Muscle Dysmorphia: A New Eating Disorder On The Horizon?

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Go big or go home?

What’s the first thing that comes to mind when you think of an eating disorder?

Like most, I’m sure your idea of an eating disorder is depicted by an emaciated white, middle-aged girl. 

Not many people think of men when it comes to eating disorders. 

This is unfortunate, because rates of eating disorders in men are skyrocketing, and men with eating disorders experience the same degree of impairment than women. 

But, there’s one peculiar trend we are noticing with men who show signs and symptoms of eating disorders. 

And that’s their strong desire to achieve muscle mass or a muscular physique (rather than on thinness, which is characteristic of women).

This is what we call “muscle dysmorhpia”.

Signs and Symptoms of Muscle Dysmorphia

The meaning and definition of muscle dysmorphia have been discussed for over 25 years now ¹Pope Jr, H. G., Gruber, A. J., Choi, P., Olivardia, R., & Phillips, K. A. (1997). Muscle dysmorphia: An underrecognized form of body dysmorphic disorder. Psychosomatics, 38(6), 548-557.

You’ve probably heard of this condition also being referred to as “bigorexia” or “reverse anorexia” because its signs and symptoms stand in stark contrast to anorexia nervosa.

You’ll see why. 

Although it’s not yet an official eating disorder, let’s take a look at some of the signs, symptoms, and criteria for this condition. 

Muscle dysmorphia is characterized by:

1. Preoccupation with the idea that one’s body is not sufficiently lean and muscular. Characteristic associated behaviors include long hours of lifting weights and excessive attention to diet.
2. The preoccupation is manifested by at least two of the following four criteria:
   • The individual frequently gives up important social, occupational, or recreational activities because of a compulsive need to maintain his or her workout and diet schedule.
   • The individual avoids situations where his or her body is exposed to others or endures such situations only with marked distress or intense anxiety.
   • The preoccupation about the inadequacy of body size or musculature causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
   • The individual continues to work out, diet, or use ergogenic substances despite knowledge of adverse physical or psychological consequences
3. The primary focus of the preoccupation and behaviors is on being too small or inadequately muscular, or a primary preoccupation only with other aspects of appearance as in other forms of body dysmorphic disorder

Let’s break this criteria down a little further.

On a cognitive level, the hallmark symptom of muscle dysmorphia is a marked preoccupation with one’s physique not being muscular enough. 

This means that the person’s attention, thoughts, and beliefs are constantly directed towards their muscle mass. 

In fact, early reports show that bodybuilders with muscle dysmorphia spend more than 5 hours a day obsessing over their muscle mass ²Olivardia R, Pope HG Jr, Hudson JI. Muscle dysmorphia in male weightlifters: A case control study. Am J Psychiatry 2000;157: 1291–1296!

On a behavioural level, muscle dysmorphia is characterized by excessive working-out and lifting weights, and extreme anxiety in the event of missed workouts.

This consequently impairs the persons occupational and social functioning. 

In fact, some men with muscle dysmorphia even skip important job interviews that interfered with their workout schedule ³Murray, S. B., Rieger, E., Touyz, S. W., & 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! 

Some other behaviours associated with muscle dysmorphia are: 

• Anabolic steroid use (more than 50% of people with this condition use steroids)
• Obsessive mirror checking
• Social avoidance 
• Body concealment 
• Excessive use of food supplements 
• Working out in spite of injury 

Causes and Consequences of Muscle Dysmorphia 

As with all mental health problems, there’s no single cause we can pinpoint; rather the cause of these disorders result from the complex interplay of various biological, psychological, and social processes. 

There appears to be certain genes that put people at risk for muscle dysmorphia, although the research on this is very preliminary.

Certain risk factors for eating disorders may also play a role in causing muscle dysmorphia. Some of these include:

• Body image concerns
• Perfectionistic tendencies 
• Low self-esteem 
• Need for approval 

What about the consequences of muscle dysmorphia?

Given that muscle dysmorphia is characterized by a variety of risky behaviours, it’s not surprising that the condition puts people at risk of many health complications. 

Some of the risks of muscle dysmorphia include: 

• Frequent injuries due to overexercise
• Damage to muscles, joints, and tendons
• Kidney damage
• Liver damage
• Heart problems

Epidemiology of Muscle Dysmorphia 

Studies on the prevalence and incidence rates of muscle dysmorphia are lacking, so at the moment we don’t yet have a precise estimate of these statistics. 

In addition to this, we believe that muscle dysmorphia is very hard to diagnose and is likely underreported. In fact, many men who have the condition do not see it as a problem and those that do may go to great lengths to hide it.

However, we do know a few things about muscle dysmorphia ⁴Tod, D., Edwards, C., & Cranswick, I. (2016). Muscle dysmorphia: current insights. Psychology research and behavior management, 9, 179:

• Substantially more men are affected
• Substantially more bodybuilders are affected, relative to non-body builder resistance trainers
• Nearly 15% of bodybuilder exhibit clinically significant levels of muscle dysmorphia
• The average age of onset is around 19 years of age

Treatment Options For Muscle Dysmorphia. 

We’re all a bit unclear of how to treat muscle dysmorphia. 

This is largely because no clinical trials have been conducted testing different treatment approaches.

That said, given muscle dysmorphia’s substantial overlap with body dysmorphic disorder (BDD) and certain eating disorders, we can argue that effective BDD and eating disorder treatments could also be applicable to muscle dysmorphia. 

The idea in treatment is to address or prevent risky behavior (e.g., steroid use) and to modify obsessional thoughts about muscle mass and ideal body types.

Some potentially effective treatment approaches include:

• Cognitive therapy 
• Behavior therapy
• Dialectical behavior therapy 
• Selective serotonin reuptake inhibitors 
• Family-based therapy