Secondary Logo

Journal Logo

Original Research

Drive for Muscularity and Social Physique Anxiety Mediate the Perceived Ideal Physique Muscle Dysmorphia Relationship

Thomas, Adam1; Tod, David A.2; Edwards, Christian J.3; McGuigan, Michael R.4

Author Information
Journal of Strength and Conditioning Research: December 2014 - Volume 28 - Issue 12 - p 3508-3514
doi: 10.1519/JSC.0000000000000573
  • Free

Abstract

Introduction

For most of the people who weight train, the activity is beneficial for their physical and psychological health. For a small minority of people, excessive weight training may be symptomatic of disturbances, such as muscle dysmorphia, defined as a preoccupation with being insufficiently small and muscular that is associated with physical, psychological, and social maladjustment (25). Given the detrimental health consequences correlated with muscle dysmorphia, investigators have searched for variables that might signal people who may develop the disturbance (14,24). Such knowledge may help strength and conditioning coaches identify people at risk and assist them in attaining suitable help. The research conducted to date has largely focused on revealing the correlates of muscle dysmorphia, such as the drive for muscularity, training goals, and weight training behavior (14,27,29,30,32). One way to advance research is to examine the ways the correlates interact (e.g., mediation and moderation) in predicting muscle dysmorphia characteristics. Scientists who reveal the way correlates interact in predicting muscle dysmorphia will provide empirical support for the theoretical propositions advanced in the literature.

Scientists have proposed several theoretical frameworks describing the development and sustainment of the condition (6,15,33). A common thread in these models is that people (mostly men) internalize the belief that high levels of muscularity is the basis of the male ideal physique and is associated with social, reproductive, and other benefits (20). Consequently, these people engage in weight training to attain the benefits. If the desire to attain the ideal physique becomes consuming, then the person may develop muscle dysmorphia. There is currently a dearth of literature exploring variables that mediate the perceived ideal physique and muscle dysmorphia relationship, and 2 possible variables include the drive for muscularity and social physique anxiety (SPA). The drive for muscularity represents a motive to increase muscularity (16,18). Social physique anxiety refers to discomfort from perceptions about other people's evaluation of one's body (5,8,13). Both the drive for muscularity and SPA have been correlated with muscle dysmorphia and ideal physique perceptions (12,27,33), highlighting the potential role these variables might have as mediators.

Figure 1 presents the proposed model tested in the current study and highlights the 1 direct and 3 indirect pathways by which perceived ideal physique might predict muscle dysmorphia characteristics. The direct pathway represents the prediction of muscle dysmorphia by perceived ideal physique and replicates findings from previous research (12). The remaining 3 pathways represent the novel aspects of the current study. They involve the prediction of muscle dysmorphia characteristics by perceived ideal physique through (a) the drive for muscularity, (b) SPA, and (c) the drive for muscularity and then SPA. Examining whether the drive for muscularity and social physique mediate the perceived ideal physique and muscle dysmorphia relationship will contribute to knowledge advancement.

Figure 1
Figure 1:
Mediation model containing direct and indirect effects.

Drive for muscularity and physique anxiety were selected for 3 reasons. First, research has consistently revealed they predict muscle dysmorphia symptoms (33). Second, together with the ideal physique, they allow a series of logical hypotheses to be developed that are both testable and conform to current theory (6,15,33). Third, they allow for applied implications that may let strength and conditioning coaches identify at-risk athletes so they can be referred for help from mental health practitioners. For example, lists of anxiety and muscular obsession symptoms can be communicated to strength and conditioning coaches to educate them on what they may observe in some clients.

