Body Dysmorphic Disorder And Eating Disorders
People who have anorexia nervosa or bulimia nervosa are concerned about their body shape, size and/or weight, of course, but there’s another body image problem with which many people also struggle: body dysmorphic disorder.
Body dysmorphic disorder, which affects up to 2.4% of the general population, causes people to become overly concerned with outward appearance and perceived flaws. It may be seen in people with eating disorders, but is a distinctly different issue.
Epidemiology Of Muscle Dysmorphia
Studies on the prevalence and incidence rates of muscle dysmorphia are lacking, so at the moment we dont yet have a precise estimate of these statistics.
In addition to this, we believe that muscle dysmorphia is very hard to diagnose and is likely underreported. In fact, many men who have the condition do not see it as a problem and those that do may go to great lengths to hide it.
However, we do know a few things about muscle dysmorphia 4Tod, D., Edwards, C., & Cranswick, I. . Muscle dysmorphia: current insights. Psychology research and behavior management, 9, 179:
- Substantially more men are affected
- Substantially more bodybuilders are affected, relative to non-body builder resistance trainers
- Nearly 15% of bodybuilder exhibit clinically significant levels of muscle dysmorphia
- The average age of onset is around 19 years of age
Coding Of The Studies
The researchers produced a protocol for extracting the characteristics of the studies and applied it to each study. The following characteristics were coded: year of the study, geographical location, sampling method, type of sample , sample size, gender, mean age, sexual orientation, ethnicity, education level, tools used for assessing MD and ED, and statistics reported to calculate the effect sizes. In addition, the researchers assessed the methodological quality of the studies by applying an ad hoc 10-item checklist, given that in the literature there is no clear methodological checklist to use in studies with a cross-sectional design where the purpose is to analyze the relationships between two variables, as in this study. Most quality checklists are designed for randomized trials and other types of research, particularly evaluations of interventions . Therefore, their criteria focus on interventions and follow-up assessments. Other checklists are focused on cohort studies however, most of their items are also related to interventions and follow-up assessments. Therefore, we developed our own criteria to assess the methodological quality of primary studies.
Appendix A shows each of the 10 items on the quality checklist. Each item scored 1 when the study met the criteria and 0 otherwise. We calculated a total quality score for each study by adding up all the corresponding quality item scores , with a higher score indicating higher overall quality.
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Similarities Between Muscle Dysmorphia And Eating Disorders
Despite MD’s belonging to the obsessive-compulsive disorders spectrum, similarities with feeding and eating disorders’ contribute to the debate pertaining its classification . Accordingly, Murray, et al. posit that like anorexia and bulimia nervosa , MD occurs during adolescence and would come from the internalization of social pressures regarding body image .
Furthermore, few authors have drawn parallels between MD and ED clinical features. Foremost, they are all characterized by high levels of body dissatisfaction and cognitive distortions about body shape for MD, one’s body is never muscular or lean enough, and never skinny enough for ED . Furthermore, dieting and excessive exercising are central features for all these conditions . A study comparing 24 men with anorexia nervosa , as diagnose with the DSM-5 criteria, to 21 men suffering of MD as diagnosed with Pope’s criteria, and 15 men gym-using controls showed that men with MD and AN reported clinical similarities regarding disturbed body image, disordered eating, as well as excessive exercising .
The Opposite Of Anorexia Bigorexia
One growing subtype of Body Dysmorphic Disorder is muscle dismorphia or bigorexia. This condition is, in some ways, the opposite of anorexia. People with muscle dismorphia are concerned that they appear too weak and frail, and particularly that their muscles are small and underdeveloped.
While muscle dysmorphia affects both genders, the majority of bigorexia sufferers are men. It is also important to note that many people that suffer from muscle dismorphia are often very muscularly developed some are even body builders. Like any type of body-image dismorphia, sufferers oftentimes have a very warped image of themselves.
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Muscle Dysmorphia And Exercise Addiction In Young Adult Men
While women with eating disorders and body image issues are typically focused on being thin, men tend to focus on gaining muscle. Research shows that 90 percent of teen boys exercise with the specific goal of bulking up, and this behavior often continues into young adulthood. Hence, researchers have coined the phrase muscle dysmorphia, also known as reverse anorexia or bigorexia. These terms describe male body image disorders that are focused around the obsessive desire to have a bigger, more muscular body.
Male body image disorders like muscle dysmorphia can lead not only to eating disorders in men but also to exercise addiction. Young men become obsessed with bodybuilding. Bigorexia statistics are hard to quantify, because many young men dont recognize that their muscle obsession is a mental health disorder. One study in the UK estimated that one in every 10 gym members struggle with muscle dysmorphia. Research on freshmen university students taking Exercise and Sport Sciences courses found that they were 10 times more likely to have muscle dysmorphia compared to a control group.
No Sign Of Going Away
In summary, more men are experiencing body dissatisfaction in recent years, which has lead many to body building to try to meet society’s unrealistic standards. When regular weight training is not enough to reduce weight and shape preoccupation, many resort to strict dieting, steroid use, binge eating, and a bulimia nervosa. More research is needed to determine whether men with a history of bulimia or subclinical features of bulimia disproportionately gravitate toward body building and anabolic steroid use as a vehicle to meet personal or societal standards of attractiveness, or whether the pursuit of the exceptionally lean and muscular ideal fosters bulimic attitudes, eating behaviors, and steroid use. However, it is clear that in our current society, this new problem will only increase with time.
