Steinfeld et al.

Journal of Eating Disorders (2020) 8:75

https://doi.org/10.1186/s40337-020-00345-w

RESEARCH ARTICLE Open Access

Development and initial psychometric

evaluation of the Body Image Matrix of
Thinness and Muscularity – Female Bodies
Beate Steinfeld* , Andrea S. Hartmann, Manuel Waldorf and Silja Vocks

Abstract
Background: Despite evidence that thinness and muscularity are part of the female body ideal, there is not yet a
reliable figure rating scale measuring the body image of women which includes both of these dimensions. To
overcome this shortcoming, the Body Image Matrix of Thinness and Muscularity - Female Bodies (BIMTM-FB) was
developed.
Methods: The objective of this study is to analyze the psychometric properties of this measure. N = 607 non-clinical
women and N = 32 women with eating disorders answered the BIMTM-FB as well as instruments assessing eating
disorder symptoms and body image disturbance in order to test the convergent validity of the BIMTM-FB. To assess
test-retest reliability, a two-week interval was determined.
Results: The results indicated that the body-fat dimension of the BIMTM-FB correlates significantly with the
Contour Drawing Rating-Scale, the Drive for Leanness Scale (DLS) and the Body Appreciation Scale, while the
muscularity dimension of the BIMTM-FB was significantly associated with the DLS and the Drive for Muscularity
Scale, proving the convergent validity of the BIMTM-FB. High coefficients of test-retest reliability were found.
Moreover, the BIMTM-FB differentiated between the clinical sample and the non-clinical controls.
Conclusions: The BIMTM-FB is a figure rating scale assessing both thinness and muscularity as part of the female
body ideal. Due to its high reliability and validity, the BIMTM-FB can be recommended in research and practice.
Keywords: Body image, Body fat, Eating disorders, Figure rating scale, Women, Muscularity

Plain English summery severely under- or overweight patients are able to iden-
The article introduces a new developed psychometric tify themselves with the figures. The application is quick
measure of the body image of females including both and almost language-free. In research and clinical prac-
thinness and muscularity (the BIMTM-FB). It assesses tice, the BIMTM-FB can assess women’s body image
women’s estimations of their actual, felt and ideal body. ideals, whether they meet their body image ideals, and
Pictures of realistic-looking standardized female bodies whether body ideals might be altered through thera-
are used as stimuli. They are varied systematically re- peutic interventions. Results indicate that women who
garding thinness, leanness and muscularity. The measure appreciate their own body tend to have a body ideal with
includes the extreme bodyshapes: very thin to very fat a higher body fat percentage. Furthermore, women with
and very unmuscular to very muscular. Thus also eating disorders compared to the non-clinical sample
showed a significant preference for severely underweight
* Correspondence: beate.steinfeld@uni-osnabrueck.de
bodies and are willing to spend significantly more time
Department of Clinical Psychology and Psychotherapy, Osnabrück University, and money in order to achieve their ideal body shape.
Knollstraße 15, 49088 Osnabrück, Germany

© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article are included in the article's Creative Commons
licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons
licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
data made available in this article, unless otherwise stated in a credit line to the data.
Steinfeld et al. Journal of Eating Disorders (2020) 8:75 Page 2 of 12

Background females’ bodies as more attractive when they are both

Body image is defined as the “picture we have in our thin and muscular as opposed to purely thin [18]. It
minds of the size, shape and form of our bodies; and our therefore appears that the traditional gender-specific
feelings concerning these characteristics …” ([1], p. 20). polarization in body image disturbance research –
Body image disturbance is associated with psychosocial reducing the female body ideal to the drive for thinness
impairment and is assumed to be a crucial factor in the [21] and the male body ideal to the drive for muscularity
development [2, 3], maintenance [4] and relapse [5] of [22, 23] – is obsolete. Smolak and Murnen [24] devel-
eating disorders and body dysmorphic disorder [6, 7]. oped the Drive for Leanness Scale and found that drive
Moreover, it is a core symptom of and diagnostic criter- for thinness, drive for leanness and drive for muscularity
ion for eating disorders [2, 4] and body dysmorphic dis- can be understood as distinct components of body
order [6, 7], as described in the DSM-5 [8]. image. Moreover, the authors reported that while
Body image disturbance is conceptualized as a multidi- women have a significantly lower ambition to be muscu-
mensional construct. Beyond body-related perceptions, lar compared to men, their desire to have an athletic
checking and avoidance behavior, it consists of thoughts, and toned body with physically fit muscles is as high as
feelings and attitudes related to physical aspects of one’s it is for men. Although Kelley et al. [25] found a signifi-
body [9]. The two basic body image-related attitudes are cantly lower drive for muscularity in women than in
body image evaluation and body image investment [10]. men, 54% of the female participants nevertheless showed
Body image evaluation refers to one’s beliefs about and an elevated drive for muscularity. Furthermore, the pres-
appraisal of one’s appearance, such as body satisfaction ence of both drive for thinness and drive for muscularity
or body dissatisfaction. Body image investment implies was correlated with a specific profile of psychological
the core affect-laden importance that individuals place risk factors, for instance regarding body compulsivity
on their appearance, and describes the degree to which and body anxiety, underscoring that muscularity is part
they define themselves and their self-worth based on of the body ideal of women as well [26, 27].
their appearance [11]. When assessing body image dis- In order to measure body image disturbance, besides
turbance, Cash [10] recommends that both body image self-rating scales, figure rating scales offer a complemen-
evaluation and body image investment are considered, in tary methodological approach [28–31]. Such scales con-
order to measure not only how people evaluate their sist of silhouettes, drawings or photographs of the
appearance, but also how important their looks are to human body that range from very thin to obese. In the
them and their self-confidence [10]. majority of studies employing such scales, participants
A positive body image cannot be equated with low are asked which figure most accurately represents their
values in body image disturbance (Tiggemann & current body size and which one represents their ideal
McCourt, 2013). Rather, a key characteristic of a positive body size. The difference between the current and the
body image appears to be body appreciation [12, 13], ideal size is called the self-ideal discrepancy [32] and can
which is defined as accepting and respecting one’s body be interpreted as a measure for body shape dissatisfac-
and holding favorable opinions toward it [14]. It is as- tion [33], thus quantifying body image evaluation [10].
sumed that body appreciation acts as a protective factor The advantage of figure rating scales lies in their ease
against sociocultural appearance pressures [13, 15]. This of use and their visual appeal [34]. Moreover, they can
functional quality of body appreciation was empirically be implemented as an almost nonverbal instrument and
supported in an experimental study by Halliwell (2013), can thus be applied transculturally as well as with
which indicated that body appreciation protected illiterate patients. As they only contain two or three
women from negative media exposure effects. Moreover, items, such scales are also very time- and cost-efficient.
Andrew et al. [16] found that in young women, greater The existing figure rating instruments differ with respect
body appreciation was related to lower internalization of to the quality of the images, i.e. silhouettes, pictures, or
societal ideals of attractiveness (thin-ideal internaliza- contours, the perspective which is presented, i.e. front or
tion, [17]). According to the tripartite influence model of side, and the number of figures displayed. One widely
body image and eating disturbance, the internalization used silhouette-based instrument is the Contour Draw-
of such societal appearance standards in turn influences ing Rating Scale (CDRS [31];), which consists of nine sil-
the development of body image disturbance [9]. houettes ranging from very thin to large, representing
In recent years, it has been acknowledged that the different body-fat percentages [31, 35]. Additionally,
sociocultural ideal of physical attractiveness in women is Mutale et al. [36] developed the Body Dissatisfaction
shifting away from a very thin body ideal toward an Scale (BDS) as a figure rating scale with nine female and
athletic, ultra-fit body ideal [18–20]. This athletic ideal is nine male computer-generated avatars which also vary
characterized by low body fat and toned, physically fit regarding body fat. A further established figure rating
muscles, and women have been found to rate other scale is the Somatomorphic Matrix [28], which is a
Steinfeld et al. Journal of Eating Disorders (2020) 8:75 Page 3 of 12

