Muscle Dysmorphia (MD) is a subtype of body dysmorphic disorder that primarily affects men. It is characterized by excessive concern that one’s body is too small and not muscular enough. While MD has some overlap with eating disorders, it is not considered an eating disorder. Individuals with MD may engage in strict eating habits, such as repeatedly counting calories or attempting to establish the perfect balance of carbohydrates, proteins and vitamins in their diets. However, the aim is to bulk up and appear more masculine as opposed to concerns with weight loss as seen in individuals with eating disorders. Additionally, not all individuals with MD have disordered eating (International OCD Foundation).
Compulsive behaviors in those with MD often include camouflaging such as wearing extra layers of clothing to appear larger or baggier clothes to hide a frame that is perceived as too small. It is also common for individuals to engage in excessive weight-lifting, often for several hours a day. Excessively checking mirrors or avoiding them are typical behaviors in MD. Often, social situations where one’s body will be on display, such as beaches or pools, are avoided. As with other forms of body dysmorphic disorder, MD can lead to missing school, work, discontinuation of athletics, or becoming housebound. Some individuals also use anabolic steroids or other performance-enhancing drugs (Phillips, 2005).
Cognitive-Behavioral Therapy is considered an effective treatment for muscle dysmorphia. Similar to treatment for other forms of BDD, treatment goals for muscle dysmorphia would include providing psychoeducation, cognitive restructuring, exposure and response prevention, and regular completion of homework assignments.
Psychoeducation for muscle dysmorphia would include information on how media and culture influences body image. Strategies for promoting long-term health would also be discussed. This includes helping the client develop realistic expectations regarding nutrition goals and exercise. Cognitive restructuring for MD would involve working with the client to develop more helpful, accurate beliefs about body size and shape. Additionally, it would target unhelpful thoughts, beliefs and behaviors related to altering body shape and weight (Wilhelm, et. al 2013). Exposure and Response Prevention is another important part of treatment. As with BDD, exposures would target situations the client is avoiding such as school, work, or other valued activities. Response prevention would assist the client with identifying all compulsive behaviors related to weight, shape, or muscularity concerns. As previously mentioned, common compulsions may include mirror-checking, comparing, frequent weighting, wearing many layers of clothing to appear bigger, and following an excessive exercise regimen. The therapist and client would develop a plan to help the client stop the compulsions (Wilhelm, et. al 2013). The client would be expected to complete weekly homework assignments associated with these treatment goals.
While much research is needed in the areas of BDD and MD, Cognitive-Behavioral Therapy has been shown to be an effective treatment. The references listed below are helpful resources to gain more information on these disorders and on effective treatment.
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International OCD Foundation (n.d.). Subtypes of BDD.
Phillips, K.A. (2005). The broken mirror. Understanding and treating body dysmorphic disorder. Oxford University Press.
Wilhelm, S., Phillips, K.A., & Stekette, G. (2013). Cognitive-Behavioral Therapy for Body Dysmorphic Disorder. The Guilford Press.