HomeRecoletos Multidisciplinary Research Journalvol. 13 no. 1 (2025)

Understanding Body Dysmorphic Disorder Risk and Exercise Addiction in the Philippines

Lhorenz Payumo | Ritz Gwyneth Gengania | Ma. Andrea Grace Lachica | Khristine Joy Licupa | Jenan Mallare | Venice Ann Ocariza | Juzhina Psalm Quinopez | Danielle Caryl Santos | Sean Rae Suyat | Moira Joan Versosa | Ria Joy Padilla

Discipline: Psychology and Health

 

Abstract:

Background: Body Dysmorphic Disorder Risk (BDDR) may incite Body Dysmorphic Disorder (BDD) following bodily imperfection fixations, potentially fuelling Exercise Addiction (EA) – excessive exercising causing musculoskeletal disorders. This study examined the correlation between BDDR and EA, their prevalence among Regular Exercisers (REs), and BDDR's significant association with age, sex, and exercise dynamics. Methods: A descriptive-correlational design was employed. BDDR was assessed using a BDD questionnaire, and EA was measured with the Exercise Addiction Inventory. Pearson's correlation determined the relationship between BDDR and EA, while prevalence was calculated using frequencies and percentages. Chi-square tests assessed associations between BDDR and demographic or exercise-related variables. Results: Among the 179 respondents, REs showed a low prevalence of BDDR and a moderate prevalence of EA. BDDR was significantly associated with age, exercise frequency, and duration (p < 0.05). Respondents with BDDR reported concerns with body build, shape, and weight. Age emerged as a predictor of BDDR, and adjusting exercise frequency and duration appeared to reduce BDDR risk. While EA and BDDR can co-occur, they are not mutually predictive. Conclusion: The findings highlight the importance of balanced exercise practices that promote physical and psychological well-being while guiding future research toward exploring additional physiological and psychological contributing factors to BDDR.



References:

  1. Abdulrasool, M. D., Joda, E., & Alawady, A. A. (2020). The effect of psycho-physiological sports proposed in terms of the hormone endorphins serotonin and their relative results on mental fitness in the aged. Annals of Tropical Medicine and Public Health, 23(13). https://doi.org/10.36295/asro.2020.231369
  2. American Heart Association. (2024, January 18). Breaking down barriers to fitness. https://www.heart.org/en/healthy-living/fitness/getting-active/breaking-down-barriers-to-fitness
  3. American Psychological Association. (2022). Cognitive behavioral therapy for body dysmorphic disorder. https://www.apa.org/education-career/ce/cognitive-behavioral-therapy-002
  4. Arayici, S. G., & Sutcu, S. T. (2024). The relationship between childhood trauma, exercise addiction, emotion regulation difficulties, and basic psychological needs in Türkiye. Journal of Clinical Sport Psychology, 19(1), 1–22. https://doi.org/10.1123/jcsp.2023-0036
  5. Bailey, R., & Pico, J. (2023, May 22). Defense mechanisms. National Center for Biotechnology Information; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559106/
  6. Barakat, C., Pearson, J., Escalante, G., Campbell, B., & De Souza, E. O. (2020). Body recomposition: Can trained individuals build muscle and lose fat at the same time? Strength & Conditioning Journal, Publish Ahead of Print(5). https://doi.org/10.1519/SSC.0000000000000584
  7. Baumeister, R. F., Campbell, J. D., Krueger, J. I., & Vohs, K. D. (2003). Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles? Psychological Science in the Public Interest, 4(1), 1–44. https://doi.org/10.1111/1529-1006.01431
