Muscle dysmorphia in men: challenges in classification and recognition

Author/s
Omar Aga
Citation
Focus Issue 6: Eating disorders
CEPiP.2024.1.103-107
Abstract

Muscle dysmorphia (MD) is a condition marked by increased preoccupation with increasing muscle size and sculpting the body to achieve a very defined muscular look akin to a bodybuilder's physique. First described in the 1990s, MD is still a condition about which little is known and there exists an ongoing debate regarding its classification, manifestations and best ways to treat it. It is undeniably closely linked with conditions on the eating disorder spectrum and this proximity has invited many opinions to challenge its classification under the umbrella of body dysmorphic disorders. Further exacerbating the efforts to understand MD is the fact that, so far, little work has been done to understand the depth at which it is affecting our society and extent of its presence among individuals. More work is needed to understand the intricacies of this condition and to clarify its position among other body image-centric conditions; only then will we be able to address it fully and take tangible steps to alleviate its symptoms.

Cite as: Cutting Edge Psychiatry in Practice 2025, 6(1):103-107; https://doi.org/10.65031/guqk8574

References

  1. Pope Jr HG, Katz DL, Hudson JI. Anorexia nervosa and "reverse anorexia" among 108 male bodybuilders. Comprehensive Psychiatry. 1993;34(6):406-9. https://doi.org/10.1016/0010-440x(93)90066-d
  2. Pope Jr HG, Gruber AJ, Choi P, Olivardia R, Phillips KA. Muscle dysmorphia: an underrecognized form of body dysmorphic disorder. Psychosomatics. 1997;38(6):548-57. https://doi.org/10.1016/s0033-3182(97)71400-2
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington DC. American Psychiatric Association (2013). https://doi.org/10.1007/springerreference_179660
  4. Olivardia R, Pope Jr HG, Hudson JI. Muscle dysmorphia in male weightlifters: a case-control study. American Journal of Psychiatry. 2000;157(8):1291-6. https://doi.org/10.1176/appi.ajp.157.8.1291
  5. Thornborrow T, Onwuegbusi T, Mohamed S, Boothroyd LG, Tov.e MJ. Muscles and the media: a natural experiment across cultures in men's body image. Frontiers in Psychology. 2020;11:495. https://doi.org/10.3389/fpsyg.2020.00495
  6. Lin Y, Lu C, Huang Z, Barnhart WR, Cui T, He J. Exploring the links between celebrity worship, body dissatisfaction, and disordered eating among young adult celebrity worshippers in China. Body Image. 2023;45:210-8. https://doi.org/10.1016/j.bodyim.2023.03.006
  7. Pope Jr HG, Olivardia R, Gruber A, Borowiecki J. Evolving ideals of male body image as seen through action toys. International Journal of Eating Disorders. 1999;26(1):65-72. https://doi.org/10.1002/(sici)1098-108x(199907)26:1<65::aid-eat8>3.3.co;2-4
  8. Angier N. Drugs, sports, body image and G.I. Joe. The New York Times (1998). Accessed 21 December 2022. Available from: https://www. nytimes.com/1998/12/22/science/drugs-sports-body-image-and-gi-joe.html.                 
  9. Tylka TL, Bergeron D, Schwartz JP. Development and psychometric evaluation of the Male Body Attitudes Scale (MBAS). Body Image. 2005;2(2):161-75. https://doi.org/10.1016/j.bodyim.2005.03.001
  10. Tran A, Darboe M, Goyal A, Birk N. Association between dating app use and unhealthy weight control behaviors and muscle enhancing behaviors in sexual minority men: a cross-sectional study. BMC Public Health. 2023;23(1):838. https://doi.org/10.1186/s12889-023-15715-7
  11. Anderson A. What is muscle dysmorphia? WebMD 2021. Accessed 21 December 2024. Available from: https://www.webmd.com/mentalhealth/ what-is-muscle-dysmorphia.       
  12. Grieve FG. A conceptual model of factors contributing to the development of muscle dysmorphia. Eating Disorders. 2007;15(1):63-80. https://doi.org/10.1080/10640260601044535
  13. Olivardia R, Pope Jr HG, Borowiecki III JJ, Cohane GH. Biceps and body image: the relationship between muscularity and self-esteem, depression, and eating disorder symptoms. Psychology of Men and Masculinity. 2004;5(2):112. https://doi.org/10.1037/1524-9220.5.2.112
  14. Rhea D, Lantz CD, Cornelius A. Development of the muscle dysmorphia inventory (MDI). Journal of Sports Medicine and Physical Fitness. 2004;44(4):428-35.
  15. Rubio-Aparicio M, Badenes-Ribera L, Sanchez-Meca J, Fabris MA, Longobardi C. A reliability generalization meta‐analysis of self‐report measures of muscle dysmorphia. Clinical Psychology: Science and Practice. 2020;27(1):120. https://doi.org/10.1111/cpsp.12303
  16. Hildebrandt T, Langenbucher J, Schlundt DG. Muscularity concerns among men: development of attitudinal and perceptual measures. Body image. 2004;1(2):169-81. https://doi.org/10.1016/j.bodyim.2004.01.001
