Is There Any Relationship Between Body Image Perception, Eating Disorders, and Muscle Dysmorphic Disorders in Male Bodybuilders?

Muscle dysmorphia: an under-recognised aspect of body dissatisfaction in men

Although men and women both experience eating disorders such as anorexia nervosa and bulimia nervosa, there are differences in the way their eating disorder may present. Body dissatisfaction or body dysmorphia in men may be more related to a drive for muscularity as opposed to thinness. Muscle dysmorphic disorder (also known as muscle dysmorphia) is a form or subtype of body dysmorphia that is characterised by an extreme desire for muscularity and a preoccupation with the idea that one's physique is too small or not sufficiently muscular. It is more common in men than women and is associated with body image distortion, excessive exercise routines, muscularity-orientated disordered eating and the use of appearance- and performance-enhancing drugs such as anabolic androgenic steroids. Risk factors for muscle dysmorphic disorder include social pressure (including to conform to gender stereotypes) and low self-esteem. The condition has negative psychological, physical, relational and financial effects. Nurses can play a role in health promotion as well as in the assessment, care and referral of men with muscle dysmorphic disorder.

Flex Friday: A content analysis of men's fitspiration on Instagram

Fitspiration is a social media trend that utilizes images and quotes to promote and inspire physical health and fitness. However, research has shown Fitspiration reinforces the rigidly defined appearance ideal, particularly in women, which can lead to negative body image. There remains limited understanding of the characteristics and impact of men's Fitspiration. The purpose of this content analysis was to investigate the nature, presentation, and text-based messages of male-focused Fitspiration on Instagram. Hashtags (#) were used to collect 1,000 random images from Instagram. Content codes for images included body type, objectification, activities, and messages conveyed. Results showed most images consisted of men accentuating their highly muscular upper bodies with low body fat, consistent with the male appearance ideal. Also, men were often shown engaging in activities irrelevant to health or fitness (i.e., passive modeling) that emphasized their physical appearance. Consistent with research examining female-focused Fitspiration, male-focused Fitspiration reinforces a glamorized appearance ideal with low focus on health and fitness.

A systematic review, meta-analysis, and meta-regression of the prevalence of self-reported disordered eating and associated factors among athletes worldwide

BACKGROUND

The purpose of this meta-analysis was to provide a pooled prevalence estimate of self-reported disordered eating (SRDE) in athletes based on the available literature, and to identify risk factors for their occurrence.

METHODS

Across ten academic databases, an electronic search was conducted from inception to 7th January 2024. The proportion of athletes scoring at or above predetermined cutoffs on validated self-reporting screening measures was used to identify disordered eating (DE). Subgroup analysis per country, per culture, and per research measure were also conducted. Age, body mass index (BMI), and sex were considered as associated/correlated factors.

RESULTS

The mean prevalence of SRDE among 70,957 athletes in 177 studies (132 publications) was 19.23% (17.04%; 21.62%), I2 = 97.4%, τ2 = 0.8990, Cochran's Q p value = 0. Australia had the highest percentage of SRDE athletes with a mean of 57.1% (36.0%-75.8%), while Iceland had the lowest, with a mean of 4.9% (1.2%-17.7%). The SRDE prevalence in Eastern countries was higher than in Western countries with 29.1% versus 18.5%. Anaerobic sports had almost double the prevalence of SRDE 37.9% (27.0%-50.2%) compared to aerobic sports 19.6% (15.2%-25%). Gymnastics sports had the highest SRDE prevalence rate, with 41.5% (30.4%-53.6%) while outdoor sports showed the lowest at 15.4% (11.6%-20.2%). Among various tools used to assess SRDE, the three-factor eating questionnaire yielded the highest SRDE rate 73.0% (60.1%-82.8%). Meta-regression analyses showed that female sex, older age, and higher BMI (all p < 0.01) are associated with higher prevalence rates of SRDE.

CONCLUSION

The outcome of this review suggests that factors specific to the sport affect eating behaviors throughout an athlete's life. As a result, one in five athletes run the risk of developing an eating disorder. Culture-specific and sport-specific diagnostic tools need to be developed and increased attention paid to nutritional deficiencies in athletes.

Did you skip leg day? The neural mechanisms of muscle perception for body parts

While the neural mechanisms underpinning the perception of muscularity are poorly understood, recent progress has been made using the psychophysical technique of visual adaptation. Prolonged visual exposure to high (low) muscularity bodies causes subsequently viewed bodies to appear less (more) muscular, revealing a recalibration of the neural populations encoding muscularity. Here, we use visual adaptation to further elucidate the tuning properties of the neural processes underpinning muscle perception for the upper and lower halves of the body. Participants manipulated the apparent muscularity of upper and lower bodies until they appeared 'normal', prior to and following exposure to a series of top/bottom halves of bodies that were either high or low in muscularity. In Experiment 1, participants were adapted to isolated own-gender body halves from one of four conditions; increased (muscularity) upper (body half), increased lower, decreased upper, or decreased lower. Despite the presence of muscle aftereffects when the body halves the participants viewed and manipulated were congruent, there was only weak evidence of muscle aftereffect transfer between the upper and lower halves of the body. Aftereffects were significantly weaker when body halves were incongruent, implying minimal overlap in the neural mechanisms encoding muscularity for body half. Experiment 2 examined the generalisability of Experiment 1's findings in a more ecologically valid context using whole-body stimuli, producing a similar pattern of results as Experiment 1, but with no evidence of cross-adaptation. Taken together, the findings are most consistent with muscle-encoding neural populations that are body-half selective. As visual adaptation has been implicated in cases of body size and shape misperception, the present study furthers our current understanding of how these perceptual inaccuracies, particularly those involving muscularity, are developed, maintained, and may potentially be treated.

