Factors Related to Muscle Dysmorphia Symptomology in Adolescent Males

Factors Related to Muscle Dysmorphia

Symptomology in Adolescent Males

Chapter 1: Introduction to the Study

Introduction

The purpose of this study was to identify factors related to muscle dysmorphia

symptomology in adolescent males. Specifically, in this quantitative research study, I

explored whether race/ethnicity, sexual orientation (gay, heterosexual, bisexual),

selfesteem, body dissatisfaction, and bodybuilding dependence predict muscle

theoretical framework, definitions, assumptions, scope and delimitations, limitations,

significance, and summary.

Background

The prevalence of muscle dysmorphia symptomology in adolescent males is

increasing but this disorder remains under diagnosed in adolescents. There is an

increasing prevalence of muscle dysmorphia symptomology among adolescents

(Brewster, 2011; Leone, Sedory, & Gray, 2005). The onset of body dysmorphic disorder

(muscle dysmorphia is a type of body dysmorphic disorder) can occur in childhood or

adolescence. Subclinical symptoms tend to begin several years before a disorder is

identified (Bjornsson et al., 2013). These findings support the need to fully understand

factors shown to be related to dysmorphic symptoms (Boroughs, Krawczyk, &

Thompson, 2010; Cafri, Olivardia, & Thompson, 2008; Davies, Smith, & Collier, 2011;

Hildebrandt, Schlundt, Langenbucher, & Chung, 2006; Readdy, Watkins, & Cardinal,

2011). Although these correlates of dysmorphic symptoms have been identified in adult

male samples, they have not been studied in male adolescents. More information is

needed to determine if these and other factors of race/ethnicity and sexual orientation are

present in nonclinical adolescent males.

There is a lack of studies about muscle dysmorphic disorder in adolescents.

Studies on adolescents tend to center around body discomfort issues rather than muscle

dysmorphic disorder (Burlew & Shurts, 2013; Nishina, Ammon, Bellmore, & Graham,

of body dissatisfaction and related psychosocial maladjustment. Petrie et al. (2010)

studied body satisfaction in middle school males and females and found that gender,

findings provided information about body dissatisfaction, which may be related to muscle

dysmorphic disorder.

that the mean age of onset was age 16-17 years, and earlier onset was related to severe

symptoms such as attempted suicide, eating disorders, substance use disorders, anxiety

disorder, and social phobia. However, Bjornsson et al. did not study factors of age,

race/ethnicity, sexual orientation, self-esteem, body dissatisfaction, bodybuilding

dependence, or muscle dysmorphia symptoms in this adolescent sample. Thus, there was

a gap in knowledge about the prevalence of muscle dysmorphia symptomology and

related factors in nonclinical adolescent males from local high schools (Bjornsson et al.,

2013; Boroughs et al., 2010; Readdy, 2011). In this study, I addressed these factors.

Problem Statement

Body dysmorphic disorder (BDD) in adolescents tends to be underdiagnosed and

dysmorphia symptomology and related factors in nonclinical adolescent males from local

high schools.

later ages, it is difficult to diagnose these disorders in adolescents. Thus, the study of

BDD must include adolescent samples for a more comprehensive understanding of

incidence and predictive factors.

Researchers have revealed factors related to muscle dysmorphia symptomology

that include race/ethnicity, sexual orientation, levels of dissatisfaction with appearance,

and bodybuilding dependence (Boroughs et al., 2010; Cafri et al., 2008; Davies et al.,

2011; Hildebrant et al., 2006; Readdy et al., 2011). However, these scholars used adult

male samples only and do not include adolescent male samples. Studies of adolescents

tend to center around body image and discomfort, and scholars have shown that body

dissatisfaction is related to gender, physical self-concept, social pressure, and self-esteem,

with similar findings across ethnic groups (Burlew & Shurts, 2013; Nishina et al., 2006;

Petrie et al., 2010). In a study of body dysmorphia with adolescents, Bjornsson et al.

(2013) revealed that mean onset was around age 16 years. However, more information

regarding body dysmorphia in adolescents is needed (Bjornsson et al., 2013; Boroughs et

al., 2010; Readdy, 2011).

There was a gap in the literature regarding the presence of factors related to

muscle dysmorphia symptomology (e.g., age, race/ethnicity, sexual orientation,

causes and factors that predict this disorder are not well understood, continued

investigation of these factors is needed with a focus on adolescent onset (Bjornsson et al.,

2013). Readdy (2011) further supported the need to examine subclinical levels of the

Purpose of the Study

dysmorphia symptomology in a nonclinical sample of adolescent males.