The purpose of this study was to investigate if the drive for muscularity and SPA mediate the relationship between the perceived male muscular ideal physique and muscle dysmorphia characteristics. As illustrated in Figure 1, there were 4 independent hypotheses: (a) there would be a significant direct pathway between the perceived ideal physique and muscle dysmorphia characteristics, (b) there would be a significant indirect pathway involving drive for muscularity as a mediator, (c) there would be a significant indirect pathway involving SPA as a mediator, and (d) there would be a significant indirect pathway involving the drive for muscularity and then SPA. Current mediation analysis theory states that it is acceptable for there to be more than 1 pathway between 2 variables (9). Consequently, the above hypotheses are independent of each other and will be tested separately, after controlling for the other 3 pathways (9).

Methods

Experimental Approach to the Problem

The mediation effects of the drive for muscularity and SPA were explored using data collected from a quantitative survey of male community gym members who were regular weight trainers, defined as engaging in regular weight training at least once a week for a minimum of 6 months. Testing involved 1 session and included subjects completing a packet of standardized and validated questionnaires. The data were subjected to current mediation analysis procedures (9) using the PROCESS macro (http://afhayes.com/) that may be used with SPSS (version 21; IBM, New York, NY, USA). The mediation analysis involves a series of regression equations (9). The series of equations allows for individual pathways to be tested while controlling for other pathways in the proposed model (illustrated in Figure 1).

Subjects

Before starting the study, the first author's institutional Human Research Ethics Committee gave approval for the experimental procedures. Before their participation in the study, all the subjects received a clear written explanation of the study's risks and benefits and had the chance to ask any questions, before they had the opportunity to provide written informed consent. All subjects signed informed consent documents. The subjects included 146 men (mean ± SD; age, 22.8 ± 5.0 years; weight, 82.0 ± 11.1 kg; height, 1.80 ± 0.07 m; body mass index, 25.1 ± 3.0). The subjects regularly engaged in weight training at least once a week (3.6 ± 1.3) and had done so for an average of 2.9 (± 1.9) years. Based on the guidelines of Tabachnick and Fidell (31), 145 participants were needed to ensure an adequate sample size for the statistical analysis undertaken. There was less than 2% missing data and Little's test indicated that they could be considered missing completely at random. The hot deck approach is recommended as the imputation method of choice (23) and was used in this study. In keeping with the guidelines of Tabachnick and Fidell (31), the statistical analysis was performed twice: once with and without the imputed values. The pattern of results was similar, so the results presented below are from the dataset with the hot deck imputed values.

Procedures

Subjects were approached as they left a community gym located in a small United Kingdom town and informed of the study. If interested, they were given documentation explaining the purpose, risks, and safeguards of the study along with an informed consent form. On completion of the informed consent form, subjects were given a packet containing the questionnaires arranged in a counterbalanced order to avoid a questionnaire presentation order affect. Subjects had as long as they wanted to complete the questionnaires, and the researcher was available to answer any questions. Subjects took approximately 10 minutes to complete the questionnaires after which they were debriefed. During the debriefing, the expected results were communicated, and subjects had the opportunity to give contact details so they could receive a copy of the findings if desired.

Measures

Drive for muscularity was measured using the Drive for Muscularity Attitudes Questionnaire (DMAQ). The 8-item DMAQ measures an individual's desire to increase their muscularity (19) and contains 8 items rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Evidence supports the DMAQ's unidimensionality, scale score reliability, test-retest reliability, and construct validity (3). In this study, the Cronbach's alpha was 0.81 (95% confidence intervals [CIs], 0.76–0.85).

