Body Image 6 (2009) 221–227

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Body Image
journal homepage: www.elsevier.com/locate/bodyimage

Characteristics of muscle dysmorphia in male football, weight training,

and competitive natural and non-natural bodybuilding samples
Timothy Baghurst *, Cathy Lirgg
Department of Health Science, Kinesiology, Recreation, and Dance, University of Arkansas, Fayetteville, AR 72701, United States

A R T I C L E I N F O A B S T R A C T

Article history: The purpose of this study was to identify differences in traits associated with muscle dysmorphia
Received 8 October 2008 between collegiate football players (n = 66), weight trainers for physique (n = 115), competitive non-
Received in revised form 5 March 2009 natural bodybuilders (n = 47), and competitive natural bodybuilders (n = 65). All participants completed
Accepted 20 March 2009
demographic questionnaires in addition to the Muscle Dysmorphia Inventory (Rhea, Lantz, & Cornelius,
2004). Results revealed a significant main effect for group, and post hoc tests found that the non-natural
Keywords: bodybuilding group did not score significantly higher than the natural bodybuilding group on any
Muscle dysmorphia
subscale except for Pharmacological Use. Both the non-natural and natural bodybuilding groups scored
Males
significantly higher than those that weight trained for physique on the Dietary Behavior and Supplement
Body image
Football Use subscales. The collegiate football players scored lowest on all subscales of the Muscle Dysmorphia
Drive for muscularity Inventory except for Physique Protection where they scored highest. Findings are discussed with future
Muscle Dysmorphia Inventory research expounded.
Natural bodybuilding ß 2009 Elsevier Ltd. All rights reserved.
Non-natural bodybuilding
Steroids

Introduction power and renounces stereotypic feminine weakness (Wesely,

Over the last several decades there has been a growing focus on
body image (Alexander, 2003), as evidenced by a 731% rise in the
number of academic articles that focus on the muscular ideal
between 2000 and 2007 compared with the previous seven years
(Thompson & Cafri, 2007). Investigation into male physique is
important, for it has become a means of gender differentiation and
can define how gender roles and gender identity are portrayed
(Mishkind, Rodin, Silberstein, & Striegel-Moore, 1986). With an
increasing number of men dissatisfied with their appearance (e.g.,
Berscheid, Walster, & Bohrnstedt, 1973; Cash, Winstead, & Janda,
1986; Garner, 1997) it has been suggested that a cultural shift from
occupational to physical identity has encouraged many males to
seek a lean, muscular, and mesomorphic body type in order to
distinguish themselves from women (Klein, 1993; Peoples, 2001;
Petrie et al., 1996).
Because males are naturally muscular and women are not, this
difference in physique can symbolize a difference between the
sexes (Goldberg, 1997). A muscular body signifies masculine
* Corresponding author at: Department of Health Science, Kinesiology, Recrea-
tion, and Dance, College of Education and Health Professions 308 HPER Building,
University of Arkansas, Fayetteville, AR 72701, United States. Tel.: +1 479 575 2858;
fax: +1 479 575 3119.
E-mail address: baghurst@sbcglobal.net (T. Baghurst).
2001). Thus, women who possess a muscular body are a threat to
how a male interprets his masculinity, as masculinity is driven by a
fear of being feminine or less than what a man should be
(Alexander, 2003). For example, Holmlund (1997) found that
images of muscular women increase male anxiety because they
threaten to abolish the visible distinction. Muscular women can
threaten male dominance in sexuality, sex, gender, the workplace,
and social power (Schulze, 1990). Therefore, men are searching for
a feature that distinguishes them from the opposite sex (Randall,
Hall, & Rogers, 1992). As Klein (1993) puts it:
The path taken by those wishing to accrue flesh has much more
to do with gender insecurities. To be male has, in our culture,
been linked with dangerous and demanding occupations and
roles, such as frontiersman, soldier, policeman and doctor. But
the golden era when ‘men were men’ has passed, and the
powerful roles traditionally the exclusive province of men have
vanished, weakened or are no longer gender-specific. Accord-
ingly, many bodybuilding men have clutched to themselves the
only trait that gives them hegemony over women; their size
(p. 36).
Roach and Eigher (1973) suggest that the ideal human form is a
representative consensus dictated by society, but that these ideals
can change over time and vary across cultures (Creekmore &

1740-1445/$ – see front matter ß 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.bodyim.2009.03.002
222 T. Baghurst, C. Lirgg / Body Image 6 (2009) 221–227
Pedersen, 1979). Over the last 50 years, the ideal male physique has
become more muscular (Goldberg, 1997) and has been observed in
several countries including South Africa (Hitzeroth, Wessels,
Zungu-Dirwayi, Oosthuizen, & Stein, 2001), the United States
(Pope, Gruber, Choi, Olivardia, & Phillips, 1997), and China (Ung,
Fones, & Ang, 2000).
