Muscle Dysmorphia: What is it? Do I have it?

Muscle dysmorphia; commonly known as “bigorexia”, is a term that has been thrown around for a couple of years in the bodybuilding and fitness world. But what is it exactly?

This disorder is a variation of Obsessive Compulsive Disorder (OCD), which the National Institute of Mental Health describes as “a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.” [1]

Those who have this disorder constantly assess and criticize their physiques. They often think to themselves that they are too small and underdeveloped. They have an extremely obsessive desire to obtain and maintain a muscular physique. Interestingly enough, it is the exact opposite mental disorder of anorexia.

dysmorphcartoon

Though it is common for us to assess ourselves in order to improve, muscle dysmorphia is quite drastic. So extreme in fact that it gets to the point where it can lead to unpleasant signs, symptoms, and behaviors such as:

  • Anxiety
  • Depression
  • Unhealthy eating patterns
    • Either consuming excess calories that may hurt general health markers such as blood pressure and triglyceride (cholesterol) levels or;
    • Severely restricting calories (malnourishment) in order to remain at a very low body fat percentage
  • Drug abuse
    • Excess usage of anabolic steroids, selective androgenic receptor modulators, growth hormone, etc.
  • Excess physical activity
    • Can increase injury risk in muscles, joints, connective tissues, etc.
  • Social situation avoidance
  • Covering up or hiding specific body parts with clothing
  • And countless others

Who Usually Has This Disorder?

Particularly men, aged 18-35, are at highest risk, as this population includes college students and young adults who are most likely to be strength training. They are often trying to capitalize on their youth and success with an admirable physique, along with trying to impress them ladies of course. 😏

This isn’t to say that women can’t suffer from this disorder. Though not nearly as likely, women who compete in physique sports (such as women’s bikini or figure competitions) or those that rely on a quote on quote “fit”physique for a living (MMA, gymnastics, tennis) are also at risk.

serena-williams-pregnancy-will-a-new-world-begin-for-the-wta-tour
Serena Williams

Can This Actually Be Diagnosed?

Unfortunately, there are no standardized procedures for diagnosing people with muscle dysmorphia. Compared to something like anorexia and bulimia, these disorders contain diagnostic criteria that have been around for much longer [2]. The understanding of muscle dysmorphia is still minimal, given that it hasn’t “been around” as long as other forms of body image disorders.

However, there have been some tools created in order to provide some sort of identification as to whether or not somebody may possess this disorder. The most popular and valid of these tools is the Muscle Appearance Satisfaction Scale (MASS).

All of these tools have a similar concept; ask questions about eating patterns, drug use, exercise habits, and self-esteem. Many of these questions are rated on what’s called a Likert Scale. This is that scale that you see has a rating such as from 1-5 or 1-7 that begins at “Highly Disagree” (#1) or a similar phrase and climbs all the way up to “Highly Agree” (highest number) or another similar phrase.

Likert-Scale-29
Example of a Likert Scale Questionnaire

How Do I Know If I Have Muscle Dysmorphia?

The most reliable and practical way to do so is to complete one of the available questionnaires or scales specifically created for muscle dysmorphia, which are most often accessible online for free with a simple Google search. The ones that I recommend are:

Muscle Appearance Satisfaction Scale (MASS) [3]

  • Very accurate because of its specific sub-scales of:
    • Bodybuilding Dependence
    • Muscle Checking
    • Substance Use
    • Injury
    • Muscle Satisfaction
  • Was used in more studies about muscle dysmorphia compared to any other test
  • Was able to demonstrate great reliability (the ability of a test to give consistent results no matter how many times it is given)

Drive for Muscularity Scale [4]

  • Was designed specifically as the opposite of the very reliable women’s test, the “Drive for Thinness” scale, meaning it was designed to be specifically used for men
  • Was able to show great internal validity (in other words, low room for diagnostic error in the population it was created for) in most of the studies it was used in

Can This Disorder Be Treated?

