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The Dark Side of Appearance: Body Image Disorders, Exercise Addiction and the Use of Enhancement Drugs Hertfordshire County Council, Public Health & the University of Hertfordshire Ornella Corazza, PhD. Reader in Substance Addictions and Behaviours Dept. of Clinical and Pharmaceutical Sciences University of Hertfordshire E-mail: o.corazza@herts.ac.uk
A globalised network world
� I think therefore I am � � I am seen therefore I am �
THE ABSENT BODY
ADDICTION IS A TERM ADDICTION IS A TERM BEHAVIOURAL BEHAVIOURAL DERIVED FROM THE DERIVED FROM THE LATIN ADDICERE LATIN ADDICERE ADDICTIONS ADDICTIONS «TO ENSLAVE» «TO ENSLAVE» «TO ASSIGN TO» «TO ASSIGN TO» For the Romans an For the Romans an addictus was a person addictus was a person who, having debt, was who, having debt, was assigned to a creditor assigned to a creditor as a slave as a slave
The concept of behavioral addictions has scientific and clinical value, but remains controversial. Why now? Issues around behavioral addictions have been long debated in the different editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and BEHAVIOURAL the International Classification of Diseases (ICD), where the ADDICTIONS: notion of ‘‘addiction’’ referred almost A CONTROVERSIAL exclusively to the intake of substances TOPIC with psychotropic activity.
• Immediate pleasure and relief (NOT long- lasting!) • Dominance : The substance (or behavior) constantly dominates the thinking (main ideation) • Craving : There is a feeling and the increasing COMMON sense of tension before taking the substance • Mood Instability: This is initially limited to FEATURES OF the beginning of substance intake (or behavioral implementation), then BEHAVIORAL increasingly generalized and extended to all aspects of existence • Psychosocial impairment : narrowing of ADDICTIONS interests, neglect of other areas of life • Tolerance : The need to increase the amount of substance (or the time dedicated to behavior) to get the ‘‘positive’’ effect • Loss of control : The need to increase the amount of time dedicated to behavior to get the ‘‘positive’’ effect.
EUROPEAN NETWORK FOR PROBLEMATIC USE OF THE INTERNET (EU-PUI) Visit us at http://www.internetandme.eu/ Multidisciplinary expertise (animal and human neuroscience, genetics, clinicians, bio & • information-technology industry, service planners, patients & carers) Advance understanding of the psycho-biological basis of different forms of PUI and the • societal cost and burden Development of innovative forms of treatment and prevention programmes • 39 countries 146 members
HIKIKOMORI: the "modern-day hermits " "pulling inward, being confined" “Acute social withdrawal” “Often seeking extreme degrees of isolation and confinement” Age: 19-27 years old Male prevalence (90%) 2,000,000 cases in Japan "I started to blame myself and my parents also blamed me for not going to school. The pressure started to build". "Then, gradually, I became afraid to go out and fearful of meeting people. And then I couldn't get out of my house."
SELFITIES Do you take more than three selfies per day? Borderline - Taking selfies at least three times a day , but NOT posting them on social media Acute - Taking selfies at least three times a day and posting every one of them on social media Chronic - Take and post the selfies on social media more than six times per day
Exercise Addic+on (EXA) • Considering its benefits in preserving or improving both physical and mental health, including the treatment of certain addictions, it might appear paradoxical that exercise can also develop into a serious dependence itself. EXA found between 0.3% and 0.5% among the general adult popula+on • (Mónok et al., 2012), and between 3.0% and 12.0% among athletes or regular exercisers (Szabo et al., 2016; Corazza et al 2019). Nonetheless, this prevalence rate may reach over 20% in elite endurance athletes, such those parIcipaIng in triathlon and/or ironman races (Blaydon & Lindner, 2002; Youngman & Simpson, 2014). Studies suggest that men generally show higher scores in EA than women. • EXA has a high comorbidity and a significant correlation with eating disorders and body image disorders (De Luca et al., 2017; Levallius et al., 2017; Rocks et al., 2017). It has been estimated that more than 40% of people suffering from eating disorder is also affected by EXA (Klein et al., 2004). • The challenge in treating this addiction is due to the fact that the habit cannot cease completely, as physical activity plays a central role in gaining and maintaining a healthy lifestyle.
