Abstract Background Muscularity-oriented disordered eating (MODE) refers to eating behaviors that focus on muscularity rather than thinness. To assess this construct, the Muscularity-Oriented Eating Test (MOET) was developed and validated in several languages. This study aimed to translate and validate a German version of the MOET and to examine its factor structure and psychometric properties in physically active men and women. Methods A total of 5,991 participants (5,556 women, 435 men) were recruited via Instagram followers of German-speaking fitness influencers. Demographic, exercise, and questionnaire data were collected. Factor structure was examined using exploratory and confirmatory factor analyses. Measurement invariance across gender, internal consistency, and convergent validity with related constructs were also assessed. Results Among the previously proposed models, the original 15-item one-factor model showed acceptable fit in women but not in men, whereas the 12-item one-factor model showed acceptable fit in both gender groups. Allowing correlated residuals between theoretically related items further improved fit for these models. Exploratory analyses identified alternative solutions, including a 6-item one-factor model with good fit in both men and women. This model also demonstrated partial measurement invariance across gender. Across model versions, internal consistency was acceptable to good, and MOET scores showed positive associations with thinness-oriented eating pathology and muscle dysmorphia symptoms. Conclusions The findings suggest that the German MOET is a useful instrument for assessing MODE. At the same time, the highly fitness-oriented composition of our sample may have contributed to the differences between our findings and those of previous validation studies. Further research in other populations, including clinical samples, is needed to further validate the assessment of MODE.

Social media platforms increasingly struggle to detect harmful content that promotes muscle dysmorphic behaviors, particularly pro-bigorexia content that disproportionately affects adolescent males. Unlike traditional eating disorder detection focused on the "thin ideal," pro-bigorexia material masquerades as legitimate fitness content through complex multimodal combinations of visual displays, coded language, and motivational messaging that evade text-based detection systems. We address this challenge by developing BigTokDetect, a clinically-informed detection framework for identifying pro-bigorexia content on TikTok. We introduce BigTok, the first expert-annotated multimodal dataset of over 2,200 TikTok videos labeled by clinical psychologists and psychiatrists across five primary categories spanning body image, nutrition, exercise, supplements, and masculinity. Through a comprehensive evaluation of state-of-the-art vision language models, we achieve 82.9

Across species, stress drives alterations in feeding behaviour, including heightened food-seeking and the overconsumption of palatable foods. The bed nucleus of the stria terminalis (BNST) acts as a neural hub linking stress and reward circuits. However, its role in human food cue and taste processing under stress remains unclear. Here, using 7-Tesla fMRI, dynamic causal modelling and in-scanner taste delivery, we demonstrate that beverage cues and taste receipt under stress modulate BNST effective connectivity. Forty-eight participants were presented a palatable and neutral beverage cue before receiving the corresponding beverages under low- and high-stress conditions. Beverage cues under stress downregulated BNST effective connectivity to the nucleus accumbens, orbitofrontal cortex, and dorsal mid-insula (dmINS), with the strength of cue-related downregulation of BNST-to-orbitofrontal effective connectivity related to changes in participants' subjective stress. In addition, taste receipt under stress downregulated effective connectivity from the dmINS to BNST. These findings provide evidence that stress-related food cue and taste processing modulates BNST reward circuitry, offering a mechanistic perspective on how stress alters responsivity to food cues.

Appetitive conditioning—the process by which neutral cues acquire positive value through repeated pairing with rewards—is fundamental to adaptive behaviour. Disturbances in this process may contribute to psychiatric symptoms, yet unlike fear conditioning, it has been relatively underexplored in clinical populations. We systematically reviewed PubMed, Embase/MEDLINE, and PsycINFO (August 2025) for studies examining appetitive conditioning in psychiatric disorders. Of 7077 records, only five met inclusion criteria,: two on ADHD, two on compulsive sexual behaviour, and one on major depressive disorder. Patients demonstrated differences in reward-related neural and behavioural responses compared with controls, including reduced striatal activation during reward anticipation and heightened responses to reward receipt in ADHD, increased amygdala activation and disrupted striatal–prefrontal connectivity in compulsive sexual behaviour, and impaired probabilistic reward learning and decision-making in depression. None of the studies directly assessed de novo appetitive learning; instead, appetitive conditioning was employed as a preliminary paradigm to probe downstream reward processes. Thus, it remains unclear whether, or which, psychiatric disorders involve abnormalities in the formation of conditioned reward associations. Future controlled experiments that explicitly and directly test the learning processes associated with appetitive conditioning are needed to clarify its role in psychopathology and its potential as a target for intervention.

