Dominic Stone
Muscle Dysmorphia (MD) is a subclass of Body Dysmorphic Disorder (BDD), a mental health condition where a person spends a lot of time worrying about flaws in their appearance. MD is characterised by a fixation on the body being too small or not muscular enough, despite having an average or muscular build. The condition mainly affects males, with symptoms usually beginning in the late teens or early adulthood. Individuals with MD often become preoccupied with their appearance, engaging in excessive weightlifting and spending hours checking their appearance in the mirror. While the exact causes of MD are unknown, factors such as biology, childhood trauma, cultural and media influences, low self-esteem, and social anxiety may contribute to its development. Treatment options for MD include cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs).
| Characteristics | Values |
|---|---|
| Definition | Being preoccupied by worries that one’s body is “too small” or “not muscular enough” despite having a normal build, or in many cases, an objectively extremely “buff” physique |
| Gender | MD mainly affects males, but research suggests that it is also prevalent among female bodybuilders |
| Age | Symptoms usually begin in the late teens or early adulthood |
| Prevalence | Research indicates that between 1.7% and 2.4% of individuals meet the criteria for BDD, and about 22% of men with BDD also meet the criteria for MD |
| Causes | Factors such as biology, being teased or bullied while growing up, problematic ways of thinking about wanting to be highly muscular, cultural and media influences, low self-esteem, feelings of social isolation, and loneliness |
| Treatment | Cognitive Behavioral Therapy (CBT), Selective Serotonin Reuptake Inhibitors (SSRIs), and support groups |
| Diagnosis | DSM-5 categorizes BDD as a subtype of Obsessive-Compulsive Disorder and notes muscle dysmorphia as a preoccupation that one's body is too small or insufficiently muscular |
| Impact | Individuals with severe MD may sacrifice relationships, interests, financial stability, and careers to focus on their appearance |
| Behavioral Signs | Excessively working out/lifting weights, constantly checking appearance in mirrors, engaging in mental rituals comparing muscularity to that of others |
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What You'll Learn
- Muscle Dysmorphia (MD) is a subclass of Body Dysmorphic Disorder (BDD)
- MD is defined by a preoccupation with the belief that one's body is not muscular enough
- MD is more common in men, especially bodybuilders and weightlifters
- MD can lead to social isolation and negatively impact relationships and careers
- Treatment for MD includes cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs)
Muscle Dysmorphia (MD) is a subclass of Body Dysmorphic Disorder (BDD)
MD is characterised by a pathological preoccupation with muscularity, which is often accompanied by a range of thoughts and beliefs about oneself and others. Individuals with MD may hold beliefs that their body is insufficiently muscular or large enough, leading to intrusive negative thoughts and a perception of negative evaluation from others. This can result in excessive weightlifting or working out for multiple hours a day, impacting their daily lives and relationships.
The exact cause of MD is unknown, but several factors may contribute to its development. Biological factors, such as genetics, play a role, with twin studies estimating the heritability of BDD at 43%. Environmental factors, such as being teased or bullied during childhood, can also influence the development of MD. Additionally, cultural and media influences that promote unrealistic body ideals can contribute to the risk of developing MD.
MD can significantly impair an individual's quality of life, leading to educational and occupational dysfunction, social isolation, and high rates of suicidal thoughts and attempts. The condition can also result in the sacrifice of relationships, personal interests, financial stability, and careers to prioritise working out and "getting big". Treatment for MD can be challenging due to the fear of losing muscle mass during recovery. However, cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) have been suggested as potential treatments, similar to the approach for BDD.
It is important to note that individuals with MD may deny or rationalise their condition and may become defensive when confronted by concerned loved ones. They may also isolate themselves or avoid social situations that draw attention to their body. MD is sometimes referred to as "bigorexia" or "reverse anorexia", and while it shares some similarities with eating disorders, it is not classified as one.
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MD is defined by a preoccupation with the belief that one's body is not muscular enough
Muscle Dysmorphia (MD) is a subtype of Body Dysmorphic Disorder (BDD), a psychopathological condition that affects an individual's thoughts and behaviours in problematic ways. MD is defined by a preoccupation with the belief that one's body is not muscular enough, despite often having a normal or well-muscled physique. This distorted perception can lead to significant distress and impairment in social and occupational functioning.
The onset of MD typically occurs in late adolescence or early adulthood, predominantly affecting males. However, it can also develop later in life, and females can suffer from the disorder as well. The exact prevalence of MD is unknown, but research suggests that between 1.7% and 2.4% of individuals may meet the criteria for BDD, with MD being a subset of this group. One study found that about 22% of men with BDD also met the criteria for MD, suggesting that approximately 0.5% of men in general may have MD. It is important to note that these numbers may be underestimates, and more research is needed.
Individuals with MD are constantly worried about their muscularity and leanness, believing their bodies to be insufficiently muscular or lean, even when they are in good physical shape. This mismatch between body image and reality leads to a compulsive drive to achieve an "ideal" body by fixing perceived flaws. The quest to "fix" their bodies can consume inordinate time, attention, and resources, including excessive exercise routines, strict dietary regimens, and the use of supplements or anabolic steroids.
MD is associated with a range of thoughts and beliefs, including the conviction that one's body is not large or muscular enough, intrusive negative thoughts about one's body, and the belief that others negatively evaluate their appearance. This can lead to social isolation, as individuals with MD may avoid activities, people, and places that threaten to reveal their perceived physical deficiencies. They may also become defensive or angry when confronted about their preoccupation with muscularity and may deny having a problem.