dimensional computerized test for men and women aim- validated figure rating scale, the CDRS. Thus, we
ing to measure satisfaction and perceptual accuracy hypothesized that participants’ ratings regarding their
regarding muscularity and body fat. The matrix consists actual, felt and ideal figure on the body-fat dimension of
of 10 × 10 contour-drawn silhouettes [28]. Like most of the BIMTM-FB would be associated with their corre-
the existing figure rating scales for women, the CDRS sponding ratings on the CDRS. Furthermore, we pre-
and BDS show good psychometric properties. However, dicted a positive correlation between participants’ BMI
the CDRS only includes the body-fat dimension [29–31], and their reported actual body size based on the body-
thus neglecting muscularity as an additional continuum fat dimension of the BIMTM-FB. Moreover, we antici-
[37]. The only widely used figure rating scale for women pated an inverse relationship of the rated body ideal on
that includes muscularity is the Somatomorphic Matrix the body-fat dimension of the BIMTM-FB with the drive
[28], but this suffers from the important shortcoming of for leanness, insofar as women with a high drive for
poor test-retest reliability [38]. Thus, to the best of our leanness would choose body shapes with less body fat as
knowledge, there is no figure rating scale for women their ideal shape and vice versa [24]. In addition, as pre-
which includes the dimensions of thinness as well as vious research indicated that a higher level of body ap-
leanness and muscularity and also shows satisfactory preciation is associated with a lower level of thin-ideal
psychometric properties. internalization [16], it was expected that a positive body
Another substantial weakness of the existing measures image, measured with the Body Appreciation Scale
is that the matrices do not include extreme shapes e.g., (BAS-2, [14]), would show a moderate positive relation-
extreme thinness or extreme overweight [32]. As ship with the rated body ideal on the body-fat dimension
patients who suffer from eating disorders are often lo- of the BIMTM-FB. In other words, we expected a higher
cated at the extremes concerning both their actual and level of body appreciation to be associated with a body
ideal body shape (Kessler et al., 2013; Tovée et al., 2003), ideal characterized by a higher percentage of body fat.
there is a risk that they will be unable to identify them- Furthermore, as patients with anorexia and bulimia ner-
selves with the bodies presented, leading to a reduced vosa have, by definition, a thin body ideal [8], we
variance and invalid results. A further common deficit of hypothesized that the rated body ideal on the BIMTM-
existing figure rating scales is that the line-drawn stimuli FB-BF would be able to differentiate between a clinical
appear unrealistic, thus hindering participants’ identifica- sample of patients with eating disorders and a non-
tion with the drawings and resulting in a lack of eco- clinical control sample. Regarding the muscularity
logical validity [30]. For some figure rating scales, dimension of the BIMTM-FB, we assumed that the rated
ecological validity is also limited by potentially distract- body ideal on the muscle dimension of the BIMTM-FB
ing details like faces or clothes [28, 30, 31, 37]. Others would be positively correlated with participants’ drive
present bodies with inconsistent postures [39] or incon- for muscularity [40, 41]. Moreover, we anticipated a
sistent body proportions, such as different length of legs moderate positive correlation between participants’ body
[30, 31]. As such, the bodies also differ in characteristics ideal and their drive for leanness. We further expected
other than body fat or muscularity, which may have an that the BIMTM-FB scores on both dimensions would
effect on participants’ ratings. be stable over a two-week period, thus confirming the
To overcome these limitations, we developed the Body test-retest reliability of the measure. Finally, we expected
Image Matrix of Thinness and Muscularity – Female that women with eating disorders would differ signifi-
Bodies (BIMTM-FB) as an instrument that captures the cantly from non-clinical controls with respect to their
two dimensions body fat and muscularity in a finely body image investment [10], meaning that patients with
graduated manner. As stimuli, this new figure rating eating disorders would be willing to invest significantly
scale for women uses realistic-looking bodies that vary more of their resources in order to reach their body
systematically regarding thinness, leanness and muscu- ideal.
larity, including the extremes very thin to very fat and
very unmuscular to very muscular. The BIMTM-FB is Method
shown in Fig. 1. Participants
The aim of the present study was to assess the validity Inclusion criteria for the present study were female sex
and test-retest reliability of the BIMTM-FB in a random and a minimum age of 18 years. The sample comprised
sample of adult women as well as in a clinical sample of N = 639 female participants who were divided into four
women with eating disorders. We expected the BIMTM- subsamples. The first two subsamples (S1 and S2) con-
FB to demonstrate convergent validity through correl- sisted of non-clinical control participants. S1 (n = 398)
ation of the scores with several other body image-related completed an online version of the questionnaire bat-
indices. More specifically, we expected the BIMTM-FB tery, while S2 (n = 179) completed a paper-and-pencil
to be strongly and positively associated with another version. These participants were recruited at the
Steinfeld et al. Journal of Eating Disorders (2020) 8:75 Page 4 of 12

Fig. 1 The Body Image Matrix of Thinness and Muscularity – Female Bodies
Steinfeld et al. Journal of Eating Disorders (2020) 8:75 Page 5 of 12

