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    Muscle dysmorphia among men

    There is an increasing prevalence in “muscle dysmorphia,” defined as men who are dissatisfied with their bodies and obsessively preoccupied with their lack of muscular appearance. This subset of body dysmorphic disorder (BDD) can lead to the use of dietary supplements and the abuse of anabolic-androgenic steroids (AASs), according to an article published in the January issue of JAMA.

    “Muscle dysmorphia is probably more common than we would guess, because people who have the disorder rarely come forward and reveal their concerns to mental health professionals,” lead author Harrison G. Pope, Jr., M.D., a professor of psychiatry at Harvard Medical School, tells Cosmetic Surgery Times.

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    Roughly 2.2% of U.S. men appear to have body dysmorphic disorder, with 9% to 25% of them afflicted with muscle dysmorphia.

    Muscle dysmorphia is so severe that it is now an official diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

    “Muscle dysmorphia is certainly justified as a legitimate diagnosis, because in its full-blown form it meets the criteria for a psychiatric disorder in that it can cause impairment of social or occupational function and/or marked subjective distress,” Dr. Pope says.

    Some men with muscle dysmorphia report lifetime use of AASs. Also, while striving to gain muscle and lose body fat, they often combine highly supraphysiologic doses of AASs with other substances to enhance their appearance and performance, including human growth hormone, thyroid hormones, insulin and more.

    Moreover, adverse health effects from AAS use include increased risk of premature death, cardiovascular disorders, psychiatric effects and possible long-term neurotoxic implications.

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    The authors also point out the detrimental role of modern media, which through images, they believe, incorrectly equates muscularity with masculinity.

    “There are no proven and tested treatments for muscle dysmorphia,” Dr. Pope says. “However, it seems likely that it would respond to treatments that have been shown effective for other forms of body dysmorphic disorder, such as cognitive-behavioral therapy (CBT) or antidepressant medications of the selective serotonin reuptake inhibitor class (e.g., fluoxetine, citalopram, sertraline).”

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