Continue reading to learn how to recognize the signs and symptoms of muscle dysmorphia in yourself or a loved one, and how to find the most suitable treatment.
What is Muscle Dysmorphia or Body Dysmorphic Disorder?
Muscle dysmorphia is a subtype of body dysmorphic disorder (BDD) that develops when a person becomes so preoccupied with the appearance of their muscles that it negatively impacts their quality of life.1
For some, muscle development becomes such an obsession that, rather than interrupting their training schedule, they will skip important events, may miss work to exercise, and may even continue working out despite experiencing pain or serious injury like broken bones.2
Diagnosing Muscle Dysmorphia
Muscle dysmorphia is listed in the DSM-5 as a subtype of body dysmorphic disorder. However, there’s an ongoing discussion in the scientific community about whether muscle dysmorphia should be classed as an eating disorder, a form of obsessive-compulsive disorder, or a behavioral addiction.3,4
A person suspected of having muscle dysmorphia can be assessed with the Muscle Dysmorphic Disorder Inventory. This survey features thirteen statements that can be scored on a five-point scale. Survey statements include:3
- I hate my body
- I think my body is too skinny/slender
- I find my chest to be too small
- I feel like I have too much body fat
- I feel depressed when I miss one or more days of exercise
- I cancel social activities with friends because of my workout/exercise schedule
- I need to gain a lot more muscle to have the ideal male body
The scale of responses is scored from 1 (never) to 5 (always), with a total score of more than 39 proposed to be the threshold for a muscle dysmorphia diagnosis.3
Signs and Symptoms of Muscle Dysmorphia
The primary characteristic of a person experiencing muscle dysmorphia is the belief that their body is never muscular enough, despite their rigorous training.2
Individuals with muscle dysmorphia perceive themselves as weak and small, even if they have a lean physique or are very muscular.6 As a result, they engage in compulsive behaviors to achieve a muscular physique that always seems out of reach.
These behaviors can include:4,5
- Wearing baggy clothes to hide the body
- Excessive exercising (e.g., compulsive weight lifting)
- Overuse of dietary supplements
- Restrictive diets
- Use of anabolic steroids
- Skipping social or work events to maintain their rigid diet and exercise regimen
- Avoiding activities that involve exposing their body, such as swimming
- Avoiding or excessively checking mirrors
- Comparing their body to others
- Overly concerned about body composition
Muscle Dysmorphia Symptoms and the Effects of Anabolic Steroids
Muscle dysmorphia can have a profound impact on all aspects of life, affecting normal daily functioning.6
Many of the short-term effects associated with muscle dysmorphia are related to excessive working out and not giving the body enough time to recover between sessions.10 This can include injury to muscles, joints, cartilage, tendons, or ligaments, which a person with muscle dysmorphia will ignore to continue exercising. This can lead to more serious injuries, including torn ligaments and broken bones that may require surgery.
People with muscle dysmorphia who use anabolic steroids may experience the following side effects:3
- Impotence
- Testicular shrinkage
- Breast enlargement
- Acne
- Increased aggression
- Hair loss
- Impotence and reduced sex drive
Related Mental Disorders
Studies have documented high comorbidity between muscle dysmorphia and eating disorders, particularly orthorexia nervosa (ON), which is an obsession with foods a person considers healthy.5 However, it’s currently unclear whether ON is a trigger for muscle dysmorphia or a consequence of it.
Treatment of Muscle Dysmorphia
Many people with muscle dysmorphia resist treatment as they believe it may harm their progress. Furthermore, it can be difficult to convince those with the condition that it is a problem, as they may not be experiencing medical complications.6
People with muscle dysmorphia may become defensive when confronted about their body obsession. The best way to help someone is to approach them with your concerns in a non-confrontational way, reassuring them that you only have their best interests at heart.
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Therapies for Muscle Dysmorphia
Treatments for muscle dysmorphia usually include psychotherapy and education, where an individual will learn about:7
- The dangers of overexercising
- The realities of a healthy body image
- The dangers anabolic steroids pose to physical and mental health
- Proper nutrition
Therapies that may be useful in the treatment of muscle dysmorphia as part of a multidisciplinary approach include:
- Cognitive behavioral therapy (CBT): This form of talking therapy targets the psychological factors (e.g., body dissatisfaction, obsession with body weight) that have contributed to the development of muscle dysmorphia. During sessions, an individual works with a therapist to build strategies to understand and change their disordered beliefs about their body and exercise, as well as find better coping strategies for their feelings.5
- Family therapy: During these counseling sessions, family members and loved ones learn how to support someone with muscle dysmorphia throughout their treatment.
- Group therapy: It can be beneficial for people living with muscle dysmorphia to talk openly with others in a similar situation. Furthermore, the strong connections formed in group therapy help with feelings of social isolation.