Body image concerns among boys and young men are increasingly oriented toward muscularity, with social media serving as a central context for communicating and evaluating these ideals. While prior research has focused on the thin-ideal, less is known about how the muscular-ideal is represented and reinforced on visual social media platforms. This study examines (1) dominant content themes, (2) perceived harm to body image, and (3) engagement patterns across #GymTok, a muscularity-oriented fitness subculture on TikTok. We conducted a content analysis of 2,210 #GymTok videos annotated by clinical experts across themes like self-objectification, rigid dieting, excessive exercise, supplement and steroid use, and masculinity. Annotators also rated the perceived harm of videos to the viewers' body image, and depicted bodies were coded according to muscularity level. Perceived harm varied across content themes, with supplement- and steroid-related content rated as most harmful. Engagement was positively associated with both muscularity and perceived harm: videos depicting more muscular bodies and those rated as more harmful received greater views, likes, shares, and comments. Although less prevalent, masculinity-focused content generated the highest engagement. These findings suggest that TikTok may not only expose users to muscular ideals and potentially harmful behaviors, but also algorithmically amplify them. By increasing the visibility of highly muscular and harmful content, recommendation systems may intensify social comparison processes, while objectification elevates the muscular body into a marker of status, masculinity, and social worth. Together, these dynamics may contribute to body image risk among boys and young men.

The pervasive expectations about ideal body types in Western society can lead to body image concerns, dissatisfaction, and in extreme cases, eating disorders and other psychopathologies related to body image. While previous research has focused on online pro-anorexia communities glorifying the "thin ideal", less attention has been given to the broader spectrum of body image concerns or how emerging disorders like muscle dysmorphia ("bigorexia") present in online platforms. To address this gap, we analyze 46 Reddit forums related to diet, fitness, and mental health. We mapped these communities along gender and body ideal dimensions, revealing distinct patterns of emotional expression and community support. Feminine-oriented communities, especially those endorsing the thin ideal, expressed higher levels of negative emotions and received caring comments in response. In contrast, muscular ideal communities displayed less negativity, regardless of gender orientation, but received aggressive compliments in response, marked by admiration and toxicity. Mental health discussions aligned more with thin ideal, feminine-leaning spaces. By uncovering these gendered emotional dynamics, our findings can inform the development of moderation strategies that foster supportive interactions while reducing exposure to harmful content.

Video gaming is highly prevalent in adolescence, yet its relationship with cortical morphology in early adolescence remains unclear. Data from the large, diverse nationwide Adolescent Brain and Cognitive Development Study cohort (N=5,686) were analyzed to investigate the association between video gaming behaviors and cortical morphology in adolescents. Adolescents (mean: 14.2 years old) reported time spent playing single and multi-player games each day and their frequency of playing mature-rated games. Measures of cortical volume, surface area, and thickness of regions defined by the Desikan-Killiany atlas were obtained from 3T MRI scanners. Generalized additive mixed effects models were used to evaluate the association between gaming behaviors and cortical morphology, adjusting for demographics, genetic ancestry, socioeconomic status, non-gaming screen time, pubertal stage, body mass index percentile, scanner characteristics, and familial relationships. In addition to regional analysis, vertexwise analysis was performed using the Fast and Efficient Mixed Effects Algorithm, which provides higher spatial resolution. Higher total gaming time was associated with lower cortical surface area and thickness across multiple regions. Single-player but not multi-player gaming was associated with altered morphology regions involved in language processing and social cognition, which may be due to the different processes engaged by each game type. Mature-rated gaming frequency was also associated with lower cortical thickness in several regions and lower surface area in the right parahippocampal gyrus. Our results demonstrate that different gaming behaviors are associated with distinct patterns of cortical morphology. Decreases in cortical surface area and thickness are a normative feature of adolescent development, and future research on long-term outcomes is required to determine whether these differences reflect variation outside of normative developmental trajectories and the directionality of this association.