Investigating the Validity of the MMPI-3 Eating Concerns (EAT) scale across Men and Women in a University Sample

Disordered eating is a major health epidemic that occurs at disproportionate rates among young adults and for which gender plays a major role in symptom presentation. Broadband psychological instruments have historically not included disordered eating as a core scale construct. The recent release of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) offers an opportunity to address this shortcoming through the newly developed Eating Concerns Scale (EAT) for which the existing literature is promising but limited. This study expands research on EAT by investigating its validity and comparing findings across gender. In 345 college students (102 men, 243 women), we examined gender differences between men and women in the EAT scale's structure, item endorsement rates, mean scores, and correlations with measures of body image and eating pathology. Differences emerged in item endorsement rate, scale score elevation rate, and correlation magnitudes. Broadly, findings further support EAT's use in detecting eating pathology and highlight ways in which the EAT scale may not effectively capture masculine expressions of eating pathology, namely binging and purging behaviors. To assess eating pathology more comprehensively, clinicians and researchers should consider including assessments of eating pathology inclusive of masculine eating patterns. Limitations and future research directions are also discussed.

Exploring risk factors of drive for muscularity and muscle dysmorphia in male adolescents from a resource-limited setting in Burkina Faso

In low-income countries, Muscle Dysmorphia (MD) has only been investigated in adult south African amateur-bodybuilders. To date, there is no epidemic study about MD or its cardinal symptom "drive for muscularity" (DFM) and its impact on young men's lives in African low-income settings. We analyzed a population-representative cross-sectional study of 838 adolescent males aged 12-20 in the rural northwestern Burkina Faso. Participants were assessed for MD with the research criteria of Pope and its cardinal symptom DFM based on the DFM scale (DMS). Since DFM has not been studied in a comparable sample so far, all possible influencing variables were examined exploratively in a linear regression model. Many respondents were underweight (41.5%) and few overweight (1.3%). No-one met standard clinical MD criteria. While 60.1% of 837 wished to be more muscular, only 8.7% of 824 desired a lower body-fat percentage. Regression analysis revealed that higher DMS scores were associated with greater internalization of the muscular body ideal, going to school, living in a rural area, older age, and a history of having faced sexual harassment or assault, but not with media exposure. Our results show that levels of DMS in Burkinabe adolescents were elevated. Risk factors for DFM in environmental circumstances where undernutrition and poverty are common are discussed.

Body image and willingness to change it-A study of university students in Poland

The present study aimed to identify declared patterns of ideal appearance among students at selected higher education institutions in Poland. In the present study, we set out to identify the body image and the propensity to change it. In order to achieve the goal of the study, a nationwide survey was carried out using a voluntary diagnostic survey. A total of 810 respondents took part in the survey. The study was conducted using a custom-made self-designed survey questionnaire with an indirect interview technique via a web-based platform (CAWI). The study results indicate that women were far more eager to maintain an attractive appearance through dieting than men. Importantly, the respondents, both women and men, did not identify influencers as role models of attractive appearance. Results of the present survey reveal that attitudes towards one's physical appearance are diverse and influenced by the considered factors. The attributes that determined the perception of oneself as an attractive person included height, weight, and body build. Normal body weight is a key feature of an attractive appearance, according to the respondents; nevertheless, students show a higher tolerance for being overweight than for being underweight. Furthermore, preferences in this respect are largely conditioned by individual personal characteristics. According to young people, a person with an attractive appearance is one who eats and exercises regularly, and who does not fall into extremes in terms of their appearance. On the other hand, the fear of growing fat and losing one's attractive appearance was frequently indicated among the concerns over personal appearance. Only one in five respondents expressed complete satisfaction with how they looked, with men and those with a normal BMI significantly more likely to do so. Respondents expressed readiness to undertake a range of activities related to increased exercise regime, changes in their eating habits, or seeking assistance (e.g., of a personal trainer) to achieve the desired body shape. Our findings can be used as a basis for discussion and consideration in developing educational activities on nutrition, as well as on overweight- and obesity-related health issues.

Eating Disorder Risk and Pathogenic Behaviors Among Collegiate Student-Athletes

CONTEXT

Eating disorders (EDs) are a cluster of behavioral conditions characterized by uneasy thoughts and behaviors that grow into severe or persistent eating disturbances. The demands on student-athletes may create mental and physical stressors that increase the likelihood of EDs and disordered eating.

OBJECTIVE

To examine the ED risk through eating attitudes and behaviors in male and female student-athletes and across various sport types (endurance, aesthetic, power, ball or team, or technical sports).

DESIGN

Cross-sectional study.

SETTING

Collegiate athletics.

PATIENTS OR OTHER PARTICIPANTS

National Collegiate Athletic Association Division I and II student-athletes (n = 2054; males = 631; females = 1423) from 40 institutions.

MAIN OUTCOME MEASURE(S)

Participants completed a web-based demographic survey and the Eating Attitudes Test-26 (EAT-26). Multiple χ2 analyses examined participants classified as at risk for EDs. Independent-samples t tests and a 1-way analyses of variance compared sex and sport type across EAT-26 totals and subscale (Dieting, Bulimia, and Oral Control) scores.

RESULTS

Overall, 25.3% (n = 520/2054) of student-athletes were classified as at risk for EDs. Differences were found between sex and ED risk (χ21,2054 = 32.9, P ≤ .01; 17.3% [n = 109/631] males, 28.9% [n = 411/1423] females) and across ED risk and sport type (χ24,2054 = 13.4, P = .01). When examining females only, we observed differences across ED risk and sport type (χ24,1423 = 13.4, P ≤ .01). No differences were evident across ED risk and sport type for males. Differences were seen between sex and binge eating (χ21,2054 = 6.8, P = .009), sex and diet pill use (χ21,2054 = 19.6, P ≤ .01), and sport type and diet pill use (χ24,2054= 12.2, P = .016), excessive exercise (χ24,2054 = 32.1, P ≤ .01), and losing more than 20 lb (9 kg) in the last 6 months (χ24,2054 = 10.2, P ≤ .037).

CONCLUSIONS

Student-athletes in the collegiate setting are at risk for EDs. Medical professionals, such as athletic trainers, need to be educated on the potential risk factors that may lead to EDs. Protocols for prevention, screening and recognition, and referral should be developed for student-athletes at risk for EDs.

