{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:34:37Z","timestamp":1787027677630,"version":"build-2736575974"},"reference-count":87,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>Muscle dysmorphia (MD) is a body image disorder characterized by an obsessive preoccupation with muscularity and compulsive behaviors such as excessive exercise, rigid dieting, and frequent body checking. MD has been linked to obsessive\u2013compulsive traits and the use of anabolic\u2013androgenic steroids (AASs), yet these associations have not been comprehensively synthesized. This systematic review and meta-analysis examined the relationships between MD, obsessive\u2013compulsive symptomatology, and AASs or performance-enhancing drug use. Following PRISMA 2020 guidelines and PROSPERO preregistration (CRD42025640206), we searched four major databases for peer-reviewed studies published between 2015 and 2025. Ten studies (five quantitative, five qualitative) met the inclusion criteria. Meta-analytic findings revealed a moderate positive correlation between MD symptom severity and obsessive\u2013compulsive traits (r \u2248 0.24), and significantly higher MD symptoms among AAS users compared to non-users (Cohen\u2019s d \u2248 0.45). Odds of MD were markedly higher in steroid-using populations. Thematic synthesis of qualitative studies highlighted compulsive training routines, identity conflicts, motivations for AAS use, and limited engagement with healthcare services. These findings suggest that MD exists at the intersection of obsessive\u2013compulsive psychopathology and substance-related behavior, warranting integrated interventions targeting both dimensions. The study contributes to understanding MD as a complex, multi-faceted disorder with significant clinical and public health relevance.<\/jats:p>","DOI":"10.3390\/bs15091206","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T07:46:17Z","timestamp":1757058377000},"page":"1206","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Muscle Dysmorphia, Obsessive\u2013Compulsive Traits, and Anabolic Steroid Use: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6342-3949","authenticated-orcid":false,"given":"Metin","family":"\u00c7\u0131naro\u011flu","sequence":"first","affiliation":[{"name":"Psychology Department, \u0130stanbul Ni\u015fanta\u015f\u0131 University, \u0130stanbul 34485, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eda","family":"Y\u0131lmazer","sequence":"additional","affiliation":[{"name":"Psychology Department, Beykoz University, \u0130stanbul 34820, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100033","DOI":"10.1016\/j.etdah.2022.100033","article-title":"Two sides of the same coin: A qualitative exploration of experiential and perceptual factors which influence the clinical interaction between physicians and anabolic-androgenic steroid using patients in the UK","volume":"2","author":"Ainsworth","year":"2022","journal-title":"Emerging Trends in Drugs, Addictions, and Health"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Albano, G. D., Amico, F., Cocimano, G., Liberto, A., Maglietta, F., Esposito, M., Rosi, G. L., Di Nunno, N., Salerno, M., and Montana, A. (2021). Adverse effects of anabolic-androgenic steroids: A literature review. Healthcare, 9, (1).","DOI":"10.3390\/healthcare9010097"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e056445","DOI":"10.1136\/bmjopen-2021-056445","article-title":"Prevalence of anabolic steroid users seeking support from physicians: A systematic review and meta-analysis","volume":"12","author":"Amaral","year":"2022","journal-title":"BMJ Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"6325860","DOI":"10.1155\/2022\/6325860","article-title":"The effect of bigorexia nervosa on eating attitudes and physical activity: A study on university students","volume":"2022","author":"Arslan","year":"2022","journal-title":"International Journal of Clinical Practice"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1556\/2006.8.2019.44","article-title":"The association between muscle dysmorphia and eating disorder symptomatology: A systematic review and meta-analysis","volume":"8","author":"Fabris","year":"2019","journal-title":"Journal of Behavioral Addictions"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Blashill, A. J., Grunewald, W., Fang, A., Davidson, E., and Wilhelm, S. (2020). Conformity to masculine norms and symptom severity among men diagnosed with muscle dysmorphia vs. body dysmorphic disorder. PLoS ONE, 15, (8).","DOI":"10.1371\/journal.pone.0237651"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.mehy.2016.06.004","article-title":"Anabolic androgenic steroid-induced