Muscle dysmorphia was assessed using the Muscle Dysmorphia Inventory (MDI). The MDI is a 27-item questionnaire measuring behavioral and psychological characteristics associated with muscle dysmorphia (26). The MDI contains 6 subscales and is designed to be used in nonclinical populations to assess at-risk characteristics. The 5-item body size/symmetry subscale assesses satisfaction with muscle size, shape, and definition. The 6-item physique protection subscale measures the extent to which an individual avoids having their body viewed by others (e.g., wearing baggy clothing). The 4-item exercise dependence subscale assesses preoccupation with maintaining a rigid schedule of intense exercise and feelings of guilt when training does not occur. The 3-item pharmacological use subscale measures the use of steroids and other illegal substances to increase muscle size and definition. The 4-item supplement use subscale assesses the use of legal substances designed to enhance workout quality or recuperation. The 5-item diet subscale measures the extent that individuals monitor and manipulate their diet to achieve muscularity. Subjects respond to each item on a 6-point Likert scale from 1 (Never) to 6 (Always). Cronbach's alphas in this study for each subscale were: 0.86 (95% CI, 0.82–0.89) for size/symmetry, 0.77 (95% CI, 0.70–0.82) for physique protection, 0.79 (95% CI, 0.72–0.84) for exercise dependence, 0.58 (95% CI, 0.44–0.68) for pharmacological use, 0.80 (95% CI, 0.74–0.85) for supplement use, and 0.82 (95% CI, 0.77–0.86) for diet manipulation. Based on these Cronbach's alphas, pharmacological use was removed from analysis because of insufficient evidence for internal consistency in the current population.

A general muscle dysmorphia measure was also included: the Muscle Appearance Satisfaction Scale-6 (MASS-6). The 6-item MASS-6 is a unidimensional measure of muscle dysmorphia derived from the longer 19-item multidimensional Muscle Appearance Satisfaction Scale (17,28). Subjects respond to each item on a 5-point Likert scale from 1 (Strongly Disagree) to 5 (Strongly Agree). Evidence for reliability, construct validity, and discriminant validity has been reported for both the longer scale and MASS-6. In this study, the MASS-6 Cronbach's alpha was 0.82 (95% CI, 0.77–0.86).

Social physique anxiety was measured using the Social Physique Anxiety Scale (SPAS). The 7-item version of the original 12-item SPAS was employed in this study because of evidence for its internal reliability, factorial invariance, and construct validity (8,21). Subjects respond to each item on a 5-point Likert scale from 1 (Not at all true for me) to 5 (Extremely true for me). In this study, the SPAS' Cronbach's alpha was 0.83 (95% CI, 0.79–0.87).

Two visual analog scales assessed subjects' perceptions of their male muscular ideal physique. The 2 items were generated from self-discrepancy theory (11) and measured the degree to which subjects believed their male physique was ideally or ought to be muscular. The wording from these items was adapted from Woodman and Steer (34), and subjects responded to each item on a 15-cm line, and they were asked to indicate, compared with the ideal physique: “how muscular you ideally would like your body to be” and “how muscular you feel your body ought to be.” The anchors ranged from 0 (not at all muscular) to 15 (extremely muscular). We replaced the word fat that Woodman and Steer (34) used with the word muscular because Woodman and Steer (34) focused on fatness in females, whereas this study was focused on muscularity in males. We used visual analog scales because they are quick to administer and are easily understood by subjects (10), and we wanted to prevent questionnaire fatigue in the subjects. Previous research has revealed that visual analog scales are sensitive to differences in self-perceptions and mood, they correlate with longer measures indicating validity, and are reliable (1,2,10). In this study, the 2 items were combined, and the correlation coefficient was 0.78 and the 95% biased corrected and accelerated CI, 0.68–.94.

A short demographic questionnaire was used to record subjects' age, number of year's weight training experience, weight training frequency, and self-reported height and weight. These data were used to describe the sample.

Statistical Analyses

The questionnaires were scored so that higher values reflected a greater drive for muscularity, belief in a male muscular ideal physique, SPA, or level of muscle dysmorphia characteristic. A visual examination of the histograms and review of Kurtosis and Skewness values indicated that the data could be considered normally distributed. Pearson's correlation coefficients were calculated to assess the bivariate correlations among the variables. The correlations were corrected for scale reliability (22). The data were subjected to modern mediation analysis procedures (9) using the PROCESS (http://afhayes.com/) macro that may be used with SPSS (version 21; IBM). The mediation analysis involves a series of regression equations (9). The series of equations allows for individual pathways to be tested while controlling for other pathways in the proposed model. More specifically, the mediation analyses tested for direct and indirect effects of ideal physique perceptions on the various muscle dysmorphia characteristics as illustrated in Figure 1. In keeping with the guidelines of Hayes (9), 95% bias corrected and accelerated bootstrapped CIs were used to determine if the effects were statistically different from zero. Bootstrapped CIs do not require the assumptions of homoscedasticity or residual normality to be satisfied and are considered more suitable and powerful indicators than traditional inferential tests (4,9). Alpha was set at 0.05.