Nature of the Study

A quantitative, nonexperimental survey research design was used for this study.

Using surveys, gathered data to determine whether factors of race/ethnicity, sexual

orientation, self-esteem, body dissatisfaction, and bodybuilding dependence predict

muscle dysmorphia symptomology in a nonclinical sample of adolescent males. This

methodology was chosen because the quantitative method allows for the collection of

numerical data for statistical analysis. The qualitative and mixed-research methodology

were not chosen for this study because these approaches provide narrative data, which

was not the focus of this study (Babbie, 2012). The use of numerical data for statistical

analysis and hypothesis testing was the goal of this study rather than gathering more

determine factors that significantly predict muscle dysmorphia symptomology. The

key study variables included the independent variables of race/ethnicity, sexual

orientation, self-esteem, body dissatisfaction, and bodybuilding dependence and the

analysis was used to determine whether the independent variables predict the dependent

predict muscle dysmorphia symptomology, as measured by the Body Dysmorphic

H12: Sexual orientation (gay, heterosexual, bisexual), as measured by the

Demographic Survey, will significantly predict muscle dysmorphia symptomology, as

(Rosenberg, 1965), will significantly predict muscle dysmorphia symptomology, as

measured by the BDDE-SR (Rosen & Reiter, 1996), among adolescent males. H03:

Self-esteem, as measured by the RSE (Rosenberg, 1965), will not significantly predict

muscle dysmorphia symptomology, as measured by the BDDE-SR

(Rosen & Reiter, 1996), among adolescent males.

Research Question #4: Is body dissatisfaction among adolescent males a

significant predictor of muscle dysmorphia symptomology?

H14: Body dissatisfaction, as measured by the Body Esteem Scale for Adolescents

and Adults (Adkins & Stivers, 2006; Mendelson, Mendelson, & White, 2001), will

significantly predict muscle dysmorphia symptomology, as measured by the BDDE-SR

(Rosen & Reiter, 1996), among adolescent males.

H04: Body dissatisfaction, as measured by the Body Esteem Scale for Adolescents

and Adults (Adkins & Stivers, 2006; Mendelson et al., 2001), will not significantly

predict muscle dysmorphia symptomology, as measured by the BDDE-SR (Rosen &

Reiter, 1996), among adolescent males.

H15: Bodybuilding dependence, as measured by the Bodybuilding Dependence

adolescent males.

Theoretical Foundation

The psycho-behavioral model of muscle dysmorphia, developed by Lantz, Rhea,

and Mayhew (2001), was used as the conceptual model for this study. The use of this

framework helps to explain the psychological factors, such as self-esteem and body

dissatisfaction, and behavioral factors, such as bodybuilding dependence, that are related

to muscle dysmorphia. For this conceptual model of muscle dysmorphia, Lantz et al.

identified self-esteem and body dissatisfaction, as precipitating factors that increase a

maintain self-esteem levels.

In this model, there are six potential behavioral characteristics that develop from

muscle dysmorphia and these include body size/symmetry, dietary constraints, physique

pathological behaviors (Lantz et al., 2001). Increases in pathological attitudes toward the

body can lead to changes in diet or other changes in order to develop the physique, which

reinforces the behavior. This reinforcement strengthens the connection between the

The use of this model is further discussed in Chapter 2. The psycho-behavioral

model of muscle dysmorphia can be used to understand how factors of age,

race/ethnicity, sexual orientation, self-esteem, body dissatisfaction, and bodybuilding

dependence predict muscle dysmorphia symptomology.

the perception of needing to spend hours each day devoted to physical activity to the

point of neglecting other areas of functioning, physical and mental health, and life

activities (Parnell, 2011). For this study, bodybuilding dependence was operationally

defined as participant self-reports assessed by the Bodybuilding Dependence Scale

Muscularity Scale, and the Exercise Dependence Scale-21. Parnell found no significant

relationship between self-esteem and muscle dysmorphia. However, a significant

partially supported the psycho-behavioral model of muscle dysmorphia. However,

selfesteem was not linked to muscle dysmorphia. Thus, more information is needed to

further explore the use of this framework with regard to muscle dysmorphia. Study

impacted self-esteem levels. Thus, there is a need to further study self-esteem as it

