Hostname: page-component-7479d7b7d-68ccn Total loading time: 0 Render date: 2024-07-14T12:14:47.325Z Has data issue: false hasContentIssue false

Prevalence of muscle dysmorphia in adolescents: findings from the EveryBODY study

Published online by Cambridge University Press:  16 March 2021

Deborah Mitchison*
Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW, Australia Department of Psychology, Centre for Emotional Health, North Ryde, NSW, Australia
Jonathan Mond
Centre for Rural Health, University of Tasmania, Launceston, TAS, Australia
Scott Griffiths
Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
Phillipa Hay
Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW, Australia Camden and Campbelltown Hospitals, SWSLHD, Camden and Campbelltown, NSW, Australia
Jason M. Nagata
Department of Pediatrics, University of California, San Francisco, CA, USA;
Kay Bussey
Department of Psychology, Centre for Emotional Health, North Ryde, NSW, Australia
Nora Trompeter
Department of Psychology, Centre for Emotional Health, North Ryde, NSW, Australia
Alexandra Lonergan
Department of Psychology, Centre for Emotional Health, North Ryde, NSW, Australia
Stuart B. Murray
Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
Author for correspondence: Deborah Mitchison, PhD, E-mail:



We sought to provide the first point prevalence estimates of muscle dysmorphia (MD), a form of body dysmorphic disorder characterized by a preoccupation with perceived insufficient muscularity, in adolescents.


Data were taken from a survey of 3618 Australian adolescents (11.172–19.76 years; 49.3% girls). Measures captured demographic characteristics, symptoms of MD and eating disorders, psychological distress and functional impairment. Diagnostic criteria for MD developed by Pope et al. (1997, Psychosomatics, 38(6), 548–557) were applied, entailing preoccupation with insufficient muscularity causing significant levels of distress or disability that cannot be better accounted for by an eating disorder.


The point prevalence of MD was 2.2% [95% confidence interval (CI) 1.6–3.0%] among boys and 1.4% (95% CI 0.9–2.0%) among girls. Prevalence was not associated with gender (V = 0.031) or socioeconomic status (SES) (partial η2< 0.001), but was marginally associated with older age (partial η2 = 0.001). Boys with MD were more likely than girls with MD to report severe preoccupation with muscularity (V = 0.259) and a weight-lifting regime that interfered with their life (V = 0.286), whereas girls with MD were more likely to report discomfort with body exposure (V = 0.380).


While future epidemiological research using diagnostic interviews is needed to verify these estimates, the findings suggest that MD is relatively common from early to late adolescence. Gender differences in MD prevalence may be minimal; however, the symptom profile appears to diverge between boys and girls. These findings provide a platform for future, analytical research designed to inform clinical and public health interventions.