University of Osnabrück in Germany through advertis- psychologist. Based on this, n = 15 women were diag-
ing in university classes and on notice boards. Students nosed with bulimia nervosa (BN) and n = 17 with
who completed the questionnaire battery received course anorexia nervosa (AN) (AN-restrictive: n = 12, AN-
credits. The online sample S1 was additionally recruited binge-purging: n = 5). Subsample S4 comprised n = 30
via social media, press reports and flyers. The online sur- participants of a community sample from a rural
vey was implemented via Unipark (Questback GmbH, region in Northern Germany. These participants com-
Berlin; Germany). A link or a QR-code led the partici- pleted the BIMTM-FB as a paper-and-pencil test
pants to the online questionnaires. The S1 participants twice over a 14-day interval in order to assess test-
entered a lottery to win one of ten 20-euro online shop- retest reliability. The average age of S4 participants
ping vouchers. Sample characteristics of S1 and S2 as was M (SD) = 36.80 (6.92) years and their mean BMI
well as the means and median scores on the employed was M (SD) = 28.04 (9.20) kg/m2. The participants of
diagnostic tests are shown in Table 1. S2 and S4 completed the BIMTM-FB directly after
Subsample S3 consisted of N = 32 female inpatients recruitment. Participants of S4 received a second
of a cooperating clinic for eating disorders, aged questionnaire form, which they were asked to
between 18 and 32 years (M = 22.22 years, SD = 3.78). complete after a two week-interval and to mail it
S3 participants completed the BIMTM-FB as a paper- back to the first author in the provided pre-paid
and-pencil test and additionally underwent the SCID-I envelope. Before beginning to answer the items, all
(Structured Clinical Interview for DSM-IV Axis I participants were informed that they had the option
disorders), which was conducted by a clinical to quit the survey at any time. Moreover, the content

Table 1 Descriptive Statistics: Sample Characteristics of S1 and S2

S1: Online sample S2: Paper pencil sample
N = 398 N = 179
Mean (SD) Mean (SD)
Age 25,04 (6,89) 22,34 (3,78)
BMI 23,33 (4,77) 22,07 (3,62)
CDRS Median (interquartile range) Median (interquartile range)
Actual 5,00 (3,00) 5,00 (2,00)
Felt 6,00 (2,00) 6,00 (2,00)
Ideal 4,00 (2,00) 4,00 (2,00)
BIMTM-FB-BF Median (interquartile range) Median (interquartile range)
Actual 4,00 (2,00) 4,00 (1,00)
Felt 4,50 (1,00) 4,00 (1,00)
Ideal 3,00 (1,00) 3,00 (0,00)
Actual 2,00 (2,00) 1,00 (1,00)
Felt 1,00 (1,00) 1,00 (1,00)
Ideal 2,00 (2,00) 2,00 (2,00)
DLS-score (with reversed polarity) Mdn = 3,67; IQR = 1,50 Mdn = 3,17; IQR = 1,33
M (SD) = 3,57 (1,06) M (SD) = 3,11 (0,99)
DMS-score (with reversed polarity, without item 10) Mdn = 2,00; IQR = 0,86 Mdn = 1,93; IQR = 0,89
M (SD) = 2,11 (0,71) M (SD) = 2,02 (0,68)
DMS-subscale: Muscularity oriented body image Mdn = 2,57; IQR = 1,29 Mdn = 2,29; IQR = 1,26
M (SD) = 2,57 (0,96) M (SD) = 2,46 (0,95)
DMS-subscale: Muscularity behavior Mdn = 1,43; IQR = 0,71 Mdn = 1,43; IQR = 0,71
M (SD) = 1,66 (0,72) M (SD) = 1,59 (0,71)
BAS-score Mdn = 3,5; IQR = 1,10 Mdn = 3,6; IQR = 7,31
M (SD) = 3,36 (0,79) M (SD) = 3,52 (0,73)
Note. CDRS Contour Drawing Rating Scale; BIMTM-FB-BF body fat dimension of the Body Image Matrix of Thinness and Muscularity – Female Bodies; BIMTM-FB-
M muscularity dimension of the Body Image Matrix of Thinness and Muscularity – Female Bodies; DLS Drive for Leannes Scale; DMS Drive for Muscularity Scale;
BAS Body Appreciation Scale
Steinfeld et al. Journal of Eating Disorders (2020) 8:75 Page 6 of 12

and the aim of the study, the voluntary and anonym- the figures which most closely resemble their actual
ous nature of participation, privacy protection and the (“How do you actually look?”), their felt (“How do you
duration of on average 35 min were explained. The feel you look?”) and their ideal body (“How would you
study was approved by the local ethics committee. like to look?”). These questions were also used, for ex-
ample, in studies by Vocks et al. [44] and a study by
Measures Arkenau et al. (2020).
Body Appreciation Scale-2 (BAS-2)
The BAS-2 [14] encompasses 10 items assessing the ap- Body mass index (BMI)
preciation of one’s own body [42]. The items assess indi- Participants were asked to report their weight in kilo-
viduals’ acceptance of their body, their favorable opinion grams and their height in centimeters. This information
toward their body, as well as their respect for their body. was then used to calculate their body mass index (BMI =
Items are rated on a 5-point Likert scale (1 = never to weight in kg / height in m2). As found, for example, by
5 = always). Reliability of the English-language version of Elgar et al. [45], self-reported and measured height and
the BAS-2 was Cronbach’s α = .94 [14]. Reliability for the weight are highly correlated, although an underreporting
BAS-2 in the current study was Cronbach’s α = .91. The of body weight by an average of .52 kg was noted.
test-retest reliability of the English version over a three-
week period was rtt = .90 [14]. In a female student sam- Contour Drawing Rating Scale (CDRS)
ple the construct validity of the BAS-2 was supported by To test the convergent validity of the BIMTM-FB, the
its strong positive correlations with appearance evalu- CDRS [31, 43] as a further figure rating scale was
ation (r = .80), self-esteem (r = .71) and proactive coping applied. Participants are asked to mark the drawing
(r = .39) as well as by its significant negative association which most closely resembles their actual, their felt and
with body dissatisfaction (r = −.73) [14]. their ideal body. Nine hand-drawn female figures with
ascending body fat are displayed. The one-week test-
Body Image Matrix of Thinness and Muscularity-Female retest reliability in a sample of female undergraduate
Bodies (BIMTM-FB) students was rtt = .78 [31]. Thompson & Gray [31] also
The BIMTM-FB is a figure rating scale that contains the reported significant associations of the chosen actual fig-
two orthogonal dimensions body fat (BIMTM-FB-BF) ure via the CDRS with the reported weight (r = .71) and
and muscularity (BIMTM-FB-M), each consisting of the participants’ BMI (r = .59), thus confirming the con-
eight figures which increase in body fat and muscularity current validity of the CDRS [32].
in small increments. Thus 8 × 8 female bodies – overall
64 figures – are displayed, covering a range of body Drive for Leanness Scale (DLS)
shapes from very thin to obese and very unmuscular to To assess the desire to have a lean and athletic body
very muscular. The level of body fat of the figures in- with trained muscles, the DLS ([24, 27], Hartmann, un-
creases successively in the horizontal direction and the published data) was used. The six items of the DLS are
level of muscularity increases in the vertical direction. rated on a 5-point response scale ranging from 1 = never
Consequently, each of the 64 multicolored silhouettes to 6 = always. The internal consistency of the German
has its own specification on the dimension of body fat version was Cronbach’s α = .78. For the English version
and on the dimension of muscularity. The BIMTM-FB is of the DLS, in a female and male student sample, Tod
shown in Fig. 1. The bodies of the BIMTM-FB were gen- et al. [46] reported correlations of drive for leanness with
erated using the rendering Software DAZ Studio 4.9 Pro athletic internalization (r = .52), pressure to attain an
(64-bit). We used a commercially available 3D model for ideal physique (r = .25), exercise frequency (r = .36), and
the bodies (“Victoria 6”, based on the Genesis software dieting (r = .25).
platform by DAZ Productions, Inc., see https://www.
daz3d.com/victoria-6), which lends a skin texture to the Drive for Muscularity Scale (DMS)
underlying polygonal base mesh and allows for realistic- In order to quantify the individual desire to have a mus-
looking body morphs. In order to minimize distraction cular body, the 15-item DMS [40, 41] was used. The
and to enhance the focus on the body and its shape, items are rated on a 6-point Likert scale ranging from
standardized postures of the torso and extremities were 1 = always to 6 = never, with higher scores indicating a
chosen. Moreover, the figures end below the face and lower drive for muscularity. As recommended by
are depicted wearing discreet underwear. The items of Waldorf et al. [41], the scores were reverse-coded and
the BIMTM-FB are identical to those of the CDRS [31, item 10, which asks about steroid use, was excluded.
43] in order to optimize the comparability of the two in- The internal consistency of the German version of the
struments. Figures are numbered consecutively from 1 DMS ranges between α = .89 and .91, and the nine-day
to 64, enabling participants to write down the number of test-retest reliability lies at rtt = .95 [41]. For a sample of
Steinfeld et al. Journal of Eating Disorders (2020) 8:75 Page 7 of 12

