Validation of the Arabic version of the Muscle Dysmorphic Disorder Inventory (Ar-MDDI) among Lebanese male university students

Abstract

Background To date, the vast majority of research on disordered eating symptomatology and body image disturbances from the Arab world have been performed exclusively among women; and mainly used thinness-oriented measures that are not sensitive to detect muscularity-oriented symptoms, which are more evident in males. Therefore, the objective of our study was to validate the Arabic version of the Muscle Dysmorphic Disorder Inventory (Ar-MDDI), in order to make it accessible for Arabic-speaking populations. Methods Using a snowball sampling technique, men university students (n = 396) from multiple universities in Lebanon filled the survey in this cross-sectional designed study (January–May 2022). A soft copy of the questionnaire was created using google forms software, and sent to participants through the different social media platforms such as Facebook, Instagram, and WhatsApp. We used the Muscle Dysmorphic Disorder Inventory to assess Muscle Dysmorphia, along with the Big Three Perfectionism Scale to assess perfectionism and Eating Attitude Test (EAT) to evaluate the inappropriate eating attitudes. To explore the factor structure of Ar-MDDI, we computed a principal-axis Exploratory Factor Analysis (EFA) with the first split-half subsample using the FACTOR software. We used data from the second split-half to conduct a Confirmatory Factor Analysis (CFA) using the SPSS AMOS v.29 software. Pearson correlation test was used to test the convergent and divergent validity of the Ar-MDDI scale with the other scores included in the study. Results The results of the EFA revealed three factors, which explained 57.68% of the common variance: Factor 1 = Appearance intolerance, Factor 2 = Drive for size, and Factor 3 = Functional impairment. The CFA fit indices of the three-factor model of the Ar-MDDI scale showed good results. Moreover, 254 (64.1%) of the participants had inappropriate eating attitudes (EAT scores ≥ 20). Indices suggested that configural, metric, and scalar invariance was supported according to eating attitudes. No significant difference between participants with appropriate versus inappropriate eating attitudes in terms of functional impairment, drive for size and appearance intolerance. Perfectionism scores correlated positively with the Ar-MDDI, which suggests divergent validity. Conclusion Our findings revealed that the validation of the Arabic scale yielded excellent properties, preliminarily supporting its use for the assessment of muscle dysmorphia among Arabic-speaking university men. This would hopefully allow for its timely detection and management in Arab clinical settings and encourage cross-cultural research on this topic.

Psychometric properties of the Arabic versions of the Three-Item Short Form of the modified Weight Bias Internalization Scale (WBIS-3) and the Muscularity Bias Internalization Scale (MBIS)

“…Validated in the Arabic language [ 47 ], the results of the EFA revealed three factors (Appearance intolerance, Drive for size, and Functional impairment) with a Cronbach’s alpha of 0.81. This scale is composed of 13 items, scored on a five-point Likert-type scale (0 = never to 4 = always) [ 58 ].…”

“…Despite these facts, most of the limited existing research on eating disorders symptomatology, body image disturbances and related problems emerging from the Arab world has traditionally focused on females [ 43 ], and has long suffered from a lack of validated instruments [ 34 ]. The few scales available are thinness-oriented (e.g., [ 44 – 46 ]); and it is only recently that a muscularity-oriented scale has been validated (i.e., [ 47 ]). No scales on weight- or muscularity-related stigmatizing beliefs exist to our knowledge.…”

Psychometric properties of an Arabic translation of the short 9-item drive for muscularity scale (DMS-9)

“…Validated in the Arabic language [ 66 ], this scale is composed of 13 items, scored on a five-point Likert-type scale (0 = never to 4 = always) (score range 0–42) [ 67 ]. In the present study, McDonald’s ω was 0.88 in the total sample.…”

“…Available instruments in the Arabic language are rather thinness-focused, such as the Eating Attitude Test [ 49 , 50 ], the Eating disorder examination questionnaire [ 51 , 52 ], the Inflexible Eating Questionnaire (IEQ) [ 53 ], the Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) [ 54 ], the Intuitive Eating Scale [ 55 ], and the Eating Disorder Inventory [ 56 , 57 ]. The only muscularity-specific measure that has recently been validated in Arabic is the Muscle Dysmorphic Disorder Inventory [ 58 ]. In addition, studies on body dissatisfaction involving Arab men samples are scarce, with a great majority of research having been performed among women [ 59 ], and having used “non-validated assessment tools” [ 60 ].…”