Body dysmorphic disorder (BDD) has been consistently linked with eating disorders, however studies that stratify associations between BDD in subjects with and without eating disorder symptomology are sparse. It was, therefore, the aim of this study to assess correlates of BDD (including social media use, motivations for exercise, exercise addiction, and sexuality) stratified by eating disorder symptomology.
Cross-sectional study of 1665 health club users recruited online completed a battery of surveys. BDD prevalence rates were calculated and logistic regression models were created in two sub-samples: indicated or no-indicated eating disorder symptomology.
The key findings showed the prevalence of BDD in participants with indicated-eating disorder symptomology was significantly higher than in participants without indicated-eating disorder symptomology, yielding an odds ratio of 12.23. Furthermore, several correlates were associated with BDD only participants with an absence of eating disorder symptomology (gender, BMI, exercise addiction, exercising for mood improvement, attractiveness and tone), with others being significantly associated with BDD in participants in the presence of indicated eating disorders symptomology (exercising for health and enjoyment, relationship status, and ethnicity).
This study provides more evidence of the complex relationship that exists between BDD and eating disorders. Furthermore, it is recommended that practitioners working with BDD subjects should screen for eating disorders due to the high morbidity associated with eating disorders.
Level of evidence
Level III: case-control analytic study.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub
Phillips KA (2000) Quality of life for patients with body dysmorphic disorder. J Nerv Ment Dis 188:170–175
Phillips KA, McElroy SL, Keck PE et al (1993) Body dysmorphic disorder: 30 cases of imagined ugliness. Am J Psychiatr 150:302–302
Schieber K, Kollei I, de Zwaan M, Martin A (2015) Classification of body dysmorphic disorder—What is the advantage of the new DSM-5 criteria? J Psychosom Res 78:223–227
Veale D, Gledhill LJ, Christodoulou P, Hodsoll J (2016) Body dysmorphic disorder in different settings: a systematic review and estimated weighted prevalence. Body Image 18:168–186. https://doi.org/10.1016/j.bodyim.2016.07.003
Cororve MB, Gleaves DH (2001) Body dysmorphic disorder: a review of conceptualizations, assessment, and treatment strategies. Clin Psychol Rev 21:949–970
Grant JE, Phillips KA (2004) Is anorexia nervosa a subtype of body dysmorphic disorder? Probably not, but read on…. Harv Rev Psychiatr 12:123–126
Phillipou A, Castle D, Rossell S (2019) Direct comparisons of anorexia nervosa and body dysmorphic disorder: a systematic review. Psychiatr Res 274:129
Hollander E, Wong CM (1995) Obsessive-compulsive spectrum disorders. J Clin Psychiatr
Landolfi E (2013) Exercise addiction. Sports Med 43:111–119. https://doi.org/10.1007/s40279-012-0013-x
Trott M, Jackson SE, Firth J et al (2020) A comparative meta-analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders. Eat Weight Disord Stud Anorex Bulim Obes. https://doi.org/10.1007/s40519-019-00842-1
Corazza O, Simonato P, Demetrovics Z et al (2019) The emergence of exercise addiction, body dysmorphic disorder, and other image-related psychopathological correlates in fitness settings: a cross sectional study. PLoS ONE 14:e0213060–e0213060
Boroughs MS, Krawczyk R, Thompson JK (2010) Body dysmorphic disorder among diverse racial/ethnic and sexual orientation groups: prevalence estimates and associated factors. Sex Roles 63:725–737
Catherine Walker D, Anderson DA, Hildebrandt T (2009) Body checking behaviors in men. Body Image 6:164–170. https://doi.org/10.1016/j.bodyim.2009.05.001
Phillips KA (2005) The broken mirror: understanding and treating body dysmorphic disorder. Oxford University Press, USA
Henn AT, Taube CO, Vocks S, Hartmann AS (2019) Body image as well as eating disorder and body dysmorphic disorder symptoms in heterosexual, homosexual, and bisexual women. Front Psychiatr 10:531. https://doi.org/10.3389/fpsyt.2019.00531
Bosley A (2011) Body image and eating disturbance in gay and bisexual men: a review. J GLBT Fam Stud 7:457–469. https://doi.org/10.1080/1550428X.2011.623962
Fardouly J, Vartanian LR (2015) Negative comparisons about one’s appearance mediate the relationship between Facebook usage and body image concerns. Body Image 12:82–88. https://doi.org/10.1016/j.bodyim.2014.10.004