female weight-trainers, Hartmann et al. found significant Results

correlations between the DMS and drive for thinness Convergent validity
(r = .31) as well as the DLS (r = .36). The correlation analysis that was performed in order to
test the convergent validity of the BIMTM-FB revealed
Eating Disorder Examination-Questionnaire (EDE-Q) significant associations of the rated actual, felt and ideal
To assess the psychopathology of eating disorders, the figure on the body fat dimension of the BIMTM-FB with
EDE-Q [47, 48], as a more economical, questionnaire ver- the corresponding responses to the CDRS, as shown in
sion of the Eating Disorder Examination interview (EDE Table 2.
[49]), was applied. All 22 items of the EDE-Q refer to the Table 3 provides a further overview of associations
past 28 days and are answered on a 7-point rating scale. between the BIMTM-FB and the other convergent mea-
Items are subdivided into the four scales “Restraint” (5 sures for S1 and S2. On the body-fat dimension of the
items), “Eating Concern” (5 items), “Weight Concern” (5 BIMTM-FB, a higher score indicates a silhouette with
items) and “Shape Concern” (8 items). Internal more body fat and a lower score indicates a figure with
consistency for the subscales ranges between Cronbach’s less body fat. Correspondingly, on the muscularity
α = .80 and .93 for healthy controls and between Cron- dimension of the BIMTM-FB, higher scores represent a
bach’s α = .67 and .93 for participants with an eating dis- figure with a higher degree of muscularity and lower
order. In a meta-analysis of 16 studies mainly examining scores represent a less muscular figure. A significant
young women, Berg et al. [50] reported an adequate con- positive correlation emerged between participants’ BMI
vergent validity, as shown by correlation coefficients be- and their reported actual body size on the body-fat
tween the EDE-Q and the EDE subscales ranging from dimension of the BIMTM-FB. Moreover, the DLS values
r = .68 to .76. were significantly inversely correlated with the body
ideal on the body-fat dimension of the BIMTM-FB, i.e.,
a higher drive for leanness was associated with less body
Investment questions fat of the chosen figure of the BIMTM-FB. For S2, a sig-
In order to evaluate the body image investment [10], the nificant positive correlation emerged between the body-
ratings of the BIMTM-FB can be supplemented with the fat dimension of the BIMTM-FB and the BAS, i.e.,
following three questions: “How many hours per day higher body appreciation was associated with more
would you invest in order to reach your rated ideal body body fat of the chosen body ideal, whereas this associ-
shape?”, “What percentage of your income would you ation did not reach significance for S1. The muscularity
invest in order to reach your rated ideal body shape?”, dimension of the BIMTM-FB was positively correlated
“How many years of your life would you invest in order with the DMS. A moderate association was found
to reach your rated ideal body shape?”. By applying the between the two measures. In sum, the medium to high
three investment questions in addition to the three rat- correlations indicate a substantial convergent validity of
ing questions of the BIMTM-FB, it is possible to meas- the BIMTM-FB.
ure the evaluative component as well as the investment Table 4 summarizes the results of a series of
component [11, 51]. Mann-Whitney U tests exploring whether BIMTM-
FB scores were able to distinguish participants with
Data analysis eating disorders from control participants. The ideal
The data analysis was performed using IBM SPSS Statis- body shape discriminated significantly between the
tics 24. As an ordinal scale level can be assumed for the
BIMTM-FB, only nonparametric tests were used. Con- Table 2 Rank Correlational Analysis with Goodman and
Kruskal’s Gamma (γ) of the BIMTM-FB-BF and the CDRS
vergent validity and test-retest reliability were assessed
Measures Sample CDRS CDRS CDRS
by calculating correlations i.e. Goodman and Kruskal’s Actual Felt Ideal
Gamma (γ), which has the advantage of being a tie-
BIMTM-FB-BF
robust rank correlation measure [52]. To test whether
Actual S1 .86***
the rated body ideal on the body-fat dimension as well
as the body image investment indicated by the partici- S2 .89***
pants were able to differentiate between patients with Felt S1 .84***
eating disorders and non-clinical women, a Mann- S2 .89***
Whitney U test was conducted as a nonparametric test. Ideal S1 .77***
The z-value was used to calculate the effect size, as pro-
S2 .87***
posed by Cohen [53]. According to Cohen’s guidelines,
Note. BIMTM-FB-BF body fat dimension of the Body Image Matrix of Thinness
r = .5 is a large effect, r = .3 is a medium effect and r = .1 and Muscularity (with the perceived actual, felt, and ideal body); CDRS Contour
is a small effect [54]. Drawing Rating Scale; S1 online sample; S2 student sample (paper-pencil)
Steinfeld et al. Journal of Eating Disorders (2020) 8:75 Page 8 of 12

