Sports Medicine

, Volume 47, Issue 2, pp 233–259 | Cite as

Muscle Dysmorphia Symptomatology and Associated Psychological Features in Bodybuilders and Non-Bodybuilder Resistance Trainers: A Systematic Review and Meta-Analysis

  • Lachlan MitchellEmail author
  • Stuart B. Murray
  • Stephen Cobley
  • Daniel Hackett
  • Janelle Gifford
  • Louise Capling
  • Helen O’Connor
Systematic Review



Muscle dysmorphia (MD) is associated with a self-perceived lack of size and muscularity, and is characterized by a preoccupation with and pursuit of a hyper-mesomorphic body. MD symptoms may hypothetically be more prevalent in bodybuilders (BBs) than in non-bodybuilder resistance trainers (NBBRTs).


Our objective was to compare MD symptomatology in BBs versus NBBRTs and identify psychological and other characteristics associated with MD in these groups.


We searched relevant databases from earliest record to February 2015 for studies examining MD symptoms in BBs and/or NBBRTs. Included studies needed to assess MD using a psychometrically validated assessment tool. Study quality was evaluated using an adapted version of the validated Downs and Black tool. We calculated between-group standardized mean difference (effect sizes [ESs]) and 95 % confidence intervals (CIs) for each MD subscale, and performed meta-analysis when five or more studies used the same MD tool. We also extracted data describing psychological or other characteristics associated with MD.


Of the 2135 studies initially identified, 31 analyzing data on 5880 participants (BBs: n = 1895, NBBRTs: n = 3523, controls: n = 462) were eligible for inclusion, though study quality was generally poor–moderate (range 7–19/22). Most participants were male (90 %). Eight different MD assessment tools were used. Meta-analysis for five studies all using the Muscle Dysmorphia Inventory (MDI) revealed there was a medium to large pooled ES for greater MD symptomatology in BBs than in NBBRTs on all MDI subscales (ES 0.53–1.12; p ≤ 0.01). Competitive BBs scored higher than non-competitive BBs (ES 1.21, 95 % CI 0.82–1.60; p < 0.001). MD symptoms were associated with anxiety (r 0.32–0.42; p ≤ 0.01), social physique anxiety (r 0.26–0.75; p < 0.01), depression (r 0.23–0.53; p ≤ 0.01), neuroticism (r 0.38; p < 0.001), and perfectionism (r 0.35; p < 0.05) and were inversely associated with self-concept (r –0.32 to –0.36; p < 0.01) and self-esteem (r –0.42 to –0.47; p < 0.01).


MD symptomatology was greater in BBs than in NBBRTs. Anxiety and social physique anxiety, depression, neuroticism, and perfectionism were positively associated with MD, while self-concept and self-esteem were negatively associated. It remains unclear whether these characteristics are exacerbated by bodybuilding, or whether individuals with these characteristics are attracted to the bodybuilding context.


Anorexia Nervosa Resistance Training Psychological Feature Pool Effect Size Exercise Dependence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethical Standards


The authors would like to acknowledge funding support of Sports Dietitians Australia, which assisted in the preparation of this manuscript.

Conflict of interest

Lachlan Mitchell, Stuart B Murray, Stephen Cobley, Daniel Hackett, Janelle Gifford, Louise Capling, and Helen O’Connor have no conflicts of interest directly relevant to the content of this review.

Supplementary material

40279_2016_564_MOESM1_ESM.docx (30 kb)
Supplementary material 1 (DOCX 29 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Lachlan Mitchell
    • 1
    Email author
  • Stuart B. Murray
    • 2
  • Stephen Cobley
    • 1
  • Daniel Hackett
    • 1
  • Janelle Gifford
    • 1
  • Louise Capling
    • 1
  • Helen O’Connor
    • 1
    • 3
  1. 1.Discipline of Exercise and Sport Science, Faculty of Health SciencesThe University of SydneyLidcombeAustralia
  2. 2.Department of PsychiatryUniversity of CaliforniaSan FranciscoUSA
  3. 3.Charles Perkins CentreUniversity of SydneySydneyAustralia

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