What is muscle dysmorphia?

Some people are unhappy with the shape of their nose, others with their hair (or lack of hair). But when you fixate on these attributes and the feeling begins to gnaw away at the core of your wellbeing, we start to call it a body image disorder.

Conditions like anorexia and bulimia are both well-known. But you may not have heard of muscle dysmorphia, a condition that can be both psychologically debilitating and physically damaging.

We investigate muscle dysmorphia, what it is and what you can do about it if you, or someone you know, might be affected by it.

What is muscle dysmorphia?

Muscle dysmorphia is part of a collection of conditions that fit into the mental health category of body dysmorphic disorders (BDD).

People with BDD have a preoccupation with the way they look, constantly thinking they are not lean or muscular enough despite what they might see in the mirror. This impossible strive for perfection can lead people down compulsive and sometimes dangerous routes or excessive exercise, strict dieting, supplementation, and, sometimes, anabolic steroids. The lifestyle changes can have a knock-on impact on work, social and family life too. Both health and finances can suffer considerably.

It has been colloquially known as bigorexia – i.e., the opposite of anorexia. But that’s a simplification that undermines the complexity of both conditions. Instead, muscle dysmorphia is a fixation on perceived flaws in appearance. It predominantly affects men, particularly bodybuilders – but can affect women and other trainers as well.

Who gets muscle dysmorphia, and what causes it? 

Anyone can have muscle dysmorphia. But often it shows itself in people sculpting their bodies for aesthetics rather than function (i.e., bodybuilders or weightlifters). The scary thing is that the path to muscle dysmorphia is probably endemic in society. One study that asked adolescent boys what they would like their bodies to look like and what they think their body looks like to others found that the boys wanted to be hench in the future and currently perceived their bodies to be much weaker and leaner than they were.

Could popular culture and all those topless Marvel hunks be a contributing factor? What about competitions that have an emphasis on appearance? How about those who strive for perfection in life or those with low self-esteem? Well, probably all of these and more act as nudges towards the condition.

Signs, behaviours, and symptoms of muscle dysmorphia

Behaviours that people with muscle dysmorphia may exhibit:

• Excessive weightlifting and a strict all-encompassing gym regime.
• The use of anabolic steroids and other performance enhancers.
• Avoiding social situations that draw attention to the body – e.g. beach days.
• Missing out on social activities to spend more time at the gym.
• Avoiding or excessively checking mirrors.
• Either constantly posting on Instagram for validation or avoiding posting but monitoring dozens of other aesthetic accounts.
• Regimented meals.
• Orthorexia – an obsession with healthy foods and supplements.
• Social anxiety and low self-esteem.

Is there a muscle dysmorphia test?

There are a few tools and surveys used to assess the severity of muscle dysmorphia. One such tool is the muscle dysmorphic disorder inventory which includes 13 questions scored from never to always.

It is not uncommon not to notice the issue when you are in it, but others around you might. If you see a friend compulsively exercising, and fretting about the way they look, try starting an open and honest conversation. Personal trainers may see this more often in their day-to-day work.

Questions on the muscle dysmorphic disorder inventory include:

1. I think my body is too skinny/slender
2. I wear loose clothing so that people cannot see my body
3. I hate my body
4. I wish I could be heavier
5. I find my chest to be too small
6. I think my legs are too thin
7. I feel like I have too much body fat
8. I am embarrassed to let people see me without a shirt
9. I feel anxious when I miss a day of exercise
10. I cancel social activities because of my workout schedule
11. I feel depressed when I miss a day of exercise
12. I miss opportunities to meet new people because of my schedule

If you find yourself agreeing with a lot of these points, it might be a good idea to seek some help.

Can muscle dysmorphia be treated? 

Yes, muscle dysmorphia can be treated. Initially, things can be tough. Often, there will be a lot of denial before acceptance, and in that early stage, lots of different voices might help – family, friends, trainers, GPs – all understanding, all supportive. 

Once acceptance is achieved, behaviour change is sometimes a difficult path to walk down. GPs and psychiatrists can get involved. Counsellors and cognitive behavioural therapy (CBT) are useful and, in some cases, antidepressants as well. There may also need to be an element of life coaching to help get finances back on track and health rehab to undo the work of anabolic steroids.

There are also useful online resources at Male Voiced and the Body Dysmorphic Disorder Foundation.

Take-home message 

Muscle dysmorphia is a mental health condition where people perceive themselves to be less muscly or lean than they are. It can lead to damaging relationships with exercise, food, health, and those around you. If you or someone you know might be suffering from muscle dysmorphia, the key is to start the conversation.

References: 

Cerea, S., Bottesi, G., Pacelli, Q.F. et al. Muscle Dysmorphia and its Associated Psychological Features in Three Groups of Recreational Athletes. Sci Rep 8, 8877 (2018). https://doi.org/10.1038/s41598-018-27176-9

Zeeck, A. et al. Muscle Dysmorphic Disorder Inventory (MDDI): Validation of a German version with a focus on gender. Plos One. Nov 16 (2018).  https://doi.org/10.1371/journal.pone.0207535

Leone, J. E., Sedory, E. J., & Gray, K. A. (2005). Recognition and treatment of muscle dysmorphia and related body image disorders. Journal of athletic training, 40(4), 352–359. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1323298/ 

Understanding and Treating Muscle Dysmorphia. Yetman, D. Nov 13, 2020. Accessed 10/10/21 https://www.healthline.com/health/muscle-dysmorphia

What it's like to have muscle dysmorphic disorder. Millar, A. Feb 11, 2020. Accessed 10/10/21 https://patient.info/news-and-features/what-its-like-to-have-muscle-dysmorphic-disorder

DSM-5: Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 23, DSM-IV to DSM-5 Body Dysmorphic Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t19/

Male Voiced https://www.malevoiced.com/

Body Dysmorphic Disorder Foundation https://bddfoundation.org/