Table 3 Rank Correlational Analysis with Goodman and the moderate negative association of the rated body ideal
Kruskal’s Gamma (γ) of BIMTM-FB and convergent measures with the drive for leanness points in the same direction,
Measures Sample BMI BAS DLS DMS demonstrating that a desire to have an athletic and
S1:N = 398; S2:N = 179 toned body with physically fit muscles is associated with
BIMTM-FB-BF choosing body shapes with less body fat as an ideal
shape and vice versa. The moderate positive association
Actual S1 .73*** −.18*** −.18*** −.02
between the muscularity dimension of the BIMTM-FB
S2 .81*** −.12 −.11 .06
and the DMS also confirms the convergent validity. The
Felt S1 .59*** −.38*** −.09 .05 inconsistent results of the online sample (S1) and the
S2 .64*** −.35*** .03 .18** paper-and-pencil sample (S2) regarding the correlation
Ideal S1 .61*** .09 −.38*** −.15** between the BAS and the body ideal ratings on the
S2 .45*** .40*** −.41*** −.25** body-fat dimension underline that more research needs
to be done in order to clarify the link between body ap-
BIMTM-FB-M
preciation and the body ideal [15]. Nevertheless, the sig-
Actual S1 .16** −.02 .15** .13**
nificant positive correlation between body ideal ratings
S2 .09 .11 .15 .02 on the body-fat dimension in the paper-and-pencil sam-
Felt S1 .18*** −.02 .14*** .13* ple (S2) and the BAS indicates that as a trend, partici-
S2 .13 .15 .14 .00 pants who appreciate their own body tend to have a
Ideal S1 .02 −.01 .29*** .33*** body ideal with a higher body fat percentage. This con-
firms previous studies, which found that a positive body
S2 −.06 −.14* .37*** .27***
image is associated with low internalization of sociocul-
Note. BIMTM-FB-BF = body fat dimension of the Body Image Matrix of Thinness
and Muscularity (with the perceived actual, felt, and ideal body); BIMTM-FB- tural appearance standards [14]. Thus, body appreciation
M = muscularity dimension of the Body Image Matrix of Thinness and might be one of the psychological factors that moderate
Muscularity (with the perceived actual, felt, and ideal body); BMI = Body Mass
Index; BAS = Body Appreciation Scale; DLS = Drive for Leanness Scale; DMS =
an individual’s degree of vulnerability to sociocultural
Drive for Muscularity Scale. S1 = online-sample, S2 = student-sample (paper- pressure [55]. This finding underlines the need to under-
pencil); * p < .05. ** p < .01. *** p < .001 stand the characteristics of a functional body image and
– especially for clinical practice – how it can be
control sample and the clinical sample. Moreover, acquired. The BIMTM-FB can be useful to assess the
the two samples differed significantly regarding the effect of viewing body positive content on women’s body
resources they were willing to invest in order to ideal. Such content might take the form of body positive
reach their ideal body shape. posts on social media, with the aim of challenging main-
stream beauty ideals and encouraging appreciation and
Test-retest reliability acceptance of all body types [56, 57].
The test-retest reliability over a two-week period for the Furthermore, the BIMTM-FB was able to differentiate
body-fat dimension and the muscularity dimension was between females with and without eating disorders, with
assessed. Tables 5 and 6 show the median scores on the the two groups varying substantially in terms of their
BIMTM-FB at both time points (T1 and T2) as well as ideal body shape. Consistent with existing studies, we
the correlation analysis. found that women with eating disorders showed a sig-
nificant preference for severely underweight bodies as
Discussion compared to the rated body ideal of the non-clinical
The present study aimed to psychometrically test the sample [58, 59]. These findings emphasize the import-
recently developed figure rating scale BIMTM-FB, which ance to include underweight bodies in figure rating
uses digitally created body depictions including extreme scales in order to also cover the very thin body ideal of
body shapes on the two dimensions thinness and mus- women with eating disorders, thus underscoring a
cularity. The BIMTM-FB consists of detailed, realistic strength of the BIMTM-FB.
female body figures and assesses respondents’ estima- Besides body image evaluation, participants with eating
tions of their actual, felt and ideal body, while differenti- disorders were also distinguishable from control partici-
ating between levels of body fat and muscularity. pants with respect to body image investment, as assessed
The convergent validity of the body-fat dimension of through the Investment Questions. The women with
the BIMTM-FB was supported by its strong positive cor- eating disorders indicated that they would be willing to
relation with the CDRS. Moreover, it was further spend significantly more time and money in order to
supported by the significant correlation between partici- achieve their ideal body shape, as compared to the
pants’ BMI and their estimations of their actual body on women in the control group. For instance, on average,
the body-fat dimension of the BIMTM-FB. Furthermore, eating disorder patients were willing to relinquish over
Steinfeld et al. Journal of Eating Disorders (2020) 8:75 Page 9 of 12

Table 4 T-test and Mann-Whitney-U test regarding sample characteristics and the BIMTM-FB-BF (S2 and S3)
Control group (S2) Clinical group (S3) Group comparison statistics
N = 179 N = 32
Mean (SD) Mean (SD) t-Value df p d
Age 22,18 (3,37) 22,22 (3,78) −0,61 209 .952 0,01
BMI 22,03 (3,62) 19,04 (4,62) 4,07 208 .000 0,79
EDE-Q
Gesamtwert 1,60 (1,18) 3,45 (1,36) −8,09 205 .000 1,53
restraint 1,20 (1,24) 2,97 (1,69) −5,65 37,18 .000 1,34
Eating concern 1,60 (1,27) 2,93 (1,32) −5,41 209 .000 1,04
Weight concern 1,93 (1,42) 3,60 (1,61) −5,97 206 .000 1,15
Shape concern 1,50 (1,20) 4,30 (1,33) −11,97 206 .000 2,30
BIMTM-FB-BF
Median (interquartile range) Median (interquartile range) Mann–Whitney U Z p r
Actual 4 (1) 3 (1) 2543,50 −1,06 .145 0,07
Felt 4 (1) 5 (1) 2206,50 −2,14 .016 0.14
Ideal 3 (0) 2 (1) 1597,50 −4,86 .000 0,27
Importance 3 (1) 4 (1,5) 2303,00 −1,67 .048 0,12
t df p d
Investment Mean (SD) Mean (SD)
Hours per day 1,38 (1,62) 6,15 (6,73) −4,01 31,65 .000 1,59
Percentage of income 8,98 (9,56) 28,97 (25,93) −4,19 32,53 .000 1,50
Years of life 1,67 (6,32) 6,84 (10,31) −2,71 33,90 .005 0,73
Notes: BMI Body Mass Index, EDE-Q Eating Disorder Examination-Questionnaire; BIMTM-FB-BF body fat dimension of the Body Image Matrix of Thinness and
Muscularity-Female Bodies (with the perceived actual, felt, and ideal body); BAS Body Appreciation Scale; DLS Drive for Leanness Scale; DMS Drive for Muscularity
Scale. S2 student-sample (paper-pencil); S3 sample of inpatients with eating disorders

