-404.

Heymsfield, S. B., Allison, D. B., Vasselli, J. R., Pietrobelli, A., Greenfield, D., & Nunez, C.
(1998). Garcinia cambogia (hydroxycitric acid) as a potential antiobesity agent: A
randomized controlled trial. JAMA, 280, 1596-1600.

Heywood, S., & McCabe, M. P. (2006). Negative affect as a mediator between body
dissatisfaction and extreme weight loss and muscle gain behaviors. Journal of Health
Psychology, 11, 833-844.

Hildebrandt, T., Schlundt, D., Langenbucher, J., & Chung, T. (2006). Presence of muscle
dysmorphia symptomology among male weightlifters. Comprehensive Psychiatry, 47,
127-135.









Hill, A., & Roberts, J. (1998). Body mass index: a comparison between self-reported and
measured height and weight. Journal of Public Health Medicine, 20, 206-210.

Hitzeroth, V., Wessels, C., Zungu-Dirwayi, N., Oosthuizen, P., & Stein, D. J. (2001). Muscle
dysmorphia: A South African sample. Psychiatry and Clinical Neurosciences, 55, 521-
523.

Huddy, D. C., Johnson, R. L., Stone, M. H., Proulx, C. M., & Pierce, K. A. (1997). Relationship
between body image and percent body fat among male and female college students
enrolled in an introductory 14-week weight-training course. Perceptual andMotor ,kill/,
85, 1075-1078.

Hutchins, G. M. (2001). Letter to the editor. New England Journal of Medicine, 344, 1095-1096.

Irving, L. M., Wall, M., Neumark-Sztainer, D., & Story, M. (2002). Steroid use among
adolescents: Findings from project eat. Journal ofAdolescent Health, 30, 243-252.

Jacobs, D. R., Jr., Ainsworth, B. E., Hartman, T. J., & Leon, A. S. (1993). A simultaneous
evaluation of 10 commonly used physical activity questionnaires. Medicine and Science in
Sports and Exercise, 25, 81-91.

Jonnalagadda, S. S., Rosenbloom, C. A., & Skinner, R. (2001). Dietary practices, attitudes, and
physiological status of collegiate freshman football players. Journal ofS eunglh and
Conditioning Research, 15, 507-513.

Kaminski, P. L., Chapman, B. P., Haynes, S. D., & Own, L. (2005). Body image, eating
behaviors, and attitudes toward exercise among gay and straight men. Eating Behaviors, 6,
179-187.

Kanayama, G., Pope, H. G., Jr., Cohane, G., & Hudson, J. I. (2003). Risk factors for anabolic-
androgenic steroid use among weightlifters: A case-control study. Drug andAlcohol
Dependence, 71, 77-86.

Kanayama, G., Pope, H. G., Jr., & Hudson, J. I. (2001). "Body image" drugs: A growing
psychosomatic problem. P %hi, ithe, iqy3' andPsychosomatics, 70, 61-65.

Keel, P. K., Klump, K. L., Leon, G. R., & Fulkerson, J. A. (1998). Disordered eating in
adolescent males from a school-based sample. International Journal ofEating Disorders,
23, 125-132.

Kostanski, M., Fisher, A., & Gullone, E. (2004). Current conceptualization of body image
dissatisfaction: Have we got it wrong? Journal of Child Psychology and Psychiatry, 45,
1317-1325.

Kostanski, M., & Gullone, E. (1998). Adolescent body image dissatisfaction: Relationships with
self-esteem, anxiety, and depression controlling for body mass. Journal of Child
Psychology and Psychiatry, 39, 255-262.









Kouri, E. M., Pope, H. G., Jr., & Katz, D. L. (1994). Letter to the editor. JAMA, 271, 347.

Kouri, E. M., Pope, H. G., Jr., Katz, D. L., & Oliva, P. (1995). Fat-free mass index in users and
nonusers of anabolic-androgenic steroids. Clinical Journal of Sport Medicine, 5, 223-228.

Kraemer, W. J., Torine, J. C., Silvestre, R., French, D. N., Ratamess, N. A., Spiering, B. A., et al.
(2005). Body size and composition of national football league players. Journal ofSun englh
and Conditioning Research, 19, 485-489.

Kreider, R. B. (1999). Dietary supplements and the promotion of muscle growth with resistance
exercise. Sports Medicine, 27, 97-110.

Labre, M. P. (2005). Burn fat, build muscle: A content analysis of Men's Health and Men's
Fitness. International Journal of Men's Health, 4, 187-200.

