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Body Image Exercise Fitness Competitions Men

Muscle Dysmorphia in Male Bodybuilders

Over the past few decades there has been an increase in the exploitation of male body image insecurities. Thanks to an aesthetics driven media and a $100 billion-dollar global fitness industry, men are now more than ever under pressure to conform to a certain type of physique.1

This means that body dysmorphia is a growing issue amongst men, who compare themselves to society’s idea of the perfect masculine body. Today, men are told that they should be muscular and lean, with a chiselled jaw and six pack abs.

23 years ago, the trend to embody this muscular ideal led to the diagnosis of a new body dysmorphia subtype. This was known as muscle dysmorphia (aka reverse anorexia or bigorexia). Individuals with this condition believe that their body is insufficiently muscular, regardless of actual muscle size and definition.

Male athletes are particularly vulnerable to developing muscle dysmorphia


Male athletes are particularly vulnerable to developing muscle dysmorphia, especially those who take part in aesthetic sports such as competitive bodybuilding.2 Bodybuilding epitomises the social ideal of muscularity: it is a sport judged solely on appearance.

When muscle dysmorphia first entered the literature in 1997, it was introduced as an aspect of what was coined the Adonis Complex by Harvard professors Harrison Pope et al. Their work documented the body dissatisfaction experienced by millions of men worldwide which led to ‘compulsive weightlifting and exercising, steroid abuse, eating disorders, and body dysmorphic disorder.’3

Muscle dysmorphia has also been placed on the obsessive compulsive disorder spectrum. This is because it is characterised by obsessive thoughts of increasing muscularity and reducing body fat, and a compulsive drive to achieve these goals. These compulsions assume the form of camouflaging; and repetitive body checking behaviours, such as measuring the size of muscles, flexing muscles in the mirror and frequent weighing.


CRITERIA


Despite its somewhat confused aetiology, muscle dysmorphia is now included in the DSM V as a form of body dysmorphic disorder. In order to be diagnosed, individuals must meet two of the following four criteria:


1: The individual frequently gives up important social, occupational or recreational activities because of a compulsive need to maintain their workout and diet schedule.

During my own research, all bodybuilders confessed that they are obsessed with training, and frequently turn down or cancel social events because of their weight lifting regime. Training also significantly interferes with their jobs and their relationships. If they are forced to forego a training session, athletes experience depression and anxiety and feel compelled to make up for the missed workout.

2: The individual avoids situations where their body is exposed to others, or endures such situations only with marked distress or intense anxiety.


In Pope’s original research, 88% of men with muscle dysmorphia reported being afraid to take their shirt off in public.4 This is also true of the bodybuilders I interviewed. Despite being able to stand on stage in nothing but the smallest of shiny posing trunks, they otherwise avoid situations or activities, such as swimming, where their bodies would be exposed.

They fear appearance-based rejection


This anxiety may originate from a desire for social acceptance. Meeting sociocultural expectations means that they are rewarded with encouragement in the form of attention and compliments. Conversely, if they do not feel that their bodies are lean enough, or muscular enough then they fear appearance-based rejection.

3: The preoccupation about the inadequacy of body size or musculature causes clinically significant distress or impairment.

Despite other people commenting on their muscle mass, all of the bodybuilders who took part in my research believe that they are insufficiently muscular. They even confessed to hating their bodies and are constantly preoccupied with negative body-image related thoughts. One study found that men with muscle dysmorphia spent more than five hours a day worrying that they are not muscular enough.5

Competitive bodybuilders have high standards of physical perfection that leads to comparison and self criticism

Competitive bodybuilders set themselves such high standards of physical perfection that it leads to relentless comparison and self criticism. The nature of competitive bodybuilding lends itself to this kind of judgement since competitor’s physiques will be compared to determine who goes home with the winning trophy.

The belief that they are insufficiently muscular has a direct effect on bodybuilders’ mental health, leading to lack of confidence, low self-esteem and anxiety.

4: The individual continues to work out, diet or use performance-enhancing substances despite knowledge of adverse physical or psychological consequences.6

Despite being aware of the risks, bodybuilders make conscious decisions to engage in health-compromising practices. These include excessive training, extreme dieting and anabolic steroid use.

Aside from a decrease in physical performance, excessive strength training can cause a wide range of adverse health effects. These include ‘adrenal insufficiency, chronic injuries, gastrointestinal distress, and immune dysfunction.’7 These conditions occur because the human body is not naturally designed to endure such large physical stress.

