EVALUATION OF THE PREVALENCE OF MUSCLE DYSMORPHIA SYMPTOMATOLOGY AND THE ASSOCIATION WITH DIETARY INTAKE IN COLLEGE AGE MALES A thesis submitted to the Kent State University College of Education, Health, and Human Services in partial fulfillment of the requirements for the degree Master of Science in Nutrition and Dietetics By Ashley Rickard August 2014 A thesis written by Ashley Deanna Rickard B.S., The Pennsylvania State University, 2012 M.S. Kent State University, 2014 Approved by _________________________, Director, Master’s Thesis Committee Amy Miracle _________________________, Member, Master’s Thesis Committee Natalie Caine-Bish _________________________, Member, Master’s Thesis Committee Lisa Chinn Accepted by _________________________, Director, School of Health Sciences Lynne Rowan _________________________, Dean, College of Education, Health and Human Services Daniel Mahony ii RICKARD, ASHLEY DEANNA, M.S., August 2014 Nutrition and Dietetics EVALUATION OF THE PREVALENCE OF MUSCLE DYSMORPHIA SYMPTOMATOLOGY AND THE ASSOCIATION WITH DIETARY INTAKE IN COLLEGE AGE MALES (107 pp.) Director of Thesis: Amy Miracle, Ph.D., R.D., CSSD The purpose of this study was to evaluate the prevalence of muscle dysmorphia (MD) symptomatology in men with varying exercise levels and to evaluate the association between MD symptomatology and dietary intake. College aged males (n=110) completed an online survey including demographic information, an instrument for identifying MD symptomatology known as the Muscle Dysmorphia Disorder Inventory (MDDI), and a food frequency questionnaire (FFQ). For statistical analysis, participants were grouped in three different ways: 1) cardiovascular exercise level, 2) weightlifting level, and 3) MDDI score. It was found that 12.73% (n=14) of the study population had MDDI scores indicating high levels of MD symptomatology. This prevalence is higher than previously reported and could reveal that the proportion of men struggling with MD is higher than previously thought. When participants were categorized by weightlifting level, the high weightlifting group exhibited significantly higher MDDI scores than the low weightlifting group. The high weightlifting group also had a higher percentage of intake from protein than the other study groups. This could indicate that weightlifting levels may be used as an indicator of MD symptomatology and that high protein intake may be a dietary strategy used by men with MD. This study also demonstrated that men who scored high or moderate on the MDDI had significantly higher energy intake than those who scored low, and men with low and moderate MDDI scores consumed a significantly higher percentage of their diet from carbohydrate than men with high MDDI scores. ACKNOWLEDGEMENTS It is with immense gratitude that I acknowledge the constant support, both personally and professionally, of my thesis adviser, Dr. Amy Miracle. I could not have asked for a better advisor to guide me through this process, and I am truly thankful for your guidance and the opportunity I have had to work with you. I would also like to thank my committee members, Dr. Natalie Caine-Bish and Dr. Lisa Chinn, for guiding me, providing me with valuable input and advice, and challenging me throughout this process. Additionally, I would like to thank Dr. Nancy Burzminski for her ceaseless encouragement and support throughout my dietetic internship and graduate studies. I have truly been blessed beyond belief with a group of professors who are far above average and have facilitated my growth throughout this season of life. A huge thank you goes out to Kristin Yeager and her statistical and qualitative software consulting team at the Kent State University library. Your guidance and assistance throughout this process were irreplaceable, and you helped turn an collection of abstract ideas into a practical reality. It is during difficult times that we gain new perspectives in life, and through these two years, I have come to appreciate my wonderful parents in a completely new way. Mom and Dad, I am grateful for the depths of your love for me, for your unending support, and for the faith you always have in me. I cannot thank you enough for your constant provision, for demonstrating the importance of hard work and perseverance, and for doing small things with great love. I love you so, so very much. To Bobby, Nana, iii and Mike, thank you for always supporting me and loving me in all circumstances. I am truly blessed with the most wonderful family for which anyone could ask. Above all, I thank God for his absolute sovereignty and his relentless pursuit of my heart. I am thankful that he continually refuses to give up on me and will be faithful to complete the work he has begun in me and through me. “He has made everything beautiful in its time. He has also set eternity in the human heart; yet no one can fathom what God has done from beginning to end.” – Ecclesiastes 3:11 iv TABLE OF CONTENTS ACKNOWLEDGEMENTS …………………………………………………………….. iii LIST OF FIGURES ……………………………………………………………………... vii LIST OF TABLES ………………………………………………………………………. viii CHAPTER I. INTRODUCTION ........................................................................................... 1 Statement of the Problem ................................................................................ 5 Hypotheses ...................................................................................................... 5 Definition of Terms ......................................................................................... 5 II. LITERATURE REVIEW …….………………………………………...…... 7 Male Physique and the Emphasis on Muscularity .......................................... 7 Masculinity and Muscularity from a Cultural Perspective ....................... 7 Muscularity and Body Image in Males ..................................................... 9 Eating Disorders in Males ......................................................................... 11 Muscle Dysmorphia ........................................................................................ 13 The History of Muscle Dysmorphia .......................................................... 13 Muscle Dysmorphia in the DSM-V ……………………………………. 17 Prevalence of Muscle Dysmorphia .......................................................... 17 Research on the Characteristics of Men with Muscle Dysmorphia ......... 18 Demographics. ..................................................................................... 18 Attitudes and behaviors. ...................................................................... 19 Mirror checking. .................................................................................. 22 Anabolic steroid use. .......................................................................... 23 Eating attitudes and nutrition habits in MD. ..................................... 24 Psychological Profile of Men with MD .................................................... 26 Etiology of Muscle Dysmorphia ..................................................................... 28 Conceptual Models Illustrating the Development of MD ........................ 28 Research on Contributing Factors ............................................................ 31 Self-objectification. ............................................................................ 31 Perfectionism. ...................................................................................... 33 Media pressure and ideal body internalization. .................................. 33 Childhood experience. ......................................................................... 34 Participation in sport. ........................................................................... 36 Interaction between body dissatisfaction, body distortion, and self- esteem. ................................................................................................. 37 Tools for Identifying and Measuring Muscle Dysmorphia ............................ 39 v III. METHODS ..................................................................................................... 46 Participants ..................................................................................................... 46 Study Recruitment .......................................................................................... 47 Questionnaire Design ……………………………………………….............. 48 Subject Demographics and Characteristics .............................................. 48 Muscle Dysmorphia Disorder Inventory …………………………...…... 48 Block Food Frequency Questionnaire ...................................................... 49 Experimental Design ...................................................................................... 49 Statistical Analysis …………………………………………………………. 51 IV. JOURNAL ARTICLE .................................................................................... 52 Introduction ………………………………………………………………… 52 Methods……………………………………………………………………... 54 Participants ............................................................................................... 54 Study Recruitment .................................................................................... 55 Questionnaire Design …………………………………….…….............. 56 Subject demographics and characteristics. .................................. 56 Muscle dysmorphia disorder inventory. …………………...…... 56 Block food frequency questionnaire. .......................................... 57 Experimental Design ...............................................................................