The Classification of Muscle Dysmorphia

By Maida, Denise Martello; Armstrong, Sharon Lee | International Journal of Men's Health, Spring 2005 | Go to article overview
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The Classification of Muscle Dysmorphia

Maida, Denise Martello, Armstrong, Sharon Lee, International Journal of Men's Health

For some time, society's emphasis on appearance has negatively affected women. Now we're finding increasing numbers of men who are also overly dissatisfied with their bodies. This trend has led to a new disorder, muscle dysmorphia (MD), which is characterized by a preoccupation with muscularity accompanied by perceptual, affective, and behavioral components that interfere with daily activities. Currently, MD is not included in the DSM-IV, although it is purported to be a kind of body dysmorphic disorder (BDD), which in turn is a somatoform disorder. This study investigated relationships among symptoms of MD and variables most relevant to a DSM classification of men who lift weights regularly. No relationship was found between MD and a measure of somatoform disorder. Instead, BDD, OCD (obsessive-compulsive disorder), body dissatisfaction, and hostility are the main predictors of MD. This suggests that MD is an OCD spectrum disorder, rather than a somatoform disorder.

Keywords: men weightlifters, muscle dysmorphia, body dissatisfaction, muscularity, DSM-IV, body dysmorphic disorder, obsessive compulsive disorder


American men are experiencing increased concern about their appearance (Olivardia, Pope, Mangweth, & Hudson, 1995). One reason may be due to Western culture's growing emphasis on unrealistic, overly muscular images of men. These muscularly endowed physiques, unattainable for the average male, have been depicted in all forms of the media and even in toy action figures. One need only compare the early GI Joe action-figure body of 1964 with the "super-articulated" GI Joe body of today to glimpse the intrusion of society's devotion to muscularity into child culture. Not surprisingly, an increasing number of teenage boys and men are concerned that they are neither muscular enough nor lean enough. These concerns have been accompanied by a higher incidence of eating disorders in males (Olivardia et al., 1995). In fact, Andersen, Cohn, and Holbrook (2000) postulate that up to 25-30 percent of eating disordered individuals might be males.


With the advent of increased body dissatisfaction comes a fairly new, still under-researched disorder, muscle dysmorphia (MD). It has already reached public awareness through the publication of The Adonis Complex (Pope, Phillips, & Olivardia, 2000). Pope, Katz, & Hudson (1993) originally referred to this disorder in the medical literature as "Reverse Anorexia Nervosa" because of its similarities to certain aspects of anorexia nervosa (AN). Individuals suffering from these two disorders share common perceptual and affective characteristics. Both show a preoccupation with appearance and experience extreme distress and anxiety associated with these preoccupations. They hide their bodies in oversized clothing and participate in compulsive behaviors such as specific eating rituals with strictly monitored food intake (not to be confused with compulsive eating behaviors, in which a person overeats without regard to physical cues of hunger or satisfaction, or binges without purging) and excessive exercise. However, whereas anorexics view their emaciated bodies as too fat, individuals suffering from MD perceive their often extremely muscular physiques as too small and even puny. Moreover, people with MD may engage in harmful and even self-destructive behaviors such as continuing to lift weights even when they are injured and using anabolic steroids (Olivardia, Pope, & Hudson, 2000). A fundamental difference between AN and MD is that anorexics, being concerned with perceived body fat, engage in characteristic pathological eating behaviors with excessive exercise as a secondary characteristic, while those suffering from muscle dysmorphia, being concerned with underdeveloped musculature, engage in pathological exercise routines with restrictive eating as a secondary characteristic (Olivardia, 2001).

The identification of muscle dysmorphia emerged from three studies examining the use of anabolic steroids in weightlifters (Pope et al.

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