Historical Review of Muscle Dysmorphia

Historical Reviews Based on Literature Findings

Statistical Manual of Mental Disorders (DSM IV-TR). This disorder can include a

is estimated that up to 100,000 or more people of the general population suffer from this

disorder worldwide (Leone et al., 2005). Adolescents are at increased risk for developing

individual psychological predisposing factors.

muscle building turned into a pathological exercise. Bilger reported that bodybuilding

started to feel unhealthy, and pathology drove many toward desperate attempts to build

the body. According to Bilger, this bodybuilding became a mania and is now thought of

by psychiatrists as an illness. Bilger claimed that for most, weight lifting can be a healthy

pastime, but for others it can be a dangerous obsession. Individuals can work out 6 hours

a day, use steroids, and lose jobs and loved ones due to BDD. These findings resulted in

the identification and naming of the disorder as muscle dysmorphia (Bilger, 1998).

caused other obsessional behaviors. It has been difficult to arrive at a prevalence rate for

that muscle dysmorphia could be found in all big gyms, along with steroid abuse. This

findings with quotes from for example, Alan M. Klein, professor of sociology and

accept the bodybuilders' rationalizations ...you'll find [muscle dysmorphia] in all the big

gyms ... It's pretty widespread" (p. 10).

to be effective. However, the main concern was the identification of the disorder because

symptoms are not always understood as a problem due to patients perceiving themselves

as healthy. Because causes and correlates of BDD were not well understood, Leone et al.

concluded that more research was needed.

Causes of muscle dysmorphia were linked to the notion that views of masculinity

may impact male behaviors. Leone et al. (2005) noted that muscle dysmorphia may be

due in part to pressures for males to appear more muscular. Athletes may be particularly

susceptible to developing a body image disorders due to this pressure. While other body

image disorders such as anorexia nervosa and bulimia nervosa have been well studied

and documented in the clinical literature, more information was needed regarding muscle

dysmorphia. Dysmorphia (or dysmorphism) is defined as a malformation of the anatomy.

The clinical term of muscle dysmorphia (MDM) has become more commonly used. The

focus of this disorder is to become large and muscular to overcome the perceived

malformation of a lack of size or strength. Muscle dysmorphia is not limited to the

athletes or the sporting world, and it is found in adolescents trying to obtain views of the

ideal body. Leone et al. reported that body image dissatisfaction is not a new focus. For

example, during medieval times, men would fill their shirts with hay to appear bigger.

feel they have a defect in their appearance. According to the DSM-IV (1994), a BDD

diagnosis includes a preoccupation with an imagined or exaggerated defect in a person's

appearance, and significant distress or impairment due to this view, in daily living. Esco

et al. noted that the causes of muscle dysmorphia are not clear, and they may include

many factors such as media pressures. Because muscle dysmorphia involves obsessions,

it may be related to obsessive-compulsive disorder. Esco et al. reported that men with

muscle dysmorphia have poor body images, low self-esteem, and depression, and they

self-esteem and a poor body image, this male may be at risk for developing muscle

Muscle dysmorphia has been consistently found among males. Baghurst and

Kissinger (2009) also reported on the disorder of muscle dysmorphia, noting that it

unclear, but characteristics have been described. Some believe that the disorder is caused

their bodies. These men wanted increased muscularity, with no fat gain. Those with MD

do have a poor body image, and they consider themselves to be less healthy.

embarrassment and shame and impairments in social and occupational functioning due to

this condition (Olivardia et al., 2000). While the sample size was small and convenient,

Olivardia et al. concluded that muscle dysmorphia is a valid diagnostic category with

stereotypical features, which differ significantly from those of normal weightlifters. This

means that it is important to understand the features of muscle dysmorphia as well as the

risk and related factors in order to ensure early diagnosis or prevention of the disorder.

Research on muscle dysmorphia is limited. Hildebrandt et al. (2006) reported that

there was limited research on muscle dysmorphia in men using nonclinical populations.

Hildebrandt et al. included different types of respondents including muscle concerned, fat

concerned, dysmorphic, normal behavior, and normal. The dysmorphic group reported

body image disturbances that were consistent with muscle dysmorphia with high levels of

body image disturbance, appearance controlling behavior, associated psychopathology,

and steroid use. Hildebrandt et al. concluded the classification of muscle dysmorphia as a

subtype of body dysmorphic disorder, as well as an obsessive-compulsive spectrum

disorder. Thus, muscle dysmorphia is a specific disorder worthy of further study to

understand related factors in order to prevent and provide early treatment of the disorder.