Current expectations of cultural health, fitness, and beauty are
clearly promoted within American culture, which emphasizes a
lean, muscular male to be the ideal (Lantz, Rhea, & Mayhew, 2001;
Pope, Phillips, & Olivardia, 2000). Unfortunately, if perceptions of
self do not equate to expectations as defined by culture, a distorted
view of self body image can develop. This can lead to dangerous
behaviors and attitudes associated with physique, specifically
through an emphasis on increased muscular development and
leanness (Gonzalez, McLachlan, & Keaney, 2001).
Muscle dysmorphia has been described as a desire or drive to
increase muscularity yet simultaneously reduce body fat percen-
tage (Morgan, 2000). It is predominantly evident in males (Pope
et al., 2000) when there is a pathological preoccupation with a lack
of muscular size and leanness (Olivardia, 2001).
The etiology of these body image concerns, specifically the
desire of men to be lean and muscular, is relatively unknown
although the media is considered to be one possible contributing
factor (Pope et al., 2000). For example, Leit, Gray, and Pope (2002)
found that media images can alter ideal self-perceived and desired
muscularity by creating a discrepancy between an individual’s
perceived muscularity and ideally desired muscularity. Parental
influences and peer experiences can also encourage muscularity in
adolescent males (Stanford & McCabe, 2005). Specifically, fathers
and male peers appear to encourage muscle development and
messages about muscularity whereas mothers emphasize weight
loss and body shape.
Those individuals that invest heavily in their physiques through
weight lifting or bodybuilding are the most prominently
researched (Lantz, Rhea, & Cornelius, 2002). Bodybuilders or
individuals focused on muscular symmetry are often used in
empirical research because muscle dysmorphia is more prevalent
within this population (Esco, Olson, & Williford, 2005). For
example, Lantz et al. found muscle dysmorphia to be significantly
more common in bodybuilders than power lifters.
Unfortunately, although research suggests that bodybuilders
are more likely to exhibit characteristics associated with muscle
dysmorphia, there are several methodological issues with these
findings that should be first considered. Because the criteria (see
Pope et al., 1997) for muscle dysmorphia were developed primarily
through research involving either bodybuilders or individuals who
used steroids and were heavily invested in their physiques (e.g.,
Blouin & Goldfield, 1995; Pope et al.), it is unclear whether these
traits are specific to these individuals. Thus, because the majority
of research has employed bodybuilders as participants, there exists
a possibility that other individuals such as athletes may exhibit
traits associated with muscle dysmorphia (Lantz et al., 2001). For
example, no significant differences have been found between
competitive male bodybuilders and weight trainers in respect to a
drive for bulk and a drive for muscle tone (Goldfield, Blouin, &
Woodside, 2006). Furthermore, Pickett, Lewis, and Cash (2005)
found no differences in the reported investment in appearance
between male competitive bodybuilders and non-competitive
weight trainers suggesting that dissatisfaction in physique may
exist in individuals who are not considered to be competitive
bodybuilders.
Although this research highlights some important findings, it is
important for future research to clearly delineate between
participants that are bodybuilders, weight lifters, or lift weights
for other purposes such as health or sporting performance. For
example, Hallsworth, Wade, and Tiggemann (2005) investigated
body image in male bodybuilders, weight lifters, and a non weight
lifting/bodybuilding sample of psychology university students; the
latter was classed as a control group. Bodybuilders were
categorized as such if they had trained for twice a week for at
least a year. No effort was made to determine prior competition
experience or the purpose for exercising in a gym setting. Weight
lifters were required to be members of a weight lifting association.
Although acting as a control group, it is possible that the university
students did not represent a true control, for approximately 66%
participated in sports that included soccer, football, running,
martial arts, and swimming. No data were ascertained to
determine the level of participation.
Kanayama, Barry, Hudson, and Pope (2006) investigated steroid
use among weight lifters. The selection of their sample was based
on whether participants could bench press 275 lbs. Although the
authors recognize that a lack of a non-weight lifting sample or
control group limited the findings, it is unclear whether the weight
lifters were bodybuilders or lifted weights primarily for other
purposes such as health or sports.