Review of the scientific rationale, development and validation of the International Olympic Committee Relative Energy Deficiency in Sport Clinical Assessment Tool: V.2 (IOC REDs CAT2)-by a subgroup of the IOC consensus on REDs

Relative Energy Deficiency in Sport (REDs) has various different risk factors, numerous signs and symptoms and is heavily influenced by one's environment. Accordingly, there is no singular validated diagnostic test. This 2023 International Olympic Committee's REDs Clinical Assessment Tool-V.2 (IOC REDs CAT2) implements a three-step process of: (1) initial screening; (2) severity/risk stratification based on any identified REDs signs/symptoms (primary and secondary indicators) and (3) a physician-led final diagnosis and treatment plan developed with the athlete, coach and their entire health and performance team. The CAT2 also introduces a more clinically nuanced four-level traffic-light (green, yellow, orange and red) severity/risk stratification with associated sport participation guidelines. Various REDs primary and secondary indicators have been identified and 'weighted' in terms of scientific support, clinical severity/risk and methodological validity and usability, allowing for objective scoring of athletes based on the presence or absence of each indicator. Early draft versions of the CAT2 were developed with associated athlete-testing, feedback and refinement, followed by REDs expert validation via voting statements (ie, online questionnaire to assess agreement on each indicator). Physician and practitioner validity and usability assessments were also implemented. The aim of the IOC REDs CAT2 is to assist qualified clinical professionals in the early and accurate diagnosis of REDs, with an appropriate clinical severity and risk assessment, in order to protect athlete health and prevent prolonged and irreversible outcomes of REDs.

2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)

Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee's expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.

Dimensional personality pathology and disordered eating in young adults: measuring the DSM-5 alternative model using the PID-5

Introduction

The Personality Inventory for DSM-5 (PID-5) is a self-report measure of personality pathology designed to measure pathological personality traits outlined in the DSM-5 alternative model of personality disorders. Within the extensive literature exploring the relationship between personality and disordered eating, there are few that explore the relationship between the PID-5 and disordered eating behaviours in a non-clinical sample of males and females: restrictive eating, binge eating, purging, chewing and spitting, excessive exercising and muscle building.

Methods

An online survey assessed disordered eating, PID-5 traits and general psychopathology and was completed by 394 female and 167 male participants aged 16-30. Simultaneous equations path models were systematically generated for each disordered eating behaviour to identify how the PID-5 scales, body dissatisfaction and age predicted behaviour.

Results

The results indicated that each of the six disordered behaviours were associated with a unique pattern of maladaptive personality traits. The statistical models differed between males and females indicating possible differences in how dimensional personality pathology and disordered eating relate.

Discussion

It was concluded that understanding disordered eating behaviour in the context of personality pathology may assist formulating potentially risky behaviour.

The association between sport type and eating/body image concerns in high school students: a cross-sectional observational study

PURPOSE

Disordered eating and body image concerns are increasingly common among adolescents, possibly representing the underpinning of eating disorders (EDs). This cross-sectional observational study aimed at investigating the relationship between various patterns of sports involvement or inactivity, and the abovementioned psychopathological dimensions.

METHODS

All adolescents attending their 3rd-5th Italian grade in a single high school reported their sociodemographic and anthropometric data, their weekly sports involvement, and filled the Eating Disorders Examination Questionnaire 6.0 (EDE-Q), the Body Uneasiness Test, and the Muscle Dysmorphia Disorder Inventory (for boys). Comparisons were performed considering sex, weekly hours of activity, and different sports type (none, individual, or team sports).

RESULTS

Of 744 enrolled students, 522 (70.2%) completed the survey. Girls showed higher underweight rates, preference for inactivity or individual sports, and higher psychometric scores compared to boys. Among girls, no differences were found based on time spent exercising or sports type. Inactive boys displayed worse weight- and shape-based psychopathology, higher body uneasiness, and higher appearance intolerance compared to those who devoted more time to exercise. Among boys, individual and team sports were associated with lower EDE-Q scores compared to inactivity, whereas body uneasiness and appearance intolerance were lower only in team sports.

CONCLUSIONS

The study confirms the presence of remarkable sex differences in eating and body concerns of adolescents. Among boys, sports involvement is tied to lower ED psychopathology, and preference for team sports may be associated with reduced concerns. Wider longitudinal studies on will clarify the direction and specificity of these findings.

LEVEL OF EVIDENCE

Level V-Cross-sectional observational study.

The mediating effect of body appreciation between muscle dysmorphia and bulimia nervosa among Lebanese adolescents

BACKGROUND

Muscle dysmorphia (MD) is a common psychological disorder present in Lebanese adolescents. Several disorders can be present concomitantly with MD such as bulimia nervosa and exercise addiction. This study aims to explore the mediating effect of body appreciation between Muscle dysmorphia and bulimia nervosa, and to validate the exercise addiction inventory scale in Lebanese adolescents.

METHODS

This was a cross-sectional designed study, conducted between August-September 2022, and enrolling 403 adolescents currently residing in Lebanon (15 to 18 years old), from all Lebanese governorates (Beirut, Mount Lebanon, North, South, and Bekaa). Our sample was chosen using the snowball technique, a soft copy of the questionnaire was created using google forms software, and an online approach was conceived to proceed with the data collection.

RESULTS

The mean age of the participants was 16.63 ± 1.46 years with 57.3% females. The factor analysis for the Exercise Addiction Inventory suggested one factor, which explained 62.58% of the common variance. The confirmatory factor analysis revealed an adequate fit to the model with satisfactory Maximum Likelihood Chi-Square/Degrees of Freedom (χ²/df), SRMR, CFI, TLI, and AVE. The mediation analysis showed that the direct relation between bulimia and MD was not significant after eliminating the effect of body appreciation (r = .12, p < .001). However, body appreciation was significantly associated with bulimia nervosa (r=-1.06, p < .001) and MD (r=-.28, p < .001).

CONCLUSION

Body appreciation was found to be a mediator between muscle dysmorphia and bulimia nervosa and thus it is the main factor leading to both disorders. Therefore, body appreciation should be addressed in the evaluation and management of Muscle Dysmorphia.

