Muscle Dysmorphia Disorder: What Is it, Who Does it Affect, and How to Find Help

When people think of eating disorders, oftentimes a certain image comes to mind. Young, white females have long been synonymous with these types of mental health conditions, but the truth is that eating disorders impact people of all genders, races, and ages.

Likewise, the overwhelming desire to be thin is not the only way eating disorders or related body image disorders can present. In fact, some people are actually driven by an urge to gain weight, in the form of muscle.

Muscle dysmorphia (MD) is being increasingly recognized as a form of body dissatisfaction, particularly among males. And as the condition is closely related to male body image, it may look strikingly different than most people’s idea of an eating or body image disorder.

What is Muscle Dysmorphia?

Muscle dysmorphia is one of the most recently recognized forms of body dysmorphic disorder (BDD), a mental health condition in which one experiences obsessive thoughts over perceived “flaws” in their body or appearance.

Specifically, MD involves a preoccupation with body shape, size, and strength. Those with these body dysmorphic disorders tend to see themselves as “puny,” weak, too small, or inadequately muscular, despite their true appearance and strength levels. [1]

Indeed, many of those who have been found at the highest risk for developing MD are involved in sports that revolve around gaining muscle or strength. One study found that bodybuilders, in particular, showcased symptoms of MD at a rate of anywhere from 3.4% to 53.6% when compared to other resistance training athletes. [2]

But, as with all body image disorders, MD—which is sometimes also called “bigorexia” or “reverse anorexia”—resides in the mind, not the body. Those with this form of body dysmorphic disorder generally compare themselves to the “ideal male body,” and will find or fixate on any area of themselves that doesn’t measure up to that impossible standard, whether or not those “flaws” are real.

Who is At Risk for Muscle Dysmorphia

Muscle dysmorphia is still a relatively new concept in scientific literature, and studies on the topic are nascent. But those that have been performed have uncovered some patterns around the condition.

Most studies have suggested that the issue primarily impacts males, with an estimated 22% of men with body dysmorphic disorder—or 0.5% of men overall—meeting criteria for MD. [3] Though one study also examined the prevalence of MD in women, finding female bodybuilders particularly susceptible to the condition. [4]

That second study suggested that it may be athletic training, rather than gender, which more accurately predicts the risk of developing MD, and other studies have borne that out.

Aside from bodybuilders, the earlier study found that strength athletes, or those who participate in sports, such as wrestling, where strength plays a primary role, showcase elevated risk factors for developing muscle dysmorphia. [2]

What Causes Muscle Dysmorphia

As with all eating disorders and related body image disorders, muscle dysmorphia is a complex condition. Most of the time, these issues don’t have one source but are developed or maintained through several factors.

For body dysmorphic disorders in general, childhood bullying around issues of body weight, or shape or other aspects of appearance are thought to play a potential role. And with muscle dysmorphia in particular, societal pressures are also thought to have an outsized impact on forming a male body obsession. [5]

Muscle dysmorphia has also been tied to obsessive compulsive disorder (OCD), with the two conditions found to be commonly co-occurring. [3] Those with the dual conditions may obsess over the idea of gaining muscle, and soothe those distracting thoughts with actions like compulsive weight lifting.

But, as with nearly all types of eating disorders and body image issues, it’s likely that low self esteem is also a primary driver. Childhood bullying, the pressure to achieve a certain weight for a sport, or the pressure of societal standards in general can all contribute to creating a sense of body image dissatisfaction, which can lead someone to fixate on perceived flaws or resort to unhelpful behaviors to achieve these standards. [5]

Muscle Dysmorphia Symptoms

Muscle dysmorphia has yet to be formally recognized as its own condition, with a list of specific symptoms. (It’s currently only classified as a subtype of body dysmorphic disorder.)

But there are several associated psychological features, as well as emotional and physical traits, that often accompany the condition.