Although Goldfield et al. (2006) made the distinction between
competitive and recreational bodybuilders in an investigation of
body image, binge eating, and bulimia nervosa, their definition of
recreational bodybuilding has similarities to definitions of weight
lifting. No data were obtained to determine whether participants
were in fact bodybuilders or whether they were weight training for
an alternative purpose such as sporting performance or for health
reasons. In addition, no data concerning the duration of time spent
at the gym were ascertained. Using a battery of tests to assess body
image, Pickett et al. (2005) investigated a group of 40 male
competitive bodybuilders, 40 non-competitive weight trainers,
and 40 athletic non-weight trainers. In addition, a Fat Free Mass
Index was obtained for all participants using measurements of
height and percent body fat obtained by calipers. It was found that
although competitive bodybuilders had a greater fat-free body
mass and reported higher social self-esteem, they also wished to be
heavier than the other groups and had a greater eating disturbance.
The groups did not differ in their situational body image discomfort
and interestingly did not differ significantly in percent body fat.
However, the bodybuilders and weight trainers were more
psychologically invested in their appearance and had a more
positive global appearance evaluation. The authors concluded that,
‘‘somewhat surprisingly. . .men who compete in public competi-
tions were no more invested in their appearance than non-
competitive weight trainers’’ (p. 220).
Although the findings of Pickett et al. (2005) initially appear
intriguing, their veracity has been questioned (see Smith, Wright,
Bruce-Low, & Hale, 2005). Although the competitive bodybuilding
group was clearly defined, the rationale for weight training was not
ascertained in the weight training group. Thus, there remains the
possibility that participants within this group could have classed
themselves as non-competitive bodybuilders, power lifters, or
motivated fitness lifters. Consequently, Smith et al. suggest that a
group of non-competitive bodybuilders and a group of non-
bodybuilding weight trainers should have been included in the
study to allow for further comparisons.
An additional concern of past research involving body-
building participants is a failure to delineate between those who
were natural bodybuilders and those who were not. Natural
bodybuilders must undergo drug testing for banned substances
and submit to a polygraph prior to competition (International
Natural Bodybuilding Association, n.d.). Non-natural body-
builders are not required to follow such guidelines and such
differences could potentially alter findings associated with body
image.
Because muscle dysmorphia is relatively unknown and
uncharted, Lantz et al. (2001) suggest several areas for investiga-
 T. Baghurst, C. Lirgg / Body Image 6 (2009) 221–227
tion. In particular, they suggest that not only should the prevalence
of the disorder be investigated in the overall population, but also
within target subgroups such as gender and sport type. Further-
more, involvement in sports directing focus on muscular size and
strength such as bodybuilding, power lifting, and football may
facilitate muscle dysmorphic tendencies. Consequently, the
purpose of this study was to identify differences in traits associated
with muscle dysmorphia between samples of male collegiate
football players, weight trainers for physique, and competitive
natural and non-natural bodybuilders. Based on current research,
it was hypothesized that, (1) the non-natural bodybuilding group
would score significantly higher than the natural bodybuilding,
weight training for physique, and football groups on all subscales
of the Muscle Dysmorphia Inventory (MDI; Rhea, Lantz, &
Cornelius, 2004), (2) the natural bodybuilding group would score
significantly higher than the weight training for physique and
football groups on all subscales of the MDI, and (3) the weight
training for physique group would score significantly higher than
the football group on all subscales of the MDI.
Method
Participants and design
Participants consisted of four groups of males: collegiate NCAA
Division One football players (n = 66), weight trainers for physique
(n = 115), competitive natural bodybuilders (n = 65), and compe-
titive non-natural bodybuilders (n = 47). All participants were
required to be training with weights at least three days a week for a
minimum average of 45 min per training session.
Collegiate football players (ATH) were recruited from a Mid-
South university. At the time of data collection, participants were
registered to play on the football team at the university.
Competitive natural bodybuilding (NBB) participants and compe-
titive non-natural bodybuilding (NNBB) participants were
recruited through contact made on established bodybuilding
websites and forums. Natural bodybuilding refers to those
competitions in which participants are drug tested and must pass
a polygraph regarding their lack of prohibited drug use. Non-
natural bodybuilding refers to those competitions where partici-
pants are not required to pass a polygraph, nor are they drug tested
prior to competition. To be included in the study, bodybuilders had
either competed in a bodybuilding competition matching their
natural/non-natural status within the previous 12 months or were
actively training for a competition to be held within the next 12
months.
Weight training for physique (WTP) participants were recruited
through contact made on recognized weight training websites and
forums. To be included in this group, the primary purpose of
participants’ weight training was to improve physique (i.e.,
participants did not weight train primarily for health reasons,
for athletic performance, bodybuilding competitions, or for any
other reason). Participants had not competed as bodybuilders
within the previous 12 months, nor had any intentions to do so
within the next 12 months.