  8. Beck, A. T. (1976). Cognitive therapy and emotional disorders. International Universities Press.
  9. Bellicha, A., Van Baak, M. A., Battista, F., Beaulieu, K., Blundell, J. E., Busetto, L., Carraça, E. V., Dicker, D., Encantado, J., Ermolao, A., Farpour‐Lambert, N., Pramono, A., Woodward, E., & Oppert, J. (2021). Effect of exercise training on weight loss, body composition changes, and weight maintenance in adults with overweight or obesity: An overview of 12 systematic reviews and 149 studies. Obesity Reviews, 22(S4). https://doi.org/10.1111/obr.13256
  10. Bullivant, B., Rhydderch, S., Griffiths, S., Mitchison, D., & Mond, J. M. (2020). Eating disorders “mental health literacy”: A scoping review. Journal of Mental Health, 29(3), 1–14. https://doi.org/10.1080/09638237.2020.1713996
  11. Cerea, S., Giraldo, M., Caudek, C., Bottesi, G., Paoli, A., & Ghisi, M. (2022). Validation of the muscle dysmorphic disorder inventory (MDDI) among Italian women practicing bodybuilding and powerlifting and in women practicing physical exercise. International Journal of Environmental Research and Public Health, 19(15), 9487. https://doi.org/10.3390/ijerph19159487
  12. Cohen, R., Fardouly, J., Newton-John, T., & Slater, A. (2019). #BoPo on instagram: An experimental investigation of the effects of viewing body positive content on young women’s mood and body image. New Media & Society, 21(7), 1546–1564. https://doi.org/10.1177/1461444819826530
  13. Cohen, R., Newton-John, T., & Slater, A. (2021). The case for body positivity on social media: Perspectives on current advances and future directions. Journal of Health Psychology, 26(13), 2365–2373. https://doi.org/10.1177/1359105320912450
  14. Corazza, O., Simonato, P., Demetrovics, Z., Mooney, R., van de Ven, K., Roman-Urrestarazu, A., Rácmolnár, L., De Luca, I., Cinosi, E., Santacroce, R., Marini, M., Wellsted, D., Sullivan, K., Bersani, G., & 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), e0213060. https://doi.org/10.1371/journal.pone.0213060
  15. Cornelissen, P. L., Johns, A., & Tovée, M. J. (2013). Body size over-estimation in women with anorexia nervosa is not qualitatively different from female controls. Body Image, 10(1), 103–111. https://doi.org/10.1016/j.bodyim.2012.09.003
  16. Cousineau, D., Ferguson, R. J., de Champlain, J., Gauthier, P., Cote, P., & Bourassa, M. (1977). Catecholamines in coronary sinus during exercise in man before and after training. Journal of Applied Physiology, 43(5), 801–806. https://doi.org/10.1152/jappl.1977.43.5.801
  17. de Mendonça, R. M. S. C., de Araújo Júnior, A. T., de Sousa, M. do S. C., & Fernandes, H. M. (2014). The effects of different exercise programmes on female body composition. Journal of Human Kinetics, 43(1), 67–78. https://doi.org/10.2478/hukin-2014-0091
  18. deVries, H. A. (1981). Tranquilizer effect of exercise: A critical review. The Physician and Sportsmedicine, 9(11), 46–55. https://doi.org/10.1080/00913847.1981.11711206
  19. DiPippo, I. (2023). Impact of body image ideals on form and frequency of exercise in college students [Senior thesis, SUNY College at Cortland].
  20. Dyremyhr, Å. E., Diaz, E., & Meland, E. (2014). How Adolescent Subjective Health and Satisfaction with Weight and Body Shape Are Related to Participation in Sports. Journal of Environmental and Public Health, 2014, 1–7. https://doi.org/10.1155/2014/851932
  21. Espinosa, A. (2020). Health behaviors, self-rated health, and health consciousness among Latinx in New York City. Journal of Immigrant and Minority Health, 23, 591–596. https://doi.org/10.1007/s10903-020-01053-y
  22. Espinosa, A., & Kadić-Maglajlić, S. (2018). The mediating role of health consciousness in the relation between emotional intelligence and health behaviors. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.02161
  23. Fang, A., & Hofmann, S. G. (2010). Relationship between social anxiety disorder and body dysmorphic disorder. Clinical Psychology Review, 30(8), 1040–1048. https://doi.org/10.1016/j.cpr.2010.08.001
  24. Franzoi, S. L. (1995). The body-as-object versus the body-as-process: Gender differences and gender considerations. Sex Roles, 33, 417–437. https://doi.org/10.1007/bf01954577
  25. Freimuth, M., Moniz, S., & Kim, S. R. (2011). Clarifying exercise addiction: Differential diagnosis, co-occurring disorders, and phases of addiction. International Journal of Environmental Research and Public Health, 8(10), 4069–4081. https://doi.org/10.3390/ijerph8104069
  26. Ganesan, S., Ravishankar, S. L., & Ramalingam, S. (2018). Are body image issues affecting our adolescents? A cross-sectional study among college going adolescent girls. Indian Journal of Community Medicine, 43(5), 42. https://doi.org/10.4103/ijcm.ijcm_62_18
