'Muscle Dysmorphia' -- Bodybuilding Gone Amuck

November 21, 1997

An international team of researchers has identified a new, '90s-style psychiatric disorder they say may be afflicting a substantial number of people -- bodybuilders in top physical shape who are chronically worried that they look puny.

They call it "muscle dysmorphia." Principal investigator Harrison G. Pope, MD, of McLean Hospital in Belmont, Massachusetts, and his colleagues at Brown University and Keele University, England, discovered the disorder in the course of several ongoing studies of athletes. They describe the disorder and recount four case studies in the November-December issue of the research journal Psychosomatics.

For many of the muscle-bound men and women identified as having the disorder, preoccupation with their bodies was so intense they routinely gave up desirable jobs, careers and social engagements to spend hours in a gym each day. They refused to go to the beach or swimming pool for fear their bodies don't look good enough to be seen.

Many reported taking anabolic steroids to build bigger muscles, but still were unsatisfied. Typically, they weighed themselves several times a day, repeatedly checked themselves in mirrors, wore baggy sweatshirts and pants even in midsummer to conceal their bodies, and experienced great distress if they had to miss even one day of weight-lifting.

The researchers report, "It appears that the disorder produces substantial morbidity, together with maladaptive behaviors such as anabolic steroid abuse, and thus may have important implications for public health."

They stress, however, that for the vast majority of Americans, there is nothing pathological about working out regularly, because dedication to bodybuilding or other sports is perfectly healthy.

"This syndrome looks almost like a reverse form of anorexia nervosa," says Dr. Pope. "In a typical case of anorexia nervosa, a woman diets until she is severely underweight. Yet, when she looks at herself in the mirror, she perceives herself as fat."

"By contrast, in typical muscle dysmorphia, a muscle-bound bodybuilder will look in the mirror and see himself or herself as out of shape. We think the underlying pathology of the two conditions may be the same, since they are both disorders of body image. The preoccupations simply go in opposite directions."

The researchers speculate that more and more people may be afflicted as weightlifting increases in popularity among both men and women. "Americans spend about $3 billion a year on commercial gym memberships," says Dr. Pope. "And this doesn't count the more than a million Americans who work out at home. With this explosion of interest, it may well be that muscle dysmorphia will become the body image disorder of the '90s, just as eating disorders leapt into public awareness in the '80s."

The research was funded in part by grants from the National Institute of Drug Abuse, the Nuffield Foundation and Wellcome Trust, and the National Alliance for Research on Schizophrenia and Depression.

Psychosomatics, the official journal of the Academy of Psychosomatic Medicine, publishes peer-reviewed research and clinical experiences in the practice of medical-surgical psychiatry. For further information, contact Tom Wise, MD, at (703) 698-3626.

Center for Advancing Health

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