Dr Helen Fawkner

Anabolic–androgenic steroids (AAS) are synthetic hormones that mimic the effect of androgens and effect bodily change by increasing power, strength, speed, and muscle mass. For men, AAS use may serve as a bodily expressed form of gender, allowing them to achieve the muscular ideal for men. AAS use in men is also linked to sexual orientation; it is higher among gay men than among heterosexual men. For women, AAS use is linked to placing less importance on, or rejecting, traditional notions about female appearance. There is, however, no evidence of AAS use being linked to sexual orientation in women.

Anabolic–androgenic steroids (AAS) are synthetic hormones that mimic the effect of androgens and effect bodily change by increasing power, strength, speed, and muscle mass. For men, AAS use may serve as a bodily expressed form of gender, allowing them to achieve the muscular ideal for men. AAS use in men is also linked to sexual orientation; it is higher among gay men than among heterosexual men. For women, AAS use is linked to placing less importance on, or rejecting, traditional notions about female appearance. There is, however, no evidence of AAS use being linked to sexual orientation in women.

Objective: Perceptions of peer behavior and attitudes exert considerable social pressure on young adults to use substances. This study investigated whether European students perceive their peers’ cannabis use and approval of cannabis use to be higher than their own personal behaviors and attitudes, and whether estimations of peer use and attitudes are associated with personal use and attitudes. Method: University students (n = 4131) from Belgium, Denmark, Germany, the Slovak Republic, Spain, Turkey and the United Kingdom completed an online survey as part of the Social Norms Intervention for Polysubstance usE in students (SNIPE) project, a feasibility study of a web-based normative feedback intervention for substance use. The survey assessed students’ (1) personal substance use and attitudes, and (2) perceptions of their peers’ cannabis use (descriptive norms) and attitudes (injunctive norms). Results: Although most respondents (92%) did not personally use cannabis in the past two months, the majority of students thought that the majority of their peers were using cannabis and that their peers had more permissive attitudes towards cannabis than themselves. Controlling for students’ age, sex, study year and religious beliefs, perceived peer descriptive norms were associated with personal cannabis use (OR: 1.42; 95% CI: 1.22, 1.64) and perceived injunctive norms were associated with personal attitudes towards cannabis use (OR: 1.46; 95% CI: 1.09, 1.94). Conclusions: European students appear to possess similar discrepancies between personal and perceived peer norms for cannabis use and attitudes as found in North American students. Interventions which address such discrepancies may be effective in reducing cannabis use. Keywords: cannabis, social norms, student health, social influence

Exposure to muscular male images in the media may explain increasing body dissatisfaction in men and predispose men to body image-related disorders. The aim of this study was to increase our understanding of men's perceptions of these media images and the possible psychological and behavioral influences of these images. As the dimensions of age, exercise status, and sexual orientation may be important in understanding men's perceptions of male media images, 34 Australian men representing these dimensions were recruited for seven focus group discussions. Ethnographic analysis revealed two main interpretations of media images: a diversity of male images and the presentation of the mesomorphic physique as ideal. Men from half of all groups, predominantly exercisers and gay men, reported that their psychological state and behavior were influenced negatively by self-comparison with these idealized images. Further research examining the role of these factors and appearance schemas in relation to body dissatisfaction is suggested.

In considering body image development in men, this article describes the ideal body for men and considers rates of body dissatisfaction among adult men. Furthermore, it selectively considers some antecedents to body image attitudes in men (e.g., physical, psychological, sociocultural, and interpersonal factors), briefly examines some behavioral consequences of body dissatisfaction in men (e.g., dieting and weight control, grooming, cosmetic surgery, steroid use, smoking, and sexual risk-taking), and considers some sociocultural reasons why men may experience body dissatisfaction.

Minor life events were examined in an attempt to determine their contribution to athletic injury risk. Male and female athletes (N = 98), from both team and individual sports (hockey, volleyball, and triathlon) were examined over the course of a competitive season. A high rate of injury was noted among these athletes (30% - 46% of the members of each team sustained at least one injury during the season). The injured athletes were found to have a significant increase in minor life events for the week prior to injury. No significant changes in minor life events occurred for the non- injured athletes. The results of the present study provide substantial evidence for a link between minor life events and athletic injury.

