Validity and Reliability Study of Turkish Version of “Muscle Dysmorphic Disorder Inventory” and “Bodybuilder Image Grid” Scales

Author(s): Asli Devrim, Pelin Bilgic*

Journal Name: Current Nutrition & Food Science

Volume 15 , Issue 5 , 2019

Become EABM
Become Reviewer
Call for Editor

Graphical Abstract:


Background: Although bigorexia symptoms are rapidly increasing, it is mostly an underrecognized condition in Turkish male bodybuilders. There are no validated screening tools to identify the symptoms.

Objective: The purpose of this study is to evaluate the validity of the Turkish version of the MDDI and the BIG towards the diagnosis of bigorexia and to provide health care professionals with early screening tools.

Methods: One hundred twenty male bodybuilders, fifty-eight professional bodybuilders and sixtytwo recreational bodybuilders, all of whom matched the research criteria, were included in this study. MDDI and BIG forms were filled by the bodybuilders, along with an “Individual Characteristic Information Form”, a “Nutrition-related Information Form”, and a “Bodybuilding-related Information Form”. To evaluate the construct validity, factor analysis was conducted and resulted in a threefactor construct.

Results: The factor-loading values ranged from 0.542- 0.827. Calculations of Cronbach’s alpha for the MDDI sum (α = 0.657) revealed a good internal consistency. The MDDI, BIG O, and BIG S intraclass correlation coefficients (ICC) were found to be 0.840, 0.908, and 0.879, respectively. As a result, MDDI had acceptable reliability and that of BIG O and BIG S was excellent.

Discussion: Turkish MDDI, BIG-O and BIG-S forms proved to be valid and reliable scales and were adequate for determining the symptoms of bigorexia in male bodybuilders. Using these forms, there was a statistically significant relationship between bigorexia and eating disorders, which were significantly positively correlated.

Conclusion: Our results support the feasibility of using the MDDI, the BIG-O, and the BIG-S forms to determine symptoms of bigorexia in Turkish population. Further studies are needed to confirm if this result can be generalized to female bodybuilders.

Keywords: Bigorexia, Bodybuilder Image Grid (BIG), bodybuilder, fat-free mass index (FFMI), muscle dysmorphia, Muscle Dysmorphic Disorder Inventory (MDDI).