Symptoms of muscle dysmorphia have been explored. Cafri et al. (2008) studied muscle

appearance symptoms, with recurrent thoughts about muscularity, appearance

dissatisfaction and checking, bodybuilding dependence, and impairment in functioning.

Those with a history of the disorder reported higher rates of mood and anxiety disorders

psychiatric conditions. Cafrie et al. provided information about muscle dysmorphia, that

Recent Studies of Muscle Dysmorphia Symptomology

There is a focus on obtaining this muscular body type for men because it is believed that

found that men with higher levels of social physique anxiety exercised more for

selfpresentational reasons instead of fitness or recreational reasons. These men reported

more symptoms of muscle dysmorphia and lower self-esteem (Grieve et al., 2008). Thus,

lower self-esteem may be a factor related to muscle dysmorphia, which supports the need

for further study of this factor.

Social pressures impact gender role stress, which may be related to body

dissatisfaction and muscle dysmorphia. Readdy et al. (2011) conducted a study to

explore gender role stress (GRS) and sociocultural appearance demands as related to

muscle dysmorphia symptoms. The sample for this study included 219 college women

and 154 college men. Readdy et al. found that age, sociocultural appearance demands,

dysmorphia may be related to perceptions of pressure to attain an attractive body more so

than global gender role stress. Thus, it may be that social pressures lead to body

they felt represented their own body, the ideal body wanted, the average body of a man

their age, and the male body preferred by women. Fat and muscularity were compared

with that of the four images. Pope et al. found that demographic and physical differences

among the three groups of men were slight. There were modest differences between

assessed fat and the fat of the images chosen. However, significant differences were

found for measures of muscularity. For all three countries, men chose an ideal body of

around 28 pounds more muscular than themselves, and they estimated women preferred a

that this discrepancy between men's actual muscularity and their body ideals may explain

impacts body image, which implies the need to explore race/ethnicity as a factor

Culture provides standards for body appearance. Tylka and Calogero (2011)

presented a discussion of the notion that culture provides specific standards for the body

appearance and display for women and men. These standards are found in the society

and the media. In Western cultures, gendered body ideals are presented, revered, and

aspired to. People try to live up to ideals and to do so, they constrict their relationships,

body ideal that a person aspires to achieve. Thus, while there are multiple factors that

may impact body image, ethnicity and race are related factors.

They assessed the influence feeling pressured by issues of body image, romance, peers,

analysis were that silencing (or being silent about views of about body), was positively

Silencing was also positively related to anxiety and depression. The internalization of the

perfect to others. Females focused on what others think, had the highest levels of distress

perfect to others was related to higher levels of distress and this factor may be related to

the relation between body image, and distress. These findings support conclusions that

trying to appear perfect can be related to body distress. This need to look perfect along

with body dissatisfaction require further study to understand how these issues can lead to

muscle dysmorphia. More information is also needed to understand muscle dysmorphia

in adolescents.

Germany, rates are 1.7% with a decline after age 44 years. While skin is the most

common area of concern in adolescents due to acne, 29% of those with BDD are focused

adolescence, have high rates of suicide ideation, suicide attempt, and completed suicide.

When age of onset is 16 years, lifetime rates of suicide ideation have been shown to

range from 58% to 78%, with adolescents having rates of 81%. Rates of suicide attempts

and shame. These individuals feel distressed and are preoccupied with their appearance

may not be understood (American Association of Suicidology, 2014). Since BDD can

Clinical features of body dysmorphic disorder in adolescents and adults.

since muscle dysmorphia is a type of BDD. BDD can begin in adolescence. Phillips,

clinical features of body dysmorphic disorder (BDD) in adolescents and adults. These

this age group. Findings were that the adolescents were preoccupied with their

appearance, with a focus on skin, hair, and stomach areas. For the adolescents, 94.3%

reported moderate, severe, or extreme distress, 80.6% reported a history of suicidal

were similar, but adolescents had significantly more delusional BDD beliefs and a rate of

suicide attempts. Thus, while adolescents and adults with BDD may be similar in some

ways, adolescents have high levels of distress and suicidal ideation and attempts. This