OBJECTIVE: The aim of this study was to investigate the strength of perceptual embodiment achieved during an adapted version of the rubber hand illusion (RHI) in response to a series of modified transcutaneous electrical nerve stimulation (TENS) pulse patterns with dynamic temporal and spatial characteristics which are more akin to the mechanical brush stroke in the original RHI. MATERIALS AND METHODS: A repeated-measures counterbalanced experimental study was conducted where each participant was exposed to four TENS interventions: continuous pattern TENS; burst pattern TENS (fixed frequency of 2 bursts per second of 100 pulses per second); amplitude-modulated pattern TENS (intensity increasing from zero to a preset level, then back to zero again in a cyclical fashion); and sham (no current) TENS. Participants rated the intensity of the RHI using a three-item numerical rating scale (each item was ranked from 0 to 10). Friedman's analysis of ranks (one-factor repeated measure) was used to test the differences in perceptual embodiment between TENS innervations; alpha was set at p ≤ 0.05. RESULTS: There were statistically significant differences in the intensity of misattribution and perceptual embodiment between sham and active TENS interventions, but no significant differences between the three active TENS conditions (amplitude-modulated TENS, burst TENS, and continuous TENS). Amplitude-modulated and burst TENS produced significantly higher intensity scores for misattribution sensation and perceptual embodiment compared with sham (no current) TENS, whereas continuous TENS did not. CONCLUSION: The findings provide tentative, but not definitive, evidence that TENS parameters with dynamic spatial and temporal characteristics may produce more intense misattribution sensations and intense perceptual embodiment than parameters with static characteristics (e.g., continuous pulse patterns).

BACKGROUND: Perceptual embodiment of an artificial limb aids manual control of prostheses and can be facilitated by somatosensory feedback. We hypothesised that transcutaneous electrical nerve stimulation (TENS) may facilitate perceptual embodiment of artificial limbs. OBJECTIVE: To determine the effect of TENS on perceptual embodiment of an artificial hand in 32 intact-limbed participants. METHODS: Participants were exposed to four experimental conditions in four counterbalanced blocks: (i) Vision (V) watching an artificial hand positioned congruently to the real hand (out of view); (ii) Vision and strong non-painful TENS in the real hand (V+T); Vision and Stroking (V+S) of the artificial and real hand with a brush; Vision, Stroking and TENS (V+S+T) watching artificial hand being stroked whilst real hand was stroked and receiving TENS. RESULTS: Repeated measure ANOVA detected effects for Condition (P< 0.001), Block (P< 0.001) and Condition x Block interaction (P< 0.001). Pairwise comparisons detected more intense perceptual embodiment for V+S+T compared with V (P< 0.001) and V+T (P< 0.001), and for V+S compared with V (P< 0.001) and V+T (P< 0.001).The intensity of perceptual embodiment increased for later blocks (P< 0.001). CONCLUSIONS: A sensation of TENS was generated within the artificial hand in individuals with intact limbs and this facilitated perceptual embodiment. The magnitude of effect was modest.

Following amputation, 50% to 90% of individuals experience phantom and/or stump pain. Transcutaneous electrical nerve stimulation (TENS) may prove to be a useful adjunct analgesic intervention, although a recent systematic review was unable to judge effectiveness owing to lack of quality evidence. The aim of this pilot study was to gather data on the effect of TENS on phantom pain and stump pain at rest and on movement. Ten individuals with a transtibial amputation and persistent moderate-to-severe phantom and/or stump pain were recruited. Inclusion criteria was a baseline pain score of ≥3 using 0 to 10 numerical rating scale (NRS). TENS was applied for 60 minutes to generate a strong but comfortable TENS sensation at the site of stump pain or projected into the site of phantom pain. Outcomes at rest and on movement before and during TENS at 30 minutes and 60 minutes were changes in the intensities of pain, nonpainful phantom sensation, and prosthesis embodiment. Mean (SD) pain intensity scores were reduced by 1.8 (1.6) at rest (P < 0.05) and 3.9 (1.9) on movement (P < 0.05) after 60 minutes of TENS. For five participants, it was possible to project TENS sensation into the phantom limb by placing the electrodes over transected afferent nerves. Nonpainful phantom sensations and prosthesis embodiment remained unchanged. This study has demonstrated that TENS has potential for reducing phantom pain and stump pain at rest and on movement. Projecting TENS sensation into the phantom limb might facilitate perceptual embodiment of prosthetic limbs. The findings support the delivery of a feasibility trial.

Gay men's greater body dissatisfaction compared to straight men has been explained as a result of gay men’s more 'appearance potent' subculture. This study aimed to critically appraise this explanation by assessing images of men and women for their physical characteristics and objectification across 8 popular gay and straight men's dating and porn websites. 1,415 images of men and 715 images of women across the website’s main pages were coded. Results showed that the gay men's websites featured more images of men that were appearance-ideal, nude, and sexualized in comparison to the straight men's websites. With the converse true for straight men’s websites. These results highlight the continuing need to develop and provide interventions that critique the appearance potency of popular media, particularly so for gay men.