Instruments
Surveys were presented in two formats. A paper-based format
was handed out to the ATH group. The NBB, NNBB, and WTP groups
were presented with the survey through an online service. Each
survey included the Exercise Specific Questionnaire (ESQ), Demo-
graphic Questionnaire (DQ), both self-produced, and the MDI.
Survey sets were tailored to the group under investigation.
Questions pertaining to bodybuilding were added to the ESQ for
the NBB and NNBB groups.
223
Demographic Questionnaire (DQ)
All participants completed a questionnaire asking for demo-
graphic data concerning each participant, which included age,
weight, height, and ethnicity. Participants were also asked to
indicate whether they had ever met with a health professional.
Exercise Specific Questionnaire (ESQ)
The ESQ determined previous and current exercise status.
Generic questions for all groups included the number of years
lifting weights, the frequency of training, the type of training, and
the desired outcome of the training. Additional questions
answered by the NBB and NNBB groups included the number of
years bodybuilding, and the number of competitions completed. In
order to confirm participants’ inclusion within these two groups,
each participant was required to indicate the date and location of
their most recent competition or the competition for which they
were currently training.
Muscle Dysmorphia Inventory (MDI)
Participants in all four groups completed the Muscle Dysmor-
phia Inventory (Rhea et al., 2004). The MDI aims to identify
characteristics associated with muscle dysmorphia based on the
criteria proposed by Lantz et al. (2001). The questionnaire uses 27
questions on a six-point Likert scale 1 = never to 6 = always to
assess characteristics associated with muscle dysmorphia. These
characteristics are broken down into six subscales: Size/Symmetry
(e.g., I am concerned with losing muscle mass), Physique
Protection (e.g., I wear bulky clothing to hide my muscular
physique from others), Exercise Dependence (e.g., It bothers me to
miss a scheduled workout), Supplement Use (e.g., I use supple-
ments to help me recuperate from strenuous workouts), Dietary
Behavior (e.g., I monitor my diet closely to limit my fat intake), and
Pharmacological Use (e.g., I use steroids). Subscales are measured
separately, as each is designed to measure conceptually indepen-
dent traits. A high score on a subscale indicates a higher propensity
to exhibit characteristics associated with that subscale. Thus, an
individual who scores highly on the Supplement Use subscale
would use supplements more frequently than an individual that
does not score highly.
The MDI subscales has reported Cronbach’s a reliability
estimates ranging between .72 and .94 (Rhea et al., 2004). Rhea
et al. assessed construct validity using item-to-total correlations,
exploratory and confirmatory factor analyses, and structure
equation modeling. Convergent validity was determined by
calculating the correlations between the subscales of the MDI,
the Body Building Dependence Scale, and the Drive for Thinness
subscale of the Eating Disorder Inventory, all of which were
significantly and positively correlated to the MDI.
In the present study, internal consistency reliability of the MDI’s
six subscales was assessed using Cronbach’s a. Physique Protection
had the highest internal consistency value (.82) followed by
Dietary Behavior (.77), Size/Symmetry (.76), Pharmacological Use
(.76), Supplement Use (.71), and Exercise Dependence (.57)
respectively. Acceptance of an internally reliable scale is typically
set at .70 (Tabachnick & Fidell, 2001), although a value of .90 could
suggest that the subscale may be exhibiting multicollinearity
(Streiner, 2003). Thus, the exercise dependence subscale of the
MDI was eliminated from further analysis.
Procedure
Institutional Review Board permission was obtained prior to
data collection. Confidentiality was ensured by numerically coding
questionnaires. Responses of paper-based questionnaires were
anonymous and at no point were participants required to provide
their names. However, Internet responses retrieved through e-
224 T. Baghurst, C. Lirgg / Body Image 6 (2009) 221–227
mailed requests included each participant’s e-mail address thereby
eliminating complete anonymity. All participants who completed
the Internet survey were informed that responses would not be
anonymous, but remain confidential.
Participants in all four groups were informed prior to
participation that the purpose of the study was to investigate
male body image. It was explained that participation in the study
implied consent. Following this explanation, participants were
provided questions appropriate to their group – either by the
primary researcher or through the survey link – and asked to
complete them as carefully and honestly as possible.
Data from the ATH group were obtained through the use of
paper-based questionnaires distributed by the primary researcher.
However, questionnaires for the NBB, NNBB, and WTP groups were
collected through two methods. First, a web-based duplicate of the
questionnaires was posted on a well-established survey website.
An explanation of the study and a link to the survey website
inviting participation was posted on specific bodybuilding and
weight training websites. Second, prospective participants whose
e-mails were readily available on the Internet were sent the
information personally. An e-mail inviting future participation was
sent to 431 prospective participants. After three days, an additional
e-mail which contained a website link to the study was sent out to
the same group of individuals. A follow-up e-mail was sent one
week later to those participants that did not participate the first
time reminding them of the opportunity.