Pope HG Jr, Gruber AJ, Choi P, Olivardia R, Phillips KA. Muscle dysmorphia. An underrecognized form of body dysmorphic disorder. Psychosomatics 1997; 38(6): 548-57.
Cafri G, Thompson JK, Ricciardelli L, McCabe M, Smolak L, Yesalis C. Pursuit of the muscular ideal: Physical and psychological consequences and putative risk factors. Clin Psychol Rev 2005; 25(2): 215-39.
Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007; 61(3): 348-58.
Madden S, Morris A, Zurynski YA, Kohn M, Elliot EJ. Burden of eating disorders in 5-13-year-old children in Australia. Med J Aust 2009; 190(8): 410-4.
Lowes J, Tiggemann M. Body dissatisfaction, dieting awareness and the impact of parental influence in young children. Br J Health Psychol 2003; 8(Pt 2): 135-47.
Cororve MB, Gleaves DH. Body dysmorphic disorder: a review of conceptualizations, assessment, and treatment strategies. Clin Psychol Rev 2001; 21(6): 949-70.
Murray SB, Rieger E, Touyz SW, De la Garza García Lic Y. Muscle dysmorphia and the DSM-V conundrum: where does it belong? A review paper. Int J Eat Disord 2010; 43(6): 483-91.
Pope HG Jr, Kanayama G, Hudson JI. Risk factors for illicit anabolic-androgenic steroid use in male weightlifters: a cross-sectional cohort study. Biol Psychiatry 2012; 71(3): 254-61.
Stice E, Shaw HE. Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings. J Psychosom Res 2002; 53(5): 985-93.
Olivardia R, Pope HG Jr, Hudson JI. Muscle dysmorphia in male weightlifters: a case-control study. Am J Psychiatry 2000; 157(8): 1291-6.
Brown J, Graham D. Body Satisfaction in Gym-active Males: An Exploration of Sexuality, Gender, and Narcissism. Sex Roles 2008; 59: 94-106.
Krug I, Pinheiro AP, Bulik C, et al. Lifetime substance abuse, family history of alcohol abuse/dependence and novelty seeking in eating disorders: comparison study of eating disorder subgroups. Psychiatry Clin Neurosci 2009; 63(1): 82-7.
Baggish AL, Weiner RB, Kanayama G, et al. Long-term anabolic-androgenic steroid use is associated with left ventricular dysfunction. Circ Heart Fail 2010; 3(4): 472-6.
Rahnema CD, Lipshultz LI, Crosnoe LE, Kovac JR, Kim ED. Anabolic steroid-induced hypogonadism: diagnosis and treatment. Fertil Steril 2014; 101(5): 1271-9.
Kanayama G, Hudson JI, Pope HG Jr. Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse: a looming public health concern? Drug Alcohol Depend 2008; 98(1-2): 1-12.
Hildebrandt T, Alfano L, Langenbucher JW. Body image disturbance in 1000 male appearance and performance enhancing drug users. J Psychiatr Res 2010; 44(13): 841-6.
Mosley PE. Bigorexia: bodybuilding and muscle dysmorphia. Eur Eat Disord Rev 2009; 17(3): 191-8.
González-Martí I, Bustos JG, Jordán OR, Mayville SB. Validation of a Spanish version of the Muscle Appearance Satisfaction Scale: escala de satisfacción muscular. Body Image 2012; 9(4): 517-23.
Goldfield GS, Woodside DB. Body image, disordered eating, and anabolic steroids in male bodybuilders: current versus former users. Phys Sportsmed 2009; 37(1): 111-4.
Pope HG Jr, Katz DL, Hudson JI. Anorexia nervosa and “reverse anorexia” among 108 male bodybuilders. Compr Psychiatry 1993; 34(6): 406-9.
Ravaldi C, Vannacci A, Zucchi T, et al. Eating disorders and body image disturbances among ballet dancers, gymnasium users and body builders. Psychopathology 2003; 36(5): 247-54.
Mayville SB, Williamson DA, White MA, Netemeyer RG, Drab DL. Development of the Muscle Appearance Satisfaction Scale: a self-report measure for the assessment of muscle dysmorphia symptoms. Assessment 2002; 9(4): 351-60.
Rhea DJ, Lantz CD, Cornelius AE. Development of the Muscle Dysmorphia Inventory (MDI). J Sports Med Phys Fitness 2004; 44(4): 428-35.
McCreary DR, Sasse DK, Saucier DM, Dorsch KD. Measuring the Drive for Muscularity: Factorial Validity of the Drive for Muscularity Scale in Men and Women. Psychol Men Masc 2004; 5: 49-58.
Stunkard AJ, Sørensen T, Schulsinger F. Use of the Danish Adoption Register for the study of obesity and thinness. Res Publ Assoc Res Nerv Ment Dis 1983; 60: 115-20.
Thompson MA, Gray JJ. Development and validation of a new body-image assessment scale. J Pers Assess 1995; 64(2): 258-69.
Thompson J, Tantleff KS. Female and male ratings of upper torso: Actual, ideal, and stereotypical conceptions. J Soc Behav Pers 1992; 7: 345-54.
Hildebrandt T, Langenbucher J, Schlundt DG. Muscularity concerns among men: development of attitudinal and perceptual measures. Body Image 2004; 1(2): 169-81.
Kouri EM, Pope HG Jr, Katz DL, Oliva P. Fat-free mass index in users and nonusers of anabolic-androgenic steroids. Clin J Sport Med 1995; 5(4): 223-8.
Schlundt DG, Woodford H, Brownlee A. Muscle dysmorphia in male weightlifters: Psychological characteristics and practices 2000.
Garner DM, Garfinkel PE. The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psychol Med 1979; 9(2): 273-9.
Savaşır I, Erol N. Yeme Tutum Testi: Anoreksiya nervoza belirtileri indeksi. Turk Psikol Derg 1989; 23: 19-25.
Foster AC, Shorter GW, Griffiths MD. Muscle dysmorphia: could it be classified as an addiction to body image? J Behav Addict 2015; 4(1): 1-5.
Pope HG Jr, Phillips KA, Olivardia R. The Adonis Complex: The Secret Crisis of Male Body Obsession. New York: NY Press 2000.
Goodale KR, Patti Lou W, Bradley C. Muscle Dysmorphia: A New Form of Eating Disorder? J Health Educ 2001; 32: 260-6.
Santarnecchi E, Dèttore D. Muscle dysmorphia in different degrees of bodybuilding activities: validation of the Italian version of Muscle Dysmorphia Disorder Inventory and Bodybuilder Image Grid. Body Image 2012; 9(3): 396-403.
Hitzeroth V, Wessels C, Zungu-Dirwayi N, Oosthuizen P, Stein DJ. Muscle dysmorphia: a South African sample. Psychiatry Clin Neurosci 2001; 55(5): 521-3.
Hildebrandt T, Schlundt D, Langenbucher J, Chung T. Presence of muscle dysmorphia symptomology among male weightlifters. Compr Psychiatry 2006; 47(2): 127-35.

open access plus

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Published on: 08 July, 2019
Page: [517 - 524]
Pages: 8
DOI: 10.2174/1573401314666181012113904

Article Metrics

PDF: 27
PRC: 1