Muscle Dysmorphia

A growing number of adolescent and adult males are dissatisfied, preoccupied, and even impaired by concerns about their physical appearance.  When body image dissatisfaction, compulsive exercise, and food intake dysregulation combine and intensify, there is a risk for a psychiatric condition known as muscle dysmorphia.  Muscle dysmorphia shares characteristics with eating disorders, obsessive–compulsive disorder, and body dysmorphic disorder.  The condition is becoming increasingly more common and is frequently associated with anabolic steroid use.  This particular condition is found overwhelmingly in the male population, and as the diagnosis of eating disorders for men continues to rise, there has been a surge in the number of patients identified as having this disorder.

Eating Disorders In The Male Population

For decades, eating disorders were commonly considered to be a female problem.  This belief came to life due to the overwhelming slant in numbers between men and women that chose to seek help for their condition.  The idea that women were the only ones struggling with these disorders was only perpetuated further as treatment facilities began to tailor programs specifically for female patients.  Until recently, the psychiatric community identified the absence of menses and the use of laxatives as requirements for some eating disorders.  These are obviously gender-biased, and it is easy to see why it would make it even more difficult for men to come forward looking for help.  The good news is that an increasing number of men are now seeking care for eating disorders and these conditions are now being understood to impact both genders.  With the growing amounts of males seeking treatment, we are now seeing more cases of muscle dysmorphia that ever.

Overview

While muscle dysmorphia does share some commonalities with several other disorders, it does have characteristics that are unique.  In particular, this condition is a disturbance of body image perception in which individuals become obsessively preoccupied with the belief they are too small, too thin, or insufficiently muscular.  However, in most cases, these individuals are actually more likely to have a higher proportion of lean body mass than the average person.  There are a number of associated behaviors that may accompany this condition, such as a rigorous weight-lifting regimen, a diet that is protein and high-energy intake focused, and possibly somewhat surprising, the desire to avoid public body display.  Many individuals that are living with this condition are convinced they look much smaller than others of similar size, leading to considerable impairment and distress.

Shared Characteristics

As noted above, muscle dysmorphia does share some characteristics with other eating disorders, and there is a resemblance with obsessive-compulsive disorder.  Common compulsive behaviors include rigorous dietary rituals, excessive exercise, self-inspection, and reassurance seeking.  This condition is characterized by obsessive thoughts that are centered on muscularity and these types of behaviors are typical among individuals with muscle dysmorphia.

In regard to eating disorders, one study reports that 22 % of male subjects suffering from muscle dysmorphia formerly met criteria for anorexia nervosa.  Additionally, 13 % of these individuals met the criteria for bulimia nervosa.  These eating disorders resemble muscle dysmorphia in that they both involve a compulsive preoccupation with perceived physical inadequacies as well as a drive to cover up defects and excessive exercise.  It is very common for these individuals to avoid activities involving eating due to fear of disrupting their diet, or forgo personal relationships that may interfere with the time needed to focus on working out or food preparation.

Steroid And Drug Abuse

Muscle dysmorphia is frequently associated with various types of substance abuse—most notably, appearance and performance-enhancing drugs.  Steroids, classified as schedule III controlled substances, are the most widely sought after and abused drugs in this category.  In addition to the damage that these types of substances cause, additional long-term consequences include dependence syndromes and progression to other recreational drugs.  In fact, a recent study focused on a population living in a treatment facility found that a significant percentage of male heroin addicts used opioids to counteract associated depression and withdrawal following steroid use.

In individuals who meet criteria for muscle dysmorphia, there is a unique combination of distorted self-perception, exercise compulsivity, disordered eating, and abuse of performance-enhancing agents.  This can be complicated further by habitual and entrenched substance abuse.  When this is the case, addiction treatment may be the necessary first step.

Nutrition Guidelines For Treatment

There are a number of angles to consider in terms of treating muscle dysmorphia, and nutrition is most certainly one of them.  For individuals who meet criteria for muscle dysmorphia, in addition to cessation of hypertrophy training, reduction or elimination of excessive sports supplements, including protein/amino acids, creatine, and pre-workout formulas is an important goal.  Reducing overall protein intake, which reportedly can be as high as 3 g/kg bodyweight, may encounter resistance from many bodybuilders who believe this will lead to muscle atrophy. Arguably the most critical objective is to avoid the diet-related extremes driven by the constant preoccupation regarding body image that characterizes these individuals.

Sustainable Recovery

The first barrier to treatment in muscle dysmorphia is usually identifying the disorder, since patients often look healthy from an outward perspective. As prevalence rises and the presentation of body image disturbance in males becomes increasingly complex, there is a need for more sophisticated assessment tools.  More research is needed to uncover neurobiological and psychosocial drivers that may underpin the unique pressures males experience with respect to accepting or trying to perfect their physical appearance.  Sustainable recovery that is based on therapeutic strategies aimed at normalizing the self-destructive thoughts, emotions, and behaviors that characterize this complex and incompletely understood condition.