Treatment of data
Face validity for the ESQ and DQ was obtained through a pilot
study using three participants from each group. The purpose of the
pilot study was to provide feedback concerning the functionality of
the questionnaires and their appropriateness to the sample for
which they were intended. It also allowed participants to provide
input on creating additional questions based on their respective
group’s identity. For this purpose participants were known to the
researcher so that feedback could be provided.
Internal consistency reliability of the MDI was assessed using
Cronbach’s a. Construct validity was assessed using a principal
component analysis (PCA). With low to moderate correlations
between MDI subscales, a one-way MANOVA was used to
determine differences within each subscale by group. Follow-up
tests were conducted using Tukey’s Honestly Significant Differ-
ence. Significance was set at an alpha level of .05.
Results
Participants and response rate
Of the e-mail request to prospective participants in the NBB,
NNBB, and WTP groups, 143 participants responded accounting for
33.2% of the invitations sent. Remaining participants were
obtained from survey links posted on Internet forums. Participants
that weight trained primarily for health or a sport other than
bodybuilding were excluded from the study.
Table 1
Participants’ physical and weight training data by mean and standard deviation.
Group Weight (lbs) Height (in.) Body fat (%)
Mean SD Mean SD Mean
NBB 192.63 24.92 68.45 8.17 9.43
NNBB 211.49 29.56 65.91 13.92 10.28
WTP 195.15 34.27 69.93 5.09 12.83
ATH 226.93 40.86 73.05 3.27 10.31
Demographic Questionnaire (DQ) responses
With respect to mean age by years, the ATH group were
significantly younger (20.5, SD = 4.41; F(1, 13) = 8.52, p = .01) than
the WTP group (29.78, SD = 10.22), NNB group (32.22, SD = 11.12),
and NNBB group. A total of 78.64% of participants identified
themselves as Caucasian, 11.65% African-American, 4.03% Hispa-
nic, 3.28% Asian, and 4.2% as an ethnicity not listed.
With respect to marital status, 52.3% of the NBB group was
married. Of the remaining three groups, 66.96% of the participants
were single. This was most evident in the ATH group where 99.5%
of the participants were single. A total of 69.37% of the NBB, NNBB,
and WTP participants were not students whereas 100% of the ATH
group participants were. Participants were asked whether they had
ever visited a mental health professional. The majority of
participants responded that they had not (90.63%) with a small
proportion responding in the affirmative (6.04%) or declining to
answer (3.33%).
Exercise Specific Questionnaire (ESQ) responses
Participants’ age, weight, height, body fat percentage (self-
reported), number of years weight training, number of work outs
per week, and length of work outs are provided in Table 1. Several
additional questions were asked of those who were competitive
bodybuilders. The NBB participants reported competing on an
average of 11.47 (SD = 14.16) occasions and had competed as
bodybuilders for 6.28 (SD = 5.74) years. Participants within this
group consisted of 19.7% who classed themselves as amateur and
80.3% as professional. The NNBB participants reported competing
on 10 (SD = 10.61) occasions and had been competing as body-
builders for 7.24 (SD = 6.22) years. All participants within this
group classed themselves as professional bodybuilders.
Muscle Dysmorphia Inventory (MDI) responses
Prior to data analysis of the MDI, items responses were checked
for completion. For the 16 items that were left blank, the mean
scores of the remaining item responses within that item’s
respective subscale were entered as the item response to ensure
a complete dataset.
Factor analysis
Although the MDI has been previously shown to be valid, a
principal component analysis (PCA) was conducted to establish
whether the factors and loadings of the five subscales with these
samples conformed to previous findings. Because only five
subscales were internally consistent, a five-factor solution was
used in the factor analysis with an oblique, varimax rotation. All
subscale items loaded with their designated subscale except for
item 23 which did not load highest on its designed factor of
Physique Protection or highly on any factor; thus, analysis was
conducted with the item removed. Once removed, five eigenvalues
exceeded the value of one with all five eigenvalues accounting for
at least 5% of the variance with a cumulative proportion of 61.02%.
Years weight training Work outs per week Length of work outs (min)
SD Mean SD Mean SD Mean SD
3.11 12.90 7.76 5.31 1.57 72.69 21.18
2.36 16.02 10.26 5.21 1.32 72.28 21.49
7.04 8.51 8.16 4.42 1.23 69.21 27.80
4.68 5.68 2.44 3.89 0.90 79.58 26.65
 T. Baghurst, C. Lirgg / Body Image 6 (2009) 221–227 225

With a five-factor loading, all subscale items loaded with their
designated subscale. Item factor loadings ranged from .55 to .89 on
designated factors and .00 to .36 on other factors.