MD is often accompanied by other mental disorders, such as eating disorders, mood disorders, anxiety disorders, and substance use disorders. It is important for individuals with MD to seek help from a therapist specialising in BDD, OCD, or body image disorders. Cognitive Behavioural Therapy (CBT) can be particularly effective in addressing negative self-talk, unhelpful thinking patterns, and compulsive behaviours associated with MD.
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MD is more common in men, especially bodybuilders and weightlifters
Muscle Dysmorphia (MD) is a form of Body Dysmorphic Disorder (BDD) characterised by a pathological preoccupation with muscularity. It is defined by a distorted perception of one's body, believing it to be "too small" or "not muscular enough", despite often having an extremely "buff" physique. This distorted perception can sometimes reach the point of delusion. Those with MD engage in repeated behaviours in response to their perceived flaws, such as constantly checking their appearance in mirrors or comparing their bodies to others'.
MD predominantly affects men, with symptoms usually beginning in the late teens or early adulthood. Research suggests that about 22% of men with BDD also meet the criteria for MD, indicating that around 0.5% of men in general may meet the criteria for MD. This figure may be an underestimate, and more research is needed.
MD is particularly prevalent among bodybuilders and weightlifters, who often spend multiple hours per day excessively working out and lifting weights. The desire to ""get big"" can lead individuals with MD to sacrifice relationships, interests, financial stability, and careers. They may also make important life decisions based on how they will impact their workout schedules.
Men in the bodybuilding community have long recognised MD, even coining the term "bigorexia" to describe it, acknowledging that it is akin to a ""reverse" form of anorexia nervosa. The first scientific report of the syndrome termed it "reverse anorexia nervosa", and subsequent reports proposed renaming it "muscle dysmorphia".
MD can have severe consequences, with those affected having a higher frequency of suicide attempts, substance use disorders, and anabolic steroid abuse.
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MD can lead to social isolation and negatively impact relationships and careers
Muscle dysmorphia (MD) is a form of body dysmorphic disorder (BDD) characterised by a pathological preoccupation with achieving a high degree of lean muscle mass, while simultaneously believing that one's body is "not big enough" or "not muscular enough". This perception of one's body is distorted and can sometimes seem delusional. MD is associated with a range of negative thoughts and beliefs about oneself and others, including the belief that one's body is insufficiently large or muscular and intrusive negative thoughts about one's body that lead to difficulty focusing.
Secondly, when confronted by concerned family members or friends about their behaviour, individuals with MD may respond with denial, rationalisation, anger, or defensiveness. They may start isolating themselves from their support network or avoiding social situations to hide their behaviour or due to feelings of shame or embarrassment. This social withdrawal is often accompanied by a rigid exercise and dietary regimen, further exacerbating social isolation.
Additionally, MD is associated with a negative self-image and low self-esteem, which can contribute to social isolation and negatively impact relationships. Individuals with MD may struggle with the belief that others negatively evaluate their appearance, leading to social anxiety and avoidance of social situations. The negative self-talk and unhelpful thinking patterns associated with MD can also spill over into other areas of their lives, including work and personal relationships.
Furthermore, the misuse and abuse of anabolic steroids and other substances to enhance muscle growth, which is common in individuals with MD, can have detrimental effects on their physical and mental health. This can impact their ability to maintain stable relationships or perform well in their careers. The presence of co-occurring mental health disorders, such as substance use disorders or eating disorders, can further complicate social functioning and interpersonal relationships.
Finally, problematic social media use has been linked to MD, with excessive time spent online potentially contributing to social isolation and negatively impacting real-life social support. The constant exposure to idealised body images and the pressure to present a certain image online can exacerbate body image concerns and social comparison tendencies, leading to further social withdrawal.
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Treatment for MD includes cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs)
Muscle Dysmorphia (MD) is a form of Body Dysmorphic Disorder (BDD) characterised by a pathological preoccupation with the idea that one's body is "too small" or "not muscular enough". This perception of one's body is distorted and can become delusional. MD is associated with a number of thoughts and beliefs about oneself and others, including the belief that one's body is insufficiently large or muscular, intrusive negative thoughts about one's body, and the belief that others negatively evaluate their appearance.
SSRIs are a well-supported, evidence-based intervention strategy that can meaningfully improve symptoms and functioning. They are often used in combination with CBT, especially in the treatment of anxiety and depression in youth. This combination has been shown to produce greater improvement than either treatment alone, with the fastest response observed in patients who are younger and have milder baseline symptoms.
The combination of CBT and SSRIs allows for a multimodal treatment approach, which is recommended by the American Academy of Child & Adolescent Psychiatry. The added value of CBT in conjunction with SSRIs typically occurs later in the treatment process, and the response can vary depending on patient characteristics.
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Frequently asked questions
Muscle dysmorphia (MD) is a subclass of body dysmorphic disorder (BDD) where the focus is on muscularity. People with MD perceive their bodies as less muscular and smaller than they really are.
People with MD often become so preoccupied with their appearance that their lives are centred on building more muscle. They may excessively work out/lift weights (multiple hours per day), constantly check the appearance of their muscles in mirrors, or engage in mental rituals comparing how muscular they are to others. They may also avoid social situations that draw attention to their body, such as swimming or going to the beach...
MD mainly affects males, with symptoms usually beginning in the late teens or early adulthood. However, research suggests that MD is also prevalent among female bodybuilders.
Cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) have been suggested as potential treatments for MD since they are the primary treatments for BDD. Seeking treatment for MD can feel like a "catch-22" dilemma, as it may involve decreasing time at the gym and ceasing any steroid use, which can be scary for those with MD.
