OTHER DISORDERS

Muscle
Dysmorphia

a specifier under Body Dysmorphia

**“Can I be too fit?”**

Going to the gym has been synonymous with health and fitness, in order to achieve the “ideal” physique that athletes and sports models have. However, can it be unhealthy to go to the gym too often?

Muscle Dysmorphia (MD) is defined as the preoccupation of worries where individuals feel their physique is too small or not muscular enough.

This view of body image becomes a personal defect in the eyes of someone with Muscle Dysmorphia, which manifests in ways to enhance their physique.

It is currently not defined as a standalone disorder in the Diagnostic and Statistical Manual of Mental Disorders 5th edition, but a specifier under Body Dysmorphic Disorder. Around 1.7 – 2.4% of the general population meet the criteria for Body Dysmorphia, of which 22% have preoccupations over their physique and meet the criteria for MD.

These preoccupations include worries about the size of certain muscles, obsession over lifting weights, maladaptive beliefs about fitness, and irrational beliefs about how others view them. The surprising aspect of MD is that individuals do not appear insufficiently muscular to others, and in fact most of them have a muscular build!

While it might appear narcissistic to constantly obsess over body image and how muscular one is, individuals with MD are often plagued with shame, doubt, and low self-esteem because of these preoccupations. MD can potentially lead to severe consequences for the individual in various areas of functioning and even physical health.

Diagnostic Criteria

As mentioned earlier, MD is a specifier under Body Dysmorphia. Symptoms of Body Dysmorphia include:

Ψ preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others, which in the case of MD, these defects or flaws are with regards to their physique and muscles
Ψ repetitive behaviours (e.g., mirror checking, going to the gym obsessively, excessive dieting) or mental acts (e.g., comparison of physique with others)
Ψ impaired functioning in social, occupational or other important domains
Ψ symptoms not better explained by an eating disorder

Causes

Several factors lead to the development of MD. Biological factors such as an imbalance in serotonin levels, dysfunction in brain areas leading to impaired visual processing, and genetic factors have been found to correlate with the incidence of Body Dysmorphia.

MD is also perpetuated by messages in the media that reinforce the idea that being muscular and strong is the ideal male type, hence individuals work towards these ideals. Furthermore, peer evaluation and comments made by others about body-image and appearance further reinforce the preoccupations.

Consequences

Individuals with MD behave obsessively with regards to attaining their idealized physique. Failure to do so could lead to significant distress and suicidal ideation. It was found that 24% to 28% of individuals with Body Dysmorphia have attempted suicide in their lifetime.

Frequent and obsessive gym-going behavior could lead to overtraining and injuries from the high volume and frequency of training. Subsequently, individuals also ignore these injuries and attempt to train through them, leading to more severe injuries as well.

Shame and embarrassment about their physique also leads to social avoidance, such as the missing of social gatherings. The compulsion to work out and eat specific diet foods can also contribute to the avoidance of meal gatherings.

To attain their ideal physique, MD individuals might also seek the use of performance enhancing drugs and cosmetic alterations. Anabolic steroid abuse is rife within the bodybuilding community, and almost 63.5% of individuals have abused steroids (Steele et al., 2020). This can lead to severe medical problems, such as heart disease, stroke, and risks of needle use. Steroid abuse also leads to psychiatric problems including irritability, aggression, depression, and mania.

Therapy

A modular form of Cognitive Behavioural Therapy (CBT) has been shown to be effective for addressing Body Dysmorphia. This includes a specific module for patients with MD and concerns over weight, shape, and muscularity.

Therapy commonly entails the following:

Ψ Psychoeducation of Muscle Dysmorphia for patients, teaching individuals about healthy exercise habits, normalizing body-image concerns, and education on steroid and drug abuse.

Ψ Cognitive strategies are then used to target cognitive errors presented by patients and these maladaptive beliefs are evaluated and challenged.

Ψ Behavioural strategies for patients to cope with their worries by exposing them to feared situations and retraining their perception of the body in a more objective way.

How can you help a friend?

Individuals with MD often perceive their physique as the only trait about them that matters. As a result, they end up discounting other positive traits, such as personality. When speaking with them, try emphasizing other positive aspects of them.

They might also view their problems as a physical problem, and the solution would be to train harder to attain their physique goals. It might be helpful to educate them about MD and encourage them to seek psychotherapy instead.