Individuals with Muscle Dysmorphia (MD) exhibit a high drive for muscularity and muscularity-oriented eating behavior. Sexual minorities are also vulnerable to disturbances in body image and eating behavior; however, research on MD in sexual minority women is scarce. Therefore, the present study aimed to propose and evaluate an exploratory theoretical model of MD in Brazilian cisgender lesbian and bisexual women that includes sociodemographic variables (sexual orientation, skin color, BMI, and age), drive for muscularity, and muscularity-oriented eating behaviors. The study included 1131 participants aged 18-50. Structural equation modeling indicated that drive for muscularity and muscularity-oriented eating behaviors were associated with different dimensions of MD symptoms. However, sexual orientation and skin color were not associated with muscularity-related dimensions among lesbians and bisexual women. Younger women were more vulnerable to muscularity-related issues, and BMI had varying associations depending on the construct analyzed. Overall, drive for muscularity and muscularity-oriented eating behaviors were interrelated with MD symptoms in cisgender lesbian and bisexual women. The final refined model demonstrated good fit: χ²(1010) = 8287.982, p < .001; χ²/df = 8.24; CFI = .949; TLI = .954; RMSEA = .080 [90% CI = .078 -.081]. These findings emphasize the importance of assessing drive for muscularity and muscularity-oriented eating behaviors as targets for screening, prevention, and intervention in health care settings.

PurposeSorority members and sexual minority (SM) women engage in high rates of alcohol consumption and risky drinking in the college environment. Little is known of the alcohol use behaviors of SM sorority members, who may be especially at-risk. This paper aims to not only further investigate SM undergraduate women's alcohol use broadly but also to understand how sorority affiliation may potentially impact their use patterns.Design/methodology/approachParticipants included 30,036 (20.7% SM) cisgender undergraduate student women aged 18-23 from the 2018-2019 Healthy Minds Study cohort. Logistic regression models were used to identify group differences in any past two-week drinking and binge drinking. Interaction terms investigated the potential moderation effect between sorority affiliation and sexual orientation on the two drinking outcomes.FindingsSorority affiliation significantly predicted both past two-week drinking outcomes. Heterosexual, lesbian and "other" SM students were less likely than bisexual students to endorse any past two-week drinking and binge drinking. Sorority affiliation moderated the association between sexual orientation and binge drinking, such that heterosexual sorority women were at the greatest risk.Originality/valueThis research supports emerging findings regarding bisexual undergraduate women's heightened risk for hazardous alcohol use. Furthermore, this work tested a novel hypothesis regarding the drinking behaviors among SM sorority members, a group that has received limited attention despite potential for more negative health outcomes. Future research is needed to understand the experiences of both sorority and non-sorority SM undergraduate women and develop interventions that target their unique vulnerabilities.