Subscale correlations
According to Huberty and Morris (1989), when addressing
potentially underlying constructs a significant multivariate main
effect should be followed by a report detailing the inter-
correlations between the variables. However, an assessment of
correlations was carried out beforehand in order to determine
whether a multivariate assessment was warranted. Correlations
ranged between .01 and .50.
MANOVA normality and outliers
Because of the moderate correlations between subscales, a one-
way MANOVA was used to determine differences within each of
the five internally consistent subscales of the MDI by group. Prior
to analysis, item outliers were corrected or eliminated from
analysis. Multivariate normality and outliers were calculated using
the maximum Mahalanobis distance. With a critical value of 22.46,
the data were reassessed for outliers following a maximum
Mahalanobis distance score of 36.16. As a consequence, two
participants from the NBB group and two participants from the
ATH group were removed from further calculations. Further review
of these participants’ scores indicated an almost random selection,
suggesting that they had either become mixed up by the questions
or did not take the questions seriously. Their removal resulted in a
maximum Mahalanobis distance score of 19.57 which falls under
the critical value.
the Physique Protection subscale, where the ATH group scored
significantly higher.
The second hypothesis stated that the NBB group would score
higher than the WTP and ATH groups on all of the MDI subscales.
The NBB group scored significantly higher than the WTP group on
the Dietary Behavior and Supplement Use subscales. No significant
differences were found between the two groups on the Physique
Protection, Size/Symmetry, and Pharmacological Use subscales.
With respect to the ATH group, the NBB group scored significantly
higher on all subscales except the subscales Physique Protection
and Pharmacological Use, where the ATH group scored signifi-
cantly higher than the NBB group.
The third hypothesis stated that that the WTP group would score
higher on all MDI subscales than the ATH group. The WTP group was
found to score significantly higher on the Dietary Behavior and Size/
Symmetry subscales. No differences were found on the Supplement
Use subscale while the ATH group scored significantly higher on the
Physique Protection and Pharmacological Use subscales.
Discussion
The purpose of this study was to identify differences in traits
associated with muscle dysmorphia between collegiate football
players, weight trainers for physique, competitive non-natural
bodybuilders, and competitive natural bodybuilders. Findings are
discussed by group in relation to current research.
Non-natural bodybuilding (NNBB) and Natural bodybuilding (NBB)
groups

MANOVA findings
The MANOVA revealed a significant main effect for group
(Wilks’ lambda = .52, F(3, 289) = 13.68, p = .01, hp2 = .19) indicating
that one or more groups significantly differed in one or more
subscale. Univariate results are shown in Table 2 with all five
subscales significant.
Follow-up tests
Tukey’s Honestly Significant Difference post hoc tests were
performed to determine the differences between groups on each
subscale of the MDI and address the preset hypotheses. The first
hypothesis stated that the NNBB group would score significantly
higher than the NBB, WTP, and ATH groups on all subscales of the
MDI. When compared with the NBB group, the NNBB group did not
score significantly higher on any subscale other than the
Pharmacological Use subscale. The NNBB score was significantly
higher than the WTP group on all subscales except for the Physique
Protection and Size/Symmetry subscales. The NNBB group scored
significantly higher than the ATH group on all subscales except for
Although it was hypothesized that the NNBB group would score
significantly higher than the other groups on all subscales of the
MDI, when compared with the NBB group, the NNBB did not score
significantly higher on any subscale except for the Pharmacological
Use. This subscale difference is not surprising, as natural body-
builders are drug tested whereas non-natural bodybuilders are not.
However, it is important to recognize that on all other subscales,
those competitive bodybuilders that are natural are equally
concerned about those traits associated with muscle dysmorphia
as are competitive non-natural bodybuilders. This is a clear
strength of the current study, for a distinction between natural and
non-natural bodybuilders has not always been considered in
methodology of some research (e.g., Pickett et al., 2005).
Steroid use has been widely accepted as being a common
indicator of a drive for muscularity and muscle dysmorphia (Cafri
et al., 2005; Kanayama et al., 2006; McCreary & Sasse, 2000; Pope
et al., 2000). However, based on the current findings, the NBB group
did not score significantly less on any other subscale of the MDI. This
is particularly important given that both the NNBB and NBB groups

Table 2
Means, standard deviations, and significance of MDI subscale scores by groupa.