  27. Glasser, W. (1976). Positive addiction. Harper & Row.
  28. Gori, A., Topino, E., & Griffiths, M. D. (2021). Protective and risk factors in exercise addiction: A series of moderated mediation analyses. International Journal of Environmental Research and Public Health, 18(18), 9706. https://doi.org/10.3390/ijerph18189706
  29. Haider, A., Wei, Z., Parveen, S., & Mehmood, A. (2023). The association between comorbid body dysmorphic disorder and depression: Moderation effect of age and mediation effect of body mass index and body image among Pakistani students. Middle East Current Psychiatry, 30(1). https://doi.org/10.1186/s43045-023-00283-8
  30. Hands, B., & Parker, H. (2016). Male and female differences in health benefits derived from physical activity: Implications for exercise prescription. Journal of Womens Health, Issues and Care, 5(4). https://doi.org/10.4172/2325-9795.1000238
  31. Harvard Health Publishing. (2014, March 9). Working off depression. Harvard Health. https://www.health.harvard.edu/mind-and-mood/working-off-depression
  32. Hausenblas, H. A., & Downs, D. S. (2002). Exercise dependence: A systematic review. Psychology of Sport and Exercise, 3(2), 89–123. https://doi.org/10.1016/s1469-0292(00)00015-7
  33. Herbert, C., Meixner, F., Wiebking, C., & Gilg, V. (2020). Regular physical activity, short-term exercise, mental health, and well-being among university students: The results of an online and a laboratory study. Frontiers in Psychology, 11(509). https://doi.org/10.3389/fpsyg.2020.00509
  34. Himanshu, Kaur, A., Kaur, A., & Singla, G. (2020). Rising dysmorphia among adolescents: A cause for concern. Journal of Family Medicine and Primary Care, 9(2), 567–570. https://doi.org/10.4103/jfmpc.jfmpc_738_19
  35. Huellemann, K. L., Pila, E., Gilchrist, J. D., Nesbitt, A. E., & Sabiston, C. M. (2021). Body-related self-conscious emotions and reasons for exercise: A latent class analysis. Body Image, 38, 127–136. https://doi.org/10.1016/j.bodyim.2021.03.016
  36. Hötting, K., & Röder, B. (2013). Beneficial effects of physical exercise on neuroplasticity and cognition. Neuroscience and Biobehavioral Reviews, 37(9 Pt B), 2243–2257. https://doi.org/10.1016/j.neubiorev.2013.04.005
  37. Ingledew, D. K., & Markland, D. (2008). The role of motives in exercise participation. Psychology & Health, 23(7), 807–828. https://doi.org/10.1080/08870440701405704
  38. Iso-Ahola, S. E. (2017). Conscious-Nonconscious processing explains why some people exercise but most don’t. Journal of Nature and Science, 3(6), 384.
  39. Jee, Y.-S. (2016). Exercise addiction and rehabilitation. Journal of Exercise Rehabilitation, 12(2), 67–68. https://doi.org/10.12965/jer.1632604.302
  40. Johns Hopkins Medicine (n.d.). Body dysmorphic disorder. https://www.hopkinsmedicine.org/health/conditions-and-diseases/body-dysmorphic-disorder
  41. Kester, S. (2020, May 15). The FITT principle: Benefits & how to use it. Healthline. https://www.healthline.com/health/fitt-principle
  42. Knee, C. R., Canevello, A., Bush, A. L., & Cook, A. (2008). Relationship-contingent self-esteem and the ups and downs of romantic relationships. Journal of Personality and Social Psychology, 95(3), 608–627. https://doi.org/10.1037/0022-3514.95.3.608
  43. Krebs, G., Fernández de la Cruz, L., Rijsdijk, F. V., Rautio, D., Enander, J., Rück, C., Lichtenstein, P., Lundström, S., Larsson, H., Eley, T. C., & Mataix-Cols, D. (2020). The association between body dysmorphic symptoms and suicidality among adolescents and young adults: A genetically informative study. Psychological Medicine, 52(7), 1–9. https://doi.org/10.1017/s0033291720002998
  44. Kuck, N., Cafitz, L., Bürkner, P.-C., Hoppen, L., Wilhelm, S., & Buhlmann, U. (2021). Body dysmorphic disorder and self-esteem: A meta-analysis. BMC Psychiatry, 21(1). https://doi.org/10.1186/s12888-021-03185-3
