Thematic Article
Volume 9 Issue 3 - 2020
Muscle Dysmorphia: Appearance, Diagnostic Approaches, Research and Treatment
Roland Müller
Leading Psychologist, Center for Obesity and Metabolic Medicine, Winterthur, Switzerland
*Corresponding Author: Roland Müller, Leading Psychologist, Center for Obesity and Metabolic Medicine, Winterthur, Switzerland.
Received: December 14, 2019; Published: February 29, 2020


Fitness training and corresponding forms of health centered lifestyles have been integrated into everyday life as a common and societal accepted phenomenon nowadays. It is furthermore associated with being healthy and through societal and industrial influences, a specific muscular and lean body image has become synonymous with fitness, sports and health. This has foremost affected male body image concerns. In recent years, the diagnostic concept of Muscle Dysmorphia (MD) emerged, addressing this relatively new, male oriented psychological disorder. Key features of MD are excessive resistance training routines combined with rigid eating or dietary habits, body image dissatisfaction, distorted body perception and in many cases androgenic anabolic steroid abuse. While the number of men affected by eating- and body image disorders are rising, societal acceptance and understanding of male body issues is still low. At the same time, research, treatment strategies and prevention programs are underdeveloped compared to efforts in female counterparts. This article highlights the current discussion about diagnostic features of MD, its appearance, state of research, prevention and treatment.

Keywords: Muscle Dysmorphia; Eating Disorders in Men; Body Image; Anabolic Androgenic Steroids


  1. Pope HG and R Olivardia. “The Adonis Complex: The Secret Crisis of Male Body Obsession”. New York: Free Press (2000). 
  2. Pope HG Jr., et al. "Muscle Dysmorphia. An Underrecognized Form of Body Dysmorphic Disorder”. Psychosomatics 38.6 (1997): 548-557. 
  3. APA. Diagnostic and Statistical Manual of Mental Disorders: Dsm-5. (5th Edition). Washington D.C.: American Psychiatric Association (2013). 
  4. Murray SB., et al. "A Comparison of Eating, Exercise, Shape, and Weight Related Symptomatology in Males with Muscle Dysmorphia and Anorexia Nervosa”. Body Image 9.2 (2012): 193-200. 
  5. Foster AC., et al. "Muscle Dysmorphia: Could It Be Classified as an Addiction to Body Image?" Journal of Behavioral Addictions 4.1 (2015): 1-5. 
  6. Murray SB., et al. "The Transition from Thinness-Oriented to Muscularity-Oriented Disordered Eating in Adolescent Males: A Clinical Observation”. Journal of Adolescent Health 60.3 (2017): 353-355. 
  7. Müller R., et al. "Muskeldysmorphe Störung. Prävalenz, Diagnostik Und Behandlung”. Neurologie and Psychiatrie 1 (2019): 24-26. 
  8. Tod D., et al. "Muscle Dysmorphia: Current Insights”. Psychology Research and Behavior Management 9 (2016): 179-188. 
  9. Santos Filho CA., et al. "Systematic Review of the Diagnostic Category Muscle Dysmorphia”. A Australian and New Zealand Journal of Psychiatry 50.4 (2016): 322-333. 
  10. Campagna JD and B Bowsher. "Prevalence of Body Dysmorphic Disorder and Muscle Dysmorphia among Entry-Level Military Personnel”. Military Medicine 181.5 (2016): 494-501. 
  11. Pope HG Jr., et al. "Anorexia Nervosa and "Reverse Anorexia" among 108 Male Bodybuilders”. Comprehensive Psychiatry 34.6 (1993): 406-409. 
  12. Hildebrandt T., et al. "Presence of Muscle Dysmorphia Symptomology among Male Weightlifters”. Comprehensive Psychiatry 47.2 (2006): 127-135. 
  13. Mor Z., et al. "Gym Exercising Patterns, Lifestyle and High-Risk Sexual Behaviour in Men Who Have Sex with Men and in Heterosexual Men”. British Medical Journal 4.11 (2014): e005205. 
  14. Calzo JP., et al. "Patterns of Body Image Concerns and Disordered Weight- and Shape-Related Behaviors in Heterosexual and Sexual Minority Adolescent Males”. Developmental Psychology 51.9 (2015): 1216-1225. 