The Impact of Sports Involvement on Body Image Perception and Ideals: A Systematic Review and Meta-Analysis

Concerns about body image may affect athletes, mainly because of specific sports models to achieve successful performance. This systematic review reports on body image dissatisfaction (BID) in athletes following the guidelines for systematic reviews and meta-analyses. From a total of 887 articles identified through a systematic search of electronic databases, 15 articles conducted on 2412 athletes were included in this review. To be eligible for inclusion, the studies must have been published in the last ten years up until September 2022 and analyze body image perception using body figure drawings and anthropometric profiles. The quality of the included studies was evaluated using the adapted Newcastle-Ottawa Scale for observational studies. These studies were compared through thematic analysis of BID to develop four general issues, including gender, sport type and level, and weight status. According to the meta-analyses, the significant medium and small effect sizes found for gender and weight status, respectively, indicated that male athletes had lower BID than females and that, among the latter, normal-weight athletes had a higher BID than underweight ones. The implications and limitations of the included studies are discussed extensively in this review, highlighting the need for further research on BID examined both in the social and the sports contexts. Sports activity should be carried out following healthy lifestyles, and promoting positive BI.

One size does not fit all: Exploring how the five-factor model facets predict disordered eating behaviours among adolescent and young adult males and females

There is a wealth of research that has highlighted the relationship between personality and eating disorders. It has been suggested that understanding how subclinical disordered eating behaviours are uniquely associated with personality can help to improve the conceptualization of individuals with eating disorders. This study aimed to explore how the facets of the Five-Factor Model (FFM) predicted restrictive eating, binge eating, purging, chewing and spitting, excessive exercising and muscle building among males and females. An online survey assessing disordered eating behaviours, FFM and general psychopathology was completed by 394 females and 167 males aged between 16 and 30 years. Simultaneous equations path models were systematically generated for each disordered eating behaviour to identify how the FFM facets, body dissatisfaction and age predicted behaviour. The results indicated that each of the six disordered behaviours were predicted by a unique pattern of thinking, feeling and behaving. Considerable differences between males and females were found for each path model, suggesting differences between males and females in the personality traits that drive disordered eating behaviours. It was concluded that it is important to take personality into account when treating males and females who engage in disordered eating behaviours.

Sports psychiatry: a desideratum on sports arena!

The emerging field of sports psychiatry has been developing steadily in recent years. This is not just a health concern but is likely to impact sporting performance and achievement significantly. An overview of sports psychiatry is provided. Psychiatric disorders of all varieties can and do present in sporting populations. Sports psychiatry keeps evolving to drive forward the importance of good mental health in sport as in life.

The indirect role of orthorexia nervosa and eating attitudes in the association between perfectionism and muscle dysmorphic disorder in Lebanese male University students - results of a pilot study

BACKGROUND

The literature highly concentrates on disorders related to body image among women but only minimally when it comes to the male population; hence, in order to provide general practitioners, and primary care physicians in general, and psychiatrists in particular, with additional information concerning muscle dysmorphia among male university students in Lebanon, this study seemed essential, and was therefore conducted to (1) identify the prevalence of MDD, and (2) evaluate the indirect effect of eating attitudes in general and orthorexia nervosa in particular, in the association between perfectionism and muscle dysmorphic disorder (MDD) among a sample of male university students.

METHODS

In this cross-sectional study conducted between September 2021 and May 2022, 396 male university students from multiple universities in Lebanon filled the online Arabic questionnaire.

RESULTS

The results showed that 26 (6.6%) of the participants had MDD. Orthorexia nervosa and eating attitudes mediated the association between perfectionism and MDD; higher perfectionism was significantly associated with higher ON and more inappropriate eating; higher ON and more inappropriate eating were significantly associated with higher MDD, whereas perfectionism had a significant total direct effect on MDD. The high prevalence of MDD among male university students in Lebanon implies further investigation on the national level in the country.

CONCLUSION

Awareness campaigns among the university students could be adopted at the national level to increase the level of knowledge on the concepts of obsessive self-destructive perfectionism, orthorexia nervosa and muscle dysmorphia.

Risk factors for eating disorders among Chinese and international university students: a comparative cross-sectional study

OBJECTIVE

The aim of the study was to investigate the prevalence of eating disorders (EDs) and their association with socio-demographic and behavioural factors among university students.

METHODS

A cross-sectional study among university students (Chinese and international) in Nanjing, China. We collected the data from 877 students, of which 811 were eligible for this study. They submitted a self-administered questionnaire (Eating Disorder Examination Questionnaire 6 (EDE-Q6) related to socio-demographic, health variables and lifestyle factors. Data were assessed with the help of SPSS software.

RESULTS

A total of 401 Chinese and 410 international university students (49.44% vs. 50.55%) participated in this study. Binary logistic regression showed that young female adults of 18~25 years of age had more risk of developing eating disorders. Higher body mass index (BMI), such as overweight and obesity, were more influential risk factors (p < 0.001) for eating disorders. The significant risks (p < 0.001) EDs were found in students who were athletes, physically active, and involved in various extra-curricular activities. Alcohol and smoking were significant risk factors associated with eating disorders.

CONCLUSION

The results indicated higher risks of eating disorders followed by objective binge eating and compensatory behaviour. In this scenario, early assessment and treatment are necessary to reduce the burden of eating disorders and to promote good nutritional practices among university students.

The associations between autistic traits and disordered eating/drive for muscularity are independent of anxiety and depression in females but not males

Previous research has shown a positive correlation between autistic traits and eating disorder symptoms, and this relationship appears to be independent of co-occurring mental health status. The current study followed a pre-registered analysis plan with the aim to investigate a previously unconsidered factor in the relationship between autistic traits and disorders of eating and body image: the drive for muscularity. Participants (N = 1068) completed the Autism Spectrum Quotient (AQ), Hospital Anxiety and Depression Scale (HADS), Eating Attitudes Test-26 (EAT-26) and Drive for Muscularity Scale (DMS). Positive correlations between AQ and EAT-26 and AQ and DMS were observed. In females, AQ remained significantly correlated with EAT-26 and DMS when controlling for co-occurring anxiety and depression symptoms, but this was not the case in males. These findings demonstrate the moderating role of sex, and the need to consider autistic traits in individuals diagnosed with, or at a heightened risk for, disorders of eating and body image.

