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Body dysmorphic disorder (BDD) is a mental health condition in which a person becomes fixated on a perceived flaw in their body. Despite gender stereotypes, BDD doesn’t only affect women. Many men develop a subclass of BDD called muscle dysmorphia (MD).

People with MD perceive themselves as less muscular and smaller than they really are. Many people with this condition have a build that’s average or more muscular than average.

MD most commonly affects men, especially men who lift weights or compete in bodybuilding. However, research suggests that MD is also prevalent among female bodybuilders.

There have been relatively few studies on the best way to treat MD, and research is ongoing. Keep reading to find out what science has discovered to date.

MD is a mental health condition in which people see their bodies as small and lacking in muscle. People with MD are often considered very muscular by other people, since they routinely engage in muscle-building activities.

The American Psychiatric Association classifies MD as a subclass of BDD. Informally, it’s sometimes referred to as “bigorexia” or “reverse anorexia.”

There’s still debate as to whether MD should be considered an eating disorder, a behavioral addiction, or a form of obsessive-compulsive disorder. People with MD often become so preoccupied with their appearance that their lives are centered on building more muscle.

Behaviors a person with MD may exhibit include:

  • excessively lifting weights
  • using anabolic steroids or other performance-enhancing drugs
  • avoiding social situations that may draw attention to their body, such as swimming or going to the beach
  • avoiding mirrors or excessively checking mirrors
  • eating meals in an extremely regimented way
  • skipping social activities to spend more time exercising

People with MD often also develop an eating disorder, particularly orthorexia. Orthorexia is characterized by an obsession with eating healthy foods. People with orthorexia and those with MD both commonly eat very regimented diets and become fixated on choosing the perfect foods to the point that it disrupts other aspects of their lives.

It’s thought that perfectionism, low self-esteem, and social anxiety may contribute to the development of MD.

Factors that contribute to the development of MD can be assessed with the Muscle Dysmorphic Disorder Inventory. This survey includes 13 questions that can be scored from “never” to “always.”

Some items that appear on this survey are:

  • I wish my arms were stronger.
  • I cancel social activities with friends because of my workout/exercise schedule.
  • I feel depressed when I miss one or more days of exercise.
  • I feel embarrassed when people see me without a shirt.
  • I hate my body.

Research suggests that MD is much more common among men than among women. Since there are no well-established criteria (or best practices) for diagnosis in a research setting, it isn’t clear how prevalent MD is in the general population. Existing studies have presented estimates anywhere from 1 to 54 percent of men.

It’s thought that bodybuilders and other people who lift weights are at a higher risk than the general population.

People with MD commonly have higher body mass indexes and more muscle than the average person because they usually engage in muscle-building activities. A 2013 study examined the risk of developing MD in competitive and noncompetitive male and female athletes.

The researchers found that:

  • Men were at a significantly higher risk of developing MD than women.
  • Competitive athletes were more at risk than noncompetitive athletes.
  • Athletes who lifted weights to change the appearance of their bodies were at higher risk than those who focused on improving performance.

A 2015 study published in the Journal of Strength and Conditioning Research examined the prevalence of MD in a group of 648 people with an average age of 29.5 who regularly lifted weights. They found that 17 percent of the participants were at risk of having MD and 33.9 percent were at risk of having an eating disorder.

A 2014 study examined the prevalence of eating disorders, orthorexia, and MD in three groups of university freshman who were studying dietetics, exercise and sport sciences, or biology. (The biology students were the control group.)

The researchers found that studying dietetics was significantly associated with eating disorder traits and studying exercise and sport sciences was significantly associated with MD traits.

Muscle dysmorphia in women

MD is thought to be fairly rare among women but more common in bodybuilders and weightlifters.

A small 1999 study examined a group of 10 female bodybuilders who had previously experienced sexual assault. Two of the women had experienced muscle dysmorphia before the assault. However, after they had experienced the assault, all 10 had MD and 7 began using steroids.

The results of this study suggest that MD may have been developed as a coping mechanism for the trauma.

There hasn’t yet been much research into the best way to treat MD. Current opinions in the medical community are shaped largely by anecdotes and case reports.

Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) have been suggested as potential treatments since they’re the primary treatments for BDD.

CBT is a type of talk therapy that can be done on your own or in a group. CBT targets the psychological factors that may have led to the development of MD. You’ll work with your therapist to build strategies to address toxic beliefs about masculinity and find ways to deal with your feelings.

SSRIs are a type of antidepressant used to treat BDD. Your doctor may recommend them if you have moderate or severe BDD or MD. These medications may take up to 12 weeks to become effective.

If you have begun using steroids or other performance-enhancing drugs as a result of MD, you may also need endocrine treatment to rebalance your hormones.

A 2015 case study found that family-based therapy was successful at treating a 15-year-old boy with MD.

Doctors and scientists in the medical community are in the early stages of understanding MD and how best to treat it. More extensive studies are needed.

Many people with MD resist treatment. However, recognizing that you have a problem and seeking treatment from a professional can give you the best chance of overcoming MD.

If you think you may be dealing with MD or any form of BDD, it’s important to visit a trained healthcare professional who can help you build a proper treatment plan.

MD is a mental health condition in which people perceive themselves as less muscular than they really are. Men are more likely than women to develop MD, and bodybuilders and other people who lift weights are at higher risk than the general population.

Researchers are still investigating the best treatment options for MD. At this time, many medical professionals recommend CBT or SSRIs, which are the two most common treatment options for BDD.