  15. Calzo JP., et al. "Gender Conformity and Use of Laxatives and Muscle-Building Products in Adolescents and Young Adults”. Pediatrics 138.2 (2016). 
  16. Murray SB., et al. "The Enigma of Male Eating Disorders: A Critical Review and Synthesis”. Clinical Psychology Review 57 (2017): 1-11. 
  17. Murray SB., et al. "Evolving Eating Disorder Psychopathology: Conceptualising Muscularity-Oriented Disordered Eating”. British Journal of Psychiatry 208.5 (2016): 414-415. 
  18. Mitchison D and J Mond. "Epidemiology of Eating Disorders, Eating Disordered Behaviour, and Body Image Disturbance in Males: A Narrative Review”. Journal of Eating Disorders 3 (2015): 20. 
  19. Darcy AM. "Eating Disorders in Adolescent Males: A Critical Examination of Five Common Assumptions”. Adolescent Psychiatry 1 (2011): 307-312. 
  20. Darcy AM and IH Lin. "Are We Asking the Right Questions? A Review of Assessment of Males with Eating Disorders”. Eating Disorders 20.5 (2012): 416-426. 
  21. McCreary DR and DK Sasse. "An Exploration of the Drive for Muscularity in Adolescent Boys and Girls”. Journal of American College Health 48.6 (2000): 297-304. 
  22. Hausenblas H and D Symons Downs. "How Much Is Too Much? The Development and Validation of the Exercise Dependence Scale”. Psychology and Health 17 (2002): 387-404. 
  23. Rhea DJ., et al. "Development of the Muscle Dysmorphia Inventory (Mdi)”. The Journal of Sports Medicine and Physical Fitness 44.4 (2004): 428-435. 
  24. Hildebrandt T., et al. "Muscularity Concerns among Men: Development of Attitudinal and Perceptual Measures”. Body Image 1.2 (2004): 169-181. 
  25. Madden S., et al. "Burden of Eating Disorders in 5-13-Year-Old Children in Australia”. Medical Journal of Australia 190.8 (2009): 410-414. 
  26. Nicholls DE., et al. "Childhood Eating Disorders: British National Surveillance Study”. British Journal of Psychiatry 198.4 (2011): 295-301. 
  27. Eddy KT., et al. "Prevalence of Dsm-5 Avoidant/Restrictive Food Intake Disorder in a Pediatric Gastroenterology Healthcare Network”. International Journal of Eating Disorders 48.5 (2015): 464-470. 
  28. Sharp CW., et al. "Clinical Presentation of Anorexia Nervosa in Males: 24 New Cases”. International Journal of Eating Disorders 15.2 (1994): 125-134. 
  29. Hudson JI., et al. "The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication”. Biological Psychiatry 61.3 (2007): 348-358. 
  30. Mosley PE. "Bigorexia: Bodybuilding and Muscle Dysmorphia”. European Eating Disorders Review 17.3 (2009): 191-198. 
  31. Murray SB., et al. "The Emotional Regulatory Features of Bulimic Episodes and Compulsive Exercise in Muscle Dysmorphia: A Case Report”. European Eating Disorders Review 20.1 (2012): 68-73. 
  32. Steele IH., et al. "Competitive Bodybuilding: Fitness, Pathology, or Both?" Harvard Review of Psychiatry 27.4 (2019): 233-240. 
  33. Kläber M. “Moderner Muskelkult. Zur Sozialgeschichte Des Bodybuilding”. Bielefeld: Tanscript (2013). 
  34. Mitchell L., et al. "Muscle Dysmorphia Symptomatology and Associated Psychological Features in Bodybuilders and Non-Bodybuilder Resistance Trainers: A Systematic Review and Meta-Analysis”. Sports Medicine 47.2 (2017): 233-259. 
  35. Michels-Lucht F., et al. "Steroid Use in Free Time Bodybuilders”. Psychotherapie, Psychosomatik, medizinische Psychologie 61.12 (2011): 512-517. 
  36. Devrim A., et al. "Is There Any Relationship between Body Image Perception, Eating Disorders, and Muscle Dysmorphic Disorders in Male Bodybuilders?" American Journal of Men's Health 12.5 (2018): 1746-1758. 
