Muscle dysmorphia is a subtype of the obsessive mental disorder body dysmorphic disorder.
It is often also grouped with eating disorders.
In muscle dysmorphia, which is sometimes called bigorexia or reverse anorexia, the delusional or exaggerated belief is that one’s own body is too small, too skinny, insufficiently muscular, or insufficiently lean, although in most cases, the individual’s build is normal or even exceptionally large and muscular already.
Muscle dysmorphia affects mostly men.
Muscle dysmorphia affects particularly those involved in sports where body size or weight are competitive factors, becoming rationales to gain muscle or become leaner.
This fixation with one’s body consumes inordinate time, attention, and resources on exercise routines, dietary regimens, and nutritional supplementation.
The use of anabolic steroids is also common.
Other body-dysmorphic concerns that are not muscle-dysmorphic are usually present as well.
Muscle dysmorphia is especially difficult to recognize, since awareness of it is scarce and persons experiencing muscle dysmorphia typically remain healthy looking.
The distress and distraction related to muscle dysmorphia may provoke absences from school, work, and social settings.
Compared to other body dysmorphic disorders, rates of suicide attempts are especially high with muscle dysmorphia.
Muscle dysmorphia’s incidence is rising, partly due to cultural emphasis on muscular male bodies.
Muscle dysmorphia’s onset is estimated at usually between ages 18 and 20.
In addition to clinical features excessive conduct of efforts to increase muscularity, activities such as dietary restriction, overtraining, and injection of growth-enhancing drugs.
Persons experiencing muscle dysmorphia generally spend over three hours daily pondering increased muscularity.
Individuals with muscular dysmorphia may feel unable to limit weightlifting.
Those suffering from the disorder closely monitor their body and may wear multiple clothing layers to make it appear larger.
Because muscle dysmorphia involves severe distress at having one’s body viewed by others, there is occupational and social functioning impairment, and adherence of dietary regimes may interfere with socialization: avoiding activities, people, and places that threaten to reveal their perceived deficiency of size or muscularity.
Roughly half of patients have poor or no insight that these perceptions are unrealistic.
There are elevated rates of diagnoses of other mental disorders, including eating disorders, mood disorders, anxiety disorders, and substance use disorder, as well as elevated rates of suicide attempts.
Risk factors for muscle dysphoria:
Trauma and bullying
Having experienced or observed traumatic events like sexual assault or domestic violence.
Sustained adolescent bullying and ridicule for actual or perceived deficiencies such as smallness, weakness, poor athleticism, or intellectual inferiority.
Low self-esteem is associated with higher levels of body dissatisfaction and of muscle dysmorphia.
Vulnerable narcissism is linked to heightened muscle dysmorphia risk.
Increased body size or muscularity may seem to enhance the masculine identity.
Media emphasizes physical attractiveness, exploiting male body-image insecurity and provokes bodily comparisons and pressure for individuals to conform.
The media increase the gap between men’s perceptions of their own muscularity versus their desired muscularity.
Athletes often share some psychological factors that may predispose to muscle dysmorphia: high levels of competitiveness, need for control, and perfectionism, and athletes tend to be more critical of their own bodies and body weight.
Athletes who also fail in their sports performance goals may escalate efforts to modify their builds that overlap those of muscle dysmorphia.
Involvement in sports where size, strength, or weight imply competitive advantage is associated with muscle dysmorphia.
MSM are at increased risk for experiencing internalized heterosexism, leading to dissatisfaction with one’s body and the internalizing of standards for attractiveness.
Dissatisfaction with muscularity has a stronger relationship with quality of life impairment when compared to dissatisfaction with body fat, height, and penis size.
Scientific research on treatment of muscle dysmorphia is limited, the evidence largely in case reports and anecdotes,
Evidence supports family-based therapy, cognitive behavioral therapy, and pharmacotherapy with selective serotonin reuptake inhibitors.
Prevalence estimates for muscle dysmorphia have greatly varied, ranging from 1% to 54% of men: gym members, weightlifters, and bodybuilders show higher prevalence than do samples from the general population.
Rates even higher have been found among users of anabolic steroids.
The disorder is rare in women but has been noted especially in female bodybuilders who have experienced sexual assault.
Many of muscle dysmorphia’s traits overlap with those of eating disorders including focus on body weight, shape, and modification.
However, body dysmorphic disorder otherwise usually lacks such dietary and exercise components.
Muscle dysmorphia and disordered eating correlate more than either correlates to body dysmorphic disorder.
Treatment for eating disorders may also be effective for muscle dysmorphia.
Some suggest behavioral addiction be reclassified as a behavioral addiction.