Last week I attended the Body Image and Related Disorders conference at Swinburne University. The focus of the conference was on eating disorders and related conditions such as body dysmorphia. Body dysmorphia is categorised as an obsessive compulsive disorder in the Diagnostics and Statistcal Manual (DSM) used in Psychology and Psychiatry but many professionals debate that it would be better classified in the eating disorder category due to its preoccupation with body image and shape. To better understand this debate, let’s delve a little deeper into what body dysmorphia is and explore the specific example of muscle dysmorphia.
Body dysmorphia has been described as that sensation you get where you have a big pimple on your chin and you are convinced everyone is looking at it. You keep resting your hand on your chin to disguise the pimple, you can’t stop thinking about the pimple, all you want to do is pop it. Life with body dysmorphia is a perceived big pimple on your chin every second of every day. This results in people with body dysmorphia having an overall lower quality of life than the general population. The condition is associated with many negative social outcomes like people with body dysmorphia being less likely to be employed or to have a romantic partner. The shame and social anxiety caused by the condition is also linked to people with body dysmorphia being less likely to leave their homes or form social relationships because they fear the judgement and disgust of others deeply. Furthermore, their obsessions and compulsions associated with the body dysmorphia prevent them from functioning well in broader societal contexts.
Body dysmorphia is a condition categorised by preoccupation and obsession with one or more perceived flaws in the appearance. The flaws are either imperceptible to others or simply do not exist and are imagined. Body dysmorphia is categorised by feelings of shame, anxiety and disgust. It is accompanied by ritualistic behaviours that are repeated in an effort to address the perceived malformation. In the case of a perceived flaw of the skin, this may involve repetitive application of make up, pulling the hair over the face or wearing a hat to disguise the skin or constantly checking the mirror and touching and/or picking at the skin.
Clearly body dysmorphia is a debilitating mental illness. I used the example of skin before but body dysmporphia concerns can centre on any part of the body: the nose, cheeks, chin, hair, knees, feet, elbows, arms, stomach, hips. You name it, somebody with dysmorphia has an obsession with it. Whilst the most common types of body dysmorphia fixations centre around the face there is a less common and less spoken about form of body dysmorphia that I find particularly interesting: muscle dysmorphia. Muscle dysmorphia centres on the perceived lack of muscularity. When it was first documented by Harrison Pope in 1993 he described it as ‘reverse anorexia’. He used this term because muscle dysmorphia involves the overvaluation of body shape that categorises anorexia but the overvaluation is in a different direction and focuses on muscularity. Muscle dysmorphia also shares other characteristics with anorexia as it can involve extreme dieting, obsessive exercise, significant psychological distress and the use of diet aids and substances to achieve body ideals. The primary factor both anorexia and muscle dysmorphia share is their obsession with body shape and the deep seeded belief that the body does not look the way it in fact does. For anorexic patients this often means lack of awareness that they are sickly thin and for muscle dysmorphics it can mean having no idea how muscular they are in reality.
Now this may shock you to hear but muscle dysmorphia is an extremely under researched area. This is quite alarming when you consider the dangerous lengths those with body dysmorphia are going to fix their perceived malformation and the psychological toll this takes. Muscle dysmorphia is an extremely distressing condition with those living with it reporting significantly lower quality of life. In fact, approximately 50% of people living with muscle dysmorphia attempt suicide. In addition, steroid use, which is engaged in by the majority of men with muscle dysmorphia, is associated with shortened lifespans and other adverse health outcomes. Furthermore, steroid use is on the rise and the cyclical process that it involves leads to dependence amongst most users. Studies have shown that when people start taking steroids they expect to be on them for six months. But in reality they are more likely to stay on them for around 66 months. The trouble is that the long term adverse impact of steroids is often not considered by the users who have muscle dysmorphia. These individuals are usually young males who are impulsive (due to their age and sex) and also desperate (due to their dysmorphia). They are unlikely to consider the long term effects of being on steroids, especially not when they convince themselves they will only be on them for a short time; ‘until they get big’. The problem with muscle dysmorphia is that one is never ‘big’ enough.
The similarities between muscle dysmorphia (in particular of the body dysmorphias) and anorexia nervosa are pervasive. Often it is commented that not many men experience anorexia and perhaps it is due to the different societal expectations placed on males and females. Women have products marketed to them that are low in fat and the body ideal projected to women is of a skinny, slim woman. Whereas products marketed to men are high protein and the body ideal projected to men is muscular. In this sense, muscle dysmorphia and anorexia can both be fought of as conditions categorised by the overvaluation of body shape in the direction of gender societal ideals. Both conditions are flavoured by obsessive compulsive components and that’s what makes the classification of mental illnesses to difficult. In order to determine whether muscle dysmorphia is best categorised as an eating disorder or an obsessive compulsive disorder, greater research is needed into understanding its underlying motivations and mechanisms.