  17. Zeeck A, Welter V, Alatas H, Hildebrandt T, Lahmann C, Hartmann A. Muscle Dysmorphic Disorder Inventory (MDDI): validation of a German version with a focus on gender. PloS One. 2018;13(11):e0207535. https://doi.org/10.1371/journal.pone.0207535
  18. Riccobono G, Pompili A, Iorio C, Carducci G, Parnanzone S, Pizziconi G, et al. An instrument for the evaluation of muscle dysmorphia: the Italian validation of the Adonis complex questionnaire. Brain and Behavior. 2020;10(7):e01666. https://doi.org/10.1002/brb3.1666
  19. Mayville SB, Williamson DA, White MA, Netemeyer RG, Drab DL. Development of the Muscle Appearance Satisfaction Scale: a self-report measure for the assessment of muscle dysmorphia symptoms. Assessment. 2002;9(4):351-60. https://doi.org/10.1177/1073191102238156
  20. Chung B. Muscle dysmorphia: a critical review of the proposed criteria. Perspectives in Biology and Medicine. 2001;44(4):565-74. https://doi.org/10.1353/pbm.2001.0062
  21. Murray SB, Rieger E, Touyz SW. Muscle dysmorphia symptomatology during a period of religious fasting: a case report. European Eating Disorders Review. 2011;19(2):162-8. https://doi.org/10.1002/erv.1016
  22. Touyz S, Kopec-Schrader E, Beumont P. Anorexia nervosa in males: a report of 12 cases. Australian and New Zealand Journal of Psychiatry. 1993;27(3):512-7. https://doi.org/10.3109/00048679309075811
  23. Grieve FG, Truba N, Bowersox S. Etiology, assessment and treatment of muscle dysmorphia. Journal of Cognitive Psychotherapy. 2009;23(4):306-14. https://doi.org/10.1891/0889-8391.23.4.306
  24. Phillips KA, Menard W, Fay C. Gender similarities and differences in 200 individuals with body dysmorphic disorder. Comprehensive Psychiatry. 2006;47(2):77-87. https://doi.org/10.1016/j.comppsych.2005.07.002
  25. Murray SB, Rieger E, Touyz SW, De la Garza García L, Yolanda. Muscle dysmorphia and the DSM‐V conundrum: where does it belong? A review paper. International Journal of Eating Disorders. 2010;43(6):483-91. https://doi.org/10.1002/eat.20828
  26. Nieuwoudt JE, Zhou S, Coutts RA, Booker R. Muscle dysmorphia: Current research and potential classification as a disorder. Psychology of Sport and Exercise. 2012;13(5):569-77. https://doi.org/10.1016/j.psychsport.2012.03.006
  27. Cooper M, Eddy KT, Thomas JJ, Franko DL, Carron‐Arthur B, Keshishian AC, et al. Muscle dysmorphia: a systematic and meta‐analytic review of the literature to assess diagnostic validity. International Journal of Eating Disorders. 2020;53(10):1583-604. https://doi.org/10.1002/eat.23349
  28. Foster A, Shorter G, Griffiths M. Muscle dysmorphia: could it be classified as an addiction to body image? Journal of Behavioral Addictions. 2015;4(1):1-5. https://doi.org/10.1556/jba.3.2014.001
  29. Tod D, Edwards C, Cranswick I. Muscle dysmorphia: current insights. Psychology Research and Behavior Management. 2016 Aug 3:179-88. https://doi.org/10.2147/prbm.s97404
  30. World Health Organisation (WHO). International Classification of Diseases 11th Revision (2021). Accessed 21 December 2024. Available from: https://icd.who.int.
  31. dos Santos Filho CA, Tirico PP, Stefano SC, Touyz SW, Claudino AM. Systematic review of the diagnostic category muscle dysmorphia. Australian and New Zealand Journal of Psychiatry. 2016;50(4):322-33. https://doi.org/10.1177/0004867415614106
  32. Anderson LK, Murray SB, Kaye WH. Clinical Handbook of Complex and Typical Eating Disorders. Oxford. Oxford University Press (2018). https://doi.org/10.1093/med-psych/9780190630409.001.0001
  33. Hitzeroth V, Wessels C, Zungu‐Dirwayi N, Oosthuizen P, Stein DJ. Muscle dysmorphia: a South African sample. Psychiatry and Clinical Neurosciences. 2001;55(5):521-3. https://doi.org/10.1046/j.1440-1819.2001.00899.x
  34. BBC News. Muscle dysmorphia: one in 10 men in gyms believed to have "bigorexia" (2015). Accessed 21 December 2024. Available from: https://www.bbc.com/news/newsbeat-34307044. 
  35. UKActive. How lockdown has affected the gender gap in activity levels (2021). Accessed 21 December 2024. Available from: https://www.ukactive.com/news/how-lockdown-has-affected-the-gender-gap-in-activity-levels/.      
  36. The UK Fitness Report - 2023/24 Gym Statistics 2023. Accessed 21 December 2024. Available from: https://www.puregym.com/blog/ukfitness-report-gym-statistics/.  
  37. MacKey B. Eating disorder statistics UK (2021). Accessed 21 December 2024. Available from: https://www.rehab4addiction.co.uk/blog/eating-disorder-statistics-uk.
  38. Amodeo AL, Esposito C, Antuoni S, Saracco G, Bacchini D. Muscle dysmorphia: what about transgender people? Culture, Health and Sexuality. 2022;24(1):63-78. https://doi.org/10.1080/13691058.2020.1814968