Studies with Adolescents

Body dissatisfaction is a factor in adolescents. Blodgett-Salafia and Lemer (2012)

disordered eating among girls and boys in middle school. These authors pointed out that

dissatisfaction, and then dieting in males, but dieting was not significantly related to

bulimic symptoms. Thus, Blodgett-Salafia and Lemer concluded that each sex has

unique experiences related to stress and body dissatisfaction and related behaviors. Thus,

supplements. The role of parent and peer pressure to lose or increase weight, or to

increase muscles was evaluated. Outcomes of Body Mass Index (BMI) over an 8-month

period were evaluated. Each variable was controlled at Time 1 and only bingeing and

food supplement use were predicted by other body change variables. Bingeing and all

other variables predicted bingeing at Time 2. Food supplement use and bingeing at Time

1 predicted food supplement use at Time 2. Perceived parent and peer pressure to lose

(or increase) weight at Time 1 predicted strategies to lose (or increase) weight at Time 2.

Perceived pressure to lose or increase weight, and increase muscles at Time 1 predicted

food supplement use at Time 2. This study was limited by the location of sample.

However, McCabe and Ricciardelli concluded that extreme body change strategies were

was also concluded that the range of body change strategies was impacted by perceived

parent and peer pressure. This study supported the need to consider body change

strategies in adolescents and further understand factors that put these males at risk for

developing muscle dysmorphia.

Ethnicity may be a factor in adolescent body change strategies. Nishina, Ammon,

Bellmore, and Graham (2006) studied body dissatisfaction and physical development

were more similarities than differences. Male participants reported similar areas and

levels of body dissatisfaction, and similar links between body dissatisfaction and

psychosocial maladjustment. Female participants reported differences, with lower levels

social maladjustment. Faster development in males predicted a stronger relationship

development predicted increased victimization. Nishina et al. concluded that physical

outcomes such as muscle dysmorphia.

There are multiple factors that are involved in body dissatisfaction. Petrie,

satisfaction in a group of 629 U.S. middle school boys and 650 girls, from grades six

through eight. Self-report measures of weight pressures, pubertal development,

internalization, self-esteem, social appearance comparison, physical self-concept, and

relationships between the variables assessed and body satisfaction. Females were most

influenced by weight loss pressures and males were most influenced by gaining weight

and musculature. Thus, issues such as self-esteem appear to impact body dissatisfaction,

Summary and Conclusion

disorder can result in dehydration, dieting, illegal substance use, over-training, exercise

2000; Phillips et al., 2006). Studies also confirm that there is a difference between

normal and pathological concern for the body (Cafri et al., 2008).

the disorder. These factors lead to potential behavioral characteristics and muscle

dysmorphia with more pathological behaviors.

Present studies of muscle dysmporphia show that that disorder includes body

image dissatisfaction and distress (Burlew & Shurts, 2013), with symptoms that can be

found in adolescence (Bjornsson et al., 2013). Yet most studies of the disorder rely on

adult samples (Boroughs et al., 2010; Davies et al., 2011; Readdy et al., 2011). Studies

of adolescents tend to focus on body discomfort issues (Brewster, 2011) and even these

studies show the link between this distress and potential devastating outcomes of suicide

(Brewster, 2011; American Association of Suicidology, 2014). Studies with adolescents

show the link between stress, pressure, body development, and body dissatisfaction

(Blodgett-Salafia & Lemer, 2012; McCabe & Ricciardelli, 2003; Nishina et al., 2006;

Petrie et al., 2010).

orientation, dissatisfaction with appearance, and bodybuilding dependence have been

to understand the prevalence of muscle dysmorphia symptomology and related factors in

nonclinical adolescent males from local high schools (Bjornsson et al., 2013; Boroughs et

heterosexual, bisexual), self-esteem, body dissatisfaction, and bodybuilding dependence,

that may predict muscle dysmorphia in adolescents. Chapter three will present

methodology used in the study to include an introduction, research design procedures,

Chapter 3: Methodology

Introduction

The purpose of this quantitative research study was to determine the factors

related to muscle dysmorphia symptomology in adolescent males. I determined the

present the research design and rationale, methodology, threats to validity, ethical

procedures, and summary.

Research Design and Rationale

orientation, self-esteem, body dissatisfaction, and bodybuilding dependence and the

dependent variable of muscle dysmorphia symptomology.

