Are anxiety and obsessive-compulsive symptoms related to muscle dysmorphia?

International Journal of Men's Health, Summer, 2009 by Christopher G. Chandler, Frederick G. Grieve, W. Pitt Derryberry, Phillip O. Pegg

The present study examines how muscle dysmorphia (MD), a clinically significant preoccupation that one's body is inadequately muscular, relates to trait anxiety and obsessive-compulsive symptoms. 97 college-age men completed the MD Inventory, the Drive for Muscularity Scale, the Male Body Attitudes Scale, the Social Physique Anxiety Scale, the trait scale of the Speilberger State-Trait Anxiety Inventory, and an abbreviated version of the Yale Brown Obsessive-Compulsive Scale. Bivariate correlation analyses revealed that trait anxiety and obsessive-compulsive symptoms demonstrated strong relationships with both social physique anxiety and overall MD symptomology. Path analysis indicated that anxiety-related variables accounted for 77 percent of the variance in MD symptoms. The findings lend support to the assertion that MD should be placed within the obsessive-compulsive spectrum of disorders.

Keywords: muscle dysmorphia, anxiety, obsessive-compulsive symptoms, men

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Although not officially listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (American Psychiatric Association, 2000) (DSM-IV-TR), muscle dysmorphia (MD) is recognized by many researchers as a legitimate psychological disorder. Olivardia (2001) provides thorough diagnostic criteria for MD. First, one must be preoccupied with the idea that his or her body is not sufficiently lean or muscular. Second, the preoccupation must cause clinically significant distress or impairment in social, occupational or other important areas of functioning as demonstrated by (a) giving up participating in important activities in these areas because of a compulsive need to maintain diet and workout schedules, (b) avoiding situations in which one's body is exposed to others, (c) exhibiting clinically significant distress in these areas of functioning, (d) continuing exercising, dieting, and using performance enhancing substances despite negative physical or psychological consequences, and (e) being preoccupied with being too small or inadequately muscular rather than on being overweight.

Grieve (2007) discusses factors that influence the development of MD. These include socio-environmental (media presentation of ideal images and sports participation), emotional (negative affect and body image dissatisfaction), psychological (idealized body image and low self-esteem), and cognitive (perfectionism) influences (Grieve). Of most interest to the present study are the emotional influences, especially negative affect.

Maida and Armstrong (2005) noted positive correlations between symptoms of MD and variables such as anxiety and obsessive-compulsive symptoms. They examined a model in which obsessive-compulsive symptoms were related to symptoms of eating disorders, body dysmorphic disorder, and MD. Obsessive-compulsive symptoms were also directly related to symptoms of MD. These findings indicate strong positive relationships between obsessive-compulsive symptoms, anxiety, symptoms of body dysmorphic disorder, and symptoms of MD, with the strongest relationship being between obsessive-compulsive symptoms and symptoms of MD. However, since Maida and Armstrong measured anxiety using the Brief Symptom Inventory (BSI; Derogatis, 1984), which is a screening instrument for psychiatric disorders, replication of these findings with a more comprehensive evaluation of anxiety is in order. Moreover, Maida and Armstrong did not directly evaluate symptoms of MD. They used a combination of measures to suggest symptoms of MD. Thus, replication with a measure designed to evaluate symptoms of MD is warranted.

Another variable of interest in terms of negative affect is social physique anxiety, a body-related anxiety that stems from the fear of others evaluating one's appearance (Hart, Leary, & Rejeski, 1989). Conceptually, symptoms of MD include concern over body shape and hiding of the body (Olivardia, 2001). Further, prior research has demonstrated a link between MD and social physique anxiety. Grieve, Jackson, Recce, Marklin, and Delaney (in press) found that men who reported higher levels of social physique anxiety also reported higher levels of MD symptoms.

Two other variables--drive for muscularity and body focus--are notable in the development of MD (Grieve, 2007). A drive for muscularity underlies the behavioral symptoms of MD in that people with the disorder want to be larger and more muscular than what they actually are (Olivardia, 2001). There is a large body of research that ties a drive for muscularity to MD (Thompson & Cafri, 2007). A second factor important in the development of MD is body focus. Individuals high in MD exhibit a number of body checking behaviors such as looking at their bodies in mirrors (Olivardia, 2001).

The present study was designed to expand upon the work of Maida and Armstrong, and evaluate the relationship that anxiety symptoms have with MD. The model proposed for the study includes obsessive-compulsive symptoms, trait anxiety, social physique anxiety, drive for muscularity and media influences as factors that are related to MD. The general model under study was taken from Grieve (2007), and was modified to include the anxiety symptoms of interest to the present research.