Can Muscle Dysmorphia Be Considered An Eating Disorder?

Muscle dysmorphia is a type of body dysmorphic disorder, generally categorized by intense feelings of focus on one’s fitness—particularly with the thought of being lean and muscular for many. These thoughts can perpetuate themselves to the point of causing harm to one’s physical and mental health, among other symptoms. 

This disorder can be triggered by external factors like media influences (such as fitness-related channels or platforms) or competitive sports. It may be seen in recreational athletes and individuals who begin exercising to improve their physical health. 

Many experts believe that muscle dysmorphia (MD), as a result, can also be classified as an eating disorder of its own. 

Below, we’ll be providing readers with an overview of muscle dysmorphia, its appearance as an eating disorder in many as well as possible available treatment options.

Origins of muscle dysmorphia: Where did this condition come from? 

While body image dissatisfaction is thought by many to have been a major concern for many people over time, muscle dysmorphia was not generally believed to be clinically recognized until the 1990s.

Since this point, researchers have hypothesized that the condition can occur as a result of intense focus on sports and performance. This may be because many forms of sports might stress the importance of athletic training to be bigger, faster and stronger than competitors. While attaining physical prowess can be beneficial for those who want to become successful athletes, some people might try to improve on those traits even more with excessive exercise, which can have negative effects.  

Many now believe that athleticism might not be exclusively responsible for this condition. Other factors, such as social media pressures can also play a role in contributing to the pressure to be muscular or extremely fit. For example:

People with non-heterosexual sexual orientations may face heightened societal pressure to achieve a lean and muscular body, possibly putting them at a higher risk for developing body dysmorphic disorders.

How is muscle dysmorphia diagnosed?

A physician will generally look at specific diagnostic criteria when examining a possible case of muscle dysmorphia. 

Specific criteria can include symptoms such as:

1. Preoccupation with the thought that one's body is not sufficiently lean or muscular: As a result, the individual may spend hours on end at the gym or dieting—the frequency of which might also be examined to confirm the presence of muscle dysmorphia.

2. Two out of five of the following symptoms:

a. The neglect of social, occupational, and recreational activities. As a result of this free time, someone may compulsively maintain a workout schedule and diet routine.

b. Avoidance of situations that may cause exposure of one’s body.  Someone living with this disorder may experience feelings of nervousness or distress if they are placed in a situation where they feel exposed.

c. Preoccupation with body size. Intense focus in this area can cause significant distress in other areas of one’s life.

d. Continuing to work out, diet, and use substances. This behavior may continue despite understanding the risks or consequences associated with it.

 e. The individual's primary preoccupation is with feeling too small or inadequate. In contrast, people who live with anorexia nervosa may be primarily preoccupied with weight gain.

Do you know someone who might have muscle dysmorphia symptoms or body dysmorphic disorder?

On the surface, muscle dysmorphia may be hard to spot in individuals, especially in people who may be athletic or involved in bodybuilding. Clinicians have put together several symptoms to watch for in those who you believe may be living with the disorder. If you observe these behaviors in yourself or someone else, you may choose to encourage or pursue the use of therapy.

Additional symptoms beyond those mentioned above may include: 

• An individual may either wear very tight or baggy clothing, even in hot temperatures. This can occur due to the nervousness or embarrassment that can occur if someone is required to take off their clothes.

• Ignoring a specific training regimen (such as functional fitness or strength) to prioritize and focus on lifting weights for muscular hypertrophy. This can be seen more with certain areas of the body—such as the "show" muscles, like the chest and biceps.

• Prioritization of training over other important aspects of life such as work, school, and social relationships. This can degrade one’s overall quality of life and have lasting effects. 

• Anabolic steroid use,* supplementation with dangerous substances, and the use of other substances that are intended to promote muscle growth that may be considered unhealthy. This can include supplements such as ones designed for quick fat loss.

• Excessive use of mirrors or similar objects to judge or criticize one's physique. The individual may also seek reassurance by asking others to comment and approve of their physique.

• Plastic surgery or desire for surgery to address perceived flaws such as the removal of body fat or surgical implants to appear sufficiently muscular. 

Even if one is not regularly in the weight-room with someone who may be experiencing symptoms of this condition it is possible to be able to see some muscle dysmorphia symptoms in other settings—including home and school. 

Identifying the signs of the condition can be a helpful first step in helping individuals who are currently living with the condition experience a higher quality of life.

*The use of steroids is associated with side effects that may increase the risk of domestic violence against partners and other family members. If you or someone you love is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Free support is available 24/7.

Why is muscle dysmorphia considered an eating disorder? 

In the DSM-5 of the American Psychiatric Association, muscle dysmorphia’s parent disorder—body dysmorphia—is generally classified as an obsessive-compulsive disorder. However, many experts believe that it may be more nuanced than this singular category definition, holding the belief that it should be examined from different angles to validate the experiences of as many people as possible.

Eating disorder classifications 

In the DSM-5, for example, anorexia nervosa is generally classified as an eating disorder. Throughout its history, muscle dysmorphia has been compared to and contrasted with anorexia. To understand this possible connection to the fullest extent, it can be helpful to review the process of weight and muscle gain and loss. We’ve summarized this below. 

Body dysmorphia and eating disorders 

To build muscle, one typically needs to be in a caloric surplus—which can occur when you consume more calories than your body burns in one day. Surplus calories and macro-nutrients can then be reserved for the purpose of rebuilding muscle that has been broken down, possibly allowing them to grow. If one does not work out, the excess calories will typically be stored as fat. 

Conversely, to lose weight or achieve leanness, an individual may need to do the opposite and go into a caloric deficit. Doing so can result in weight loss as fewer calories are consumed. 

Someone who lives with muscle dysmorphia symptoms might begin to experience difficulty in finding their perfect balance of muscularity and leanness—which can result in feelings of inadequacy. As a result, they may turn to unhealthy dieting habits to achieve a certain appearance or level of comfort. With this in mind, it can be helpful to acknowledge:

What supportive strategies are available to improve body image?

For many, one of the most powerful first steps can be the recognition and the acknowledgement of dysmorphia and its effects in one’s life. After, many may seek different forms of treatment or risk mitigation, such as: 

• Online counseling 

• Body check avoidance 

• Accountability partners

• Peer support groups 

• Journaling

• Mindfulness

• Dietary or activity support methods 

• Emphasis on proper nutrition 

These steps might help reduce the compulsive behaviors and thoughts associated with muscle dysmorphia and related body image disorders. A mental health professional or specialist in the treatment of muscle dysmorphia may provide suggested readings intended to address associated psychological features of body image disorders. 

How can online therapy support those who live with this condition? 

Online therapy can support those who live with this condition in openly discussing their feelings regarding body-image, self-esteem and how it impacts their life. This can be a helpful first step for many, facing feelings that they may have attempted to otherwise disregard in the progression of the condition. Online therapy can be an ideal setting for this, as in-person intervention may not foster the same environmental level of openness or vulnerability as efficiently as online therapy settings can. BetterHelp can connect you with an online therapist in your area of need. 

Is online therapy effective? 

One form of psychotherapy, known as online cognitive-behavioral therapy (CBT) can provide relief from muscle dysmorphia symptoms using cognitive-restructuring techniques and ritual prevention exercises—possibly helping a person focus holistically on their entire self as opposed to excessively focusing on details or minor flaws.