Muscle Dysmorphia: What Happens when Body Image Collides with Exercise, Nutrition, and Substance Abuse?

Muscle Dysmorphic Disorder aka Muscle Dysmorphia aka Bigorexia

A growing number of adolescent and adult males are dissatisfied, preoccupied – even impaired by concerns about their physical appearance. Feelings of discontent and insecurity can lead to disordered eating and substance abuse when males compare themselves against popularized cultural standards of attractiveness and see themselves falling short. When body image dissatisfaction, compulsive exercise, and food intake dysregulation combine and intensify, risk increases for a psychiatric condition identified within the past 20 years known as muscle dysmorphia, a disturbance of self-perception in which individuals are obsessively preoccupied with the belief they are insufficiently large or muscular. Muscle dysmorphia shares characteristics with eating disorders (such as persistent attention to intake and compensatory behaviors focused on control of weight/shape), obsessive-compulsive disorder (excessive body monitoring and physical activity), and body dysmorphic disorder (including extreme attention to outward appearance). The condition is frequently associated with anabolic androgenic steroid abuse, which may exacerbate an observed exercise dependence or compulsive drive for muscularity. Therapeutic approaches are guided by the individual symptom picture with respect to issues such as obsessional thoughts/compulsive behaviors, mood dysregulation, and anxiety, and have principally been derived from clinical studies examining body dysmorphic disorder, for which both psychotropic medications and cognitive behavioral therapy are considered first-line treatment. Nutrition education and support is also warranted. More research is needed to increase understanding regarding the unique pressures and profound subjective distress males can experience with respect to accepting their bodies, as well as to develop better approaches to assessment and treatment of this complex condition.

About the author: David A. Wiss
David A. Wiss
David Wiss, MS, RDN is the founder of Nutrition in Recovery, which specializes in: Addictions, Eating Disorders, Mental Health, Body Image, and General Wellness. Mr. Wiss works closely with individuals to help them revolutionize their relationship with food and has shared his expertise with numerous eating disorder and addiction facilities throughout the greater Los Angeles area. David is a nationally recognized expert in nutrition for addiction and is currently working on his Ph.D. in Public Health from UCLA.