six hours per day in order to reach their body ideal, as FB ratings. This corresponds with the findings of test-
compared to the average of one hour per day reported retest reliability from other figure rating scales (e.g.,
by the non-clinical sample. These results confirm the as- CDRS, [31]) and marks an advantage over the Somato-
sociation between body image investment and disturbed morphic Matrix, which demonstrated low test-retest re-
eating attitudes reported in previous research [51]. Fur- liability [38]. In sum, the results indicate that the
thermore, they support Cash’s [10] recommendation to BIMTM-FB has good convergent validity as well as high
not solely consider how individuals evaluate their ap- test-retest reliability. Moreover, the present findings sug-
pearance, but also to take into account how important gest that the BIMTM-FB is able to differentiate between
their appearance is to them. participants with eating disorders and a non-clinical
In line with our expectations, a high test-retest reliabil- sample.
ity of the BIMTM-FB over a two-week interval was con- While the present study was able to provide evidence
firmed, indicating the temporal stability of the BIMTM- of the validity and reliability of a newly developed figure

Table 5 Median and Test-Retest Rank Correlational Analysis Table 6 Median and Test-Retest Rank Correlational Analysis
with Goodman and Kruskal’s Gamma (γ) of the BIMTM-FB-BF for with Goodman and Kruskal’s Gamma (γ) of the BIMTM-FB-M for
T1 and T2 T1 and T2
BIMTM-FB-BF Actual Felt Ideal BIMTM-FB-M Actual Felt Ideal
T1: Mdn (IQR) 5 (2,00) 5 (2,00) 4 (1,00) T1: Mdn (IQR) 2,00 (2,00) 2,00 (3,00) 3,00 (3,00)
T2: Mdn (IQR) 5 (2,00) 5 (2,00) 4 (2,00) T2: Mdn (IQR) 2,00 (3,00) 2,00 (3,00) 3,00 (2,00)
γ (Correlation 1*** .99*** 1*** γ (Correlation .99*** .99*** .98***
between T1 und T2) Between T1 und T2)
BIMTM-FB-BF body fat dimension of the Body Image Matrix of Thinness and Note. BIMTM-FB-M muscularity dimension of the Body Image Matrix of
Muscularity (with the perceived actual, felt, and ideal body); Mdn median; Thinness and Muscularity (with the perceived actual, felt, and ideal body);
IQR interquartile range; S3: N = 30; *** p < .001 Mdn median; IQR interquartile range; S3 N = 30; *** p < .001
Steinfeld et al. Journal of Eating Disorders (2020) 8:75 Page 10 of 12

rating scale, some shortcomings need to be mentioned. order to examine body image ideals or assess
First, the bodies that are presented in the BIMTM-FB whether women’s actual body corresponds to their
are of Caucasian skin pigmentation. This may limit the ideals in terms of body fat and muscularity. Another
identification of women from non-Caucasian popula- possible research approach is to test the sensitivity
tions with the presented figures, in turn impairing the to change of the BIMTM-FB, exploring whether it
ecological validity of the BIMTM-FB for these groups can be used as a state or trait measure. Given a high
[60]. To overcome this limitation, the development of sensitivity to change of the BIMTM-FB, as a pre-
BIMTM-FB versions for women from different ethnic post measure, it could test whether rigidly held body
backgrounds might be considered. Second, the pictured ideals might be altered through therapeutic interven-
body figures of the BIMTM-FB cannot be directly asso- tions. Conversely, the effect of media exposure on
ciated with anthropometric data such as BMI, fat-free the body image ideal regarding thinness and muscu-
mass index and body fat percentage. Thus, only if inde- larity could also be examined with the BIMTM-FB.
pendent raters compare the individual’s actual body Besides, as the BIMTM-FB also encompasses the se-
shape with the corresponding rating on the BIMTM-FB verely thin, severely overweight and very muscular
can the perceptual body image disturbance be measured. body shapes, it can be especially useful in clinical re-
In future studies, this limitation can be overcome by search and practice when working with extremely
subsequently linking anthropometric data to each body thin, obese or muscular subjects, e.g. with patients
figure of the BIMTM-FB, e.g. by identifying a female with anorexia nervosa or binge eating disorder.
model for each body figure of the BIMTM-FB that cor-
responds to the figure’s shape and registering the Supplementary Information
model’s BMI, fat-free mass index and body fat percent- The online version contains supplementary material available at https://doi.
age. Third, future psychometric studies of the BIMTM- org/10.1186/s40337-020-00345-w.
FB should include different samples that are especially
vulnerable for body image disturbances. For instance, Additional file 1.

studies should aim to test the psychometric properties of

the BIMTM-FB for other clinical groups, such as females Abbreviations
with binge eating disorder, body dysmorphic disorder BAS-2: Body Appreciation Scale-2; BIMTM-FB: The Body Image Matrix of
Thinness and Muscularity – Female Bodies; BMI: Body Mass Index;
and its subtype muscle dysmorphia, as well as other CDRS: Contour Drawing Rating Scale; DLS: Drive for Leanness Scale;
mental disorders to which body image disturbance is DMS: Drive for Muscularity Scale; EDE-Q: Eating Disorder Examination-
relevant, like posttraumatic stress disorder, borderline Questionnaire; SCID-I: Structured Clinical Interview for DSM-IV Axis I disorders;
S1 to S4: Subsample 1 to Subsample 4
personality disorder, and social anxiety disorder [61–64].
Fourth, the BMI that was used in the present study Acknowledgements
to test the convergent validity of the rated actual Not applicable.
body size on the body-fat dimension of the BIMTM-
FB was not objectively measured. Instead, we relied Authors’ contributions
on participants’ disclosure of their weight and height. BS, SV and MW contributed to the conception and design of the study as
well as to the development of the BIMTM-FB. BS and SV contributed to the
In future studies, the BMI should be measured data analysis. BS, ASH, MW and SV contributed to the interpretation of data
objectively i.e. by weighing and measuring participants and drafting the article or revising it critically for important intellectual con-
under standardized conditions. tent. All authors read and approved the final manuscript.