Research Design

orientation, self-esteem, body dissatisfaction, and bodybuilding dependence predict

of quantitative surveys to gather data from a group of high school male adolescents

determine whether the independent variables predict the dependent variable.

Rationale

Methodology

locally. Inclusion criteria included high school males of all ages and males with no

based on a power analysis of 91. A power analysis was conducted to determine the

sample size needed to accurately reject a null hypothesis for a regression analysis with a

power level of .80. The alpha level was set at .05 and the beta level was set at .80.

medium effect (.3 to .5), a sample of 91 was needed to yield a power of around 0.8 in

testing hypotheses. Thus, it was determined that a sample size of 91 participants would

be sufficient to test each of the hypotheses with a power of .80.

contacted a local high school principal regarding study approval. Following IRB and

high school principal approval, I distributed research packets to the teachers to be given

to all male students. Quantitative surveys were used to gather data from a group of high

school adolescents. After contacting IRB and receiving approval, the participants

received a packet containing a letter of introduction, a letter of consent/assent, and the

research surveys. Participants willing to participate were instructed to complete packet

contents and return them to me, via the teacher. I gathered the packets from the teachers,

hand-scored the surveys, and computed the statistical results. Participants were informed

that their participation was voluntary, they may ask questions at any time, they may

withdraw from the study at any time, and that confidentiality regarding the participant

Body Building Dependence Scale. The Bodybuilding Dependence Scale (BDS)

was developed by Smith et al. (1998). This scale is appropriate to the current study

from subscales of social dependence, training dependence, and mastery dependence.

Each of these subscales demonstrates satisfactory internal consistency with Cronbach

alphas  of 0.78, 0.76, and 0.75 respectively (Smith & Hale, 2004). Validity reports

regarding this scale are that there are significant and moderate correlations between all

to the point of neglecting other areas of functioning, physical and mental health, and life

activities (Parnell, 2011). For this study, BBD was operationally defined as participant

self-reports and was measured with the BBDS (Smith et al., 1998). Higher scores mean

higher degrees of BBD. An example of a scale item is, “If I miss a weight training

workout, I feel as though my muscle mass has shrunk."

may ask questions at any time to avoid any confusion, risk, or harm. The sample was not

from a vulnerable population.

Chapter 4: Results

Introduction

The purpose of this study was to determine the factors related to muscle

dysmorphia symptomology in adolescent males. Specifically, I determined if the

independent variables of (a) race/ethnicity, (b) sexual orientation (gay, heterosexual,

bisexual), (c) self-esteem, (d) body dissatisfaction, and (e) bodybuilding dependence

predicted the dependent variable of muscle dysmorphia symptomology in a nonclinical

sample of adolescent males. The research questions and hypotheses were as follows:

Research Question 1: Is race/ethnicity among adolescent males a significant

predictor of muscle dysmorphia symptomology?

H01 Race/ethnicity, as measured by the Demographic Survey, will not

significantly predict muscle dysmorphia symptomology, as measured by the BDDE-SR

Research Question #3: Is self-esteem among adolescent males a significant predictor of

Reiter, 1996), among adolescent males.

H03: Self-esteem, as measured by the RSE (Rosenberg, 1965), will not

significantly predict muscle dysmorphia symptomology, as measured by the BDDE-SR

(Rosen & Reiter, 1996), among adolescent males.

Research Question #4: Is body dissatisfaction among adolescent males a

significant predictor of muscle dysmorphia symptomology?

H14: Body dissatisfaction, as measured by the Body Esteem Scale for Adolescents

and Adults (Adkins & Stivers, 2006; Mendelson et al., 2001), will significantly predict

H04: Body dissatisfaction, as measured by the Body Esteem Scale for Adolescents

H15: Bodybuilding dependence, as measured by the Bodybuilding Dependence

Scale (Smith, Hale, & Collins, 1998), will significantly predict muscle dysmorphia

symptomology, as measured by the BDDE-SR (Rosen & Reiter, 1996), among

H05: Bodybuilding dependence, as measured by the Bodybuilding Dependence

Scale (Smith et al., 1998), will not significantly predict muscle dysmorphia

symptomology, as measured by the BDDE-SR (Rosen & Reiter, 1996), among

adolescent males.

Table 1 presents the descriptive data for the demographic and information

variables (gender, age, race/ethnicity, sexual identity). The sample consisted of 97 male

students. Most participants reported their ethnicity as being African American (37.1%),

the participants in this study reported their sexual identity to be heterosexual (84.5%).