BACKGROUND:Emotional difficulties are common among individuals with Eating Disorders (EDs). Following Panksepp's theoretical model, which conceptualises primary emotional systems as the evolutionary foundation of personality, this study aimed to identify distinct profiles of primary emotional systems within a clinical eating disorder (ED) sample. It further examined differences in sociodemographic, clinical, and psychopathological characteristics across profiles, as well as associations between clinical features and profile membership. METHODS:In this cross-sectional study, data were obtained from the Regional Centre for ED registry at the University Hospital of Verona. Measures included the Affective Neuroscience Personality scales, the Eating Disorder Examination, the Symptom CheckList-90-Revised, the Life Stressor Checklist-Revised, and the Impact of Event Scale-Revised. A Latent Profile Analysis was conducted, followed by inferential analyses. RESULTS:Among 122 patients, three profiles emerged: (1) high FEAR and SADNESS, and low SEEKING and PLAY; (2) low negative primary emotional systems and CARE; (3) high positive primary emotional systems and high SADNESS and ANGER. Profiles differed by age, sex, illness duration, trauma burden, depressive-anxiety symptoms, and ED severity. DISCUSSION:Findings revealed emotional heterogeneity among ED patients, underscoring the importance of considering individual emotional differences in treatment planning. Study limitations and directions for future research are discussed.

Many adolescents initiate social media use during early adolescence, but the associations of early social media use with neurodevelopment have not been extensively studied. We utilized neuroimaging data from the U.S. Adolescent Brain Cognitive Development (ABCD) Study to investigate the association of social media use (hours per day) or social media addiction (Social Media Addiction Questionnaire) with brain morphology in early adolescence. We analyzed data from 7,614 participants with high-quality structural MRI and complete covariate data at Year 2 (2018-2020, ages 10-13). In addition to pre-defined cortical regions, we performed vertexwise analysis using the Fast and Efficient Mixed Effects Algorithm (FEMA), which is unbiased by arbitrary borders between atlas-based brain regions and provides higher spatial resolution. After adjusting for demographics, socioeconomic factors, genetic ancestry, non-social media screen time, and scanner features, higher average daily social media use was significantly associated with lower total cortical thickness and volume. Region-of-interest (ROI) and vertexwise analysis identified broad regions with lower cortical thickness across the prefrontal cortices, temporal lobe, occipital lobe, and parietal lobe associated with social media use and social media addiction, which overlap with key nodes of the default mode network, prefrontal executive control networks, and visual processing and attention networks. Social media addiction was not significantly associated with differences in brain morphology in ROI analysis. Our findings in a large nationwide population demonstrate that higher social media use is associated with variation in cortical morphology, but future studies are required to establish the directionality of this association.

Body image concerns among adolescent boys and young men are increasingly recognised as societal ideals shift towards a lean, muscular physique. In severe cases, these pressures can lead to muscle dysmorphia, a specifier of body dysmorphic disorder marked by preoccupation with being too small or insufficiently muscular. Adolescents and young adults are developmentally vulnerable and might be at higher risk for a variety of eating-related and body image-related concerns, including muscle dysmorphia. This narrative Review synthesises current evidence on the epidemiology, assessment, and treatment of muscle dysmorphia in adolescents and young adults to guide clinicians. Although some treatment approaches show promise, outcome data in large, diverse, clinical adolescent samples remain scarce. Muscle dysmorphia-specific preventive strategies are few, although eating disorder prevention programmes show potential for reducing muscle dysmorphia symptoms. Future research should investigate pharmacotherapy and prevention programmes, validate assessment tools across populations, and examine cultural influences internationally. Advancing understanding of muscle dysmorphia will better equip clinicians to identify and address symptoms in adolescents and young adults.

OBJECTIVE:Telehealth services have become part of many eating disorder (ED) treatment settings; yet, few studies have examined the effectiveness of family-based treatment (FBT) delivered via telehealth. This study compared in-person and telehealth FBT in rates of weight restoration, treatment completion, and metrics of treatment progress, and explored potential moderators of these outcomes. METHOD:Retrospective chart review identified 169 adolescents (10-18 years) with restrictive EDs who received FBT in person before the COVID-19 pandemic (n = 92) or via telehealth during the pandemic (n = 77). Regression models examined the effect of FBT format, controlling for baseline percent of expected body weight (%EBW). Zip code-based geospatial analyses compared the distance each format reached. RESULTS:Treatment format (in-person versus telehealth) did not predict whether patients were weight restored to ≥ 95% of EBW at the end of treatment (OR = 0.74) or completed treatment (ORs = 0.53-1.74). Older age predicted lower odds of treatment completion among in-person but not telehealth patients; there was no moderating effect of age on weight restoration or of baseline %EBW on either outcome. Patients who received FBT via telehealth were less likely to be early responders (i.e., gained 2.3 kg by session four; OR = 0.33). FBT format did not predict the number of sessions to 95% EBW (f 2 = 0.01), hospitalization frequency, or distance reached (d = 0.27). DISCUSSION:Results suggest no significant differences between telehealth and in-person FBT in restoring weight or preventing hospitalization for adolescents with restrictive EDs, and support continued use of telehealth FBT to improve treatment accessibility and scalability. Additional research using a randomized design and ED psychopathology measures is needed.

