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Muscle Dysmorphia: An Obsession with Muscle Size

Learn to recognize the signs of this dangerous condition in your clients and employees.

"When I asked him about his training goals during new member orientation, he simply said, 'I just want my muscles to get as big as possible.' His fitness test results were excellent - he has a great aerobic capacity, good muscular endurance scores and a very low body fat level. He says he used to play soccer and basketball, but quit this year so he could have more time to work out. I helped him design a lifting routine to increase strength and bulk up a bit, but I am a little worried. He's kind of intense and self-absorbed. He never takes his eyes off his reflection in the mirrors. I checked his records, and he comes every single day for at least two hours, even though I advised him to take at least one day a week off for recovery.

"I know being concerned about appearance is normal, but I think he's getting a little obsessive. I remember reading about a psychological problem called muscle dysmorphia, where people have body image problems they try to solve with excessive lifting. Do you think I should check in with him again, even though he hasn't bought any more sessions with me?"

What is muscle dysmorphia?

The term "muscle dysmorphia" was coined by psychiatrist (and weightlifter) Harrison G. Pope Jr., to described people abnormally preoccupied with the appearance of their muscles. People with muscle dysmorphia worry excessively that their muscles are not large enough, and go to great lengths to increase muscle size. Not surprisingly, resistance training forms the heart of their efforts, which is why you might see people with muscle dysmorphia in a fitness center.

What is an "abnormal preoccupation," and how do preoccupied lifters differ from the average fitness center member (and employee)? After all, many people who perform resistance training hope to improve their appearance, perhaps along with their health and athletic performance.

Muscle dysmorphia is generally diagnosed when a preoccupation with muscularity interferes with daily life or good health. People with muscle dysmorphia may have several of the following characteristics.

Devotion to daily resistance exercise, even when injured. People with muscle dysmorphia are afraid to take even one day off, for fear their muscles will begin to atrophy. People with muscle dysmorphia obsess about exercise, and can't take time off even when they develop symptoms of injury. They may feel unable to control exercise participation.

Profound dissatisfaction with their bodies. People with muscle dysmorphia focus excessively on how they look. They may spend a great deal of time assessing their appearance in front of mirrors. They may wear baggy clothes, and avoid situations that require exposing their body, such as going to the beach. Many people with muscle dysmorphia even avoid fitness centers, where they worry about others appraising their bodies, choosing to work out at home instead. People with this disorder may spend more than three hours a day thinking about their muscularity.

Extremely rigid or ritualistic eating behaviors. Most people with muscle dysmorphia may consume special diets to lose fat and build muscle. They often consume dietary supplements that claim to build muscle and burn fat.

Anabolic androgenic steroid use. People with muscle dysmorphia may use steroids, even though they understand the health risks involved.

Additional psychological disorders. Many people with muscle dysmorphia also have eating disorders, or mood disorders such as depression and anxiety. Many also have other symptoms of obsessive compulsive disorders.

Like other addicts, people with muscle dysmorphia lose the ability to enjoy life, and spend a great deal of time on their addiction. They may give up activities they previously enjoyed, reduce contact with friends and family, and even lose their jobs when all of their efforts go into their training programs.

How harmful is muscle dysmorphia?

While muscle dysmorphia is rarely fatal, complications can develop from overtraining, and from supplement and drug use. If you are worried about a client, friend or employee, share your concern, and refer him/her to an experienced mental healthcare provider.
Chung, B. Muscle dysmorphia: A critical review of the proposed criteria. Perspectives in Biology and Medicine 44 (4): 565-575, 2001.
Leone, J.E., E.J. Sedory and K.A. Gray. Recognition and treatment of muscle dysmorphia and related body image disorders. Journal of Athletic Training 40 (4): 352-359, 2005.
Pope, H.G., Jr, A.J. Gruber, P.Y. Choi, et al. Muscle dysmorphia: An underrecognized form of body dysmorphic disorder. Psychosomatics 38: 548-557, 1997.
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