Examination of the association of muscle dysmorphia (bigorexia) and social physique anxiety in the male bodybuilders

PURPOSE

This study aimed to examine the association between social physique anxiety and muscular dystrophy in bodybuilders.

DESIGN AND METHODS

This cross-sectional study included 384 male bodybuilders.

FINDINGS

5.7% of the participants reported muscular dystrophy. Younger age and use of protein powder were associated with higher scores on the muscle dysmorphic disorder Inventory. Higher muscular dystrophy was associated with higher social physique anxiety.

PRACTICE IMPLICATIONS

Young male bodybuilders using protein powder are at increased risk to suffer from social physique anxiety and muscular dystrophy.

Body image as a multidimensional concept: A systematic review of body image facets in eating disorders and muscle dysmorphia

Body image disturbance is core to the psychopathology of eating disorders (EDs), and related disorders such as muscle dysmorphia (MD). Global measures of body image fail to quantify specific aspects of body image disturbance that characterizes EDs, and may be differentially associated to outcomes. The aim of this systematic review was to provide an overview of specific body image facets and synthesize findings from controlled studies that compared clinical ED/MD and control-comparison groups in body image disturbance. One-hundred sixty-seven studies met inclusion criteria, and reported on comparisons among 30,584 individuals in 28 body image facets, which were more broadly grouped into evaluative, perceptual, cognitive-affective and motivational categories for the purpose of the present review. Effect sizes were calculated as Cohen's d for every comparison between ED and control groups. Body dissatisfaction (evaluative category) was the most prevalent facet assessed across studies (62 %), and differences between clinical and control groups were the largest in this category, especially for bulimia nervosa (d = 1.37). Scarcity of studies with male and MD clinical samples, and use of single-item and non-validated measures, should encourage development of instruments for body image facets pertinent to EDs and MD that can be validly applied across gender.

Understanding exercise addiction, psychiatric characteristics and use of anabolic androgenic steroids among recreational athletes – An online survey study

Background

The purpose of this paper was to explore maladaptive behaviors among physically active individuals, including exercise dependence and use of anabolic steroids. Both exercise addiction (EA) and use of anabolic androgenic steroids (AAS) correlate to high amounts of exercise and EA have been linked to eating disorders and other mental health problems.

Methods

An internet survey was spread through fitness-related social media. Inclusion criteria were age ≥ 15 years and exercise frequency ≥ thrice weekly. Exercise addiction inventory identified those at-risk of EA (rEA). Characteristics of rEA were compared to those not at risk. In a separate analysis, AAS users were compared to AAS-naïve individuals.

Results

In total, 3,029 participants completed the questionnaire. Of these, 11% screened positive for being rEA, and 23% for ED. Factors associated with EA included daily exercise, social phobia, eating disorders and OCD. Risk consumption of alcohol was a negative predictor. Thirty seven participants had taken AAS the last year. These were mainly men, bodybuilders/powerlifters and more often used amphetamines and opioids.

Discussion

This exploratory study supports EA being strongly associated with eating disorders. Identified associations between EA and compulsive or anxiety disorders warrant further research to clarify if these associations arise prior to, together with, or secondary to EA.

Use of online and paper-and-pencil questionnaires to assess the distribution of orthorexia nervosa, muscle dysmorphia and eating disorders among university students: can different approaches lead to different results?

PURPOSE

Administration of questionnaires to assess the diffusion of disordered eating behaviours via the web is becoming common today. The aim of this study is to assess whether two different approaches of administering a test to assess traits of eating disorders (EDs), orthorexia nervosa (ON) and muscle dysmorphia (MD) by email recruitment and online completion (web-based survey-WBS) and by in person recruitment and paper-and-pencil completion (paper-based survey-PBS), gives different results.

METHODS

During 2 consecutive academic years, a self-reported questionnaire consisting of questions about personal characteristics and three tests for the evaluation of ON (ORTO-15), MD (MDDI-ITA), and EDs (EAT-26) were administered to two groups of undergraduates, respectively, as a WBS and a PBS.

RESULTS

The WBS response rate was 6.7% (N = 137), and the PBS response rate was 86.5% (N = 372). The WBS group showed a statistically significant higher prevalence of students with eating disordered behaviours (21.2% vs 5.4%) and registered a higher mean score on the EAT-26 test (13.5 ± 11.1 vs 6.0 ± 8.0); no differences between the two groups emerged for ON and MD prevalence and test scores. Moreover, in the WBS group, the number of students with one or more tests with test scores above the cut-off values was significantly higher (46.0% vs 32.3%).

CONCLUSION

The choice of the approach to administer a questionnaire to assess the diffusion of EDs and related issues must take into account all the factors that can result in selection bias and that can affect the reliability of the results.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional survey.

Eating Behaviors Among Male Bodybuilders and Runners: Application of the Trans-Contextual Model of Motivation

This article focuses on two popular sports that can put male athletes at risk of developing an eating disorder: bodybuilding and running. Bodybuilders concentrate on gaining muscle mass and runners on leaning body mass. Based on the trans-contextual model of motivation, this study aimed to better understand the psychological mechanisms underlying eating disorders in these athletes. In all, 272 male bodybuilders and 217 male runners completed measures of sport motivation, theory of planned behavior variables (i.e., attitude, subjective norm, perceived behavioral control, and intention to gain muscle mass/lean body mass), and eating disorders (dieting, control, and bulimia behaviors). The results revealed satisfactory fit indices for both samples. Autonomous and controlled motivations for sport were positively directly and indirectly related to eating disorders in these athletes. This motivational mechanism needs more in-depth investigation, and motivational profiles might help distinguish athletes with and without eating disorders.