Results

Table 1 presents the mean values, SDs, and correlations among the variables. The perception of the male muscular ideal physique was significantly correlated with the drive for muscularity, the global muscle dysmorphia measure, and each of the muscle dysmorphia characteristics except physique protection. The drive for muscularity was significantly correlated with SPA, the global muscle dysmorphia measure, and each of the muscle dysmorphia characteristics. Social physique anxiety correlated with the global measure of muscle dysmorphia, physique protection, supplementation, and size/symmetry perceptions. The muscle dysmorphia characteristics correlated significantly with each other.

Table 1
Table 1:
Means ±SD and correlations among the measured variables.*

Table 2 presents the results from the main mediation analysis. For global muscle dysmorphia, exercise dependence, size/symmetry, and supplementation, there was a significant direct effect and a significant indirect drive for muscularity effect as indicated by the bootstrapped 95% CIs not including zero. These results indicate that (a) independent of the indirect paths, ideal physique perception directly predicted muscle dysmorphia characteristics and (b) independent of the direct and indirect paths, ideal physique perceptions also significantly predicted muscle dysmorphia characteristics through the drive for muscularity. For the size/symmetry characteristics, there was also a significant indirect drive for muscularity and SPA effect independent of the other pathways. For physique protection, the bootstrap 95% CIs revealed a significant indirect drive for muscularity and SPA effect. For diet manipulation, there was a direct effect of ideal physique perception. The remaining direct and indirect effects were nonsignificant because zero was included in the CIs.

Table 2
Table 2:
Direct and indirect effects, standard errors, and 95% bias corrected and accelerated bootstrapped confidence intervals (CIs) from the mediation analysis.*

Regression diagnostics were computed to assess the presence of bias in the results and to assess the satisfaction of regression assumptions. There was no evidence of predictor multicollinearity because tolerance values were well above 0.2, and variance inflation factor values were close to 1 (4). Cook's and Mahalanobis distances were inside cutoff values indicating no influential cases, and these values, along with residual plots, indicated no obvious outliers (4). The Durbin-Watson tests were nonsignificant indicating that residuals were independent. Homoscedasticity and residual normality was not assessed because bootstrapping was employed to calculate CIs and does not require these assumptions. In summary, regression diagnostics did not provide evidence of bias in the results, and they can be generalized back to the population under study.

Discussion

The main analysis provides support that the drive for muscularity and SPA mediates the relationship between perceptions about the male muscular ideal physique and characteristics of muscle dysmorphia. Specifically, evidence for indirect pathways was found for the global measure of muscle dysmorphia, exercise dependence, size/symmetry, supplementation, and physique protection. These indirect effects were independent of the direct effect of regressing characteristics of muscle dysmorphia on perceptions about the male muscular ideal physique. These findings provide advancement on previous literature in the following ways.

Previous research has identified that muscle dysmorphia and its characteristics are significantly related with the drive for muscularity, perceptions about the ideal male physique, and SPA (12,27,33). This research, however, has focused on examining the relationships among the variables without considering the potential mediating role of the drive for muscularity or SPA. This study has extended this research by suggesting that the drive for muscularity and SPA may act as mediators in the relationship perceptions about the male ideal physique have with muscle dysmorphia characteristics. More specifically, in most of the characteristics results revealed that in addition to the direct pathway (except diet), the drive for muscularity provided the second pathway by which perceptions about the ideal physique related with muscle dysmorphia. These results suggest that males with a strong subscription to a muscular ideal physique have a greater drive for muscularity, compared with those individuals with less investment in a muscular physique, and in turn, this desire is associated with muscle dysmorphia.