Original Article
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington: American Psychiatric Publishing Inc.Google Scholar
Australian Bureau of Statistics. (2016). Census of population and housing: Socio-economic indexes for areas (SEIFA), Australia. Retrieved from Scholar
Bentley, C., Gratwick-Sarll, K., Harrison, C., & Mond, J. (2015). Sex differences in psychosocial impairment associated with eating disorder features in adolescents: A school-based study. International Journal of Eating Disorders, 48(6), 633640.CrossRefGoogle ScholarPubMed
Bozsik, F., Whisenhunt, B. L., Hudson, D. L., Bennett, B., & Lundgren, J. D. (2018). Thin is in? Think again: The rising importance of muscularity in the thin ideal female body. Sex Roles, 79(9), 609615. doi: 10.1007/s11199-017-0886-0CrossRefGoogle Scholar
Burt, A., Mitchison, D., Dale, E., Bussey, K., Trompeter, N., Lonergan, A., & Hay, P. (2020). Prevalence, features and health impacts of eating disorders amongst first-Australian yiramarang (adolescents) and in comparison with other Australian adolescents. Journal of Eating Disorders, 8(1), 10. doi: 10.1186/s40337-020-0286-7CrossRefGoogle Scholar
Cafri, G., Olivardia, R., & Thompson, J. (2008). Symptom characteristics and psychiatric comorbidity among males with muscle dysmorphia. Comprehensive Psychiatry, 49, 374379.CrossRefGoogle ScholarPubMed
Cunningham, M. L., Szabo, M., Kambanis, P. E., Murray, S. B., Thomas, J. J., Eddy, K. T., … Griffiths, S. (2019). Negative psychological correlates of the pursuit of muscularity among women. International Journal of Eating Disorders, 52(11), 13261331. doi: 10.1002/eat.23178CrossRefGoogle ScholarPubMed
Fairburn, C. G., & Beglin, S. J. (2008). Eating disorder examination questionnaire (EDE-Q 6.0). In Fairburn, C. G. (Ed.), Cognitive behavior therapy and eating disorders (pp. 309314). New York: Guilford Press.Google ScholarPubMed
Girard, M., Rodgers, R. F., & Chabrol, H. (2018). Prospective predictors of body dissatisfaction, drive for thinness, and muscularity concerns among young women in France: A sociocultural model. Body Image, 26, 103110. doi: Scholar
Griffiths, S., & Murray, S. B. (2018). Muscle dysmorphia: Clinical presentation and treatment strategies. In Anderson, L., Murray, S. B., & Kaye, W. H. (Eds.), Clinical handbook of Complex and atypical eating disorders (pp. 235252). New York: Oxford University Press.Google Scholar
Griffiths, S., Murray, S. B., Bentley, C., Gratwick-Sarll, K., Harrison, C., & Mond, J. M. (2017). Sex differences in quality of life impairment associated with body dissatisfaction in adolescents. Journal of Adolescent Health, 61(1), 7782.CrossRefGoogle ScholarPubMed
Heyman, I., Fombonne, E., Simmons, H., Ford, T., Meltzer, H., & Goodman, R. (2001). Prevalence of obsessive–compulsive disorder in the British nationwide survey of child mental health. The British Journal of Psychiatry, 179(4), 324329.CrossRefGoogle ScholarPubMed
Kanayama, G., Boynes, M., Hudson, J. I., Field, A. E., & Pope, H. G. Jr. (2007). Anabolic steroid abuse among teenage girls: An illusory problem? Drug and Alcohol Dependence, 88(2–3), 156162. doi:10.1016/j.drugalcdep.2006.10.013CrossRefGoogle ScholarPubMed
Karazsia, B. T., Murnen, S. K., & Tylka, T. L. (2017). Is body dissatisfaction changing across time? A cross-temporal meta-analysis. Psychological Bulletin, 143(3), 293320. doi: 10.1037/bul0000081CrossRefGoogle Scholar
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S.-L., … Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(06), 959976.CrossRefGoogle ScholarPubMed
Krebs, G., Fernández de la Cruz, L., & Mataix-Cols, D. (2017). Recent advances in understanding and managing body dysmorphic disorder. Evidence-Based Mental Health, 20(3), 7175. doi: 10.1136/eb-2017-102702CrossRefGoogle ScholarPubMed
