Muscle Dysmorphia

Body Dysmorphic Disorder

Body dysmorphic disorder is recognized as a psychopathologic condition in the Diagnostic and Statistical Manual of Mental Disorders. This disorder is often seen as a subcategory of obsessive-compulsive disorder with more specific criteria. Dissatisfaction with anything related to the human body is possible, ranging from baldness to skin appearance. Perceived flaws in the patient's body are often unappreciated by others but are very real to the person experiencing them. Focus on the flaw is so preoccupying that people often become depressed and obsessed and may even lose relationships or jobs as a result. Body dysmorphic disorder is often confused with vanity; this is not the case as most people don't want to look great, they just want to look acceptable. 

Muscle Dysmorphia

Formally defined, MDM is a pathologic preoccupation with muscularity and leanness. A subcategory of body dysmorphic disorder, MDM involves a specific dissatisfaction with muscularity rather than the body as a whole, with a discrepancy between the imagined and actual self. In one of the first papers addressing MDM, were explained the symptoms and epidemiology, and proposed diagnostic criteria. Individuals obsess about being inadequately muscular and lean when, in fact, they are not. With MDM, compulsions may include spending endless hours in the gym or countless amounts of money on supplements; deviant eating patterns; or even substance abuse.

Who Gets Muscle Dysmorphia?

Muscle dysmorphia affects men more often than women. It’s common among athletes. Sports where weight and strength matter — like football, wrestling, and bodybuilding — have the most cases of MD.  

Cases of muscle dysmorphia are increasing. Approximately 100,000 people worldwide meet the psychological criteria for muscle dysmorphia. But most experts agree that we are currently underestimating the number of cases because it’s difficult to diagnose. 

Muscle dysmorphia is associated with a number of thoughts and beliefs about one’s self and others, including:

• Beliefs that one’s body is not sufficiently muscular and large enough
• Over valuing appearance
• Intrusive negative thoughts about one’s body that leads to distractibility and difficulty focusing attention
• Belief that other’s negatively evaluate their appearance

There are also a number of behavioral signs of muscle dysmorphia, including:

• Excessively working out/lifting weights (multiple hours per day)
• Repeatedly counting calories
• Avoiding eating out at restaurants due to perceived lack of control over food content
• Balancing carbohydrates, fats, proteins, and vitamins to achieve a “perfect” formula
• Eating multiple meals throughout the day at rigidly adhered to schedules
• Excessively checking mirrors, or other reflective surfaces
• Avoidance of mirrors, or other reflective surfaces
• Avoidance of social situations where bodies may be on display (e.g., the beach, or pool)
• Camouflaging one’s bodies by wearing multiple layers of clothing to appear “larger”
• Use of anabolic steroids or other appearance and performance enhancing drugs

There hasn’t yet been much research into the best way to treat MD. Current opinions in the medical community are shaped largely by anecdotes and case reports. Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) have been suggested as potential treatments since they’re the primary treatments for BDD.

CBT is a type of talk therapy that can be done on your own or in a group. CBT targets the psychological factors that may have led to the development of MD. You’ll work with your therapist to build strategies to address toxic beliefs about masculinity and find ways to deal with your feelings.

SSRIs are a type of antidepressant used to treat BDD. Your doctor may recommend them if you have moderate or severe BDD or MD. These medications may take up to 12 weeks to become effective.