  37. Baghurst T and C Lirgg. "Characteristics of Muscle Dysmorphia in Male Football, Weight Training, and Competitive Natural and Non-Natural Bodybuilding Samples”. Body Image 6.3 (2009): 221-227. 
  38. Longobardi C., et al. "Muscle Dysmorphia and Psychopathology: Findings from an Italian Sample of Male Bodybuilders”. Psychiatry Research 256 (2017): 231-236. 
  39. Mitchell L., et al. "Correlates of Muscle Dysmorphia Symptomatology in Natural Bodybuilders: Distinguishing Factors in the Pursuit of Hyper-Muscularity”. Body Image 22 (2017): 1-5. 
  40. Kanayama G and HG Pope Jr. "History and Epidemiology of Anabolic Androgens in Athletes and Non-Athletes”. Molecular and Cellular Endocrinology 464 (2018): 4-13. 
  41. Goldman AL., et al. "The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders among Young Men”. The Journal of Clinical Endocrinology and Metabolism 104.4 (2019): 1069-1074. 
  42. Kläber M. “Zum Medikamentenmissbrauch Im Breiten- Und Freizeitsport. Entstehung”, Entwicklung Prävention. Schwerpunkt Fitnessstudios. Frankfurt am Main: Deutscher Olympischer Sport bund (2014). 
  43. Johnson MD., et al. "Anabolic Steroid Use by Male Adolescents”. Pediatrics 83.6 (1989): 921-924. 
  44. Settanni M., et al. "Muscle Dysmorphia and Anabolic Steroid Abuse: Can We Trust the Data of Online Research?" Psychiatry Research 263 (2018): 288. 
  45. Piacentino D., et al. "Anabolic-Androgenic Steroid Use and Psychopathology in Athletes. A Systematic Review”. Current Neuropharmacology 13.1 (2015): 101-121. 
  46. Lindqvist AS., et al. "A Retrospective 30-Year Follow-up Study of Former Swedish-Elite Male Athletes in Power Sports with a Past Anabolic Androgenic Steroids Use: A Focus on Mental Health”. B British Journal of Sports Medicine 47.15 (2013): 965-969. 
  47. Pope HG Jr and DL Katz. "Affective and Psychotic Symptoms Associated with Anabolic Steroid Use”. The American Journal of Psychiatry 145.4 (1988): 487-490. 
  48. Pope HG Jr., et al. "Adverse Health Consequences of Performance-Enhancing Drugs: An Endocrine Society Scientific Statement”. Endocrine Reviews 35.3 (2014): 341-375. 
  49. Smolak L., et al. "Sociocultural Influences and Muscle Building in Adolescent Boys”. Psychology of Men and Masculinity 6.4 (2005): 227-234. 
  50. Cramblitt B and M Pritchard. "Media's Influence on the Drive for Muscularity in Undergraduates”. Eating Behaviors 14.4 (2013): 441-446. 
  51. Begin C., et al. Rodrigue. "Psychosocial Factors Underlying Symptoms of Muscle Dysmorphia in a Non-Clinical Sample of Men”. Psychiatry Research 272 (2019): 319-325. 
  52. Palazon-Bru A., et al. "Screening Tool to Determine Risk of Having Muscle Dysmorphia Symptoms in Men Who Engage in Weight Training at a Gym”. Clinical Journal of Sport Medicine 28.2 (2018): 168-173. 
  53. Lin L., et al. "Hearing Vs. Engaging in Negative Body Talk: An Examination of Adult Men”. Journal of Eating Disorders 27.6 (2019): 538-549. 
  54. Schneider C., et al. "Biological, Psychological, and Sociocultural Factors Contributing to the Drive for Muscularity in Weight-Training Men”. Frontiers in Psychology 7 (2016): 1992. 
  55. Lavender JM and DA Anderson. "Contribution of Emotion Regulation Difficulties to Disordered Eating and Body Dissatisfaction in College Men”. International Journal of Eating Disorders 43.4 (2010): 352-357. 
  56. Jin X., et al. "Attentional Biases toward Body Images in Males at High Risk of Muscle Dysmorphia”. Peer-Reviewed Journal 6 (2018): e4273. 
  57. Waldorf M., et al. "Body-Oriented Gaze Behaviors in Men with Muscle Dysmorphia Diagnoses”. Journal of Abnormal Psychology 128.2 (2019): 140-150. 