In addition, the drive for muscularity and SPA pathway was significant when predicting size/symmetry concerns and attempts at physique protection. These results imply that SPA plays a role in muscle dysmorphia characteristics that are focused most directly on body shape, and then only in combination with the drive for muscularity. The remaining muscle dysmorphia characteristics were either the global measure or involved behaviors associated with developing muscularity (exercise, supplementation, and diet) rather than being focused specifically on body shape.

As the second contribution, the current results provide some support for theoretical frameworks that have been proposed (6,15,33). Across these various frameworks, there is a common theme that people (typically men) learn that the ideal male physique is highly muscular, and these perceptions give rise to the desire for muscularity, SPA, and muscle dysmorphia (33). The current results provide insight into how these variables might influence each other. For example, it is theoretically understandable that SPA was a relevant mediating factor only when in combination with the drive for muscularity and not independently. The ideal physique measure in this study indicates a male's perception about how his body relates to the ideal. The drive for muscularity, however, is defined as the desire to achieve more muscle (18). Social physique anxiety represents the discomfort feel of individuals when they perceive others will evaluate their bodies negatively because they believe it is not a suitable shape (8). Such discomfort is likely to arise only after the individual has identified the mismatch between their ideal and current muscularity levels that is typically associated with the drive for muscularity. The discomfort then predicts muscle dysmorphia concerns focused specifically on body shape.

In addition to advancing the research and theoretical literature, the current results also highlight avenues of enquiry to further knowledge about the characteristics of muscle dysmorphia. The drive for muscularity and SPA, for example, may mediate or even moderate relationships muscle dysmorphia may have with other variables. Based on social-cultural perspectives, researchers could select other variables for examination, such as the internalization of messages about the muscular ideal physique that individuals receive from the media and significant others in their lives. Regarding perceptions about the muscular ideal physique, the drive for muscularity and SPA may not be the only mediators (and there may be moderators). One possible moderator, for example, may be the desire for social affiliation. Perhaps the relationship between ideal physique perceptions and muscle dysmorphia may be stronger in people scoring high on a need for social affiliation measure compared with those with low scores. The benefit from further exploring mediators and moderators is the generation of knowledge about the mechanisms leading to muscle dysmorphia and the social and other conditions under which the preoccupation is likely to emerge. This knowledge may give rise to interventions to help people at risk of the disorder.

The current results provide initial evidence for the construct validity of the visual analog scales to assess perceptions regarding the ideal male physique. The items were grounded in discrepancy theory (11), quick to administer, and easily understood by subjects (10). The use of such a method may help prevent questionnaire fatigue in subjects and represent a feasible method in studies where people may be asked to complete a number of self-report measures. Although the current results are promising, investigators could continue to use the measure to assess its psychometric properties.

We have been cautious in our interpretation of the results because causality cannot typically be inferred from a descriptive study without sound theoretical justification. Although the results conform and add to the theory about muscle dysmorphia characteristics in the population studied (7,15,33), we are mindful that we did not adopt an experimental design. It would be unethical, however, for an experiment to proceed that involved an intervention designed to increase people's preoccupation with a muscular ideal physique because of the known likely negative physical, behavioral, and psychological consequences (e.g., drug use, exercise dependence, anxiety). Given that such experiments should not be approved, descriptive research represents the best evidence available to guide theory development and practical applications. Each descriptive design (e.g., longitudinal, qualitative, cross-sectional), however, has limitations and the best way forward might be for investigators to adopt various designs to examine the topic from different angles to help address limitations each method possesses.