Lipson, S. M., Stewart, S., & Griffiths, S. (2020). Athleisure: A qualitative investigation of a multi-billion-dollar clothing trend. Body Image, 32, 513. doi: ScholarPubMed
Mackey, E. R., & La Greca, A. M. (2008). Does this make me look fat? Peer crowd and peer contributions to adolescent girls’ weight control behaviors. Journal of Youth and Adolescence, 37(9), 10971110.CrossRefGoogle Scholar
Mayville, S., Katz, R. C., Gipson, M. T., & Cabral, K. (1999). Assessing the prevalence of body dysmorphic disorder in an ethnically diverse group of adolescents. Journal of Child and Family Studies, 8(3), 357362.CrossRefGoogle Scholar
McCreary, D. R., & Sasse, D. K. (2000). An exploration of the drive for muscularity in adolescent boys and girls. Journal of American College Health, 48(6), 297304. doi: 10.1080/07448480009596271CrossRefGoogle ScholarPubMed
McCreary, D. R., Sasse, D. K., Saucier, D. M., & Dorsch, K. D. (2004). Measuring the drive for muscularity: Factorial validity of the drive for muscularity scale in men and women. Psychology of Men and Masculinity, 5(1), 49.CrossRefGoogle Scholar
Mitchison, D., Hay, P., Engel, S., Crosby, R., Le Grange, D., Lacey, H., … Touyz, S. (2013). Assessment of quality of life in people with severe and enduring anorexia nervosa: A comparison of generic and specific instruments. BMC Psychiatry, 13(1), 284.CrossRefGoogle ScholarPubMed
Mitchison, D., & Mond, J. (2015). Epidemiology of eating disorders, eating disordered behaviour, and body image disturbance in males: A narrative review. Journal of Eating Disorders, 3(1), 20. doi: 10.1186/s40337-015-0058-yCrossRefGoogle ScholarPubMed
Mitchison, D., Mond, J., Bussey, K., Trompeter, N., Lonergan, A., Griffiths, S., … Hay, P. (2019). DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance. Psychological Medicine, 50(6), 981990.CrossRefGoogle ScholarPubMed
Mond, J. M., & Hay, P. J. (2007). Functional impairment associated with bulimic behaviors in a community sample of men and women. International Journal of Eating Disorders, 40(5), 391398.CrossRefGoogle Scholar
Mond, J. M., Mitchison, D., & Hay, P. J. (2013) Eating disordered behavior in men: Prevalence, impairment in quality of life, and implications for prevention and health promotion. In Cohn, L. & Lemberg, R. (Eds.), Current findings on males with eating disorders (pp. 195208). London: Routledge.Google Scholar
Murray, S. B., & Baghurst, T. (2013). Revisiting the diagnostic criteria for muscle dysmorphia. Strength & Conditioning Journal, 35(1), 6974. doi: 10.1519/SSC.0b013e3182723f24CrossRefGoogle Scholar
Murray, S. B., Nagata, J. M., Griffiths, S., Calzo, J. P., Brown, T. A., Mitchison, D., … Mond, J. M. (2017a). The enigma of male eating disorders: A critical review and synthesis. Clinical Psychology Review, 57, 111. doi: ScholarPubMed
Murray, S. B., Pila, E., Griffiths, S., & Le Grange, D. (2017b). When illness severity and research dollars do not align: Are we overlooking eating disorders? World Psychiatry, 16(3), 321.CrossRefGoogle Scholar
Murray, S. B., Rieger, E., Hildebrandt, T., Karlov, L., Russell, J., Boon, E., … Touyz, S. W. (2012). A comparison of eating, exercise, shape, and weight related symptomatology in males with muscle dysmorphia and anorexia nervosa. Body Image, 9(2), 193200. doi: ScholarPubMed
Murray, S. B., & Touyz, S. W. (2013). Muscle dysmorphia: Towards a diagnostic consensus. Australian and New Zealand Journal of Psychiatry, 47(3), 206207. doi: 10.1177/0004867412452018CrossRefGoogle ScholarPubMed
