Muscle dysmorphia

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Muscle dysmorphia
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Preoccupation with not being sufficiently muscular, excessive exercise, dietary supplements use
Complications	Anxiety, depression, steroid abuse
Onset	Typically in adolescence or early adulthood
Duration	Long-term
Types	N/A
Causes	Body image issues, societal pressure, genetic predisposition
Risks	Male gender, bodybuilding, perfectionism
Diagnosis	Clinical assessment, DSM-5 criteria
Differential diagnosis	Body dysmorphic disorder, eating disorders
Prevention	Awareness, healthy body image promotion
Treatment	Cognitive behavioral therapy, medication
Medication	N/A
Prognosis	Variable, depends on treatment adherence
Frequency	Unknown, more common in males
Deaths	N/A

Muscle dysmorphia is a subtype of body dysmorphic disorder, characterized by a preoccupation with the idea that one's body is not sufficiently muscular or lean.

Definition and Classification

Muscle dysmorphia, also known as "bigorexia" or "reverse anorexia," was first recognized in the psychiatric literature in the 1990s. It is classified under the Obsessive-Compulsive and Related Disorders category of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as a form of body dysmorphic disorder (BDD).

Epidemiology

Although muscle dysmorphia is most often reported in males, it can occur in females as well. The disorder is frequently observed in those involved in sports or professions that emphasize body size and muscularity, such as bodybuilding, wrestling, and modeling. It often begins in late adolescence or early adulthood but can occur at any age.

Symptoms and Diagnosis

• Individuals with muscle dysmorphia are excessively concerned with their muscle size, perceiving themselves as small or weak despite having a muscular physique. They often engage in compulsive weightlifting and intense workout routines, adhere strictly to high-protein diets, and may use performance-enhancing substances like anabolic steroids.
• Other symptoms may include distress or impairment in social, occupational, or other important areas of functioning, and avoiding situations where their bodies may be exposed or compared to others.
• Diagnosis is primarily clinical, based on the individual's self-report and observable behaviors. Psychiatric evaluation includes ruling out differential diagnoses, such as eating disorders and other forms of BDD.

Treatment

• Treatment typically involves cognitive-behavioral therapy (CBT), the most evidence-based treatment for BDD and its variants. CBT for muscle dysmorphia focuses on challenging body-related beliefs, reducing body-checking and body-avoidance behaviors, and improving body image flexibility.
• Medication, such as selective serotonin reuptake inhibitors (SSRIs), may also be used, particularly in individuals who exhibit obsessive-compulsive tendencies or when muscle dysmorphia is comorbid with depression or anxiety disorders.

References

<references>

• Murray, S. B., Rieger, E., Hildebrandt, T., Karlov, L., Russell, J., Boon, E., ... & Touyz, S. W. (2012). A comparison of eating, exercise, shape, and weight related symptomatology *in males with muscle dysmorphia and anorexia nervosa. Body image, 9(2), 193-200.
• Pope, 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.
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5¬Æ). American Psychiatric Pub.

</references>

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