It is up to the suffering person to seek treatment. Nobody will know for sure if you have it just by looking at you. Unfortunately, as most sufferers are men, many don’t seek treatment because they are embarrassed or ashamed.

Particularly in Western society, especially those that are younger adults, men are portrayed in the media as providers, caregivers, rugged, and tough. Because of this, many don’t want to be identified with a mental disorder, as this is the complete opposite portrayal of what’s called the masculine ideal.

fightclub_1
Don’t talk about Fight Club dammit

Some methods that have been used to help people recognize this condition are group discussions and open knowledge of a support/coaching staff.

However, no specific programs have been created to help those who may have muscle dysmorphia. The only treatments that have been widely used involve antidepressants and/or cognitive behavioral therapy (basically therapy that helps to focus your thoughts on how/why you feel a certain way), similar to the way that depression is treated [5].

Unfortunately, this isn’t practical and unlikely to occur unless that person believes their case is unique and severe.

Alright, Then What’s The Solution?

Therapists, mental health specialists, and those that are involved with athletes should increase awareness of this disorder. This can be done by:

  • Include this topic in health courses at the university level in order to briefly educate those that are at highest risk (those being college-aged male students)
  • Offering confidential services such as group discussion and meetings in the community

Just to name a couple.

Okay Zach, But What Can WE Do???

If you believe you or somebody you know has this disorder; communication is very important. Talking with somebody you trust will give you honest and unbiased insight (friend, parent, sibling, etc.). This way, you’ll get an outside view on the matter.

talk-to-a-friend

Also, seek out help online, as sketchy as it may sound. Today, we are more connected than ever before. We are able to communicate with those who share similar feeling and experiences through forums, discussion boards, and website communities. This can often alleviate the condition, as the feeling of isolation and loneliness is a significant reason as to why people develop this disorder [6].

You’d also be surprised to know that there are various resources out there online to help with muscle dysmorphia. There are various articles and content (such as this one) that contain valuable information and allow one to explore their treatment options from different people’s perspectives.

But if you feel your case is more severe, the same places that specialize in eating disorders and mental health conditions most often treat for this disorder as well.

Conclusion

This is just the tip of the iceberg when it comes to muscle dysmorphia. If you are interested in learning more, feel free to explore the references listed at the bottom of the page.

If you happen to be a male between the ages of 18-35 and attend The University of Tampa, I am conducting my own study on this topic starting in the fall semester (August 2018). If you are interested in participating, please contact me. It won’t take much of your time I promise 🙂

Also, feel free to contact me with any questions or comments you may have.

What do you guys think? How do you think we can find solutions to this issue?

Let me know in the comments!

Thanks!

References:

1. Obsessive-Compulsive Disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

2. Compte, E. J., Sepulveda, A. R., & Torrente, F. (2015). A two-stage epidemiological study of eating disorders and muscle dysmorphia in male university students in Buenos Aires. International Journal of Eating Disorders, 48(8), 1092-1101. doi:10.1002/eat.22448

3. Mayville, Stephen B., et al. “Development of the Muscle Appearance Satisfaction Scale.” Assessment, vol. 9, no. 4, 2002, pp. 351–360., doi:10.1177/1073191102238156.

4. Dakanalis, Antonios, et al. “Are the Male Body Dissatisfaction and Drive for Muscularity Scales Reliable and Valid Instruments?” Journal of Health Psychology, vol. 20, no. 1, 2013, pp. 48–59., doi:10.1177/1359105313498108

5. Leone, J. E., Sedory, E. J., & Gray, K. A. (2005). Recognition and Treatment of Muscle Dysmorphia and Related Body Image Disorders. Journal of Athletic Training, 40(4), 352-359.

6. Bo, S., Zoccali, R., Ponzo, V., Soldati, L., Carli, L. D., Benso, A., . . . Abbate-Daga, G. (2014). University courses, eating problems and muscle dysmorphia: Are there any associations? Journal of Translational Medicine, 12(1). doi:10.1186/s12967-014-0221-2

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