Landers, D. M., & Arent, S. M. (2001). Physical activity and mental health. In R. N. Singer, H.
A. Hausenblas, & C. M. Janelle (Eds.), Handbook of sport psychology (2nd Ed., pp 740-
765). New York, NY: Wiley.

Lantz, C. D., Rhea, D. J., & Cornelius, A. E. (2002). Muscle dysmorphia in elite-level power
lifters and bodybuilders: A test of differences within a conceptual model. Journal of
S. eungth and Conditioning Research, 16, 649-655.

Lefavi, R. G., Reeve, T. G., & Newland, M. C. (1990). Relationship between anabolic steroid
use and selected psychological parameters in male bodybuilders. Journal of Sport
Behavior, 13, 157-166.

Leit, R. A., Gray, J. J., & Pope, H. G., Jr. (2002). The media's representation of the ideal male
body: A cause for muscle dysmorphia? International Journal ofEating Disorders, 31,
334-338.

Leit, R. A., Pope, H. G., Jr., & Gray, J. J. (2001). Cultural expectations of muscularity in men:
The evolution of playgirl centerfolds. International Journal ofEating Disorders, 29, 90-
93.

Macgregor, F. C. (1981). Patient dissatisfaction with results of technically satisfactory surgery.
Aesthetic Plastic Surgery, 5, 27-32.

Mangweth, B., Pope, H. G., Jr., Kemmler, G., Ebenbichler, C., Hausmann, A., De Col, C., et al.
(2001). Body image and psychopathology in male bodybuilders. Py) h,,1thei ,1qpy and
Psychosomatics, 70, 38-43.

Manson, J. E., Skerrett, P. J., Greenland, P., & VanItallie, T. B. (2004). The escalating
pandemics of obesity and sedentary lifestyle: A call to action for clinicians. Archives of
Internal Medicine, 164, 249-258.









Mayville, S. B., Williamson, D. A., White, M. A., Netemeyer, R. G., & Drab, D. L. (2002).
Development of the muscle appearance satisfaction scale: A self-report measure for the
assessment of muscle dysmorphia symptoms. Assessment, 9, 351-360.

Mazzeo, S. E., Slof, R. M., Tozzi, F., Kendler, K. S., & Bulik, C. M. (2004). Characteristics of
men with persistent thinness. Obesity Research, 12, 1367-1369.

McCabe, M. P., & Ricciardelli, L. A. (2003). Body image and strategies to lose weight and
increase muscle among boys and girls. Health Psychology, 22, 39-46.

McCabe, M. P., & Ricciardelli, L. A. (2004a). A longitudinal study of pubertal timing and
extreme body change behaviors among adolescent boys and girls. Adolescence, 39, 145-
166.

McCabe, M. P., & Ricciardelli, L. A. (2004b). Body image dissatisfaction among males across
the lifespan: A review of past literature. Journal of Psychosomatic Research, 56, 675-685.

McCabe, M. P., & Ricciardelli, L. A. (2005). A prospective study of pressures from parents,
peers, and the media on extreme weight change behaviors among adolescent boys and
girls. Behaviour Research and Therapy, 43, 653-668.

McCabe, M. P., Ricciardelli, L. A., & Banfield, S. (2001). Body image, strategies to change
muscles and weight, and puberty: Do they impact on positive and negative affect among
adolescent boys and girls? Eating Behaviours, 2, 129-149.

McCabe, M. P., Ricciardelli, L. A., & Finemore, J. (2002). The role of puberty, media, and
popularity with peers as strategies to increase weight, decrease weight and increase muscle
tone among adolescent boys and girls. Journal ofPsychosomatic Research, 52, 145-153.

McCreary, D. R., Karvinen, K., & Davis, C. (2006). The relationship between the drive for
muscularity and anthropometric measures of muscularity and adiposity. Body Image, 3,
145-152.

McCreary, D. R., & Sasse, D. K. (2000). An exploration of the drive for muscularity in
adolescent boys and girls. Journal ofAmerican College Health, 48, 297-304.

McCreary, D. R., Sasse, D. K., Saucier, D. M., & Dorsch, K. D. (2004). Measuring the drive for
muscularity: Factorial validity of the drive for muscularity scale in men and women.
Psychology of Men & Masculinity, 5, 49-58.

McGee, R., & Williams, S. (2000). Does low self-esteem predict health compromising
behaviours among adolescents? Journal ofAdolescence, 23, 569-582.

Moore, J. M., Timperio, A. F., Crawford, D. A., Burns, C. M., & Cameron-Smith, D. (2002).
Weight management and weight loss strategies of professional jockeys. International
Journal of Sport Nutrition and Exercise Metabolism, 12, 1-13.