Elevated symptoms of muscle dysmorphia and disordered eating among male gym-goers in Riyadh: a cross-sectional screening study

Abstract Background Muscle dysmorphia (MD) refers to distressing concerns about being insufficiently muscular and is increasingly reported among gym-going men. Evidence from Saudi Arabia is limited. This study estimated the proportion of gym-going men in Riyadh who screened positive for elevated MD symptomatology and examined associations with disordered eating symptoms and sociodemographic factors. Methods A cross-sectional survey was conducted among male gym-goers in Riyadh. Elevated MD symptomatology was assessed using the Muscle Dysmorphic Disorder Inventory (MDDI), and disordered eating symptoms were screened using the Patient Health Questionnaire–Eating Disorders Module (PHQ-ED). Group differences were examined using appropriate bivariate tests. A stepwise binary logistic regression model was used to identify predictors of screening-positive status for elevated MD symptomatology (MDDI ≥ 39). Results Of 303 participants, 49.8% screened positive for elevated MD symptomatology (MDDI ≥ 39). Screening-positive PHQ-ED status was associated with screening-positive MDDI status (Fisher’s exact test, p = 0.030). In the final stepwise multivariable model, marital status and graduate-level education were associated with screening-positive MDDI status. Body mass index (BMI) was not retained in the final stepwise model, and PHQ-ED status could not be evaluated in the multivariable model due to sparse data/complete separation (non-estimable odds ratios). Conclusions Nearly half of the surveyed gym-going men screened positive for elevated MD symptomatology, indicating a high symptom burden in this selected sample. These findings should not be interpreted as diagnostic prevalence. Screening-based approaches in gym settings may help identify individuals who report high distress or interference and may benefit from further clinical assessment. Larger studies using probability sampling and structured diagnostic interviews are needed to estimate diagnostic prevalence and clarify associated factors.