Muscle dysmorphia (MD) is a mental health condition in which a person believes that their muscles are not large or developed enough.
MD typically begins in adolescence or early adulthood. Symptoms may include excessive exercise, calorie counting, and a preoccupation with obtaining a muscular appearance.
On the surface, a preoccupation with building muscle may seem harmless. However, symptoms of MD can negatively affect a person’s life, such as by making it difficult for them to maintain relationships or a career.
People with MD may also experience feelings of shame, low self-esteem, and (in some cases) an increased risk of suicide.
This article will discuss MD — including its symptoms, causes, risk factors, diagnosis, and treatment — and answer two frequently asked questions.
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
People with MD experience persistent feelings of dissatisfaction about the development of their muscles.
As a result, they may engage in excessive behaviors aimed at building muscle, including:
- exercising compulsively
- maintaining a rigid diet
- using dietary supplements in an extreme way
- using anabolic-androgenic steroids
People with MD may fixate on increasing their muscle size regardless of the true state of their physique. It is possible for a person of any size, including those who already have well-developed muscles, to experience MD.
It is also possible for a muscular person to exercise regularly and not live with MD. However, people with MD typically prioritize diet and exercise to build muscle at the expense of important aspects of life, such as their relationships or career.
In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), MD is a specifier for body dysmorphic disorder (BDD).
This means that when healthcare professionals diagnose BDD, they
Prevalence
MD prevalence can vary among demographics. For example, a
The study authors suggested a marginal association of MD with older age but not with gender or socioeconomic status.
By comparison, a
According to a
However, older research suggests that MD or high levels of its symptoms may affect
MD symptoms may include:
- spending excessive amounts of time exercising
- exercising despite injury risk
- exercising through pain
- wearing baggy or layered clothing to hide perceived imperfections
- wearing clothing that accentuates certain areas of the body
- prioritizing physical appearance
- scheduling other activities around workouts
- sacrificing a career, relationships, finances, and other interests for exercise
- believing that one’s muscles should be larger
- counting calories
- being fixated on food content
- maintaining a rigid dietary schedule
- obsessing about or avoiding mirrors
- using steroids or performance-enhancing drugs
According to the International OCD Foundation (IOCDF), there is no specific cause of MD. However, factors such as the following may contribute to this condition:
- biology
- childhood teasing or bullying
- cultural or media influences
- low self-esteem
- social isolation
- loneliness
People who participate in appearance-related sports may have a higher risk of developing MD. A small
The researchers found that bodybuilders with symptoms of social anxiety and orthorexia nervosa had a greater chance of experiencing MD symptoms.
People with perfectionist tendencies may also be at risk of developing MD.
Perfectionism can affect a person directly by driving them to obtain what they perceive to be a perfect body. Indirect perfectionistic thinking may cause them to be dissatisfied with the body they currently have.
MD and other mental health conditions
According to the IOCDF, MD commonly occurs alongside the following mental health conditions:
- substance use disorder
- obsessive-compulsive disorder (OCD)
- eating disorders
- mood disorders
- social anxiety disorder
- attention deficit hyperactivity disorder
The association between eating disorder symptoms and MD symptoms is positive and statistically significant, according to a
The review authors also noted a link between MD symptoms and OCD obsessions and compulsions:
- Obsessions: People with MD have a preoccupation with the size of their muscles.
- Compulsions: People with MD perform repetitive and compulsive behaviors, such as checking themselves in mirrors or mentally assessing their appearance in comparison to others.
The DSM-5
MD is a subtype of BDD, so a diagnosis may initially focus on BDD. Healthcare professionals
They may ask how a person feels about their appearance, whether these feelings affect their quality of life, and whether the person experiences repetitive or compulsive thoughts and behaviors.
If a person shows signs of BDD, a doctor may ask further questions to diagnose the MD subtype. For example, they may use the MDDI,
- drive for size
- appearance intolerance
- functional impairment
Treatment options for MD
- Psychotherapy: cognitive behavioral therapy, metacognitive therapy, family therapy, or other techniques
- Selective serotonin reuptake inhibitors: antidepressant medications such as fluoxetine (Prozac) and citalopram (Celexa)
Treatment may involve a mix of psychotherapy and medication. Typically, surgical treatment to adjust the perceived imperfections is not effective and may worsen symptoms of MD.
A person’s treatment team may also include an endocrinologist if they have used steroids.
People with MD might not seek treatment because they might deny or not recognize that they are experiencing a mental health condition.
However, if a person is showing symptoms of MD, they may benefit from speaking with a healthcare professional.
The IOCDF recommends contacting a healthcare professional who specializes in BDD, body image disorders, or OCD.
People with BDD may have an increased risk of suicide. A
People can also contact the 988 Suicide and Crisis Lifeline 24 hours a day at 988. People who are hard of hearing can use their preferred relay service or dial 711 then 988.
The following are two frequently asked questions about muscle dysmorphia.
Is muscle dysmorphia becoming more common?
A
The authors cite social media as a possible influencing factor.
What is the difference between bigorexia and muscle dysmorphia?
“Bigorexia” is another name for MD. People may also refer to this condition as “reverse anorexia.”
Muscle dysmorphia is a mental health condition involving a preoccupation with increasing the size of one’s muscles.
People with MD may prioritize building muscle at the expense of important aspects of life, such as their career, relationships, or overall health.
Although anyone can develop MD, participation in appearance-oriented sports such as bodybuilding may increase a person’s risk. Treatment typically includes therapy and medication.