This represents a fertile ground not only for the development of addictions but also for the development of image related psychopathologies
BODY DYSMORPHIC DISORDER (BDD) BDD is severe disorder characterized by distressing preoccupation with perceived imperfections in one’s physical appearance and time- consuming rituals (e.g., excessive mirror checking,cosmetic surgery seeking) aimed at checking, hiding, or fixing “flaws.”
MD is a condition in which the principal symptom is a marked preoccupation with one’s body being insufficiently muscular. In the DSM-5, it is classified as a subtype of BDD MUSCLE DYSMORPHIA (MD)
Image and Performance Enhancing Drugs (IPEDs), or simply “life-style drugs», as umbrella term used to describe a wide rage of products, which have the apparent potential to improve mental and physical functions, including: • Anabolic drugs to enhance structure and function of muscles • Drugs taken for weight loss • Image-enhancing drugs taken to modify the ageing process, beauty and cosmetic appearance • “Sex drugs” and aphrodisiacs • Cognitive enhancers • Drugs taken to improve mood/social behaviours
AIM To investigate whether there is a potential link between image perception, exercise addiction and the use of PIEDS
METHODS Online survey, targeting people who regularly engage in fitness. • Recruitment was supported via a dedicated project website (https://humanenhancementdrugs.com) and adverts on fitness blogs and other social media platforms Measures being used investigated • – Demographics – PIEDS use and knowledge – Exercise Addiction (Exercise Addiction Inventory; EAI) – Body Image Perception (Anxiety Appearance Index; AAI) – Self-Esteem (Rosenberg’s Self Esteem Scale; RSE) The study was approved by the Ethics Committee Ethical at University of • Hertfordshire prior to data collection (HSK/SF/UH/00104).
Sample 1711 Type of activity UK (377) Netherlands (189) Italy (494) Walking 53.3% Hungary (651) Running 79.2% Sex 66.3 % F 33.7% M Bodyweight 28.7% Mean Age 30.17 ± 10.26 Lift weights 27.2% Swimming 19.6% Occupation 63.6% Employed Hiking 12.8% 29% Student 5.3% Unemployed Gymnastics 11.3% 1.3% Retired Football 8.9% Yoga 8.7%
EA & BDD EA was detected in 11.7% of the overall sample, considering the cut-off • score of 24 points in the EAI. This was higher amongst male (15%) , indicating a greater exposure to physical injuries and withdrawal symptoms, like depression, anxiety and mood swings. Participants were also very concerned about their physical appearance • with 38.5% at risk of BDD, considering a cut-off score of 19 in the AAI. This mainly affected the mainly female (47.2%). This result was much higher not only than the scores reported among the general population (where BBD prevalence ranges from 0.7% to 2.3%), but also of those found among at risk populations (6.7% among general dermatology patients, 14.0% among cosmetic dermatology patients, 10% in the maxillofacial setting, and 21% in patients seeking rhinoplasty (Bouman et al., 2017, Brito et al., 2016, Locatelli et al., 2017).
EAI and AAI in the four countries
DISCLOSING THE USE OF PRODUCTS TO INCREASE FITNESS PERFORMANCE Yes, 39.80% No, 60.20%
VARIETY OF PRODUCTS BEING USED (n=1711) Caffeine Amino Antioxid 29.8% acid Proteins Vitamins ants 39.1% 63.3% 52.5% 8.2% Nitric Oxide Laxatives 8.2% 2.3% (17% UK Pilot) Thyroid Herbal Fish Oil Amphetamine Hormone products 27.9% 2.3% 3% 9.4% (14% UK pilot) (9% UK pilot) Mineral Salt 13.1% Anabolic Ginseng Steroid 7.9% 5.9% Sibutramine Guarana’ Diuretics (9% UK pilot) 1.1.% 7% 4.9% GHB (6% UK 1.8% pilot)
Side effects - No previous medical advise - 8% of the sample reported side-effects from taking products, including: Difficulties Sleeping Headaches Diarrhea High BP Mood Swings Acne Depression Heart Palpita=ons Hair Loss
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