Muscle dysmorphia and mediating variables in physically active brazilian men

Authors

DOI:

https://doi.org/10.21527/2176-7114.2026.51.16627

Keywords:

Body image, body dysmorphic disorders, men, mediation analysis

Abstract

To assess whether muscularity dissatisfaction is a significant mediator between appearance ideal internalization and muscle dysmorphia symptoms in physically active Brazilian men. This is a cross-sectional study, which included 915 physically active Brazilian men aged 18 to 35, of any color, race, or ethnicity. Through an online survey, participants responded to a sociodemographic questionnaire, as well as measures to assess symptoms of muscle dysmorphia (Muscle Dysmorphic Disorder Inventory), appearance ideal internalization (Sociocultural Attitudes Toward Appearance Questionnaire-4), and muscularity dissatisfaction (Male Body Attitudes Scale - Revised). The correlation between variables was evaluated using Spearman’s correlation coefficient (rho), and a simple mediation analysis with bootstrapping of 5,000 resamples was conducted. Muscle dysmorphia symptoms showed a significant, positive correlation of moderate magnitude with appearance ideal internalization and a large magnitude with muscularity dissatisfaction. Muscularity dissatisfaction partially mediated (~50%) the relationship between appearance ideal internalization and muscle dysmorphia symptoms. Therefore, muscularity dissatisfaction represents an important mediator between appearance ideal internalization and muscle dysmorphia symptoms in physically active Brazilian men. These findings underscore the importance of interventions aimed at both reducing the appearance ideal internalization and addressing body dissatisfaction, thereby contributing to the prevention and treatment of muscle dysmorphia in this population.

References

1. Carvalho PHB, Ferreira MEC. Disordered eating and body change behaviours: support for the Tripartite Influence Model among Brazilian male university students. Ciênc Saúde Colet. 2020;25(11):4485-95. DOI: https://doi.org/10.1590/1413-812320202511.35572018

2. Compte EJ, Sepúlveda AR, Torrente F. Approximations to an integrated model of eating disorders and muscle dysmorphia among university male students in Argentina. Men Masc. 2020;23(2):288-305. DOI: https://doi.org/10.1177/1097184X17753039

3. Prnjak K, Jukic I, Mitchison D, Griffiths S, Hay P. Body image as a multidimensional concept: A systematic review of body image facets in eating disorders and muscle dysmorphia. Body Image. 2022;42:347-60. DOI: https://doi.org/10.1016/j.bodyim.2022.07.006

4. Klimek P, Murray SB, Brown T, Gonzales IV M, Blashill AJ. Thinness and muscularity internalization: Associations with disordered eating and muscle dysmorphia in men. Int J Eat Disord. 2018;51(4):352-7. DOI: https://doi.org/10.1002/eat.22844

5. Bégin C, Turcotte O, Rodrigue C. Psychosocial factors underlying symptoms of muscle dysmorphia in a non-clinical sample of men. Psychiatry Res. 2019;272:319-25. DOI: https://doi.org/10.1016/j.psychres.2018.12.120

6. American Psychiatric Association. DSM-5: Manual diagnóstico e estatístico de transtornos mentais. Porto Alegre: Artmed Editora; 2014.

7. Pope Jr HG, Katz DL, Hudson JI. Anorexia nervosa and “reverse anorexia” among 108 male bodybuilders. Compr Psychiatry. 1993;34(6):406-9. DOI: https://doi.org/10.1016/0010440X(93)90066-D

8. Grunewald W, Blashill AJ. Muscle dysmorphia. Eating disorders in boys and men. 1ª ed. Cham: Editora Springer; 2021. p. 103-115.

9. Pope Jr HG, Gruber AJ, Choi P, Olivardia R, Phillips KA. Muscle dysmorphia: An underrecognized form of body dysmorphic disorder. Psychosomatics. 1997;38(6):548-57. DOI: https://doi.org/10.1016/S0033-3182(97)71400-2

10. Gomes VMGM, Compte EJ, Almeida M, Campos PF, Queiroz ACC, Pereira LF, et al. Psychometric properties of the Muscle Dysmorphic Disorder Inventory among physically active Brazilian college men. Psychol Men Masc. 2020;21(4):622-31. DOI: https://doi.org/10.1037/men0000307

11. Albuquerque LDS, Griep RH, Aquino EML, Cardoso LO, Chor D, Fonseca MJMF. Fatores associados à insatisfação com a Imagem Corporal em adultos: análise seccional do ELSA-Brasil. Ciênc Saúde Coletiva. 2021;26(5):1941-54. DOI: https://doi.org/10.1590/1413-81232021265.07152019

12. Almeida M, Hudson TA, Campos PF, Gomes VMGM, Compte EJ, Carvalho PHB. Evaluating muscle dysmorphia symptoms: Testing several factor structures of the Muscle Appearance Satisfaction Scale among Brazilian men. Psychol Men Masc. 2023;24(1):63-75. DOI: https://doi.org/10.1037/men0000412

13. Abrahin OSC, Sousa EC, Santos AM. Prevalence of the use of anabolic-androgenic steroids in Brazil: a systematic review. Subst Use Misuse. 2014;49(9):1156-62. DOI: https://doi.org/10.3109/10826084.2014.903750

14. Nogueira FRS, Souza A, Brito A. Prevalência do uso e efeitos de recursos ergogênicos por praticantes de musculação nas academias brasileiras: uma revisão sistematizada. Rev Bras Ativ Fís Saúde. 2013;18(1):16-30. DOI: https://doi.org/10.12820/rbafs.v.18n1p16-30