MDI subscale NBB NNBB WTP ATH F (3, 289) Prob. Effect sizeb

Mean SD Mean SD Mean SD Mean SD

Dietary Behavior 23.35 4.73 23.04 3.37 20.17c,d 4.89 16.56c,d,e 4.85 28.27 p = .01 hp2 = .23
Supplement Use 16.63 3.99 17.85 3.83 13.82c,d 4.96 12.3c,d 4.60 18.99 p = .01 hp2 = .17
Physique Protection 13.46 4.82 14.38 5.53 13.08 5.79 17.38c,d,e 5.62 9.02 p = .01 hp2 = .09
Size/Symmetry 20.02 5.14 21.15 4.92 19.52 5.67 16.83c,d,e 4.80 7.12 p = .01 hp2 = .07
Pharm. Use 3.65 1.38 6.29c 2.57 3.79d 1.47 5.62c,e 4.03 18.76 p = .01 hp2 = .17
Note. Higher subscale score indicates a greater likelihood of exhibiting the traits associated with that subscale. Possible scores for each subscale range between 0 and 30
except for Supplement Use and Pharmacology Use which have a maximum possible score of 24 and 12, respectively.
a
Significance was set at p < .05.
b
Partial eta squared.
c
Significance between NNB and other groups.
d
Significance between NNBB and other groups.
e
Significance between WTP and ATH groups.
226 T. Baghurst, C. Lirgg / Body Image 6 (2009) 221–227
were competitive bodybuilders and therefore likely to be heavily
invested in their physiques. Although steroid use can often be
underreported (Pope et al.) due to a fear of exposure (Johnson, Jay,
Shoup, & Rickert, 1989), the data collected for this study was
confidentially collected online for both groups. Therefore, it is
assumed that participants were more likely to report their
pharmacological use than if data were collected in a one-to-one
format.
Weight training for physique (WTP) group
A further strength of this study included the distinction
between those that weight trained for competition and those
that weight trained for the primary purpose of enhancing their
physique. Unlike studies such as Goldfield et al. (2006) where
participants’ purpose for weight training was not clearly ascer-
tained, participants that weight trained primarily for health or for
purposes not associated with their physique were removed from
analysis. A similar weakness is evident in a study by Pickett et al.
(2005) in which competitive bodybuilders were not separated by
competition format (i.e. natural versus non-natural). Conse-
quently, the current study’s groups were clearly defined allowing
for comparisons across groups.
Although Pickett et al. (2005) reported that non-competitive
weight trainers were equally invested in their appearance as
compared with competitive bodybuilders, the findings of the
present study only partially support this finding. With respect to
the MDI subscales, the WTP group scored significantly lower than
the NNBB and NBB groups on Dietary Behavior and Supplement
Use. No differences were found on the Physique Protection and
Size/Symmetry subscales, while WTP scored significantly lower
than the NNBB group on the Pharmacological Use subscale but not
the NBB group where no significant differences were found.
It is interesting to note that no differences were found between
these three groups with respect to the Size/Symmetry subscale and
might indicate that each group viewed this subscale as equally
important. The key subscales that differentiate WTP from the NNBB
and NBB groups are the Dietary Behavior and Supplement Use
subscales. Those within the WTP group may either lack dietary
knowledge or fail to value its importance. Also noteworthy is that the
WTP group had trained with weights for an average of four years less
than the NBB group and six years less than the NNBB group.
Competitive bodybuilding requires careful and meticulous
attention to nutrition. For example, in their review of literature
associated with the macronutrient intake of competitive body-
builders, Lambert, Frank, and Evans (2004) highlight the crucial
adjustments between macronutrients based on the phase of
training or stage of the competitive bodybuilding season. Thus,
although the WTP group scored significantly lower in areas of
dietary behavior, this may have been due to a lack of experience in
the weight training environment, failure to value nutrition as
important, or a lack of knowledge concerning nutrition; knowledge
of nutrition is a key component within this subscale.
Athlete (ATH) group
Although Lantz et al. (2001) suggest that characteristics of
muscle dysmorphia may be evident in athletic populations, the ATH
group scored lowest on all subscales of the MDI except for Physique
Protection where they scored highest. Several possible reasons may
account for this finding. First, demographically the group was
heavier, taller, younger, and had a larger percentage of African-
American participants than the other groups. Although some
research has investigated body image among African-Americans,
the vast majority of this research is among females (e.g., Hesse-Biber,
Howling, Leavy, & Lovejoy, 2004; Snooks & Hall, 2002). In their study
of gaming magazines, Harrison and Bond (2007) found that White
preadolescent boys’ exposure to these magazines increased their
drive for muscularity. Similar findings were not evident in Black
preadolescent boys which the authors suggest could be associated
with the use of White characters portrayed in these magazines.
Therefore, further research is needed to determine whether ethnic
differences exist in male body image.