With little actual appraisal, a more 'appearance potent' (i.e., a reverence for appearance ideals) subculture has been used to explain gay men's greater body dissatisfaction in comparison to straight men's. This study sought to assess the respective appearance potency of each subculture by a content analysis of 32 issues of the most read gay (Attitude, Gay Times) and straight men's magazines (Men's Health, FHM) in the UK. Images of men and women were coded for their physical characteristics, objectification and nudity, as were the number of appearance adverts and articles. The gay men's magazines featured more images of men that were appearance ideal, nude and sexualized than the straight men's magazines. The converse was true for the images of women and appearance adverts. Although more research is needed to understand the effect of this content on the viewer, the findings are consistent with a more appearance potent gay male subculture.

It is well documented that body-image attitudes in women are in some way influenced by cultural socialisation (e.g., media influence and ideal internalisation), physical characteristics (e.g., weight and shape), and personality attributes (e.g., self-esteem and locus of control). Self-esteem is a fundamental aspect of psychological well-being and a woman’s satisfaction with her weight is likely to form a central facet of her self-esteem. That said, much of the literature has focused on negative body image and there is a distinct lack of research that has considered these variables in a pregnant population. The experience of pregnancy presents a definitive, yet naturally-occurring deviation from a fit and slender bodily ideal during adulthood. Hence, the present study examined factors that were predictive of positive body image in nulliparous pregnant women (N = 181). Participants were represented across all three trimesters with a mean age of 27.7 years (SD = 5.20) and self-reported good to excellent health. Participants completed scales that measured body appreciation (BAS), societal influence on body image (SATAQ – 3), self-esteem (RSES) and a new locus of control measure specific to pregnancy weight gain and exercise (PLOC – WGE). The overall model explained 57.6% of the variance, statistically significant at p < .001. Regressional analyses showed that self-esteem was the strongest predictor of body appreciation, over and above that of general internalisation (SATAQ – IG) and levels of internality (PLOC - I). Findings highlight the importance of nurturing pregnant women’s self-esteem as a means of increasing body confidence through the transition towards motherhood.

Objective: To examine men’s body dissatisfaction qualitatively. Design: Forty-two British men aged 18–45 years took part in a two-session group intervention across 12 groups. The intervention was designed to improve body dissatisfaction by engaging them in a critique of the appearance ideal through written and behavioural exercises. Main outcome measures/results: Analysis of the topics discussed during the intervention generated two core themes. Theme 1 showed that, in general, men minimised the existence of their own body dissatisfaction while (somewhat surprisingly) outlining the ubiquity and potency of the appearance ideal for men in general. Theme 2 involved men reporting the problematic impact of body dissatisfaction in their lives (despite earlier minimisation), such as social avoidance, strict eating and supplement regimes, or difficulty in situations where the body was exposed. Conclusion: The results stress the need to acknowledge that men experience a range of impacts of body dissatisfaction beyond clinical presentations (such as disordered eating) that influence their everyday lives, while also recognising that they tend to minimise this dissatisfaction in conversation. These findings have important implications for advocacy and interventions to improve men’s body dissatisfaction.

This pilot study evaluated a body image intervention for men, Body Project M. Seventy-four British undergraduate men took part in two 90-min intervention sessions, and completed standardised assessments of body image, bulimic pathology, and related outcomes at baseline, post-intervention, and 3-month follow-up. Fifty-three other men completed the questionnaires as an assessment-only control group. Per-protocol analysis showed that Body Project M improved men’s dissatisfaction with body fat and muscularity, body appreciation, muscularity enhancing behaviours, appearance comparisons, and internalization (ds = 0.46 - 0.80) at post-intervention. All except dissatisfaction with muscularity and internalization were sustained at 3-month follow-up. No effects were found for bulimic pathology. Post-intervention effects for dissatisfaction with muscularity and internalization only were retained under intention-to-treat analysis. Participants were favourable towards the intervention. This study provides preliminary evidence for the acceptability and post-intervention efficacy of Body Project M. Further development of the intervention is required to improve and sustain effects.

Integration of prosthetic limb awareness into body schema is likely to aid manual control of the prosthesis. Physiotherapists and prosthetists use techniques to generate mechanical, visual and/or auditory feedback related to stimulation of the stump and proximal residual limb to improve prosthetic limb awareness. Electrical stimulation of afferent nerves using implanted electrodes can generate sensations of touch, joint movement, and position, in the missing, phantom limbs of amputees. We report here a novel hypothesis that non-invasive transcutaneous electrical nerve stimulation (TENS) could be used to facilitate the process of perceptual embodiment of a prosthesis into the body schema of amputees. Using a modified version of the rubber hand illusion (RHI), we have found that TENS paraesthesiae can be made to feel like it is emanating from a prosthetic hand in healthy participants with intact limbs. In addition, participants reported perceptual embodiment of the prosthetic hand into their body schema, i.e. it felt as if it is part of their body. We predict that projecting TENS paraesthesiae into the prosthetic limb(s) of amputees will provide sufficient sensory input to facilitate perceptual embodiment. This could prove to be a simple and inexpensive training aid to improve ambulation and prosthesis success. © 2008 Elsevier Ltd. All rights reserved.