Funding
Conclusion We acknowledge support by Deutsche Forschungsgemeinschaft (DFG) and
Overall, the BIMTM-FB displayed good psychometric Open Access Publishing Fund of Osnabrück University.
properties as a measure of the body image of
females including both thinness and muscularity. Availability of data and materials
The datasets used and analysed during the current study are available from
The artificial but realistic-looking standardized bod-
the corresponding author on reasonable request.
ies of the BIMTM-FB offer high ecological validity.
As the BIMTM-FB is quick to answer and almost Ethics approval and consent to participate
language-free, it can be easily applied in research The survey protocol was approved by the ethics committee of Osnabrück
and clinical practice in various language areas and – University.
after adjustment and validation – for intercultural
Consent for publication
comparisons. Moreover, the BIMTM-FB can be Not applicable.
administered even in the case of illiteracy. Thus, in
future research, the BIMTM-FB could be a useful Competing interests
addition to established body image measures in The authors declare that there are no conflicts of interests.
Steinfeld et al. Journal of Eating Disorders (2020) 8:75 Page 11 of 12

Received: 8 July 2020 Accepted: 23 October 2020 27. McCreary DR. The drive for muscularity scale: description, psychometrics,
and research findings. In: Thompson JK, Cafri G, editors. The muscular ideal:
psychological, social, and medical perspectives. Washington, DC: American
Psychological Association; 2007. p. 87–106.
References 28. Gruber AJ, Pope HG, Borowiecki J, Cohane G. The development of the
1. Slade PD. Body image in anorexia nervosa. Br J Psychiatry. 1988;153:S2,20–2. somatomorphic matrix: a bi-axial instrument for measuring body image in
2. Jacobi C, Hayward C, de Zwaan M, Kraemer H, Agras WS. Coming to terms men and women. Kinanthropometry VI. 1999;5:217–31.
with risk factors for eating disorders: application of risk terminology and 29. Stunkard AJ, Sorensen T, Schulsinger T. Use of the Danish adoption register
suggestions for a general taxonomy. Psychol Bull. 2004;130:1,19–65. for the study of obesity and thinness. In: Kety SS, Rowland LP, Sidman RL,
3. Striegel-Moore RH, Bulik CM. Risk factors for eating disorders. Am Psychol. Matthysse SW, editors. Genetics of neurological and psychiatric disorders.
2007;62:3,181. New York: Raven Press; 1983. p. 115–20.
4. Stice E, Shaw HE. Role of body dissatisfaction in the onset and maintenance 30. Swami V, Salem N, Furnham A, Tovée MJ. Initial examination of the validity
of eating pathology: a synthesis of research findings. J Psychosom Res. and reliability of the female photographic figure rating scale for body
2002;53:5,985–93. image assessment. Personal Individ Differ. 2008;44:1752–61.
5. McLean SA, Paxton SJ. Body image in the context of eating disorders. 31. Thompson MA, Gray JJ. Development and validation of a new body image
Psychiatr Clin. 2019;42:1,145–56. assessment scale. J Pers Assess. 1995;64:2,258–69.
6. Donyavi V, Rabiei R, Nikfarjam M, Mohmmad NB. Body image and meta- 32. Gardner RM, Brown DL. Body image assessment: a review of figural drawing
worry as mediators of body dysmorphic disorder. Int J Clin Med. 2015;6:3. scales. Personal Individ Differ. 2010;48:2,107–11.
7. Veale D. Advances in a cognitive behavioural model of body dysmorphic 33. Gardner RM. Perceptual measures of body image for adolescents and
disorder. Body Image. 2004;1:1,113–25. adults. In: Cash TF, Smolak L, editors. Body image: A handbook of science,
8. American Psychiatric Association. Diagnostic and statistical manual of practice, and prevention. 2nd ed. New York: Guilford Press; 2011. p. 46–153.
mental disorders (DSM-5®). Washington, DC: American Psychiatric Pub; 2013. 34. Hill AJ. Body image assessment of children. In: Cash TF, Smolak L, editors.
9. Thompson JK, Heinberg LJ, Altabe M, Tantleff-Dunn S. Exacting beauty: Body image: a handbook of science, practice, and prevention. 2nd ed. New
theory, assessment, and treatment of body image disturbance. Washington: York: Guilford Press; 2011. p. 138–45.
American Psychological Association; 1999. 35. Wertheim EH, Paxton SJ, Tilgner L. Test–retest reliability and construct
10. Cash TF. Crucial considerations in the assessment of body image. In: Cash validity of contour drawing rating scale scores in a sample of early
TF, Smolak L, editors. Body image: A handbook of science, practice, and adolescent girls. Body Image. 2004;1:2,199–205.
prevention. 2nd ed. New York: Guilford Press; 2011. p. 129–37. 36. Mutale GJ, Dunn AK, Stiller J, Larkin RF. Development of a body
11. Cash TF, Smolak L. Body image: a handbook of science, practice, and dissatisfaction scale assessment tool. New Sch Psychol Bull. 2016;13:2,47–57.
prevention. 2nd ed. New York: Guilford Press; 2011. 37. Gillen MM, Markey CN. Development and validation of the muscle Pictoral
12. Frisén A, Holmqvist K. What characterizes early adolescents with a positive measure. Arch Assess Psychol. 2015;5:11–22.
body image? A qualitative investigation of Swedish girls and boys. Body 38. Cafri G, Roehrig M, Thompson JK. Reliability assessment of the
Image. 2010;7:3,205–12. somatomorphic matrix. Int J Eat Disorder. 2004;35(4):597–600.
13. Wood-Barcalow NL, Tylka TL, Augustus-Horvath CL. “But I like my body”: 39. Swami V, Einon D, Furnham A. The leg-to-body ratio as a human aesthetic
positive body image characteristics and a holistic model for young-adult criterion. Body Image. 2006;3:4,317–23.
women. Body Image. 2010;7:2,106–16. 40. McCreary DR, Sasse DK. An exploration of the drive for muscularity in
14. Tylka TL, Wood-Barcalow NL. The body appreciation Scale-2: item adolescent boys and girls. J Am Coll Heal. 2000;48:6,297–304.
refinement and psychometric evaluation. Body Image. 2015;12:53–67. 41. Waldorf M, Cordes M, Vocks S, McCreary D. “Ich wünschte, ich wäre
15. Andrew R, Tiggemann M, Clark L. The protective role of body appreciation muskulöser”: Eine teststatistische Überprüfung der deutschsprachigen
against media-induced body dissatisfaction. Body Image. 2015;15:98–104. Fassung der Drive for Muscularity Scale (DMS). Diagnostica. 2014;60:140–52.
16. Andrew R, Tiggemann M, Clark L. Predicting body appreciation in young 42. Tylka TL. Overview of the field of positive body image. In: Daniels EA, Gillen MM,
women: an integrated model of positive body image. Body Image. 2016;18: Markey CH, editors. Body positive: understanding and improving body image in
34–42. science and practice. Cambridge, UK: Cambridge University Press; 2018. p. 6–33.
17. Thompson JK, Stice E. Thin-ideal internalization: mounting evidence for a 43. Vocks S, Bauer A, Legenbauer T. Körperbildtherapie bei Anorexia und
new risk factor for body-image disturbance and eating pathology. Curr Dir Bulimia nervosa. Göttingen: Hogrefe; 2018.
Psychol Sci. 2001;10(5):181–3. 44. Vocks S, Legenbauer T, Rüddel H, Troje N. Static and dynamic body image
18. Bozsik F, Whisenhunt BL, Hudson DL, Bennett B, Lundgren JD. Thin is in? in bulimia nervosa: mental representation of body dimensions and motion
Think again: the rising importance of muscularity in the thin ideal female patterns. Intern J Eat Dis. 2007. https://doi.org/10.1002/eat.20336.
body. Sex Roles. 2018;79(9–10):609–15. 45. Elgar FJ, Roberts C, Tudor-Smith C, Moore L. Validity of self-reported height
19. Tiggemann M, Zaccardo M. Strong is the new skinny: a content analysis of and weight and predictors of bias in adolescents. J Adolesc Health. 2005;37:
fitspiration websites. J Health Psychol. 2016;17:1–9. 5,371–5.
20. Webb JB, Vinoski ER, Warren-Findlow J, Burrell MI, Putz DY. Downward dog
46. Tod D, Edwards C, Hall G. Drive for leanness and health-related behavior
becomes fit body, inc.: a content analysis of 40 years of female cover
within a social/cultural perspective. Body Image. 2013;10:4,640–3.
images of yoga journal. Body Image. 2017;22:129–35.
47. Fairburn CG, Beglin SJ. The assessment of eating disorders: interview or self-
21. Sands R. Reconceptualization of body image and drive for thinness. Intern J
report questionnaire? Int J Eat Disord. 1994;16:363–70.
Eat Dis. 2000;28:397–407.
22. Hildebrandt T, Langenbucher J, Schlundt DG. Muscularity concerns among 48. Grilo CM, Reas DL, Hopwood CJ, Crosby RD. Factor structure and construct
men: development of attitudinal and perceptual measures. Body Image. validity of the eating disorder examination-questionnaire in college students:
2004;1:169–81. further support for a modified brief version. Int J Eat Dis. 2015;48:3,284–9.
23. Wertheim E, Paxton S, Blaney S. Body image in girls. In: Smolak L, 49. Fairburn CG, Cooper Z, O’Connor ME (2014) Eating disorder examination
Thompson JK, editors. Body Image, Eating Disorders, and Obesity in (Edition17.0D). http://www.credo-oxford.com/7.2.html. Accessed 26
Youth. 2nd ed. Washington, DC: American Psychological Association; January 2020.
2009. p. 47–76. 50. Berg KC, Peterson CB, Frazier P, Crow SJ. Convergence of scores on the
24. Smolak L, Murnen SK. Drive for leanness: assessment and relationship to interview and questionnaire versions of the Eating Disorder Examination: A
gender, gender role and objectification. Body Image. 2008;5:251–60. meta-analytic review. Psychol Assess. 2011;23:3,714.
25. Kelley CCG, Neufeld JM, Musher-Eizenman DR. Drive for thinness and drive 51. Cash TF, Melnyk SE, Hrabosky JI. The assessment of body image investment:
for muscularity: opposite ends of the continuum or separate constructs? an extensive revision of the appearance schemas inventory. Int J Eat
Body Image. 2010;7:74–7. Disorder. 2004;35:3,305–16.
26. Gruber AJ. A more muscular female body ideal. In: Thompson JK, Cafri G, 52. Göktaş A, Işçi Ö. A comparison of the most commonly used measures of
editors. The muscular ideal: psychological, social, and medical perspectives. association for doubly ordered square contingency tables via simulation.
Washington, DC: American Psychiatric Association; 2007. p. 217–34. Metodoloski Zvezki. 2011;8:17–37.
Steinfeld et al. Journal of Eating Disorders (2020) 8:75 Page 12 of 12

53. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed.
Hillsdale: Erlbaum; 1988.
54. Coolican H. Research methods and statistics in psychology, 359. London:
Hodder; 2009.
55. Tiggemann M. Sociocultural perspectives on human appearance and body
image. In: Cash TF, Smolak L, editors. Body image: A handbook of science,
practice, and prevention. 2nd ed. New York: Guilford Press; 2011. p. 12–9.
56. Cohen R, Irwin L, Newton-John T, Slater A. # bodypositivity: a content
analysis of body positive accounts on Instagram. Body Image. 2019a;29:
47–57.
57. Cohen R, Fardouly J, Newton-John T, Slater A. # BoPo on Instagram: an
experimental investigation of the effects of viewing body positive content
on young women’s mood and body image. New Media Soc. 2019b;21:
7,1546–64.
58. Cash TF, Deagle EA. The nature and extent of body-image disturbances in
anorexia nervosa and bulimia nervosa: a meta-analysis. Int J Eat Disorder.
1997;22:107–25.
59. Mölbert SC, Thaler A, Mohler BJ, Streuber S, Romero J, Black MJ, et al.
Assessing body image in anorexia nervosa using biometric self-avatars in
virtual reality: attitudinal components rather than visual body size
estimation are distorted. Psychol Med. 2018;48:642–53.
60. Talbot D, Smith E, Cass J. Development and validation of the new
Somatomorphic matrix–male: a figural rating scale for measuring male
actual–ideal body discrepancy. Psychol Men Mascular. 2018;20:3,356.
61. Dyer A, Borgmann E, Kleindienst N, Feldmann RE Jr, Vocks S, Bohus M.
Body image in patients with posttraumatic stress disorder after
childhood sexual abuse and co-occurring eating disorder.
Psychopathology. 2013a;46:3,186–91.
62. Dyer A, Borgmann E, Feldmann RE Jr, Kleindienst N, Priebe K, Bohus M,
Vocks S. Body image disturbance in patients with borderline personality
disorder: impact of eating disorders and perceived childhood sexual abuse.
Body Image. 2013b;10:2,220–5.
63. Dyer AS, Bublatzky F, Alpers GW. Körperbildstörungen bei Trauma und
sozialer Ängstlichkeit. Z Psychiatr Psychol Psychother. 2015;63:59–6.
64. Hilbert A, Tuschen-Caffier B. Eating Disorder Examination-Questionnaire;
deutschsprachige Übersetzung. Tübingen: Dgvt-Verlag; 2016.

Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.