Mental and Emotional Symptoms of Muscle Dysmorphia

Muscle dysmorphia is driven by the idea of not being muscular enough, and while people who struggle with MD may sometimes openly discuss these concerns, they may also manifest as a number of other symptoms, including: [2, 3, 5]

• Avoiding social situations that may draw attention to their body, e.g. going to the beach
• Avoiding mirrors, or checking oneself in mirrors excessively
• Fixation on diet, including caloric intake or micro- or macronutrients
• Avoiding restaurants or food others have prepared

Those who struggle with MD may also enact strict routines around eating and working out and experience distress, agitation, or anxiety when those routines are disrupted.

Physical Muscle Dysmorphia Symptoms

Gaining and maintaining muscle can be a physically punishing and time-consuming task. And while many people enjoy getting in shape in healthy ways, there are some aspects of a physical health routine that may point to MD or other related body image concerns, including: [2, 3, 5]

• Exercising excessively, even when exhausted or injured
• Consistently exercising longer or harder than originally intended
• Foregoing other social situations or previously enjoyed pastimes to exercise more
• Rapid muscle gain or weight loss

Perhaps most directly impactful for those with MD is the idea that outside influences, relationships, and events are distractions to exercise and muscle gain. For those close to someone with MD, there may be a feeling of distance or avoidance from their loved one.

Dangers of Muscle Dysmorphia

At its core, muscle dysmorphia is defined by a fixation on perceived bodily flaws, despite these “flaws” often being minuscule or outright imagined. Still, the pattern of unhelpful thoughts centered around this idea can lead to unhelpful, or even dangerous, behavior.

The use and abuse of anabolic steroids and other performance-enhancing drugs has been tied to MD in a number of studies. [1, 2, 3] And these drugs are known to bring on a number of potentially devastating effects, including: [6]

• Cardiovascular risks, including high blood pressure, blood clots, and heart failure
• Stroke
• Hormonal imbalance, which can lead to low sperm count
• Increased aggression or mania
• Delusions

Those with body dysmorphic disorder in general also unfortunately struggle with disproportionately high rates of suicide, suicide attempts, and hospitalization. [1]

Finding Treatment for Muscle Dysmorphia

Muscle dysmorphia is a serious mental health condition, which can bring on a number of dangerous or potentially even deadly consequences. If you or a loved one are struggling with MD, it’s important to seek out help.

A combination of mental and physical health interventions can likely help improve conditions or help someone adopt an overall healthier mindset and behaviors.

Speaking with a therapist, psychiatrist, primary care physician, or other trusted medical professional is a great place to start. These experts are generally educated in a number of different eating and body image disorders, and may be able to help point you in the direction of a helpful program or treatment option.

If you’d rather not speak about this sensitive topic face-to-face, a number of mental health and eating disorder hotlines can also help. While allowing callers to remain anonymous, these services provide additional information and resources for those seeking treatment or help for mental health disorders.

Regardless of where you look for help or the type of program you ultimately decide on, the most important part of the process is starting. Overcoming such deeply-held beliefs and ingrained behaviors may seem impossible, but with the right kind of help, it’s possible to start building a healthier life and future.

Resources

1. Phillips KA, & Castle DJ. (2001). Body dysmorphic disorder in men. BMJ; 323(7320):1015–1016.
2. Cerea S, Bottesi G, Pacelli Q, Paoli A, Ghisi M. (2018). Muscle Dysmorphia and its Associated Psychological Features in Three Groups of Recreational Athletes. Scientific Reports; 8(8877).
3. Olivardia R, Blashill A, Hoffman J. (n.d.). Muscle Dysmorphia. International OCD Foundation. Accessed April 2023.
4. Skemp K, Mikat R, Schenck K, Kramer N. (2013). Muscle Dysmorphia Risk May Be Influenced by Goals of the Weightlifter. Journal of Strength and Conditioning Research; 27(9):2427-2432.
5. 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.
6. What are the side effects of anabolic steroid misuse? (2023, February 9). National Institute on Drug Abuse. Accessed April 2023.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

Last Updated on April 27, 2023
Published on EatingDisorderHope.com