Measures of muscularity-oriented psychopathology: A content analysis

In recent decades, sociocultural body ideals across genders have increasingly emphasized muscularity. For example, inspirational fitness content is proliferating on social media, glorifying unattainably muscular and “lean” physiques (Bell et al., 2024). In pursuit of these bodies, many individuals engage in rigid exercise and eating regimes and use muscle-building supplements and substances (Ganson & Rodgers, 2022). In response, there has been a boom in research examining psychopathology related to the pursuit of muscularity. Muscle dysmorphia, which involves a persistent belief that one’s physique is too small or inadequately muscular, was added to the DSM-5 in 2013 as a specifier of body dysmorphic disorder (American Psychiatric Association, 2013). Additionally, interventions targeting muscularity concerns have been piloted (Brown et al., 2017; Murray & Griffiths, 2015). Together, these developments reflect increasing recognition that muscularity-oriented psychopathology is clinically relevant. But its conceptual boundaries remain unsettled. This rapid growth has produced a wide array of measures assessing constructs related to muscularity, such as muscle dysmorphia, muscularity ideals, compulsive exercise, rigid eating behaviours, and supplement or substance use (e.g., Hildebrandt et al., 2004; Murray et al., 2018; Uhlmann et al., 2020). Measures often overlap in some domains while diverging in others. This diversity is not inherently problematic, but it does create challenges. Without clarity about what existing measures actually capture, it becomes difficult to compare findings across studies, to determine how specific constructs relate to one another, or to identify which features may be underrepresented. Mapping this measurement landscape is therefore a critical step toward understanding how muscularity-oriented psychopathology is currently conceptualized and operationalized in research, and toward informing future assessment and theory development. Therefore, there is a need to empirically evaluate the content of measures. Content analysis allows us to characterize the range of features present within measures and to evaluate the extent to which different measures overlap. In recent years, content analyses have been conducted on measures examining numerous psychological conditions, including depression, anxiety, obsessive-compulsive disorder, mania, trauma, gaming disorder, harsh parenting, pain catastrophizing, and post-stroke fatigue (Backhaus et al., 2023; Chrobak et al., 2018, 2021; Crombez et al., 2020; Fried, 2017; Karhulahti et al., 2023; Karstoft & Armour, 2023; Skogestad et al., 2019; Visontay et al., 2019; Wall & Lee, 2022). Most notably, recent papers have used content analysis to examine measures assessing eating disorders and maladaptive exercise (Christensen Pacella et al., 2025; Lampe et al., 2024), which are conditions closely related to muscularity-oriented psychopathology. Drawing from these papers, this study aims to analyze the features assessed by existing measures of muscularity-oriented thoughts, emotions, behaviours, and/or consequences, as well as quantify the degree of content overlap among measures.