Medications for Muscle Dysmorphia
There are no medications specifically for the treatment of muscle dysmorphia, but a person may be prescribed one or more of the following medications to address the consequences of the condition:
- Selective serotonin reuptake inhibitors (SSRIs): These may be prescribed to treat comorbid mood and anxiety disorders that are common in people with muscle dysmorphia.8
- Hormone treatment: If a person has been using anabolic steroids or other performance-enhancing drugs, they may require endocrine treatment to rebalance their hormone levels.4
How to Help Someone with Muscle Dysmorphia
Recognizing that you or your loved one has a problem with muscle dysmorphia is the first step on the journey to recovery. It’s important to consult with a trustworthy healthcare professional who can help build a personalized treatment plan to maximize the chances of overcoming muscle dysmorphia.
Understanding Muscle Dysmorphia
A person with muscle dysmorphia may believe that there is no problem and that it’s perfectly normal, even admirable, to strive for a more muscular physique. In reality, preoccupation with building muscle can completely take over someone’s life.
It can be common for those with male body image issues or male body obsession.
No matter how hard a person with muscle dysmorphia works out, they may still be dissatisfied with their body, which can lead them to work out more, further restrict their diet, or contemplate using steroids or other performance-enhancing drugs. However, they may still perceive themselves as “too small,” and the cycle continues.
The longer a person suffers from muscle dysmorphia, the more isolated they are likely to become. This, along with the discomfort they feel in their own skin, may lead to anxiety, depression, and mood disorders.
History of Muscle Dysmorphia
Muscle dysmorphia was initially identified in 1993 in a study of male bodybuilders, a proportion of whom displayed behavioral similarities to those with anorexia nervosa. It was originally termed “reverse anorexia” due to the obsession with increasing body size.8
The American Psychiatric Association recognized muscle dysmorphia in the DSM-5 in 2013, where it is classified as a subset of body dysmorphic disorder.
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FAQs
Men and athletes are particularly at risk of developing body dysmorphic disorders, like muscle dysmorphia, due to the pressures around sports performance and societal body ideals, which promote lean and muscular physiques.6
The main characteristic of muscle dysmorphia is a belief that one’s body is too small or insufficiently muscular, and this may drive a person to:
- Hide their body from others
- Exercise excessively
- Adhere to a strict diet
- Prioritize working out over family, work, and social commitments
- Use performance-enhancing drugs
Although there is no singular cause of muscle dysmorphia, research indicates that dysfunctional eating patterns, as well as psychological issues such as social anxiety, low self-esteem, and perfectionist tendencies, can increase the likelihood of developing this condition.4
Resources
- Grunewald W, & Blashill A. (2021). Muscle dysmorphia. Eating Disorders in Boys and Men; 103–115.
- Schneider C, Agthe M, Yanagida T, Voracek M, & Hennig-Fast K. (2017). Effects of muscle dysmorphia, social comparisons and body schema priming on desire for social interaction: An experimental approach. BMC Psychology; 5(1).
- AlGhareeb M, Almutawa YM, Karaidi N, Albalawi R, Aldwsri A, Helmy M, Alenezi AF, Trabelsi K, Ghazzawi HA, & Jahrami H. (2023). Muscle dysmorphic disorder inventory (MDDI): Translation and validation of an Arabic-language version. Research Square.
- Zeeck A, Welter V, Alatas H, Hildebrandt T, Lahmann C, & Hartmann A. (2018). Muscle dysmorphic disorder inventory (MDDI): Validation of a German version with a focus on gender. PLOS ONE; 13(11).
- Yetman D. (2020, November 13). Muscle dysmorphia: Risk factors, treatment, outlook. Healthline. Retrieved March 21, 2023.
- Pope HG, Gruber AJ, Choi P, Olivardia R, & Phillips KA. (1997). Muscle dysmorphia: An underrecognized form of body dysmorphic disorder. Psychosomatics; 38(6):548–557.
- Leone JE, Sedory EJ, & Gray KA. (2005). Recognition and treatment of muscle dysmorphia and related body image disorders. Journal of Athletic Training; 40(4):352–359.
- Murray SB, Rieger E, Touyz SW, & De la Garza García Lic Y. (2010). Muscle dysmorphia and the DSM-V conundrum: Where does it belong? A review paper. International Journal of Eating Disorders; 43(6):483–491.
- Grant J. (2015). Commentary on: Muscle dysmorphia: Could it be classified as an addiction to body image? Journal of Behavioral Addictions; 4(1):6–7.
- Cerea S, Bottesi G, Pacelli QF, Paoli A, & Ghisi M. (2018). Muscle Dysmorphia and its Associated Psychological Features in Three Groups of Recreational Athletes. Scientific Reports; 8(1):8877.