Muscle dysmorphia: the compulsive pursuit of a muscular body

Peer reviewed / Manuscript (overview) received: 13 April 2020 / Revision accepted: 25 June 2020

Characteristics, prevalence, causes, treatment, prevention and nutritional implications

Characteristics and classification of muscle dysmorphia

Diagnostic challenges
The diagnostic classification of muscle dysmorphia (MD) continues to be inconsistent and the subject of debate. For example, in the DSM-5¹, MD is classified as a research diagnosis within the spectrum of obsessive-compulsive disorders as a specification of body dysmorphic disorder (300.7), whereas in ICD-10², it is classified under somatoform disorders as a subtype of body dysmorphic disorder without delusions (F45.21) or other persistent delusional disorders (F22.8) Some authors also call for MD to be classified within the spectrum of eating disorders [1]. Originally, MD was described as “reverse anorexia” [2] because affected persons often exhibit rigid, orthorexic eating behaviors and follow a strict diet plan.

This type of eating behavior, which ignores hunger and satiety, is intended to optimize muscle growth. Carbohydrate, protein and fat intakes are carefully controlled in order to enhance the effects of training as much as possible [3]. In fact, Murray et al. (2012) [4] found significantly higher levels of eating behavior psychopathology in patients with MD compared to anorexia patients. Eating rules in particular play a significant role in MD. Common examples of such rules include eating every 3 hours regardless of hunger or satiety, eating 5 g of protein per kilogram of body weight, precise calculation of macronutrient content in food and depriving oneself of “necessary” or good-tasting foods [4].

Abstract

Muscle dysmorphia is a form of body dysmorphic disorder in which the affected persons feel like he/she is not sufficiently fit and muscular despite having a very pronounced musculature and in which the affected persons have thought patterns and behaviors focused on building muscle mass. Muscle dysmorphia was only recently identified as mental health condition: it was described as “reverse anorexia” in the 1990s. Therefore, there is still no clear consensus on how it should be classified and diagnosed. Figures on its prevalence also vary widely between studies. It is assumed that the disorder follows the biopsychosocial model, in which genetic, neurobiological, psychological and sociocultural factors all play a role. Intervention is based on the approach to treating anorexia nervosa and focuses on nutrition therapy in particular. In addition, adequate preventative methods are an important strategy in reducing the likelihood that the disorder will develop. This article provides an overview of the current state of knowledge about the disorder, together with a case study and possible preventative measures.

Keywords: muscle dysmorphia, body dysmorphic disorder, mental illness, exercise addiction, eating disorder

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¹ Diagnostic and Statistical Manual of Mental Disorders, 5th edition
² International Classification of Diseases

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