Practical Applications

The results indicate perceptions about the ideal physique predict muscle dysmorphia symptoms both directly and indirectly through the drive for muscularity and SPA. Strength and conditioning coaches may recognize individuals at risk for muscle dysmorphia if clients subscribe greatly to the male muscular ideal physique, display a high drive for muscularity, or exhibit SPA symptoms. Specific behaviors that strength and conditioning coaches might observe include (a) clients' verbal statements highlighting a preoccupation with attaining the ideal physique or negative perceptions of their own muscularity, (b) heightened interest in others (e.g., athletes or celebrities) who have high muscularity, (c) excessive time spent weight training, (d) drug abuse, (e) admissions of strained relationships and impaired occupational functioning, and (f) anxiety symptoms. If strength and conditioning coaches perceive clients to have severe muscularity or anxiety concerns that could be associated with detrimental physical and psychological consequences, then they should refer clients to mental health care professionals for help. The second implication for strength and conditioning coaches is to consider the extent to which they advocate the muscular ideal physique as a reason to undertake weight training. For example, do they make a large number of comments about clients' appearance? Although highlighting the attainment of a muscular physique is a legitimate way for strength and conditioning coaches to encourage individuals to weight train, coaches who overemphasize an ideal body shape may unwittingly encourage excessive client behavior. Instead, coaches who balance advocating such a benefit with the myriad of others associated with weight training, such as physical health, psychological well-being, and enhanced athletic or daily functional performance, will encourage positive attitudes in clients and avoid encouraging a small minority of clients to develop a preoccupation with their appearance.

Acknowledgments

This study was undertaken in the psychology laboratories at the Department of Psychology, Aberystwyth University, Aberystwyth, United Kingdom. The study received no external funding.