Perceived ideal body weight exacerbates bulimia and dieting in Bodybuilding Athletes

The passion of bodybuilding athletes for a symmetric, lean, heavily muscled body leads them to carry out exhausting exercise programs and restrictive eating regimens, sometimes resulting in disordered eating behaviors. This study investigates potential exacerbators on the development of disordered eating in bodybuilding (professional and recreational) and strength athletes. This cross-sectional single time point study involved 103 Cypriot bodybuilding athletes of both sexes, performing at three levels: professional, recreational and strength athletes. The Eating Attitude Test 26 (EAT-26) and The Three Factor Eating Questionnaire (TFEQ-R21) were used to evaluate disordered eating and eating behaviors respectively. Scores on the items of the questionnaires according to sex were compared using the Mann-Whitney U test and differences according to bodybuilding performance status or/and body weight deviation category using the Kruskal-Wallis test. The current study was performed under the auspices of the Hellenic Center of Education & Treatment of Eating Disorders (KEADD). The degree of deviation between the perceived ideal body weight and the actual body weight was associated with increased risk of eating disorder. Athletes who desired a lower body weight recorded higher scores on EAT-26 overall (p=0.001), and the subscales of dieting (p=0.01) and bulimia (p=0.001). Cognitive restraint and emotional eating scales of TFEQ-R21 were more pronounced in the non-professional athletes (p=0.01). The emotional eating score was higher in women. There is a need for appropriate sport-specific, gender-specific preventive intervention to deescalate the risk of eating disorder, in both professional and non-professional bodybuilding athletes.

Validity and Reliability of the Muscularity Oriented Eating Test (MOET) in Turkish

Objectives: In this study, we determine the validity and reliability of the Muscularity Oriented Eating Test (MOET) among Turkish university students, thereby creating the MOET-TR. Methods: First, the MOET was translated by using the translation-back translation method for cultural equivalence. Then, the validity and reliability analyses were performed on 460 university students. To analyze the stability of the scale over time, the MOET-TR was applied to approximately 20% of the sample number for a second time after 2-4 weeks. Results: The one-factor structure of the MOET-TR demonstrated a good agreement with the fix index values. Cronbach's for the MOET-TR was 0.88, and the ICC value was 0.84. In addition, we found a positive statistically significant relationship between the total scores obtained from the DMS, EAT-40, REZZY, and IPAQ-Short forms used to evaluate the convergent divergent validity of the MOET-TR (p < .05). Conclusions: The MOET-TR is suitable for the Turkish culture and can be used to identify individuals who have muscularity oriented eating disorders, who are uncomfortable with their body shape, and who turn their body shapes into a social phobia.

Eating Perception, Nutrition Knowledge and Body Image among Para-Athletes: Practical Challenges in Nutritional Support

Limited information exists on dietary practices in para-athletes. The aim of this study was to clarify the actual situation of para-athletes' dietary practice and to sort out the factors (i.e., eating perception, nutrition knowledge, and body image), that may hinder their dietary practices, and explored the practical challenges in nutritional support and improving nutrition knowledge for para-athletes. Thirty-two Japanese para-athletes (22 men) and 45 collegiate student athletes without disabilities (27 men) participated in the online survey. The questionnaire included demographic characteristics, eating perception, dietary practices, and nutrition knowledge. The Japanese version of the body appreciation scale was used to determine their body image. Para-athletes who answered that they knew their ideal amount and way of eating showed significantly higher body image scores (r = 0.604, p < 0.001). However, mean score for nutrition knowledge of para-athletes were significantly lower than collegiate student athletes (19.4 ± 6.8 vs. 24.2 ± 6.1 points, p = 0.001). Both groups did not identify a dietitian as the source of nutrition information or receiving their nutrition advice. The results indicate para-athletes have unique eating perceptions and inadequate nutrition knowledge. Future interventions are needed to examine nutritional supports and education in relation to the role of dietitians.

Biopsychosocial Effects of Competition Preparation in Natural Bodybuilders

Bodybuilders are judged on the subjective visual assessment of their muscular size, proportion, and leanness. This case series tracked four drug-free bodybuilders (3 male) during the off-season, pre-competition and recovery phases. This study aimed to comprehensively profile key biopsychosocial changes occurring pre/post competition in a group of British natural bodybuilders. We measured: resting metabolic rate (RMR), body composition (via BIA, ultrasound and sum of 7 skinfolds), lipid profiles, fasted glucose, blood pressure, power output (Wingate), grip strength, and carried out psychometric questionnaires (EAT-26, STAI, BUT) over an eight-month period. Mean weight loss from 5 months (5M) to pre-contest (PRE) was 8.6 ± 4.1 kg, followed by an increase of 7.9 ± 1.6 kg two months post contest (POST). The mean RMR of the cohort was stable from 1899 ± 630 kcal (5M) to 1897 ± 598 kcal (PRE), before decreasing to 1797 ± 242 kcal (POST). Mean peak power declined from 770 ± 113.0 w (5M), to 700.0 ± 134.4 w (PRE), before increasing to 816.0 ± 116.2 w (POST). Competition dieting had no effect on EAT-26 or BUT scores, suggesting no body dysmorphic or eating disorder concerns, although trait anxiety was elevated in three out of the four participants throughout the observation. Many of the biopsychosocial changes that occur to bodybuilders as they prepare for competition return to baseline measurements 2 months post competition.

Differences in attitudes, behaviours and beliefs towards eating between female bodybuilding athletes and non-athletes, and the implications for eating disorders and disordered eating

Background

Female athletes participating in sports emphasising aesthetics are potentially more prone to developing disordered eating (DE) and eating disorders (EDs) than non-athletes, males, and those participating in sports with less emphasis on leanness. Despite this, female bodybuilding athletes have received little attention.

Aim

To investigate differences in eating attitudes, behaviours and beliefs in female bodybuilding athletes and a non-athlete group.

Methods

A cross-sectional study design was used with the eating attitude test-26 (EAT-26) distributed to 75 women (49.3% bodybuilding athletes; 50.7% non-athletes) and the female athlete screening tool (FAST) distributed to the female bodybuilding group only.