hepatotoxicity","volume":"93","author":"Bond","year":"2016","journal-title":"Medical Hypotheses"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Bond, P., Smit, D. L., and de Ronde, W. (2022). Anabolic\u2013androgenic steroids: How do they work and what are the risks?. Frontiers in Endocrinology, 13.","DOI":"10.3389\/fendo.2022.1059473"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2055","DOI":"10.1007\/s11606-021-06751-3","article-title":"Harm reduction in male patients actively using anabolic androgenic steroids (AAS) and performance-enhancing drugs (PEDs): A review","volume":"36","author":"Bonnecaze","year":"2021","journal-title":"Journal of General Internal Medicine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1080\/13651501.2022.2151474","article-title":"Effects of exercise on obsessive-compulsive disorder symptoms: A systematic review and meta-analysis","volume":"27","author":"Bottoms","year":"2023","journal-title":"International Journal of Psychiatry in Clinical Practice"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"B\u00f6rjesson, A., Ekebergh, M., Dahl, M. L., Ekstr\u00f6m, L., Lehtihet, M., and Vicente, V. (2021b). Women\u2019s experiences of using anabolic androgenic steroids. Frontiers in Sports and Active Living, 3.","DOI":"10.3389\/fspor.2021.656413"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Brytek-Matera, A., Staniszewska, A., and Hallit, S. (2020). Identifying the profile of orthorexic behavior and \u201cnormal\u201d eating behavior with cluster analysis: A cross-sectional study among polish adults. Nutrients, 12, (11).","DOI":"10.3390\/nu12113490"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1080\/13284207.2024.2376036","article-title":"A clinician\u2019s quick guide to evidence-based approaches: Body dysmorphic disorder","volume":"29","author":"Cadman","year":"2025","journal-title":"Clinical Psychologist"},{"key":"ref_14","first-page":"260869","article-title":"Muscles that matter: An interpretative phenomenological analysis of emotions and experiences of female bodybuilders in Italy","volume":"12","author":"Calzolari","year":"2023","journal-title":"Connexion: Journal of Humanities and Social Sciences"},{"key":"ref_15","unstructured":"Carvalho, A. (2023). The appearance and enhancing use ideal of drugs image-of anxiety, the and perfect excessive performance. The body in the mind: Exercise addiction, body image and the use of enhancement drugs, Cambridge University Press."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1097\/YIC.0000000000000342","article-title":"Body dysmorphic disorder: A treatment synthesis and consensus on behalf of the international college of obsessive-compulsive spectrum disorders and the obsessive compulsive and related disorders network of the European college of neuropsychopharmacology","volume":"36","author":"Castle","year":"2021","journal-title":"International Clinical Psychopharmacology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"8877","DOI":"10.1038\/s41598-018-27176-9","article-title":"Muscle dysmorphia and its associated psychological features in three groups of recreational athletes","volume":"8","author":"Cerea","year":"2018","journal-title":"Scientific Reports"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"143","DOI":"10.3149\/jmh.0802.143","article-title":"Are anxiety and obsessive-compulsive symptoms related to muscle dysmorphia","volume":"8","author":"Chandler","year":"2009","journal-title":"International Journal of Men\u2019s Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1002\/eat.23349","article-title":"Muscle dysmorphia: A systematic and meta-analytic review of the literature to assess diagnostic validity","volume":"53","author":"Cooper","year":"2020","journal-title":"International Journal of Eating Disorders"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Coquet, R., Roussel, P., and Ohl, F. (2018). Understanding the paths to appearance-and performance-enhancing drug use in bodybuilding. Frontiers in Psychology, 9.","DOI":"10.3389\/fpsyg.2018.01431"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Corazza, O., Simonato, P., Demetrovics, Z., Mooney, R., Van De Ven, K., Roman-Urrestarazu, A., R\u00e1cmoln\u00e1r, L., De Luca, I., Cinosi, E., Santacroce, R., Marini, M., Wellsted, D., Sullivan, K., Bersani, G., and Martinotti, G. (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, (4).","DOI":"10.1371\/journal.pone.0213060"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Cox, L., Piatkowski, T., and McVeigh, J. (2024). \u201cI would never go to the doctor and speak about steroids\u201d: Anabolic androgenic steroids, stigma and harm. Drugs: Education, Prevention and Policy, 