Eckler P, Kalyango Y, Paasch E (2017) Facebook use and negative body image among US college women. Women Health 57:249–267
Fermino RC, Pezzini MR, Reis RS (2010) Reasons for physical activity practice and body image among health clubs users. Rev Bras Med Esporte 16:18–23. https://doi.org/10.1590/S1517-86922010000100003
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders IV, 4th ed. Washington, DC
Brohede S, Wingren G, Wijma B, Wijma K (2013) Validation of the Body Dysmorphic Disorder Questionnaire in a community sample of Swedish women. Psychiatr Res 210:647–652
Jenkins-Guarnieri MA, Wright SL, Johnson B (2013) Development and validation of a social media use integration scale. Psychol Pop Media Cult 2:38
Maree T (2017) The social media use integration scale: toward reliability and validity. Int J Human-Comput Interact 33:963–972. https://doi.org/10.1080/10447318.2017.1301041
Silberstein LR, Striegel-Moore RH, Timko C, Rodin J (1988) Behavioral and psychological implications of body dissatisfaction: do men and women differ? Sex Roles 19:219–232. https://doi.org/10.1007/BF00290156
Cash TF, Novy PL, Grant JR (1994) Why do women exercise? Factor analysis and further validation of the Reasons for Exercise Inventory. Percept Mot Skills. https://doi.org/10.2466/pms.19184.108.40.2069
Terry A, Szabo A, Griffiths M (2004) The exercise addiction inventory: a new brief screening tool. Addict Res Theory 12:489–499. https://doi.org/10.1080/16066350310001637363
Brown RIF (1993) Some contributions of the study of gambling to the study of other addictions. In: Eadington W, Cornelius J (eds) Gambling behavior and problem gambling. Commercial Gaming, University of Nevada, Nevada, pp 241–272
Griffiths MD, Urbán R, Demetrovics Z et al (2015) A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Med Open 1:5
Lichtenstein MB, Jensen TT (2016) Exercise addiction in CrossFit: prevalence and psychometric properties of the Exercise Addiction Inventory. Addict Behav Rep 3:33–37. https://doi.org/10.1016/j.abrep.2016.02.002
Garner DM, Olmsted MP, Bohr Y, Garfinkel PE (1982) The Eating Attitudes Test: psychometric features and clinical correlates. Psychol Med 12:871–878. https://doi.org/10.1017/S0033291700049163
Doninger GL, Enders CK, Burnett KF (2005) Validity evidence for Eating Attitudes Test scores in a sample of female college athletes. Meas Phys Educ Exerc Sci 9:35–49
Pope Z, Gao Y, Bolter N, Pritchard M (2015) Validity and reliability of eating disorder assessments used with athletes: a review. J Sport Health Sci 4:211–221. https://doi.org/10.1016/j.jshs.2014.05.001
IBM Corp. (2019) SPSS for Macintosh Version 26
Little RJA (1988) A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc 83:1198–1202. https://doi.org/10.2307/2290157
Cash TF, Deagle EA III (1997) The nature and extent of body-image disturbances in anorexia nervosa and bulimia nervosa: a meta. Int J Eat Disord 22:107–125
Rabe-Jablonska Jolanta J, Sobow Tomasz M (2000) The links between body dysmorphic disorder and eating disorders. Eur Psychiatr J Assoc Eur Psychiatr 15:302–305. https://doi.org/10.1016/s0924-9338(00)00398-9
Fardouly J, Diedrichs PC, Vartanian LR, Halliwell E (2015) Social comparisons on social media: The impact of Facebook on young women’s body image concerns and mood. Body Image 13:38–45
Fardouly J, Vartanian LR (2016) Social media and body image concerns: current research and future directions. Curr Opin Psychol. https://doi.org/10.1016/j.copsyc.2015.09.005
Abraham S (2016) Eating disorders: The facts, 7th edn. Oxford University Press, Hampshire
Trott M, Yang L, Jackson SE et al (2020) Prevalence and correlates of exercise addiction in the presence vs absence of indicated eating disorders. Front Sports Act Living 2:84. https://doi.org/10.3389/fspor.2020.00084
Demetriou C, Ozer BU, Essau CA (2015) Self-report questionnaires. In: The Encyclopedia of Clinical Psychology. American Cancer Society, pp 1–6
Conflict of interest
No authors declare any conflict or competing interests.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
All participants provided informed consent prior to their participation.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Trott, M., Johnstone, J., Firth, J. et al. Prevalence and correlates of body dysmorphic disorder in health club users in the presence vs absence of eating disorder symptomology. Eat Weight Disord 26, 1169–1177 (2021). https://doi.org/10.1007/s40519-020-01018-y
- Eating disorders
- Body dysmorphic disorder
- Social media
- Exercise addiction
- Exercise motivation