Second, participants in the ATH group may be adhering to
expected norms within this particular athletic group. The high
Physique Protection scores may not be directly associated with
physique protection but rather team identity and traditions. For
example, the use of team clothing or uniforms is often a means for
increasing team cohesion and identity (Carron & Spink, 1993).
Third, Physique Protection may be higher in this group due to the
type of clothing worn during competition. Football players are
expected to wear tight fitting uniforms while potentially competing
in a stadium of thousands of fans and/or millions of fans on television.
Thus, athletes may be exhibiting a form of social physique anxiety.
Social physique anxiety is defined as the anxiety an individual
experiences when evaluated on their physique by another individual
(Hart, Leary, & Rejeski, 1989). Thus, future research should consider
administering an evaluative tool such as the Social Physique Anxiety
Scale (SPAS-7; Motl & Conroy, 2001) in conjunction with Physique
Protection measures associated with muscularity.
Also of interest within the ATH group were the high scores of
the Pharmacological Use subscale when compared with the WTP
and NBB groups. Although the NBB group was expected to score
low on this subscale since participants must be drug tested prior to
competition, the ATH was also expected to score low given the
illegality of steroids and many forms of diuretics and laxatives in
the National Collegiate Athletic Association. However, a lack of
education regarding the terms steroids, laxatives, and diuretics
may have influenced this finding. For example, steroid users may
obtain their information from other users, books, and magazines
(Perry, Lund, Deninger, Kutscher, & Schneider, 2005); thus,
participants may not have clearly understood the terminology.
Limitations and future research
Several limitations and areas for future research not previously
mentioned should be noted. First, not all data were collected in the
same manner. Participants within the ATH group completed their
questionnaires as a group and close proximity to others may have
influenced responses differently to those that completed their
responses privately online. Second, although the ATH group was
comprised entirely of competitive football players, no distinction
was made between positions due to insufficient group numbers. This
is important, as certain positions typically require specific degrees of
muscularity, body fat, and weight compared with others. Their
significantly younger age may also have impacted these findings.
Third, although participants’ ethnicity was ascertained, country
of residence or country of origin was not. Though the idealization
of a lean and muscular physique has been reported in various
countries (Hitzeroth et al., 2001; Pope et al., 1997; Ung et al., 2000),
some participants may have responded differently based on their
current location or country of origin. Future research should
consider comparing MDI scores based on participants’ origins, for
different cultures may view muscularity differently.
Fourth, although the MDI has been reported to have strong
reliability and validity estimates, the current study suggests that
the internal consistency reliability of the Exercise Dependence
subscale was low. In addition, one item was removed from the
Physique Protection subscale due to its poor loading. Thus, future
research needs to further address the reliability and validity of this
Inventory. Because the MDI has not previously been tested on
natural bodybuilders and football players, future research needs to
 T. Baghurst, C. Lirgg / Body Image 6 (2009) 221–227
determine whether the findings of this study are synonymous with
these particular groups, or whether the reliability and validity of
the MDI needs to be reevaluated.
Finally, no research has delineated between competitive natural
and non-natural bodybuilders to determine whether the purpose of
steroid use among non-natural bodybuilders is due to reasons other
than competition format. This is a particularly interesting finding in
the current study, and future research should determine whether
rationale for competing and reasons for becoming a competitive
bodybuilder differ between groups. Currently, it is unclear why
bodybuilders choose to compete in natural or non-natural
competitions. In the present study non-natural bodybuilders did
not score significantly higher than the natural bodybuilders on any
subscale of the MDI except for pharmacology use. Therefore, after
separating laxative, diuretic, and steroid use, future research should
consider whether these pharmacological uses refer to a subset or
subtype of muscle dysmorphia. Indeed, if other characteristics of
muscle dysmorphia do not appear to differentiate natural and non-
natural bodybuilders, research should attempt to identify the
motivations behind why bodybuilders choose to use or not use
steroids. Case studies of natural and non-natural bodybuilders may
help to determine root contributors of pharmacological use.
Conclusion
Muscle dysmorphia and male body image in general are
receiving greater attention both within the scientific community
and the popular media. However, a continued need for further
research is necessary. This study furthers current beliefs about
muscle dysmorphia through several avenues. First, it questions the
inclusion of pharmacological use as a trait associated with muscle
dysmorphia. Second, this study highlights the need for clear
sample definitions between natural and non-natural competitive
bodybuilders. Third, those that weight train for physique exhibit
some traits associated with muscle dysmorphia, but differ from
bodybuilding groups with respect to their nutritional habits or
knowledge. Finally, contrary to expectations, collegiate football
players do not appear to exhibit traits associated with muscle
dysmorphia to the same degree as other weight training groups.
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