1\u201313.","DOI":"10.1080\/09687637.2024.2373056"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.encep.2021.11.004","article-title":"\u201cMuscle Pics\u201d, a new body-checking behavior in muscle dysmorphia?","volume":"49","author":"Cuadrado","year":"2023","journal-title":"L\u2019encephale"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Cuzzolaro, M. (2018). Body dysmorphic disorder and muscle dysmorphia. Body image, eating, and weight: A guide to assessment, treatment, and prevention, Springer International Publishing.","DOI":"10.1007\/978-3-319-90817-5"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1007\/s40429-021-00358-8","article-title":"Exercise addiction and perfectionism: A systematic review of the literature","volume":"8","author":"Juwono","year":"2021","journal-title":"Current Addiction Reports"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"104542","DOI":"10.1016\/j.actpsy.2024.104542","article-title":"Efficacy of cognitive-behavioral therapy in reducing muscle dysmorphia symptoms among Turkish gym goers: A pilot study","volume":"250","author":"Sayar","year":"2024","journal-title":"Acta Psychologica"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Davey, G., Dash, S., and Meeten, F. (2014). Obsessive compulsive disorder, Bloomsbury Publishing.","DOI":"10.1007\/978-1-137-30869-6"},{"key":"ref_28","first-page":"102","article-title":"Differential prevalence of depressive and narcissistic traits in competing and non-competing bodybuilders in relation to muscle dysmorphia levels","volume":"20","author":"Fabris","year":"2020","journal-title":"Journal of Psychiatry and Clinical Psychology"},{"key":"ref_29","first-page":"68","article-title":"The disordered-eating, obsessive-compulsive, and body dysmorphic characteristics of muscle dysmorphia: A bimodal perspective","volume":"5","author":"Diehl","year":"2016","journal-title":"New Male Studies"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1556\/2006.2021.00061","article-title":"The expanded interactional model of exercise addiction","volume":"10","author":"Dinardi","year":"2021","journal-title":"Journal of Behavioral Addictions"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3577","DOI":"10.1007\/s12144-020-00857-3","article-title":"Homophobic bullying victimization and muscle Dysmorphic concerns in men having sex with men: The mediating role of paranoid ideation","volume":"41","author":"Fabris","year":"2022a","journal-title":"Current Psychology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1080\/00918369.2020.1813512","article-title":"Prevalence and co-occurrence of different types of body dysmorphic disorder among men having sex with men","volume":"69","author":"Fabris","year":"2022b","journal-title":"Journal of Homosexuality"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1037\/men0000096","article-title":"Attachment style and risk of muscle dysmorphia in a sample of male bodybuilders","volume":"19","author":"Fabris","year":"2018","journal-title":"Psychology of Men & Masculinity"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"170","DOI":"10.3109\/13651501.2012.755206","article-title":"A prospective population-based cohort study of the prevalence, incidence and impact of obsessive-compulsive symptomatology","volume":"17","author":"Fineberg","year":"2013","journal-title":"International Journal of Psychiatry in Clinical Practice"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1556\/JBA.3.2014.001","article-title":"Muscle dysmorphia: Could it be classified as an addiction to body image?","volume":"4","author":"Foster","year":"2015","journal-title":"Journal of Behavioral Addictions"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s40337-025-01233-x","article-title":"Prevalence and correlates of muscle dysmorphia in a sample of boys and men in Canada and the United States","volume":"13","author":"Ganson","year":"2025a","journal-title":"Journal of Eating Disorders"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"101903","DOI":"10.1016\/j.bodyim.2025.101903","article-title":"Associations between muscularity-oriented social media content and muscle dysmorphia among boys and men","volume":"53","author":"Ganson","year":"2025b","journal-title":"Body Image"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.rcpeng.2017.06.003","article-title":"Muscle dysmorphia and use of ergogenics substances. A systematic review","volume":"46","year":"2017","journal-title":"Revista Colombiana de Psiquiatr\u00eda (English Ed.)"