  58. Grieve FG. "A Conceptual Model of Factors Contributing to the Development of Muscle Dysmorphia”. International Journal of Eating Disorders 15.1 (2007): 63-80. 
  59. Murray SB., et al. "Go Big or Go Home: A Thematic Content Analysis of Pro-Muscularity Websites”. Body Image 16 (2016): 17-20. 
  60. Pila E., et al. "A Thematic Content Analysis of #Cheatmeal Images on Social Media: Characterizing an Emerging Dietary Trend”. International Journal of Eating Disorders 50.6 (2017): 698-706. 
  61. Whitfield THF., et al. "Viewing Sexually Explicit Media and Its Association with Mental Health among Gay and Bisexual Men across the U.S”. Archives of Sexual Behavior 47.4 (2018): 1163-1172. 
  62. Blond A. "Impacts of Exposure to Images of Ideal Bodies on Male Body Dissatisfaction: A Review”. Body Image 5.3 (2008): 244-250. 
  63. Galioto R and JH Crowther. "The Effects of Exposure to Slender and Muscular Images on Male Body Dissatisfaction”. Body Image 10.4 (2013): 566-573. 
  64. Griffiths S., et al. "Physical Appearance Concerns Are Uniquely Associated with the Severity of Steroid Dependence and Depression in Anabolic-Androgenic Steroid Users”. Drug and Alcohol Review 37.5 (2018): 664-670. 
  65. Blashill AJ., et al. "Anabolic Steroid Misuse among Us Adolescent Boys: Disparities by Sexual Orientation and Race/Ethnicity”. American Journal of Public Health 107.2 (2017): 319-321. 
  66. Hildebrandt T., et al. "Fitness Supplements as a Gateway Substance for Anabolic-Androgenic Steroid Use”. Psychology of Addictive Behaviors 26.4 (2012): 955-962. 
  67. Kläber M. “Doping Im Fitnessstudio”. Bielefeld: Transcript (2010). 
  68. Kanayama G and HG Pope Jr. "Gods, Men, and Muscle Dysmorphia”. Harvard Review of Psychiatry 19.2 (2011): 95-98. 
  69. Rutgers H., et al. “Europeactive European Health & Fitness Market Report 2019”. Europe Active (2019). 
  70. Striegel RH., et al. "Why Men Should Be Included in Research on Binge Eating: Results from a Comparison of Psychosocial Impairment in Men and Women”. International Journal of Eating Disorders 45.2 (2012): 233-240. 
  71. Griffiths S., et al. "Young Peoples' Stigmatizing Attitudes and Beliefs About Anorexia Nervosa and Muscle Dysmorphia”. International Journal of Eating Disorders 47.2 (2014): 189-195. 
  72. Austen E and S Griffiths. "Why Do Men Stigmatize Individuals with Eating Disorders More Than Women? Experimental Evidence That Sex Differences in Conformity to Gender Norms, Not Biological Sex, Drive Eating Disorders' Stigmatization”. Eating Disorders 27.3 (2019): 267-290. 
  73. Blashill AJ., et al. "Cognitive Behavioral Therapy for Body Image and Self-Care (Cbt-Bisc) in Sexual Minority Men Living with Hiv: A Randomized Controlled Trial”. Health Psychology Journal 36.10 (2017): 937-946. 
  74. Markey CH., et al. "Does "Body Talk" Improve Body Satisfaction among Same-Sex Couples?" Body Image 23 (2017): 103-108. 
  75. Nice. "Obsessive-Compulsive Disorder and Body Dysmorphic Disorder: Treatment (Cg31)”. (2005). 
  76. Wilhelm S., et al. “Cognitive Behavioural Therapy for Body Dysmorphic Disorder”. New York: The Guildford Press (2012). 
  77. Morgan JF. “The Invisible Man-a Self Help Guide for Men with Eating Disorders, Compulsive Exercise and Bigorexia”. Sussex: Routledge (2008). 
Citation: Roland Müller. “Muscle Dysmorphia: Appearance, Diagnostic Approaches, Research and Treatment”. EC Psychology and Psychiatry 9.3 (2020): 01-09.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

January Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the January issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for January Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the January issue of respective journals. Submissions are accepted on/before January 30, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to