  45. Loewen, Á., Blasco-Fontecilla, H., Li, C., Bella-Fernández, M., & Ruiz-Antorán, B. (2024). Prevalence of body dysmorphic disorder in the Spanish population: Cross-Sectional web-based questionnaire study. JMIR Formative Research, 8, e46515–e46515. https://doi.org/10.2196/46515
  46. Longo, M. R. (2015). Implicit and explicit body representations. European Psychologist, 20(1), 6–15. https://doi.org/10.1027/1016-9040/a000198
  47. Lox, C. L., Martin Ginis, K. A., Gainforth, H. L., & Petruzzello, S. J. (2019). The psychology of exercise: Integrating theory and practice (5th ed.). Routledge. https://doi.org/10.4324/9780429287480
  48. Nguyen, N. (2023). Exercise and health: Examination of the relationship between gym attendance, mental health, and perceptions of body image. Psi Beta Research Journal Brief Reports, 3(1), 44–49. https://doi.org/10.54581/iyox4962
  49. Mayo Clinic (2022, December 13). Body dysmorphic disorder - Diagnosis and treatment https://www.mayoclinic.org/diseases-conditions/body-dysmorphic-disorder/diagnosis-treatment/drc-20353944
  50. Meyer, C., Petróczi, A., Demetrovics, Z., Szabo, A., & Griffiths, M. D. (2021). The comorbidity of exercise addiction with depressive, personality, and obsessive-compulsive disorders: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 18(2), 553. https://doi.org/10.3390/ijerph18020553
  51. O’Dea, J. A. (2012). Body image and self-esteem. In T. Cash (Ed.), Encyclopedia of Body Image and Human Appearance (pp. 141–147). Elsevier Inc. https://doi.org/10.1016/b978-0-12-384925-0.00021-3
  52. O’Gorman, B., Sheffield, J., Clarke, R., & Griffiths, S. (2019). “Guys don’t talk about their bodies”: A qualitative investigation of male body dissatisfaction and sociocultural influences in a sample of 40 Australian males. Clinical Psychologist, 24(2). https://doi.org/10.1111/cp.12198
  53. Olave, L., Estévez, A., Momeñe, J., Muñoz-Navarro, R., Gómez-Romero, M. J., Boticario, M. J., & Iruarrizaga, I. (2021). Exercise addiction and muscle dysmorphia: The role of emotional dependence and attachment. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.681808
  54. Oliveira, D. V. de, Freire, G. L. M., Souza, M. F. de, Xavier, S. E. da S., Moraes, J. F. V. N. de, & Nascimento Júnior, J. R. A. do. (2023). Comparison of the indicative of muscle dysmorphia among recreational and competitive Crossfit athletes. Revista Brasileira de Cineantropometria & Desempenho Humano, 25, e84948. https://doi.org/10.1590/1980-0037.2023v25e84948
  55. Orenstein, G., & Lewis, L. (2022, November 7). Erikson’s stages of psychosocial development. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556096/
  56. Ouyang, Y., Wang, K., Zhang, T., Peng, L., Song, G., & Luo, J. (2020). The influence of sports participation on body image, self-efficacy, and self-esteem in college students. Frontiers in Psychology, 10(1). https://doi.org/10.3389/fpsyg.2019.03039
  57. Panão, I., & Carraça, E. V. (2019). Effects of exercise motivations on body image and eating habits/behaviours: A systematic review. Nutrition & Dietetics, 77(1), 41–59. https://doi.org/10.1111/1747-0080.12575
  58. Phillips, K. (n.d.). Prevalence of BDD. International OCD Foundation. https://bdd.iocdf.org/professionals/prevalence/
  59. Reynolds, K. A., Plateau, C. R., & Haycraft, E. (2023). Sociocultural influences on compulsive exercise in young people: A systematic review. Adolescent Research Review, 8, 179–194. https://doi.org/10.1007/s40894-022-00180-x
  60. Rice, K., Prichard, I., Tiggemann, M., & Slater, A. (2016). Exposure to barbie: Effects on thin-ideal internalisation, body esteem, and body dissatisfaction among young girls. Body Image, 19, 142–149.