15. Campos PF, Frazier LD, Almeida M, Carvalho PHB. Validation and measurement invariance of the Compulsive Exercise Test among Brazilian and American young adults. Eat Weight Disord. 2024;29(1):2-11. DOI: https://doi:10.1007/s40519-023-01627-3

16. Gorrasi ISR, Bonetta S, Roppolo M, Daga GA, Bo S, Tagliabue A, et al. Traits of orthorexia nervosa and muscle dysmorphia in Italian university students: a multicenter study. Eat Weight Disord. 2020;25(5):1413-23. DOI: https://doi.org/10.1007/s40519-019-00779-5

17. Laus MF, Junqueira ACP, Almeida SS, Costa TMB, Swami V. Body image, muscle dysmorphia, and muscularity concerns: a comparison of crossfit athletes, weight-trainers, and non-athletes. Motricidade. 2022;18(1):50-60. DOI: https://doi.org/10.6063/motricidade.25584

18. Compte EJ, Sepúlveda AR, Torrente F. Approximations to an integrated model of eating disorders and muscle dysmorphia among university male students in Argentina. Men Masculinities. 2020;23(2):288-305. DOI: https://doi.org/10.1177/1097184X17753039

19. Roberts A, Roberts Jr JM. Multiple regression: A practical introduction. 1ª ed. New York: SAGE Publications; 2020.

20. Organização Mundial de Saúde (OMS). Physical status: the use and interpretation of anthropometry [recurso eletrônico]. Geneva: OMS; 1995. http://www.unu.edu/unupress/food/FNBv27n4_sup pl_2_final.pdf. Acessado em 25 de outubro de 2024.

21. Organização Mundial da Saúde (OMS). Physical Activity [recurso eletrônico]. Geneva: OMS; 2022. https://www.who.int/news-room/fact-sheets/detail/physical-activity. Acessado em 20 de outubro de 2024.

22. Hildebrandt T, Langenbucher J, Schlundt DG. Muscularity concerns among men: Development of attitudinal and perceptual measures. Body Image. 2004;1(2):169-81. DOI: https://doi.org/10.1016/j.bodyim.2004.01.001

23. Almeida M, Gomes VMGM, Carvalho PHB. Adaptação transcultural e análise de equivalências da Male Body Attitudes Scale-Revised (MBAS-R) e do Muscle Dysmorphic Disorder Inventory (MDDI) para jovens adultos brasileiros. Principia. 2019;19(2):1-11. DOI: https://doi.org/10.34019/2179-3700.2019.v19.29914

24. Ryan TA, Morrison TG, Roddy S, McCutcheon J. Psychometric properties of the revised male body attitudes scale among Irish men. Body Image. 2011;8(1):64-9. DOI: https://doi.org/10.1016/j.bodyim.2010.10.004

25. Almeida M, Brown TA, Neves CM, Campos PF, Resende TRO, Carvalho PHB. Psychometric properties of the Male Body Attitudes Scale - Revised among Brazilian men. Psychol Men Masc. 2021;22(4):592-601. DOI: https://doi.org/10.1037/men0000363

26. Schaefer LM, Burke NL, Thompson JK, Dedrick RF, Heinberg LJ, Calogero RM, et al. Development and validation of the sociocultural attitudes towards appearance questionnaire-4 (SATAQ-4). Psychol Assess. 2015;27(1):54-67. DOI: https://doi.org/10.1037/a0037917

27. Barra JV, Silva WRD, Marôco J, Campos JADB. Adaptação transcultural e validação do Questionário de Atitudes Socioculturais em Relação à Aparência-4 (SATAQ-4) aplicado a estudantes universitários. Cad Saúde Pública. 2019;35(5):e00170218. DOI: https://doi.org/10.1590/0102-311X00170218

28. Enders CK. Applied missing data analysis. 2ª ed. New York: Guilford Publications; 2022.

29. Little RJA. A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc. 1988;83(404):1198-1202. DOI: https://doi.org/10.2307/2290157

30. Lovakov A, Agadullina ER. Empirically derived guidelines for effect size interpretation in social psychology. Eur J Soc Psychol. 2021;51(3):485-504. DOI: https://doi.org/10.1002/ejsp.2752

31. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. 3ª ed. New York: The Guilford Press; 2022.

32. Kalkbrenner MT. Alpha, omega, and H internal consistency reliability estimates: Reviewing these options and when to use them. Couns Outcome Res Eval. 2023;14(1):77-88. DOI: https://doi.org/10.1080/21501378.2021.1940118

33. Baião PHM, Souza AGP, Santos CG, Oliveira Júnior ML, Almeida M, Carvalho PHB. Preditores de dismorfia muscular em homens brasileiros de minoria sexual e de gênero. J Bras Psiquiatr. 2023;72(2):118-126. DOI: https://doi.org/10.1590/0047-2085000000418

34. Chatmon BNM. Males and mental health stigma. Am J Men's Health. 2020;14(4): 1557988320949322. DOI: https://doi.org/10.1177/1557988320949322

35. Cooper M, Eddy KT, Thomas JJ, Franko DL, Carron-Arthur B, Keshishian AC, Griffiths KM. Muscle dysmorphia: A systematic and meta analytic review of the literature to assess diagnostic validity. Int J Eat Disord. 2020;53(10):1583-1604. DOI: https://doi.org/0.1002/eat.23349

Downloads

Published

2026-07-17

How to Cite

Santos, M. V. G., Almeida, M., & Hudson, T. A. (2026). Muscle dysmorphia and mediating variables in physically active brazilian men. Revista Contexto & Saúde, 26(51), e16627. https://doi.org/10.21527/2176-7114.2026.51.16627

Issue

Section

ORIGINAL ARTICLE