Results

Demographic characteristics revealed no significant difference in age, stature or body mass index (P = 0.106 to 0.173), though differences in body mass were evident (P = 0.0001 to 0.042). Bodybuilding athletes scored significantly higher (P = 0.001) than non-athletes on the EAT-26 questionnaire, with significantly more athletes (56.8%) being labelled as ‘at risk’ of an ED than non-athletes (23.7%, P = 0.001). Responses to the FAST questionnaire indicated female bodybuilding athletes have high preoccupation with their body mass; engage in exercise to alter their body mass; and disclosed negative perceptions of themselves.

Conclusion

In all, female bodybuilding athletes demonstrate behaviours associated with DE and EDs as well as a preoccupation with nutrition intake, exercise, and strategies to alter their appearance. These findings have important implications for those managing female bodybuilding athletes such as strength and conditioning coaches, athletic trainers, nutritionist and dietitians with respect to detecting DE and EDs as well as minimising the risk factors.

Energy Intake Deficiency Promotes Bone Resorption and Energy Metabolism Suppression in Japanese Male Endurance Runners: A Pilot Study

It has been reported that male athletes face increased risk for low energy availability and resulting health consequences similar to female athletes. The present study aimed to reveal the energy status of Japanese male runners and to examine the association between energy deficiency and physiological characteristics such as energy metabolism, bone health, and hormonal status. Six male collegiate long-distance runners during a training season participated in this study. Energy intake (EI) was assessed using 3-day dietary records with food pictures. Exercise energy expenditure (EEE) was determined by the HR-VO₂ method. Body composition and bone status were measured by dual-energy X-ray absorptiometry. Energy availability (EA) was calculated by subtraction of EEE from EI and normalized by fat-free mass (FFM). Energy balance (EB) was calculated EI minus estimated total energy expenditure (TEE). Resting energy expenditure (REE) was measured by indirect calorimetry using the Douglas bag technique, and blood sampling was conducted to assess hormonal status. The mean EA of the subjects was 18.9 ± 6.8 kcal/kg FFM/day, and severe negative EB (range: -1444 ~ -722 kcal/d) was observed. REE of four runners was suppressed, and moreover, bone resorption was promoted in all subjects. The data in our study suggested that energy deficiency could promote bone resorption and energy metabolism suppression in Japanese male endurance runners. Additional short- and long-term studies are needed to clarify the health risks caused by energy deficiency in male athletes and explore strategies to prevent health problems related to energy deficiency in long-distance runners.

Relationship between orthorexia nervosa, muscle dysmorphic disorder (bigorexia), and self-confidence levels in male students

PURPOSE

This study aims to determine the prevalence of muscular dysmorphic disorder (bigorexia) and orthorexia nervosa in male students and to evaluate the relationship between these conditions and self-esteem.

DESIGN AND METHODS

This cross-sectional study included 430 male students.

FINDINGS

While the tendency of orthorexia among faculty of sports sciences (FSSs)' students was 28.8%, this rate was 16.3% for nursing department (ND); for tendency to bigorexia, it was found to be 16.3% in FSS students and 6% in ND. There was a negative correlation between the ortorexia scale and self-confidence scales. And, there was a week negative correlation between the bigorexia Inventory and the self-confidence scale.

PRACTICE IMPLICATIONS

This study is thought to help understand the factors affecting body image perception and to identify risky situations especially in young university students. It is thought that health professionals will guide the planning of initiatives that will help individuals gain healthy lifestyle behaviors.

Muscle dysmorphia: A systematic and meta-analytic review of the literature to assess diagnostic validity

OBJECTIVE

Although muscle dysmorphia (MD) is a new addition to DSM-5 as a specifier of body dysmorphic disorder (BDD), previous studies have treated MD as a stand-alone diagnosis. We aimed to assess the validity of MD as a stand-alone diagnosis via systematic and meta-analytic review of MD literature using both Robins and Guze criteria and additional criteria from Kendler.

METHOD

We performed a systematic search of ProQuest, PsycInfo, and PubMed databases for the period of January 1993 to October 2019 resulting in 40 papers to examine Robins and Guze's criteria (clinical picture) as well as those added by Kendler (antecedent validators; concurrent validators; predictive validators).

RESULTS

We identified two distinct symptomatic presentations of MD using cluster analysis, a behavioral type and cognitive/behavioral type. For examining the concurrent validators, quantitative meta-analyses differentiated MD populations from controls; however, results were inconclusive in delineating MD from existing disorders. For assessing antecedent and predictive validators, the symptomatic profiles, treatment response, and familial links for MD were similar to those for BDD and for eating disorders.

DISCUSSION

We found preliminary support for MD as a clinically valid presentation, but insufficient evidence to determine whether it is best categorized as a specifier of BDD or unique psychiatric condition.

Is problematic exercise really problematic? A dimensional approach

OBJECTIVE

Though moderate exercise has numerous health benefits, some individuals may become excessively preoccupied with exercise, endorsing features akin to "addiction." The aim of this study was to evaluate the relationships between problematic exercise (viewed dimensionally), quality of life, and psychological measures.

METHODS

Young adults were recruited from an established population-based cohort in the United Kingdom and completed an online survey. The factor structure of the Exercise Addiction Inventory (EAI) was characterized. Relationships between dimensional EAI factor scores and other variables (impulsivity, compulsivity, emotional dysregulation) were elicited.

RESULTS

Six hundred and forty-two individuals took part in the study (mean age 23.4 years, 64.7% female). The EAI yielded two factors - a "general factor" and a "relationship conflict factor." Both EAI factor scores were associated with disordered eating, impulsivity (UPPS), and compulsivity (CHI-T). Only the relationship conflict factor score was significantly associated with impaired quality of life (all domains) and with maladaptive personality traits (emotional dysregulation and obsessive-compulsive personality disorder traits). Few participants met conventional threshold for full exercise addiction (1.1%).