  61. Roberts, S. R., Maheux, A. J., Ladd, B. A., & Choukas-Bradley, S. (2022). The role of digital media in adolescents’ body image and disordered eating. In J. Nesi, E. H. Telzer, & M. J. Prinstein (Eds.), Handbook of Adolescent Digital Media Use and Mental Health (pp. 242–263). Cambridge University Press. https://doi.org/10.1017/9781108976237.014
  62. Rodrigues, D., & Rodrigues, S. (2022). To look like superman: Male body dysmorphia. Sciential - McMaster Undergraduate Science Journal, 8, 39–43. https://doi.org/10.15173/sciential.vi8.3036
  63. Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328–335. https://doi.org/10.1177/109019817400200403
  64. Rote, A. E., Swartz, A. M., & Klos, L. A. (2013). Associations between lifestyle physical activity and body image attitudes among women. Women & Health, 53(3), 282–297. https://doi.org/10.1080/03630242.2013.773956
  65. SantaBarbara, N. J., Nosrat, S., Whitworth, J. W., & Ciccolo, J. T. (2023). Acute psychological effects of resistance exercise in men with symptoms of muscle dysmorphia. Journal of Strength and Conditioning Research, 37(2), 277–283. https://doi.org/10.1519/jsc.0000000000003615
  66. Schaefer, L. M., & Thompson, J. K. (2014). The development and validation of the Physical Appearance Comparison Scale‑Revised (PACS‑R). Eating Behaviors, 15(2), 209–217. https://doi.org/10.1016/j.eatbeh.2014.01.001
  67. Silva, R. C., & Steins, G. (2023). Social media and body dissatisfaction in young adults: An experimental investigation of the effects of different image content and influencing constructs. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1037932
  68. Smith, P. J., & Merwin, R. M. (2021). The role of exercise in management of mental health disorders: An integrative review. Annual Review of Medicine, 72(1), 45–62. https://doi.org/10.1146/annurev-med-060619-022943
  69. Soler, P. T., Novaes, J., & Miguel Fernandes, H. (2018). Influencing factors of social anxiety disorder and body dysmorphic disorder in a nonclinical Brazilian population. Psychological Reports, 122(6), 2155–2177. https://doi.org/10.1177/0033294118805003
  70. Szabo, A. (1995). The impact of exercise deprivation on well-being of habitual exercises. Australian Journal of Science and Medicine in Sport, 27(3), 68–75.
  71. Tiggemann, M., & McCourt, A. (2013). Body appreciation in adult women: Relationships with age and body satisfaction. Body Image, 10(4), 624–627. https://doi.org/10.1016/j.bodyim.2013.07.003
  72. Veale, D., & Singh, A. R. (2019). Understanding and treating body dysmorphic disorder. Indian Journal of Psychiatry, 61(7), 131–135. https://doi.org/10.4103/psychiatry.indianjpsychiatry_528_18
  73. Weinstein, A., & Szabo, A. (2023). Exercise addiction: A narrative overview of research issues. Dialogues in Clinical Neuroscience, 25(1), 1–13. https://doi.org/10.1080/19585969.2023.2164841
  74. Westberg, K. H., Nyholm, M., Nygren, J. M., & Svedberg, P. (2022). Mental health problems among young people—a scoping review of help-seeking. International Journal of Environmental Research and Public Health, 19(3), 1430. https://doi.org/10.3390/ijerph19031430
  75. Xie, Z. (2024). The influence of social media on perception of body image and beauty standards on young people. Transactions on Social Science, Education and Humanities Research, 5, 143–148. https://doi.org/10.62051/67rvhh97
  76. Yeung, O., & Johnston, K. (2019). The physical activity economy in Asia: Market size, participation, barriers, and options to increase movement (Background Paper prepared for the Asian Development Outlook 2020 Update: Wellness in Worrying Times). Asian Development Bank. https://www.adb.org/sites/default/files/institutional-document/633886/adou2020bp-physical-activity-economy-asia.pdf.
  77. Zheng, Y., Zhang, L., Shao, P., & Guo, X. (2021). The association of muscle dysmorphia, social physique anxiety, and body checking behavior in male college students with weight exercise. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.726032