The sample size was 97.

Table 1

Non-White 92 94.8

Statistical Assumptions

Multicollinearity Results

regression analysis showed that sexual orientation was not a significant predictor of

muscle dysmorphia symptomology (t= 1.753, p=.083).

Research Question 3

selfesteem will significantly predict muscle dysmorphia symptomology among

Coefficients based on a regression analysis showed that self-esteem was not a significant

significant predictor of muscle dysmorphia symptomology, with higher dissatisfaction

scores resulting in higher symptomology scores (t=-5.166, p =.000, B=-.540).

Research Question 5

RQ 5 asked the following: Is bodybuilding dependence (mastery, training, and

social dependence) among adolescent males a significant predictor of muscle dysmorphia

symptomology? The null hhypothesis stated that bodybuilding dependence (mastery,

training, and social dependence) will significantly predict muscle dysmorphia

symptomology among adolescent males. This hypothesis was broken down into three

parts. Null Hypothesis 5a stated that mastery dependence will significantly predict

muscle dysmorphia symptomology among adolescent males. Null Hypothesis 5b stated

that training dependence will significantly predict muscle dysmorphia symptomology

among adolescent males. Null Hypothesis 5c stated that social dependence will

hypothesis, with higher levels of training and social dependence resulting in higher levels

of muscle dysmorphia symptoms. Coefficients based on a regression analysis showed

that mastery dependence was not a significant predictor of muscle dysmorphia

symptomology (t=-3.649, p =.000, B =-.677) Coefficients based on a regression analysis

dependence were significant predictors of muscle dysmorphia symptomology among

adolescent males. For the variable of body building dependence, the subscales of body

training and social dependence significantly predicted muscle dysmorphia symptomology

among adolescent males. The subscale of mastery dependence did not significantly

predict muscle dysmorphia symptomology among adolescent males. In the next chapter,

disorder are not well understood (Brewster, 2011; Leone et al., 2005). In this chapter, I

The general research objective was to demonstrate whether race/ethnicity, sexual

orientation (gay/bisexual and heterosexual), self-esteem, body dissatisfaction, and

bodybuilding dependence predict the dependent variable of muscle dysmorphia

physical appearance are a particular focus. This can lead to severe distress and anxiety

that interrupts daily living. Exaggerated fears with dysfunctional body dissatisfaction

preoccupation with thoughts that the body is flawed (Brewster, 2011).

Current study findings are also consistent with those presented by the American

adults. However, as noted bythe American Association of Suicidology (2014) and

Phillips et al. (2006), there are other factors to consider that might impact outcomes such

as impaired functioning, poor grades, excessive school absences due to

selfconsciousness, shame, and high rates and levels of impairment in school, work, and

significantly predicted muscle dysmorphia symptomology among adolescent males, is

consistent with the previous claims. McCabe and Ricciardelli (2003) conducted a

longitudinal study of body change strategies among adolescent males and explored

change strategies of increase weight, increase muscles, eating and exercise to lose weight,

impacted by perceived parent and peer pressure. Thus, adolescent males may use

strategies such as increasing muscles (training) to change their body when dissatisfied

(social dependence).

dysmorphic symptoms. However, while Baghurst and Kissinger found that exercise

addiction or dependence was also related to muscle dysmorphic symptoms, findings from

this study were that mastery dependence was not a significant predictor.

Grieve et al. (2008) also reported that social physique anxiety or the anxiety felt

due to beliefs that the body is being evaluated, can lead to symptoms of muscle

dependence and body dissatisfaction, are consistent with those presented by Bilger

(1998). The link between body building dependence and body dissatisfaction was noted

by Bilger (1998) who discussed "barbell blues". With this view, healthy practices of

muscle building can become pathological in a desperate attempt to build the body and

The finding that body dissatisfaction is related to muscle dysmorphia is also

consistent with those presented by Davies, Smith, and Collier (2011), who reported that

many previous claims noted above.

The psycho-behavioral model of muscle dysmorphia was used as the theoretical

framework for this study (Lantz, Rhea, & Mayhew, 2001). This framework can be used

to help understand that psychological factors such as self-esteem and body dissatisfaction

and behavioral factors such as bodybuilding dependence may predict muscle dysmorphia.

factors that lead to increased motivation to engage in exercises for physique

development. When muscles are developed, self-esteem increases which leads to an

increased commitment to the exercise regimen and a dependence on this regimen. The

study finding that self-esteem did not significant predict muscle dysmorphia

dependence and muscle dysmorphia symptoms, was not fully supported by current study

findings.