Muscle dysmorphia is a mental health condition that often requires psychotherapy to improve prognosis. To date, a dearth of literature has examined whether people with muscle dysmorphia utilize mental health treatment and how self-stigma around seeking psychological help impacts treatment utilization. Using data from an international sample of boys and men (N = 1,553), this study aimed to determine the association between possible muscle dysmorphia, self-stigma of seeking psychological help, and current mental health treatment. Analyses were also conducted to determine whether self-stigma of seeking psychological help attenuated the association between possible muscle dysmorphia and currently being in mental health treatment. Results from regression analyses revealed that those with possible muscle dysmorphia endorsed significantly higher self-stigma of seeking psychological help and significantly lower odds of being currently in mental health treatment. Self-stigma of seeking psychological help attenuated the association between those with possible muscle dysmorphia and currently being in mental health treatment. These findings provide preliminary evidence that self-stigma of seeking psychological help may attenuate mental health treatment utilization among boys and men with possible muscle dysmorphia. Greater health care and public health efforts are needed to increase awareness of muscle dysmorphia and muscularity-related concerns and behaviors to reduce stigma.

There is a continued need to identify the prevalence and sociodemographic correlates of eating disorders, particularly among the under-researched group of boys and men, to inform prevention and intervention efforts. Data from The Study of Boys and Men, a sample of 1553 boys and men aged between 15 and 35 years in Canada and the United States, were analyzed in 2024. Probable eating disorder diagnoses were identified using a previously established algorithm based on current diagnostic criteria. A multivariable logistic regression analysis was used to determine the sociodemographic correlates of meeting the criteria for any probable eating disorder diagnosis. The prevalence of meeting the criteria for any probable eating disorder diagnosis was 21.3 % (95 % confidence interval [CI] 18.7-24.1), while meeting criteria for a probable bulimia nervosa diagnosis had the highest prevalence (5.8 %, 95 % CI 4.6-7.1) and anorexia nervosa had the lowest prevalence (0.34 %, 95 % CI 0.1-0.8). Boys and men who identified as gay (adjusted odds ratio [AOR] 2.28, 95 % CI 1.35-3.85) or bisexual (AOR 2.22, 95 % CI 1.23-3.99) had higher odds of meeting criteria for any probable eating disorder diagnosis, compared to those who did not. Finally, boys and men who had a higher body mass index (BMI) (AOR 1.18, 95 % CI 1.14-1.23) had greater odds of meeting criteria for any probable eating disorder diagnosis. Findings add to the growing understanding of eating disorders among boys and men. Targeted and tailored prevention and intervention programming is needed for sexual minority boys and men, and those with higher BMIs.

Muscle dysmorphia is a significant mental health condition that has been under-researched in epidemiological, community-based studies. Therefore, this study aimed to identify the prevalence and correlates of probable muscle dysmorphia among a sample of Canadian (n = 784) and American (n = 563) boys and men ages 15–35 years. The sample comprised 1,488 boys and men who completed a variety of measures and items to capture sociodemographic characteristics and muscle dysmorphia symptoms. Diagnostic criteria were applied to identify probable muscle dysmorphia among the sample. Unadjusted (e.g., chi-square tests, independent samples t-tests) and adjusted (e.g., logistic regression) analyses were used to determine the sociodemographic factors (e.g., age, body mass index, gender, race/ethnicity, sexual orientation, education, relationship status, and country) associated with cases of probable muscle dysmorphia. The prevalence of probable muscle dysmorphia was 2.8