CAUSE

The cause of muscle dysmorphia is multifaceted with various cognitive, biological, psychological and sociocultural factors that influence its expression

The biological model proposes that the condition may be ‘a problem of somatoperception’ (a problem with knowing your own body). This is thought to be ‘related to organic lesions or processing issues in the right parietal lobe of the brain.’8

Other research suggests that some individuals have a genetic predisposition to developing muscle dysmorphia. This biological theory also involves an environmental component since it proposes that the condition only emerges following exposure to certain trauma such as domestic violence, physical assault, bullying or abuse.


Given the correlation between muscle mass and strength, it is understandable how the desire for a strong, muscular body may be a reaction to physical abuse or feelings of vulnerability. Being muscular is a way of safeguarding and defending oneself against future mistreatment.

Several of my interviewees had experienced bullying and even serious trauma, leaving one man I spoke to suffering from complex PTSD. He confessed that his muscular physique makes him feel more able to protect himself, and others: it is his ‘safety blanket.’

Athletes tend to have psychological factors that predispose them to muscle dysmorphia

In addition, athletes tend to have psychological factors that predispose them to muscle dysmorphia, such as perfectionism and high levels of competitiveness.9 These are linked in the world of competitive bodybuilding where success depends upon having a perfect, balanced physique.

TREATMENT

Despite its increasing prevalence and potentially serious consequences, muscle dysmorphia goes largely untreated. This is partly because it is difficult to diagnose.

Identifying the disorder can be problematic since competitive bodybuilders have an outward appearance of health

The characteristics that are associated with muscle dysmorphia, such as exercise and good nutrition, along with the discipline and motivation required to build a muscular physique, are typically viewed as positive traits.

Even if individuals with muscle dysmorphia are aware that they might need some kind of intervention, many are ashamed of their condition. There are social taboos both against men having body image concerns in the first place, and also against expressing their feelings about them.

Current treatment methods are the same as those prescribed for general body dysmorphia. These include cognitive behavioural therapy and antidepressant medications.10 Their efficacy remains controversial, however, and the relapse rate is high.11

Regarding future diagnosis and treatment, it is important that fitness coaches and health care professionals are informed about the signs and symptoms of muscle dysmorphia; and its potential dangers. This will enable them to identify who may be at risk and to prescribe the correct treatment.

There has to be a paradigm shift in how male bodies are portrayed

In order to tackle muscle dysmorphia on a wider sociocultural level, however, ultimately there has to be a paradigm shift in how male bodies are portrayed by media and advertising. It is important for us to remember that while Adonis was a demigod, everyone else is only human.


  1. https://www.businessinsider.com/fitness-has-exploded-into-a-nearly-100-billion-global-industry-2019-9?r=US&IR=T
  2. https://journals.sagepub.com/doi/pdf/10.1177/1557988318786868
  3. https://www.researchgate.net/publication/247715403_The_Adonis_Complex_The_Secret_Crisis_of_Male_Body_Obsession_Looking_Good_Male_Body_Image_in_Modern_America_Making_the_Body_Beautiful_A_Cultural_History_of_Aesthetic_Surgery_Body_Modification
  4. Pope, H.G.; Phillips, K.A.; Olivardia, R, The Adonis Complex: How to Identify, Treat, and Prevent Body Obsession in Men and Boys (Touchstone, New York, 2000)
  5. Pope, H.G.; Phillips, K.A.; Olivardia, R, The Adonis Complex: How to Identify, Treat, and Prevent Body Obsession in Men and Boys (Touchstone, New York, 2000)
  6. https://www.researchgate.net/publication/23225701_Bigorexia_Bodybuilding_and_Muscle_Dysmorphia
  7. http://darwinian-medicine.com/the-dangers-of-excessive-strength-training/
  8. https://ziggibson.wordpress.com/2017/02/05/muscle-dysmorphia-and-the-adonis-complex-mirror-mirror-on-the-wall-why-am-i-not-the-biggest-of-them-all/
  9. https://en.wikipedia.org/wiki/Muscle_dysmorphia
  10. http://eprints.worc.ac.uk/4859/1/Muscle%20Dysmorphia%20Current%20insights.pdf
  11. https://ziggibson.wordpress.com/2017/02/05/muscle-dysmorphia-and-the-adonis-complex-mirror-mirror-on-the-wall-why-am-i-not-the-biggest-of-them-all/