CONCLUSION

Higher problematic exercise scores, in a sample largely free from exercise addiction, were associated with impulsive and compulsive personality features, emotional dysregulation, and disordered eating. Further research is needed to examine whether these results generalize to other populations (such as gym attendees) and are evident using more rigorous in-person clinical assessment rather than online assessment. Longitudinal research is needed to examine both positive and negative impacts of exercise, since moderate exercise may, in fact, be useful for those with impulsive/compulsive tendencies, by dampening negative emotional states or substituting for other more damaging types of repetitive habit.

Body dissatisfaction, addiction to exercise and risk behaviour for eating disorders among exercise practitioners

OBJECTIVE

This study investigated the association between body dissatisfaction (BD), addiction to exercise and risk behaviors to eating disorders (EDs) among Brazilian exercise practitioners, besides comparing the variables according to sex, age group and modality.

METHODS

Participants were 60 exercice practitioners of fitness (n = 44) and crossfit (n = 16), with mean age of 26.58 ± 7.76 years. Data collection was conducted through Eating Attitudes Test-26 (EAT-26), Diagnosis of Orthorexia Questionnaire (ORTO-15), Body Shape Questionnaire (BSQ) and Scale of Dedication to Exercise (SDE). Data analysis was conducted through Kolmogorov-Smirnov and independent t tests, Pearson correlation, and Path Analysis (p < .05).

RESULTS

Main results showed the association between BD, addiction to exercise and risk behaviour for EDs. Further, individuals dissatisfied with their bodies showed higher level of addiction to exercise and risk behavior for EDs. Furthermore, women showed higher presence of BD than men, and fitness participants reported higher presence of addiction to exercise than crossfit practitioners.

CONCLUSIONS

This study revealed that BD seems to be a determinant factor for risk behavior for ED's and addiction to exercise among fitness and crossfit particpants.

A systematic and methodological review of attentional biases in eating disorders: Food, body, and perfectionism

OBJECTIVE

The current systematic and methodological review aimed to critically review existing literature utilizing implicit processing, or automatic approach- and/or avoidance-related attentional biases between eating disorder (ED) and nonclinical samples, which (a) highlights how psychophysiological methods advance knowledge of ED implicit bias; (b) explains how findings fit into transdiagnostic versus disorder-specific ED frameworks; and (c) suggests how research can address perfectionism-related ED biases.

METHOD

Three databases were systematically searched to identify studies: PubMed, Scopus, and PsychInfo electronic databases. Peer-reviewed studies of 18- to 39-year-olds with both clinical ED and healthy samples assessing visual attentional biases using pictorial and/or linguistic stimuli related to food, body, and/or perfectionism were included.

RESULTS

Forty-six studies were included. While behavioral results were often similar across ED diagnoses, studies incorporating psychophysiological measures often revealed disease-specific attentional biases. Specifically, women with bulimia nervosa (BN) tend to approach food and other body types, whereas women with anorexia nervosa (AN) tend to avoid food as well as overweight bodies.

CONCLUSIONS

Further integration of psychophysiological and behavioral methods may identify subtle processing variations in ED, which may guide prevention strategies and interventions, and provide important clinical implications. Few implicit bias studies include male participants, investigate binge-eating disorder, or evaluate perfectionism-relevant stimuli, despite the fact that perfectionism is implicated in models of ED.

A Narrative Review on Female Physique Athletes: The Physiological and Psychological Implications of Weight Management Practices

Physique competitions are events in which aesthetic appearance and posing ability are valued above physical performance. Female physique athletes are required to possess high lean body mass and extremely low fat mass in competition. As such, extended periods of reduced energy intake and intensive training regimens are used with acute weight loss practices at the end of the precompetition phase. This represents an increased risk for chronic low energy availability and associated symptoms of relative energy deficiency in sport, compromising both psychological and physiological health. Available literature suggests that a large proportion of female physique athletes report menstrual irregularities (e.g., amenorrhea and oligomenorrhea), which are unlikely to normalize immediately postcompetition. Furthermore, the tendency to reduce intakes of numerous essential micronutrients is prominent among those using restrictive eating patterns. Following competition, reduced resting metabolic rate, and hyperphagia, is also a concern for these female athletes, which can result in frequent weight cycling, distorted body image, and disordered eating/eating disorders. Overall, female physique athletes are an understudied population, and the need for more robust studies to detect low energy availability and associated health effects is warranted. This narrative review aims to define the natural female physique athlete, explore some of the physiological and psychological implications of weight management practices experienced by female physique athletes, and propose future research directions.

Disordered eating attitudes correlate with body dissatisfaction among Kuwaiti male college students

BACKGROUND

The prevalence of disordered eating attitudes and body dissatisfaction based on muscularity and body fat was investigated among male college students in Kuwait with a range of body mass index values including underweight, normal weight, overweight, and obese participants.

METHODS

Data were collected, using the Eating Attitudes Test (EAT-26) and the Bodybuilder Image Grid (BIG), from 400 male undergraduate students (84.8% Kuwaiti nationals) recruited from both public and private universities in Kuwait. An anonymous, self-administered questionnaire was used to determine the prevalence of symptomatology indicative of anorexia nervosa and bulimia nervosa and to examine the associations between body dissatisfaction and muscularity and body fat.

RESULTS

Most participants were dissatisfied with their current muscle mass and body fat (67.3 and 69%, respectively). Logistic regression analyses produced odds ratios (ORs) demonstrating that students dissatisfied with their muscularity and body fat and those who indicated a desire to decrease both muscularity and body fat had significantly higher odds of being at risk of disordered eating attitudes (OR = 2.241, 95% CI [1.17, 3.6], p = .032, and OR = 1.898, 95% CI [1.214, 2.967], p = .005, respectively). Obese participants also had higher odds of exhibiting disordered eating attitudes (OR = 2.06, 95% CI [1.17, 3.60], p = .011).

CONCLUSION

The high proportion of disordered eating attitudes among Kuwaiti college men was associated with high levels of body image dissatisfaction in relation to both body fat and muscularity. High levels of eating disorder symptoms were also linked to obesity.