OBJECTIVES: In able-bodied participants, it is possible to induce a sense of perceptual embodiment in an artificial hand using a visual-tactile illusion. In amputee patients, electrical stimulation of sensory afferents using transcutaneous electrical nerve stimulation (TENS) has been shown to generate somatic sensations in an amputee's phantom limb(s). However, the effects of TENS on the perceptual embodiment of an artificial limb are not known. Our objective was to investigate the effects of TENS on the perceptual embodiment of an artificial limb in fully intact able-bodied participants. MATERIALS AND METHODS: We used a modified version of the rubber hand illusion presented to 30 able-bodied participants (16 women, 14 men) to convey TENS paresthesia to an artificial hand. TENS electrodes were located over superficial radial nerve on the lateral aspect of the right forearm (1 cm proximal to the wrist), which was hidden from view. TENS intensity was increased to a strong non-painful TENS sensation (electrical paresthesia) was felt beneath the electrodes and projecting into the fingers of the hand. The electrical characteristics of TENS were asymmetric biphasic electrical pulsed waves, continuous pulse pattern, 120 Hz pulse frequency (rate), and 80 µs pulse duration (width). RESULTS: Participants reported significantly higher intensities of the rubber hand illusion during the two TENS conditions (mean = 5.8, standard deviation = 1.9) compared with the two non-TENS conditions (mean = 4.9, standard deviation = 1.7), p < 0.0005. CONCLUSIONS: Our findings provide initial evidence that TENS paresthesia can be projected into an artificial limb, and this can enhance the sense of perceptual embodiment of an artificial hand. Further exploratory studies involving an amputee population are warranted.

Objectives: Developing increased understanding of the specificities of young men’s body image-related experiences has been noted as a priority. While previous research has pointed to barriers to gaining authentic insight in this area, recent developments have indicated that providing explicit justification and validation for male discussion may offer increased willingness for engagement. The aim of this study was to explore young men’s personal accounts surrounding this topic; addressing the broad research question: ‘What do young men say about body image and appearance related issues?’. Design: Individual semi-structured interviews were conducted with young men (N=13) aged 16-39 (M=27). Interviews centred on recent research evidence highlighting potential issues for men in relation to body image and appearance, as well as participant’s individual experiences; generating rich, qualitative data. Methods: Underpinned by a critical realist framework, data were analysed using discursively-informed thematic analysis. Results: Findings show that young men were happy to critically engage with the topic in this context, largely adopting a position of emancipatory agent. Analysis indicated that body dissatisfaction was considered both normative and problematic; requiring increased public debate. In addition, analysis highlighted the multiplicity of young men’s body-related concerns, including social expectations related to physicality, and perception of individual control. Furthermore, competing social discourses of masculinity currently available to young men were suggested to have increased body related discussion, whilst continuing to inhibit a genuine dialogue. Conclusions: Notably, the findings emphasise the role of masculinity in, and the specificity of, body image and appearance-related issues for young men.

Government agendas have highlighted the requirement for rapid investigation into the body image related experiences of young men, yet a suggested feminisation of body and appearance related topics, and a tendency for non-disclosure, continue to present obstacles to achieving this. However, previous research has indicated that online, anonymous contexts may present useful environments for circumnavigating these barriers. Thus, the aim of this study was to explore young men’s accounts in relation to body image and appearance related issues, using an anonymous online survey. Young men (N=114) ages 16-39 (M=26) took part in a qualitative survey comprising of eight open ended questions, and data were analysed using discursively-informed thematic analysis. Results indicated that the young men welcomed the opportunity to critically engage with the topic and disclose personal body ‘worries’; also revealing that in everyday contexts, discussion is habitually inhibited by social ideals of masculinity. In addition, whilst dominant body ideals were identified as largely unobtainable, they remained significant for physical self-appraisals, and a goal to aspire to. Results are discussed in relation to the potential health implications of negotiating competing discourses, as well as the requirement for increased male specific educational resources which challenge prevailing masculine discourses.

Associated with numerous adverse health outcomes, body dissatisfaction in young men requires close examination. This study explores online accounts relating to male body image, including young men’s personal disclosures within one online newspaper article, and posts responding to this topic. Discursively informed thematic analysis indicated that non-disclosure was considered a problematic social expectation by the young men featured in the article. Also, reader posts variously constructed body dissatisfaction as a symptom of adolescence, a lack of self-care and an incapacity to capitalise on compensatory qualities. Our analysis suggests young men may welcome safe opportunities to critically discuss prevailing body image ideals.