Psychometric Assessment of Muscle Dysmorphia in Men: A Systematic Review of Existing Instruments and their Applicability to Pakistani Populations

Abstract

Muscle dysmorphia (MD) is a male-predominant body image disorder characterized by a pathological preoccupation with perceived muscular inadequacy. While extensively researched in Western contexts, culturally validated psychometric instruments for South Asian populations are lacking. Following PRISMA guidelines, this systematic review evaluated existing MD assessment tools published between January 2000 and December 2024 across PubMed, PsycINFO, Scopus, Web of Science, and Google Scholar. Twenty-one studies evaluating four primary scales—the Muscle Dysmorphic Disorder Inventory (MDDI), Drive for Muscularity Scale (DMS), Muscle Appearance Satisfaction Scale (MASS), and Muscle Dysmorphia Questionnaire (MDQ)—were analyzed using the COSMIN checklist. Although these instruments demonstrate acceptable reliability and validity in Western samples, none have been psychometrically validated or culturally adapted for Pakistani or broader South Asian men. Key dimensions such as collectivistic masculinity norms, family expectations, religious or dietary beliefs, and local gym cultures are omitted, highlighting significant cross-cultural measurement biases.