Nagata, J. M., Ganson, K. T., Griffiths, S., Mitchison, D., Garber, A. K., Vittinghoff, E., … Murray, S. B. (2020). Prevalence and correlates of muscle-enhancing behaviors among adolescents and young adults in the United States. International Journal of Adolescent Medicine and Health. doi: Scholar
Olivardia, R., Pope, H., & Hudson, J. (2000). Muscle dysmorphia in male weightlifters: A case-control study. American Journal of Psychiatry, 157, 12911296.CrossRefGoogle ScholarPubMed
Phillips, K. A., Menard, W., & Fay, C. (2006). Gender similarities and differences in 200 individuals with body dysmorphic disorder. Comprehensive Psychiatry, 47(2), 7787. doi: ScholarPubMed
Phillips, K. A., Wilhelm, S., Koran, L. M., Didie, E. R., Fallon, B. A., Feusner, J., & Stein, D. J. (2010). Body dysmorphic disorder: Some key issues for DSM-V. Depression and Anxiety, 27(6), 573591. doi: 10.1002/da.20709CrossRefGoogle ScholarPubMed
Pope, H. G., Gruber, A. J., Choi, P., Olivardia, R., & Phillips, K. A. (1997). Muscle dysmorphia: An underrecognized form of body dysmorphic disorder. Psychosomatics, 38(6), 548557. doi: ScholarPubMed
Pope, H. G., Katz, D. L., & Hudson, J. I. (1993). Anorexia nervosa and “reverse anorexia” among 108 male bodybuilders. Comprehensive Psychiatry, 34(6), 406409.CrossRefGoogle Scholar
Pope, C., Pope, H., Menard, W., Fay, C., Olivardia, R., & Phillips, K. (2005). Clinical features of muscle dysmorphia among males with body dysmorphic disorder. Body Image, 2, 395400.CrossRefGoogle ScholarPubMed
Rief, W., Buhlmann, U., Wilhelm, S., Borkenhagen, A., & Brahler, E. (2006). The prevalence of body dysmorphic disorder: A population-based survey. Psychological Medicine, 36(6), 877885. doi: 10.1017/S0033291706007264CrossRefGoogle ScholarPubMed
Sandgren, S. S., & Lavallee, D. (2018). Muscle dysmorphia research neglects DSM-5 diagnostic criteria. Journal of Loss and Trauma, 23(3), 211243. doi: 10.1080/15325024.2018.1428484CrossRefGoogle Scholar
Schmidt, U., Adan, R., Böhm, I., Campbell, I. C., Dingemans, A., Ehrlich, S., … Himmerich, H. (2016). Eating disorders: The big issue. The Lancet Psychiatry, 3(4), 313315.CrossRefGoogle Scholar
Schneider, S. C., Mond, J., Turner, C. M., & Hudson, J. L. (2017). Sex differences in the presentation of body dysmorphic disorder in a community sample of adolescents. Journal of Clinical Child & Adolescent Psychology, 48, 516528. doi: 10.1080/15374416.2017.1321001.CrossRefGoogle Scholar
Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68(7), 714723.CrossRefGoogle ScholarPubMed
Trompeter, N., Bussey, K., Hay, P., Mond, J., Murray, S. B., Lonergan, A., … Mitchison, D. (2018). Fear of negative evaluation and weight/shape concerns among adolescents: The moderating effects of gender and weight status. Journal of Youth and Adolescence, 47(7), 13981408. doi: 10.1007/s10964-018-0872-zCrossRefGoogle ScholarPubMed
Vandereycken, W. (2011). Media hype, diagnostic fad or genuine disorder? Professionals’ opinions about night eating syndrome, orthorexia, muscle dysmorphia, and emetophobia. Eating Disorders, 19(2), 145155.CrossRefGoogle ScholarPubMed
Varni, J. W., Burwinkle, T. M., Seid, M., & Skarr, D. (2003). The PedsQL 4.0 as a pediatric population health measure: Feasibility, reliability, and validity. Ambulatory Pediatrics, 3(6), 329341.2.0.CO;2>CrossRefGoogle ScholarPubMed
Varni, J. W., Limbers, C. A., & Burwinkle, T. M. (2007). Impaired health-related quality of life in children and adolescents with chronic conditions: A comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL™ 4.0 generic core scales. Health and Quality of Life Outcomes, 5(1), 43. doi: 10.1186/1477-7525-5-43CrossRefGoogle ScholarPubMed
Veale, D., & Neziroglu, F. A. (2010). Body dysmorphic disorder: A treatment manual (Vol. 15). West Sussex: Wiley-Blackwell.CrossRefGoogle Scholar