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What is muscle dysmorphia?

By Remie Jaggard

Muscle

Muscle dysmorphia (MD) is a subtype of Body Dysmorphic Disorder. Like other forms of Body Dysmorphic Disorder, the individual selectively focuses their attention on a specific flaw – one which is either minor, or imagined. Individuals with MD are typically preoccupied with thoughts surrounding their appearance, and in particular their muscularity.

MD is characterized by features of disordered eating practices and an overvaluation of a muscular body ideal. The following behaviours are typically presented in an individual with MD:

  • Core fear of insufficient muscularity;
  • Compulsive exercise behaviors;
  • Disordered eating practices;
  • Intense anxiety and guilt felt if exercise or dietary regime is deviated from; individuals with MD often perceive a loss of muscle tone should they miss the gym;
  • Body shame/disguising/avoidance.

Individuals with MD often rigidly follow a very strict and rule-driven exercise and dietary plan. An individual with MDs regime may often involve some of the following aspects:

  • High level of protein consumption;
  • Restriction of dietary energy intake e.g. by restricting their carbohydrate and fat consumption;
  • Bulking and cutting/shredding phases (e.g. bulking up your body by increasing caloric intake and shredding the excess fat by increasing one’s training volume);
  • Fastidious use of supplements;
  • Frequent weighing – this will often occur as a means of calculating their optimal macronutrient consumption (e.g. 2 grams of protein per kilogram);
  • Anabolic steroid use.

There are aspects of MD which are comparable to both Anorexia Nervosa and Bulimia Nervosa. The cognitive drive behind Anorexia Nervosa differs for the male and female population. Males are much more driven by the desire for leanness/muscularity compared to females. This musculature desire is often what leads to excessive exercise (which is often the first symptom) and potentially the strict regime. Often individuals with MD allow for a certain number of “cheat meals” within a given period – this could be one meal a week, or one whole cheat day a week. However, anecdotal evidence has suggested that these cheat meals tend to occur in similar fashions to binge episodes. These cheat meals are similar because there is a large amount of calorie-dense food being consumed in a single sitting and they are usually followed by compensatory behaviours (e.g. excessive exercise or protein supplementation). A key difference that has been observed between these cheat meals and binge episodes is that, individuals with MD do not experience a “loss of control” during these meals, this could be due to the fact the cheat meals are more socially sanctioned. Rather, these cheat meals are instead more comparable to “planned binges”. In addition, MD and eating disorders share many common features and as such, it is not surprising that there is a large diagnostic crossover between MD and Anorexia Nervosa. Therefore, whilst technically eating disorders and MD are separate disagnoses, it is important to note that eating disorders in males may present as MD as opposed to the typical eating disorder profile.

This article has been inspired by & adapted from the Webinar presented by Dr Stuart Murray from the Australia and New Zealand Academy for Eating Disorders on the 29th of July, 2015.

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