References

1. Birkeland R, Thompson JK, Herbozo S, Roehrig M, Cafri G, van den Berg P. Media exposure, mood, and body image dissatisfaction: An experimental test of person versus product priming. Body Image 2: 53–61, 2005.
2. Durkin SJ, Paxton SJ. Predictors of vulnerability to reduced body image satisfaction and psychological wellbeing in response to exposure to idealized female media images in adolescent girls. J Psychosom Res 53: 995–1005, 2002.
3. Edwards C, Tod D, Morrison TG, Molnar G. Drive for muscularity. In: Psychology of Strength and Conditioning: Current Perspectives. Tod D., Lavallee D., eds. London, United Kingdom: Routledge, 2012. pp. 148–172.
4. Field A. Discovering Statistics Using SPSS. 3rd ed. Thousand Oaks, CA: Sage, 2013.
5. Gammage KL, Gabriel DA. Trait self-presentational concerns and performance in a maximal isometric strength test. J Strength Cond Res 23: 1287–1291, 2009.
6. Grieve FG. A conceptual model of factors contributing to the development of muscle dysmorphia. Eat Disord 15: 63–80, 2007.
7. Grieve FG, Truba N, Bowersox S. Etiology, assessment, and treatment of muscle dysmorphia. J Cogn Psychot 23: 306–314, 2009.
8. Hart EA, Leary MR, Rejeski WJ. The measurement of social physique anxiety. J Sport Exerc Psychol 11: 94–104, 1989.
9. Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis. New York, NY: Guilford, 2013.
10. Heinberg LJ, Thompson JK. Body image and televised images of thinness and attractiveness: A controlled laboratory investigation. J Soc Clin Psychol 14: 325–338, 1995.
11. Higgins ET. Self-discrepancy: A theory relating self and affect. Psychol Rev 94: 319–340, 1987.
12. Hildebrandt T, Langenbucher J, Schlundt DG. Muscularity concerns among men: Development of attitudinal and perceptual measures. Body Image 1: 169–181, 2004.
13. Lamarche L, Gammage KL, Gabriel DA. The effects of experimenter gender on state social physique anxiety and strength in a testing environment. J Strength Cond Res 25: 533–538, 2011.
14. Lantz CD, Rhea DJ, Cornelius AE. Muscle dysmorphia in elite-level power lifters and bodybuilders: A test of differences within a conceptual model. J Strength Cond Res 16: 649–655, 2002.
15. Lantz CD, Rhea DJ, Mayhew JL. The drive for size: A psycho-behavioral model of muscle dysmorphia. Int Sports J 5: 71–86, 2001.
16. Leone JE, Fetro JV. Perceptions and attitudes toward androgenic-anabolic steroid use among two age categories: A qualitative inquiry. J Strength Cond Res 21: 532–537, 2007.
17. Mayville SB, Williamson DA, White MA, Netemeyer RG, Drab DL. Development of the muscle appearance satisfaction scale: A self-report measure for the assessment of muscle dysmorphia symptoms. Assessment 9: 351–360, 2002.
18. McCreary DR, Sasse DK. An exploration of the drive for muscularity in adolescent boys and girls. J Am Coll Health 48: 297–304, 2000.
19. Morrison TG, Morrison MA, Hopkins C, Rowan ET. Muscle mania: Development of a new scale examining the drive for muscularity in Canadian men. Psychol Men Masc 5: 30–39, 2004.
20. Morrison TG, Morrison MA, McCann L. Striving for bodily perfection? An overview of the drive for muscularity. In: Body Image: New Research. Kindes M.V., ed. New York, NY: Nova Science, 2006. pp. 1–34.
21. Motl RW, Conroy DE. Validity and factorial invariance of the Social Physique Anxiety Scale. Med Sci Sports Exerc 32: 1007–1017, 2000.
22. Murphy KR, Davidshofer CO. Psychological Testing: Principles and Applications. 4th ed. Upper Saddle River, NJ: Prentice Hall, 1998.
23. Myers TA. Goodbye, listwise deletion: Presenting hot deck imputation as an easy and effective tool for handling missing data. Commun Methods Meas 5: 297–310, 2011.
24. Olivardia R. Muscle dysmorphia: Characteristics, assessment, and treatment. In: The Muscular Ideal: Psychological, Social, and Medical Perspectives. Thompson J.K., Cafri G., eds. Washington, DC: American Psychological Association, 2007. pp. 123–139.
25. Pope HG Jr, Gruber AJ, Choi P, Olivardia R, Phillips KA. Muscle dysmorphia: An underrecognized form of body dysmorphic disorder. Psychosomatics 38: 548–557, 1997.
26. Rhea DJ, Lantz CD, Cornelius AE. Development of the muscle dysmorphia inventory (MDI). J Sports Med Phys Fitness 44: 428–435, 2004.
27. Robert CA, Munroe-Chandler KJ, Gammage KL. The relationship between the drive for muscularity and muscle dysmorphia in male and female weight trainers. J Strength Cond Res 23: 1656–1662, 2009.
28. Ryan TA, Morrison TG. Psychometric properties of the muscle appearance satisfaction scale among Irish and British men. Body Image 7: 246–250, 2010.
29. Segura-García C, Ammendolia A, Procopio L, Papaianni MC, Sinopoli F, Bianco C, De Fazio P, Capranica L. Body uneasiness, eating disorders, and muscle dysmorphia in individuals who over exercise. J Strength Cond Res 24: 3098–3104, 2010.
30. Skemp KM, Mikat RP, Schenck KP, Kramer NA. Muscle dysmorphia: Risk may be influenced by goals of the weightlifter. J Strength Cond Res 27: 2427–2432, 2013.
31. Tabachnick BG, Fidell LS. Using Multivariate Statistics. 4th ed. Boston, MA: Allyn and Bacon, 2001.
32. Thomas LS, Tod DA, Lavallee DE. Variability in muscle dysmorphia symptoms: The influence of weight training. J Strength Cond Res 25: 846–851, 2011.
33. Tod DA, Lavallee DE. Towards a conceptual understanding of muscle dysmorphia development and sustainment. Int Rev Sport Exerc Psychol 3: 111–131, 2010.
34. Woodman T, Steer R. Body self-discrepancies and women's social physique anxiety: The moderating role of the feared body. Br J Psychol 102: 147–160, 2011.
Keywords:

ideal muscular male physique; appearance; weight training

Copyright © 2014 by the National Strength & Conditioning Association.