Muscle Dysmorphia: Causes and Impacts

Muscle Dysmorphia

“70 eggs, 14 tins of tuna, 10.5 pounds of beef, I 0 pounds of chicken, 9 gallons of non-fat milk, 4 loaves of bread, and as many sacks of brown rice, whole wheat pasta, baking potatoes, and fruits as I could load into my shopping carts” (Fussell, 1991) may seem like a extra ordinary list of food to buy, considering its just for one person! But to a bodybuilder it’s just all the necessary foods to “grow”. Grow muscles. This sort of addiction, obsession, and dedication to grow muscles is growing at a very fast pace. Bodybuilding now has the sixth largest sports federation .The fast growing pace has got the attention of researchers. One of the first researches was done by Oxford-educated Samuel Wilson Fussell an ex- competitive bodybuilder, who writes about his obsession of body building in his book Muscle: Confessions of an Unlikely Bodybuilder.

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“It beat the street. It beat my girlfriend. It beat my family. I didn’t have to think. I didn’t have to care. I didn’t have to feel. I simply had to lift.” (Fussell, 1991). This overwhelming drive for gaining lean mass was initially called “bigameraria” by Taylor (1985), later coined “reverse anorexia” by pope, Katz, Hudson, (1993). Finally renamed and defined by Pope (1997) as “muscle dysmorphia”, a disorder in which a person becomes obsessed with the idea he/she is not muscular enough. Muscle dysmorphia is a very specific type of body dysmorphic disorder (BDD) , The worddysmorphiccomes from two Greek words,dysthat means “bad,” or “ugly;” and morphos which means “shape” or “form”. Hence it is characterized as a sub category of BDD which is characterized as a somatoform disorders in the DSM – IV- TR. However it is arguable considering the historical and clinical aspects of this syndrome as an Obsessive compulsive disorder (OCD) (Chung, 2001). Example “Eat, Lift, Sleep” a motivational and life style slogan preached in the world of body building, as in a lifestyle which requires “eat”ing to train, “lift” as in working out, “sleep” as a recovery phase for muscles to rest and grow. A lifestyle followed by serious lifters.

”We are all bodybuilders in a sense,” Fussell (1991) adds. ”It’s just that some of us don’t go to the gym.” There are currently no specific studies done to estimate the prevalence of muscle dysmorphia, mainly due to the fact it falls under BDD thus preventing solo studies. The current estimation of BDD in the U.S is 1-2 % of the population (Arthur, 2010). However, the figures are thought to be a underestimate because BDD is frequently under diagnosed (Arthur, 2010). Unfortunately there have been no studies done speculating BDD and race, though one may speculate that cultures and groups with high emphasis on physical beauty and attractiveness may be more prone to this disorder. Majority of studies till date have been conducted on Caucasian patients, however studies indicate Asian Americans and African Americans with BDD are more likely concerned about facial features or skin tone which dominates the mass media and have been derived from Caucasian Americans (Peiss & Joni, 1998). As for now only one case of muscle dysmorphia has been reported from Asia (Ung, Fones & Ang, 2000). Case being of a 24 year old Chinese Singaporean male with a deep fear of weight and muscle loss associated with compulsive weight training, forced eating, depressed mood and disturbed body image (Ung, Fones & Ang, 2000).

In a research conducted by Yang, Gray, and Pope (2005) to determine the prevalence of muscle dysmorphia in Asia, 55 heterosexual Taiwanese men of Chinese origin where selected. Theauthors administereda computerized test of body image to 55 heterosexual men of Chinese origin inTaiwan and compared the results to those previously obtainedin an identical study in the United States and Europe. The results indicated Taiwanese men exhibitedsignificantly less body dissatisfaction than their Western counterparts. Hence concluding muscle dysmorphia a more common among western cultures. Also the U.S and European men claimed their ideal body type to be 13 kilograms more muscle than what they had. Where else the ideal body type for the Thai people where 2 kilograms more muscles than what they had. In the second experiment carried out by the same authors they counted the number of undressed male and female modelsin American versus Taiwanese women’s magazine advertisements (Yang, Gray & Pope, 2005). The purpose was to show the impact of body image value in society. Not surprisingly the results where Asian men were almost never show undressed where else 43% of western men were baring pecs or abs (Yang, Gray & Pope, 2005). Thus portraying the notion that in Asia muscles don’t make a man, which in result means lower rate of muscle dysmorphia.
“If this “no pain, no gain” adage were true, then, I would learn not just to accept pain, but to embrace it.” (Fussell, 1991). The pain loving Fussell had not only learnt to “embrace pain” but he gave up his job, family, and friends to purse bodybuilding. This sort of situation is described as a major symptom of muscle dysmorphia by Olivardia (2000). The symptoms include constant checking of own body in the mirror, disgusted by reflection or shadow of own image, frequent comparison with other on body shape and size. More serious symptoms include missing or bypassing social events and jobs related work to work out in the gym and eat the right diet by consuming the right amount of protein. The more severe symptoms include injecting with Synthol (liquid muscles) or usage of anabolic steroids for cosmetic reasons.

