Body Image Dissatisfaction vs Muscle Dysmorphia

We have read with interest the article entitled "The misuse of anabolic-androgenic steroids among Iranian recreational male body-builders and their relation with psycological, social and demographic factors" (1). Although the obtained results were enriching for the understanding of the problem in Iran, like the authors, we also believe that a more adecuate questionnaire could be used instead of the Multidimensional BodySelf Relations Questionnaire-Appearance (MBSRQ-AS), wich is a scale that evaluates body image satisfaction in a general fashion. Body image is the set of perceptions and feelings about the own physical appearance, it is usually determined by body shape, size and attractiveness to other people (2, 3). The body image is ruled by these areas, which can vary widely from one individual to another. Thus, instruments evaluating this variable could probably not reveal potential specific distortions in male bodybuilders. We recommend the use of the Muscle Appeareance Satisfaction Scale (MASS), which is a more specific measure that assesses if the patient has symptoms of muscle dysmorphia (2). This is an obsessive compulsive condition characterized by the need for excesive physical activity and other behaviours in order to achieve an exaggerated musculature (4). The MASS is a 19-item five-point Likert-like scale that comprises five dimensions (Exercise Dependence, Checking, Substance Use, Physical Injury and Satisfaction with Self-Image) and shows good psychometric properties (4). It has been translated and validated in several languages like Chinese (5) and Spanish (6) as examples. Evaluating muscle dysmorphia would provide more relevant and specific results in bodybuilders because it is a recognized and established pathology. However, to ensure the measurement success and the understanding of the MASS scale, we recommend its validation in the local languages, like Persian in the case of Iran. Finally, the authors provided interesting results about the relation of body image in male bodybuilders with psycological, social and demographic factors. We think that the validation and utilization of the MASS when studying this population would offer valuable and more specific information to future studies.