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1177\/1403494820973096","article-title":"Prevalence, mental health and substance use of anabolic steroid users: A population-based study on young individuals","volume":"49","author":"Gestsdottir","year":"2021","journal-title":"Scandinavian Journal of Public Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"32697","DOI":"10.1007\/s12144-024-06815-7","article-title":"Mirror, mirror on the wall: The role of narcissism, muscle dysmorphia, and self-esteem in bodybuilders\u2019 muscularity-oriented disordered eating","volume":"43","author":"Giancola","year":"2024","journal-title":"Current Psychology"},{"key":"ref_41","first-page":"243","article-title":"Muscle dysmorphia: Detection of the use-abuse of anabolic adrogenic steroids in a Spanish sample","volume":"30","author":"Sokolova","year":"2018","journal-title":"Adicciones"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Grunewald, W., and Blashill, A. J. (2021). Muscle dysmorphia. Eating disorders in boys and men, Springer International Publishing.","DOI":"10.1007\/978-3-030-67127-3_8"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Gunnarsson, B., Entezarjou, A., Fern\u00e1ndez-Aranda, F., Jim\u00e9nez-Murcia, S., Kentt\u00e4, G., and H\u00e5kansson, A. (2022). Understanding exercise addiction, psychiatric characteristics and use of anabolic androgenic steroids among recreational athletes\u2013An online survey study. Frontiers in Sports and Active Living, 4.","DOI":"10.3389\/fspor.2022.903777"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1556\/2006.2024.00085","article-title":"Body image and risk of exercise addiction in adults: A systematic review and meta-analysis","volume":"14","author":"Guo","year":"2025","journal-title":"Journal of Behavioral Addictions"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1556\/JBA.2.2013.4.8","article-title":"Exercise dependence and muscle dysmorphia in novice and experienced female bodybuilders","volume":"2","author":"Hale","year":"2013","journal-title":"Journal of Behavioral Addictions"},{"key":"ref_46","first-page":"1178221820904150","article-title":"The anabolic androgenic steroid treatment gap: A national study of substance use disorder treatment","volume":"14","author":"Havnes","year":"2020","journal-title":"Substance Abuse: Research and Treatment"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1007\/s00414-023-03046-6","article-title":"A qualitative assessment of anabolic\u2013androgenic steroid use among gym users in Jordan: Motives, perception, and safety","volume":"137","author":"Izzat","year":"2023","journal-title":"International Journal of Legal Medicine"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1111\/j.1360-0443.2009.02734.x","article-title":"Anabolic\u2013androgenic steroid dependence: An emerging disorder","volume":"104","author":"Kanayama","year":"2009","journal-title":"Addiction"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e2411088","DOI":"10.1001\/jamanetworkopen.2024.11088","article-title":"Exploring anabolic androgenic steroid use among cisgender gay, bisexual, and queer men","volume":"7","author":"Kutscher","year":"2024","journal-title":"JAMA Network Open"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.mehy.2017.09.001","article-title":"How extreme dieting becomes compulsive: A novel hypothesis for the role of anxiety in the development and maintenance of anorexia nervosa","volume":"108","author":"Lloyd","year":"2017","journal-title":"Medical Hypotheses"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.psychres.2017.06.065","article-title":"Muscle dysmorphia and psychopathology: Findings from an Italian sample of male bodybuilders","volume":"256","author":"Longobardi","year":"2017","journal-title":"Psychiatry Research"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Macho, J., Mudrak, J., and Slepicka, P. (2021). Enhancing the self: Amateur bodybuilders making sense of experiences with appearance and performance-enhancing drugs. Frontiers in Psychology, 12.","DOI":"10.3389\/fpsyg.2021.648467"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"100213","DOI":"10.1016\/j.peh.2021.100213","article-title":"Seeing Shred: Differences in muscle dysmorphia, orthorexia nervosa, depression, and obsessive-compulsive tendencies among groups of weightlifting athletes","volume":"10","author":"MacPhail","year":"2022","journal-title":"Performance Enhancement & Health"},{"key":"ref_54","first-page":"143","article-title":"Treatment of compulsive exercise in eating disorders and muscle dysmorphia: A systematic review and meta-analysis","volume":"29","author":"Martenstyn","year":"2022a","journal-title":"Clinical Psychology: Science and Practice"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.bodyim.2022.10.009","article-title":"A qualitative investigation of the phenomenology of muscle