For psycho-behavioral model of muscle dysmorphia, there are potential

behavioral characteristics that develop from muscle dysmorphia and these include body

size/symmetry, physique protection or hiding, and bodybuilding dependence. Each of

these factors can lead to pathological attitudes and behaviors (Lantz et al., 2001).

Negative attitudes toward the body can lead to diet and other behavioral changes to

attitudes regarding physical development (Lantz et al., 2001). The study findings that

body dissatisfaction and bodybuilding dependence significantly predicted muscle

dysmorphia symptomology among adolescent males, helps to support this theory. In

addition, the psycho-behavioral model of muscle dysmorphia can be used to explain

dependence. Current study findings were in part consistent with those presented by

Parnell (2011). Again, Parnell used the psycho-behavioral model as a theoretical

framework and found a significant relationship between body dissatisfaction and muscle

that race/ethnicity predicted muscle dysmorphia symptomoloty and sexual orientation did

There were study limitations due to sample, method and design, measurement

students were included in the study, it is assumed that findings can be generalized to only

other male adolescent high school students.

and cannot be directly manipulated results were observed from existing groups and this

limited the findings to descriptions. There are limitations of a correlation design which

Recommendations

Since there are study limitations due to the sample, it is recommended that it be

replicated in a future study and include a larger sample of clinical and nonclinical

samples of adolescent males. A comparison of the two groups would determine which

predictor variables are significantly related to muscle dysmorphia symptomology for each

groups. The assessment of additional characteristics such as age, multiple geographic

location, socioeconomic status, academic performance, family support, clinical and

nonclinical groups is recommended for a future study since these variables may have

influenced outcomes of the current study.

Since the study is limited by its design, the use of a mixed study would allow for

the gathering of both quantitative and qualitative data which would have helped to further

explain or verify findings since participants would have a chance to provide more

factors that impact self-esteem such as impaired functioning, poor grades, excessive

school absences due to self-consciousness, shame, and high rates and levels of

whetherrace/ethnicity, sexual orientation, self-esteem, body dissatisfaction, and

related to self-esteem and other factors, such as body issues or eating disorders that may

that body dissatisfaction and bodybuilding dependence predict muscle dysmorphia,

which was supported by the current study findings. These results align with this theory

since these factors were theorized to be related to muscle dysmorphia. Implications for

adolescent students, practitioners, and educators are that factors that predict muscle

dysmorphia must be understood and provided to help educate teens and the public, to

Positive Social Change

dysmorphia symptoms and predictive factors of race/ethnicity, body dissatisfaction, and

bodybuilding dependence in a nonclinical adolescent male sample. These findings have a

potential positive impact on social change at the individual and professional level. At the

For example, an individual who is more informed about the risk factors may be more able

to change behaviors before they become a problem. At the professional level, findings

support professional practice with new insights into the identification and treatment of

risk for developing muscle dysmorphia. In this manner, schools could provide teens with

dissatisfaction, and bodybuilding dependence. These factors must be considered

to muscle dysmorphia. Study findings also support the theoretical framework used for

that factors such as self-esteem, body dissatisfaction, and bodybuilding dependence

predict muscle dysmorphia, which was partially supported by the current study findings.

Conclusions

Body dysmorphic disorder is a problem in adolescence that is under diagnosed

and untreated (Bjornsson et al., 2013; Boroughs et al., 2010; Readdy, 2011). The causes

The specific problem for this study was that more information was needed to fill the gap

in the literature to determine factors that predict muscle dysmorpic disorder in nonclinical

adolescent males from local high schools. The purpose of this quantitative research study

was to determine factors related to muscle dysmorphia symptomology in adolescent

symptomology including race/ethnicity, levels of dissatisfaction with appearance, and

bodybuilding dependence. However since these studies used adult male samples only,

the current study was needed to explore these factors in an adolescent male sample.

gap in the literature regarding factors that predict muscle dysmorphia symptomology

(race/ethnicity, sexual orientation, self-esteem, body dissatisfaction, and bodybuilding

predictive factors which can provide information to individuals and health care providers

to help prevent muscle dysmorphic disorder in adolescent males.