Association between muscle dysmorphia psychopathology and binge eating in a large at-risk cohort of men and women

Robin Halioua; Andrea Wyssen; Samuel Iff; Yannis Karrer; Erich Seifritz; Boris B Quednow; Malte Christian Claussen

doi:10.1186/s40337-022-00632-8

Association between muscle dysmorphia psychopathology and binge eating in a large at-risk cohort of men and women

J Eat Disord. 2022 Jul 25;10(1):109. doi: 10.1186/s40337-022-00632-8.

Authors

Robin Halioua¹, Andrea Wyssen², Samuel Iff^{3

4}, Yannis Karrer³, Erich Seifritz³, Boris B Quednow⁵, Malte Christian Claussen^{3

6

7}

Affiliations

¹ Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland. robin.halioua@pukzh.ch.
² University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
³ Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland.
⁴ Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland.
⁵ Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁶ Private Clinic Wyss AG, Muenchenbuchsee, Switzerland.
⁷ Adult Psychiatry, Psychiatric Services Grisons, Chur, Switzerland.

Abstract

Background: Current research on muscle dysmorphia (MD) has focused on restrained eating behaviors and has adopted a primarily male perspective. Despite initial evidence, the role of possible binge eating associated with MD has only been scarcely investigated. To extend the transdiagnostic and cross-gender approaches and address the dearth in research related to MD, this study investigated the association between MD psychopathology and binge eating in men and women.

Methods: This study investigated the association between MD psychopathology and binge eating in both men and women. Participants were a sample of 5905 men (n = 422) and women (n = 5483) social media users aged 18-72 years. They completed an online survey that included self-report measures assessing demographics, binge eating, MD psychopathology, and drive for thinness and leanness. Binge eating was assessed using the diagnostic questions of the validated German version of the Eating Disorder Examination-Questionnaire. The Muscle Dysmorphic Disorder Inventory (MDDI) was used to assess MD psychopathology. A total score of > 39 was set as a cutoff to define an "MD at-risk" state for both men and women. Hierarchical logistic regression analysis was used to analyze the association between MD psychopathology and binge eating.

Results: MD psychopathology was significantly positively associated with binge eating in both men and women. Among the three MDDI subscales, only appearance intolerance was significantly associated with MD, and drive for size and functional impairment were not associated. MD at-risk status yielded a predicted probability of binge eating of 25% for men and 66.9% for women. The increased probability of binge eating associated with MD at-risk status was mainly accounted for by appearance intolerance in men and drive for thinness in women.

Conclusion: MD psychopathology is positively associated with binge eating in both men and women. Binge eating episodes should therefore form part of the clinical assessment of MD.

Keywords: Binge eating; Body image; Bulimic feature; Eating disorder; Muscle dysmorphia; Muscular ideal.

Plain language summary

Muscle dysmorphia is a mental disorder in which those affected are constantly preoccupied with being insufficiently muscular. Although there is initial evidence that binge eating may play a role in the clinical presentation of muscle dysmorphia (MD), this has not been investigated. In addition, MD has rarely been studied in women. We conducted a study involving 5905 men (n = 422) and women (n = 5483) using self-report questionnaires to examine the association between binge eating and symptoms of MD. We found that symptoms of MD and binge eating are positively associated. According to our model, two-thirds of women and one-quarter of men at-risk for MD exhibit binge eating. Binge eating episodes should therefore form part of the clinical assessment of MD.