dysmorphia: Part 1","volume":"43","author":"Martenstyn","year":"2022b","journal-title":"Body Image"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"101842","DOI":"10.1016\/j.bodyim.2024.101842","article-title":"Evaluation of an 8-week telehealth cognitive-behavioural therapy (CBT) program for adults with muscle dysmorphia: A pilot and feasibility study","volume":"52","author":"Martenstyn","year":"2025","journal-title":"Body Image"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s40337-021-00375-y","article-title":"Treatment of compulsive exercise in eating disorders and muscle dysmorphia: Protocol for a systematic review","volume":"9","author":"Martenstyn","year":"2021","journal-title":"Journal of Eating Disorders"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Mesce, M., Cerniglia, L., and Cimino, S. (2022). Body image concerns: The impact of digital technologies and psychopathological risks in a normative sample of adolescents. Behavioral Sciences, 12, (8).","DOI":"10.3390\/bs12080255"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s40279-016-0564-3","article-title":"Muscle dysmorphia symptomatology and associated psychological features in bodybuilders and non-bodybuilder resistance trainers: A systematic review and meta-analysis","volume":"47","author":"Mitchell","year":"2017","journal-title":"Sports Medicine"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3142","DOI":"10.1017\/S0033291720005206","article-title":"Prevalence of muscle dysmorphia in adolescents: Findings from the EveryBODY study","volume":"52","author":"Mitchison","year":"2022","journal-title":"Psychological Medicine"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.drugalcdep.2016.06.008","article-title":"Anabolic steroid use and body image psychopathology in men: Delineating between appearance-versus performance-driven motivations","volume":"165","author":"Murray","year":"2016","journal-title":"Drug and Alcohol Dependence"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1002\/erv.2194","article-title":"An investigation of the transdiagnostic model of eating disorders in the context of muscle dysmorphia","volume":"21","author":"Murray","year":"2013","journal-title":"European Eating Disorders Review"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1002\/eat.23708","article-title":"Appearance and performance-enhancing drugs and supplements, eating disorders, and muscle dysmorphia among gender minority people","volume":"55","author":"Nagata","year":"2022","journal-title":"International Journal of Eating Disorders"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"9133","DOI":"10.1038\/s41598-022-13048-w","article-title":"Anabolic\u2013androgenic steroid use is associated with psychopathy, risk-taking, anger, and physical problems","volume":"12","author":"Nelson","year":"2022","journal-title":"Scientific Reports"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Olave, L., Est\u00e9vez, A., Mome\u00f1e, J., Mu\u00f1oz-Navarro, R., G\u00f3mez-Romero, M. J., Boticario, M. J., and Iruarrizaga, I. (2021). Exercise addiction and muscle dysmorphia: The role of emotional dependence and attachment. Frontiers in Psychology, 12.","DOI":"10.3389\/fpsyg.2021.681808"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1080\/10673220127900","article-title":"Mirror, mirror on the wall, who\u2019s the largest of them all? The features and phenomenology of muscle dysmorphia","volume":"9","author":"Olivardia","year":"2001","journal-title":"Harvard Review of Psychiatry"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1176\/appi.ajp.157.8.1291","article-title":"Muscle dysmorphia in male weightlifters: A case-control study","volume":"157","author":"Olivardia","year":"2000","journal-title":"American Journal of Psychiatry"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1097\/01.jsm.0000180872.22426.bb","article-title":"Anabolic steroid use in weightlifters and bodybuilders: An internet survey of drug utilization","volume":"15","author":"Perry","year":"2005","journal-title":"Clinical Journal of Sport Medicine"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.psychres.2019.01.106","article-title":"Direct comparisons of anorexia nervosa and body dysmorphic disorder: A systematic review","volume":"274","author":"Phillipou","year":"2019","journal-title":"Psychiatry Research"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1176\/appi.focus.130205","article-title":"Body dysmorphic disorder: Clinical aspects and relationship to obsessive-compulsive disorder","volume":"13","author":"Phillips","year":"2015","journal-title":"Focus"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.bodyim.2005.09.001","article-title":"Clinical features of muscle dysmorphia among males with body dysmorphic disorder","volume":"2","author":"Pope","year":"2005","journal-title":"Body Image"},{"key":"ref_73","unstructured":"Pope, H., Phillips, K. A., and Olivardia, R. (2000). The Adonis complex: The secret crisis of male body obsession, Simon and Schuster."