Body image concerns among men are increasingly common and can have a serious impact on mental health. And for an estimated one in ten young men who go the gym in the UK, these body image concerns can result in a mental health condition known as muscle dysmorphia.
Though researchers are only just beginning to understand the complexities of the condition, it appears young men are currently being affected by it at a higher rate compared to other populations. It’s believed there are many reasons driving this, but researchers have found that media and social media pressure, alongside changing ideas of masculinity may both be major causes.
Sometimes referred to as “bigorexia” or “reverse anorexia”, people with muscle dysmorphia believe their body is too small, skinny, or insufficiently muscular – even though the opposite may be true. This distorted view causes a preoccupation with becoming overly muscular and lean, often leading to the development of dangerous habits, such as excessive weight training, restrictive dieting and the use of substances such as anabolic steroids. It can also lead to anxiety, depression and may affect their daily life.
But currently diagnosing muscle dysmorphia is still difficult. Though several self-report surveys exist to help physicians diagnose patients, these surveys only assess related symptoms (such as a desire for bigger muscle, or body image issues) rather than offering a robust diagnosis.
Diagnosis also relies on patients meeting a specific set of criteria, such as having a preoccupation with being lean and muscular, weight lifting excessively and dieting. But since so many different methods are used to diagnose muscle dysmorphia, this can make fully understanding the condition difficult.
However, in general, most experts agree people with muscle dysmorphia tend to engage in steroid use, have symptoms of eating disorders (such as compulsive exercise and eating habits) and higher body dissatisfaction, usually with their general appearance, weight and muscularity.
People with muscle dysmorphia also tend to have lower self-esteem, higher anxiety levels when their physique is exposed, higher rates of depression, and obsessive compulsive behaviours towards exercise and diet. For example, people may prioritise training over work or social activities or strictly eat every three hours to ensure muscle gain. And if these behaviours are disrupted, it causes anxiety and emotional disturbance.
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Muscle dysmorphia tends to affect men in their mid-20s to mid-30s, though average age of onset is 19 years old. Research suggests it’s most common in weightlifting and bodybuilding communities.
However, research also shows almost 6% of US students have it. Another study found 4.2% of women and 12.7% of men in the US military have muscle dysmorphia. So while it appears to predominantly affect young men, there’s limited research on its prevalence in other populations.
The ‘ideal’ body
There are many reasons a person may develop muscle dysmorphia, and it’s unique to each person. However, research suggests that the media (and social media), as well as pressure from family and friends, are likely causes.
For example, media portrayals of men over time have become more muscular. Specifically, over several decades male models in magazines have become significantly larger and leaner. Even male action figures have changed over time, becoming unrealistically muscular.
Muscle dysmorphia is linked to the belief that a muscular physique is ideal. So being exposed to these images and ideals in the media may cause concern and a distorted view of one’s body. Studies also show social media use is directly linked to the idolisation of muscularity in young boys. Viewing images of fit people on social media also predicts a fixation with becoming more muscular.
The view that being muscular is valuable is typically learned from friends and family, and pressure to be muscular may come in the form of comparisons or comments about appearance from loved ones. Research shows some men even seek a muscular physique to cope with bullying and emasculation from family members and romantic partners.
Some researchers also believe believe a so-called “masculine crisis” may be contributing to increased cases of muscle dysmorphia. This reflects the perceived belief there are less opportunities for men to assert their masculinity through manual and industrial labour. This may leave some men feeling threatened and emasculated.
As a result, men have learned to use a muscular physique to visually show their masculinity. Increasingly, masculinity in modern culture represents not what you do, but how you look. So, the value that society has placed on being muscular may explain why muscle dysmorphia is more common in men.
Given muscle dysmorphia is potentially under-reported, we cannot accurately know how common it is. Instead, we can only speculate based on the limited evidence we have. The uncertainty is partly because of inconsistent diagnostic tools, and the notion it’s taboo for men to be concerned with appearance or sharing their feelings.
Little research has explored the treatment options for muscle dysmorphia, but one review suggests that cognitive behavioural therapy, thought restructuring (a technique that helps people understand and challenge their thoughts, feelings, and beliefs), and family therapy could all be beneficial.
Given that internal experiences are hard to change, people suffer with the condition long-term. But seeing as the condition is similar to body dysmorphic disorder, which causes people to obsess over perceived flaws in their appearance more generally, researchers may already have promising potential solutions to help manage emotions and symptoms associated with muscle dysmorphia.