This study aimed to determine whether the internalization of body ideals and sociocultural pressures to adhere to body ideals are associated with a greater likelihood of having probable muscle dysmorphia. Cross-sectional data from 1553 boys and men ages 15-35 from Canada and the United States were used. Multiple logistic regression analyses determined the association between the internalization of three body ideals, sociocultural pressures to adhere to body ideals from four sources, and having probable muscle dysmorphia. The odds of having probable muscle dysmorphia were significantly greater for those who internalized the muscular ideal and general attractiveness ideal. Conversely, endorsing the thin/low body fat ideal was significantly associated with lower odds of having probable muscle dysmorphia. Pressure from peers, but no other sources, showed a significant association with greater odds of having probable muscle dysmorphia. Findings expand prior research by investigating correlates of muscle dysmorphia versus muscle dysmorphia symptomatology. The strong association with internalization of the general attractiveness ideal provides new insights into how overall appearance may be highly relevant for boys and men with muscle dysmorphia, warranting future investigation.

This study investigated the association between muscle-building supplement use and muscle dysmorphia symptomatology among Canadian adolescents and young adults. Data from the Canadian Study of Adolescent Health Behaviors (N = 2,731) were analyzed. Multiple linear and logistic regression analyses were used to assess the association between six commonly used muscle-building supplements (e.g., amino acids/branched-chain amino acids, creatine monohydrate, pre-workout drinks or powders, protein bars, weight/mass gainers, and whey protein shakes or powders), and an aggregated sum score of muscle-building supplements used, and muscle dysmorphia symptomatology (measured using the Muscle Dysmorphic Disorder Inventory [MDDI]), including scoring above the clinical cut-off (≥ 40 on the MDDI). The mean age of the sample was 22.9 years ( SD = 3.9), 54.3% identified as a cisgender girl or woman, 62.4% identified as white, and 58.8% identified as heterosexual. Findings revealed that use of all six muscle-building supplements, and using a greater number of muscle-building supplements, were associated with greater total muscle dysmorphia symptomatology, as well as greater odds of meeting the clinical cut-off for muscle dysmorphia. These findings add to a growing body of literature on the association between muscle-building supplement use and muscle dysmorphia symptomatology by including multiple muscle-building supplements and utilizing a diverse, national sample of adolescents and young adults. Findings warrant further investigation and the development of intervention strategies to decrease the use of increasingly normalized muscle-building supplements and muscle dysmorphia symptomatology.

BACKGROUND:Simultaneous alcohol and marijuana use (SAM) and food restriction on days students intend to drink are associated with an increased risk of substance use-related consequences. However, these negative outcomes have been studied mostly in alcohol-only use contexts. Little is known about the combination of alcohol, marijuana, SAM, and food restriction. Therefore, the current cross-sectional study investigated whether alcohol, marijuana, or SAM use and food restriction on substance use days were associated with an increased risk of negative substance-use outcomes. METHOD:901 college students completed a survey about their substance use and eating behaviors. Hierarchical regression analyses tested the relations between these patterns and use-related consequences. RESULTS:Among past 30-day alcohol users, alcohol use quantity and food restriction on substance use days independently associated with greater alcohol use consequences. Past 30-day frequency of food restriction on alcohol use days moderated the effect between average drink quantity and alcohol use consequences. Among past 30-day marijuana users, number of hours high and food restriction on use days independently associated with greater marijuana use consequences. For past 30-day SAM users, alcohol use quantity on SAM days significantly associated with greater alcohol consequences. Food restriction on SAM days moderated the effect of marijuana use quantity (i.e., number of times used) on marijuana use consequences. CONCLUSIONS:These results provide the basis for further exploration of food restriction and SAM, as well as targeted interventions among at-risk populations.