There are three known explanations for the cause of muscle dysmorphia, the cognitive, psychodynamic, and the biological explanation. The most common theory is the cognitive explanation, which explains the cultural shift in the last 30 years which has changed the idea of the ideal male body image. These include models, wrestlers etc which has been blamed at the media by many researchers (Agliata &Tantleff, 2004). In a study by Pope et al. (1999) revealed the massive changes over the action figures sold to kids. The findings indicated an increased muscular body parts from the GI Joe toys of the 1973 to the GI Joe of 1998. The evolution of the toys reveals a 10 inch increase of the chest and almost 14 inch increase in the biceps of the toys to name a few changes. When the action figures height was increased to 70 inches, the figures were larger than the largest bodybuilders that have lived! To prove the effect media has on portraying the idealized male body, a research was conducted in which it demonstrated the decrease in body image satisfaction in college -aged males after an acute media exposure (Leit, Gray, & Pope, 2002). Hence it’s a valid reason to assume continuous exposure to these images over time may have a negative body image satisfaction. The psychodynamic explanation links body image with unresolved childhood. As a reason of being either bullied or teased in childhood, hence being more vulnerable to low- self esteem. Therefore a preoccupation with musculature could be treated as an individual’s unconscious displacement of sexual or emotional. Finally the biological explanation explains a serotonin irregularity is mostly responsible for the disorder.

Since most muscle dysmorphia patients appear healthy and fit it is often difficult to determine who is affected by this condition. To be diagnosed with muscle dysmorphia there are certain criterias (Olivardia, Pope & Hudson, 2000). These include being dissatisfied with one’s body for not being lean and muscular, following hours of workout and a rigid diet. Some of the other criterias are to forgo important situation so that workout and diet can remain unchanged, avoid situations where body is exposed and if exposed intense anxiety sweep the whole body and using supplements and over training even after knowing the potential risks. All the criteria need not apply to be diagnosed, two or more leads to conclusion of muscle dysmorphia.

Several tools are developed to assess the risk of MD (Esco, Olson, & Williford, 2005) the most used tools are two the Muscle Appearance Satisfaction Scale (MASS) devolved by Mayville(2002) which contains factor content, such as dependence, muscle checking, substance use, injury, and muscle satisfaction. Finally the Muscle Dysmorphia Inventory developed by Pope uses a 6 factor to determine risk of MD. The factors differ from the one developed by Mayville, the factors here include body size, supplement use, exercise dependence, pharmacological use, dietary behaviour and physique protection.
“I can decide what body weight I want and take myself up or down to meet it” is a quote from Arnold Schwarzenegger book often referred to as the “Bible” of bodybuilding. This is the effect of bodybuilding in Arnold’s life but it’s not quite the same in a person who has been diagnosed with muscle dysmorphia. There are several risks associated with the compulsive behaviour of MD, risks ranging from the damage of musculosketal injuries (Leone, Sedora, & Gray, 2005). due to overtraining to liver damage due to steroid abuse. The heavy use of bodybuilding supplements which are not approved by the FDA also poses a great danger as all the drugs are passed through the kidney. More common dilemma in a gym-goers mind is the protein consumption, the recommended consumption is around 30-40 grams for male but according to the bodybuilding world it is supposedly 3-5 grams per kilo of body weight. A protein supplement used for building muscles contains 20-60 grams of protein per serving which exceeds the daily recommended. And to note this is just one serving! The seriousness of this reaches potential risk to a person diagnosed with MD since this is what his life would be revolving around. Bodybuilding attracts loners because of the individuality of the sport (Klein, 1995) and once obsessed he socially isolates himself like Fussell as mentioned earlier who gave up his job, friends, and family for the sake of bodybuilding. Like anorexia patient’s bodybuilders display high degree of confidence but in reality the self esteem is low.( Klein, 1995) Further being diagnosed with muscle dysmorphia means the person always assumes he is “puny” or “tiny” thought he may be above average. This results in steroid abuse which later leads to steroid addiction, thereby increasing his muscle mass whereby decreasing his lifespan.

The biggest challenge with muscle dysmorphia is not the disorder but the treatment. There are several barriers in the treatment of MD. The first biggest challenge being people with MD do not consider them ill (Leone, Sedora, & Gray, 2005), they consider it their lifestyle. If they do come to realize how their symptoms have affected them they feel shy and embarrassed regarding the issue (Dawes & Mankin, 2004). When living a life where they want to get big and bigger, coming clean with the issue makes them look fragile which is their worst nightmare. When treated it is beneficial to focus on issues which have been created due to the disorder, such as lost relationships, family time, leisure time etc. The most sought out treatment remains anti-depressant medicines alone (Phillips, Albertini & Rasmuseen, 2002) or with cognitive behaviour therapy.

With this we can conclude Muscle dysmorphia is a serious issue yet to be recognised as a major issue, but with the growing number of members in health clubs and increased sales in supplements it will not be a big surprise if muscle dysmorphia becomes the most prevalent type of body dysmorphic disorder .


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