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/S0033-3182(97)71400-2","article-title":"Muscle dysmorphia: An underrecognized form of body dysmorphic disorder","volume":"38","author":"Pope","year":"1997","journal-title":"Psychosomatics"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"9358","DOI":"10.1007\/s12144-025-07733-y","article-title":"Taxometric evidence for the dimensional structure of body dysmorphic disorder and muscle dysmorphia","volume":"44","author":"Rocha","year":"2025","journal-title":"Current Psychology"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1080\/10640260902848477","article-title":"The relationship between anabolic androgenic steroids and muscle dysmorphia: A review","volume":"17","author":"Rohman","year":"2009","journal-title":"Eating Disorders"},{"key":"ref_77","first-page":"120","article-title":"A reliability generalization meta-analysis of self-report measures of muscle dysmorphia","volume":"27","author":"Fabris","year":"2020","journal-title":"Clinical Psychology: Science and Practice"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1038\/s41572-024-00577-z","article-title":"Body dysmorphic disorder","volume":"10","author":"Feusner","year":"2024","journal-title":"Nature Reviews Disease Primers"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Scarth, M., Westlye, L. T., Havnes, I. A., and Bj\u00f8rnebekk, A. (2023). Investigating anabolic-androgenic steroid dependence and muscle dysmorphia with network analysis among male weightlifters. BMC Psychiatry, 23, (1).","DOI":"10.1186\/s12888-023-04781-1"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Schreiber, K., and Hausenblas, H. A. (2015). The truth about exercise addiction: Understanding the dark side of thinspiration, Rowman & Littlefield.","DOI":"10.5771\/9781442233300"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"3098","DOI":"10.1519\/JSC.0b013e3181d0a575","article-title":"Body uneasiness, eating disorders, and muscle dysmorphia in individuals who overexercise","volume":"24","author":"Ammendolia","year":"2010","journal-title":"The Journal of Strength & Conditioning Research"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"116583","DOI":"10.1016\/j.psychres.2025.116583","article-title":"Assessing the accuracy and consistency of large language models in triaging social media posts for psychological distress","volume":"351","author":"Settanni","year":"2025","journal-title":"Psychiatry Research"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Specter, S. E., and Wiss, D. A. (2014). Muscle dysmorphia: Where body image obsession, compulsive exercise, disordered eating, and substance abuse intersect in susceptible males. Eating disorders, addictions and substance use disorders: Research, clinical and treatment perspectives, Springer.","DOI":"10.1007\/978-3-642-45378-6_20"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/978-3-540-79088-4_18","article-title":"Androgenic anabolic steroid abuse and the cardiovascular system","volume":"195","author":"Vanberg","year":"2009","journal-title":"Doping in Sports: Biochemical Principles, Effects and Analysis"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Vasiliu, O. (2023). At the crossroads between eating disorders and body dysmorphic disorders\u2014The case of bigorexia nervosa. Brain Sciences, 13, (9).","DOI":"10.3390\/brainsci13091234"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/B978-0-12-384925-0.00025-0","article-title":"Body image behaviors: Checking, fixing, and avoiding","volume":"1","author":"Walker","year":"2012","journal-title":"Encyclopedia of Body Image and Human Appearance"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/19585969.2023.2164841","article-title":"Exercise addiction: A narrative overview of research issues","volume":"25","author":"Weinstein","year":"2023","journal-title":"Dialogues in Clinical Neuroscience"}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/15\/9\/1206\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:39:48Z","timestamp":1760035188000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/15\/9\/1206"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,4]]},"references-count":87,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["bs15091206"],"URL":"https:\/\/doi.org\/10.3390\/bs15091206","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,4]]}}}