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Tips For Coping With Male Body Image Issues
The vast majority of the focus around body image and eating disorders focuses on women. Consequently, young men often have a harder time accessing supportive communities or finding guidance tailored for their male body image issues. Here are a few tips that may help young men establish healthier attitudes and behaviors surrounding body image and exercise.
- Limit social media use or adjust what comes into your feed, in order to avoid negative social comparison.
- Remember that media portrayals of muscular bodies are often curated and unrealistic.
- Be honest about your struggles with negative body image issues, and find safe places to talk about what youre going through.
- Create exercise and eating goals that emphasize overall health and wellness rather than appearance.
- Build confidence and healthy masculinity through activities that arent related to body image, such as volunteering, hikes in nature, and creative expression.
- Help build male body positivity by accepting your body as it is, and focusing on what you like about it.
Hopefully, the male body positivity movement will begin to grow in momentum as awareness around the prevalence and severity of male body image issues increases.
What Are The Symptoms Of Muscle Dysmorphia
Muscle dysmorphia symptoms typically start to appear in the late teens â but can also start later in life.
Itâs difficult to tell that someone has muscle dysmorphia by looking at their body, because people with the condition are often in very good shape. Instead, the symptoms that are the most obvious are behavioral changes.
The exact symptoms of MD will be different from person to person. In general, symptoms include:
- Repeatedly studying yourself in the mirror to judge your body for negative attributes or to attempt to evaluate your physical prowess
- Avoiding mirrors because you have already decided on a negative body image
- Sticking firmly to a strict and excessive exercise routine
- A willingness to continue exercising even when youâre injured and in pain
- Maintaining a very strict diet
- A willingness to sacrifice important events in order to maintain your diet and exercise routine
- Taking too many dietary supplements â often more than the recommended amount
- Using steroids â often taking more than the recommended amount
- Extreme social anxiety â particularly among bodybuilders
In a few cases, people with body dysmorphic disorders may be so convinced that theyâll never reach their idea of a âperfectâ body that they become suicidal. If you or anyone you know experiences this symptom itâs important to immediately get medical help â either by calling 911, contacting your doctor, or .
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How Can Muscle Dysmorphia Be Treated
Individuals suffering from muscle dysmorphia rarely seek treatment or feel they need help, which serves as one of the most challenging obstacles to recovery. Not seeking treatment can lead to severe consequences such as the loss of relationships, damage to muscles and joints, kidney and liver damage, and heart problems.
Muscle dysmorphia has similarities with and can occur alongside other disorders. Because of that, some of the same medications and therapies can correct the behavior and distorted thinking. Therapy for eating disorders and mental health conditions depend on the specific needs of the individual. As with other eating disorders, Cognitive Behavioral Therapy is a very effective treatment. The goal of CBT is to change the distorted thoughts that people have. It revolves around the theory that negative thinking leads to negative behaviors and emotions. By changing thought patterns, people naturally have more positive behaviors and feelings. Individuals with muscle dysmorphia have distorted thoughts that include inaccurate self-image. They also have an impractical perception of how they should look. CBT helps them see how these beliefs cause them harm. It also teaches them coping and life skills so that they dont obsess with their body image anymore.
Symptoms Of Body Dysmorphic Disorder
People who have body dysmorphic disorder are preoccupied or obsessed with one or more perceived flaws in their appearance. This preoccupation or obsession typically focuses on one or more body areas or features, such as their skin, hair, or nose. However, any body area or part can be the subject of concern.
The Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition outlines the criteria for a diagnosis of body dysmorphic disorder. BDD is not classified as an eating disorder in the DSM-5. Instead, it is listed under the category of “Obsessive-Compulsive and Related Disorders.” The DSM-5 lists the following diagnostic criteria:
- Preoccupation with one or more perceived defects in appearance that are not noticeable to others and are not truly disfigured.
- At some point, the person suffering has performed repetitive actions or thoughts in response to the concerns. This may be something like continuously comparing their appearance to that of others, mirror checking, or skin picking.
- This obsession causes distress and problems in a persons social, work, or other areas of life.
- This obsession isnt better explained as a symptom of an eating disorder .
Muscle dysmorphia or a preoccupation with the idea that your muscles are too small is considered a subtype of body dysmorphic disorder.
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The Link Between Male Body Image Issues And Mental Health
Male body image issues dont occur in a vacuum. Mental health conditions and low self-esteem in men are often at the root of these unhealthy behaviors and co-occurring disorders. A meta-analysis of 23 studies, mostly involving young males at Western universities, found that male body image issues are significantly associated with anxiety and depression.
Because young people are particularly focused on their appearance, body dissatisfaction can lead to suicidal thoughts and behaviors, and contribute to other underlying mental health conditions. In addition, teen boys who experience bullying due to their appearance may continue to suffer from body dissatisfaction and related issues as they mature into young adults. Male body image issues can be a result of trauma connected with bullying, sexual trauma, or other childhood trauma.
Moreover, during the pandemic, isolation and lack of social and physical activity has led to a spike in disordered eating and negative body image issues in men. In a recent survey of 2,000 males in Britain, almost half of the respondents said that their body image issues had impacted their mental health. Furthermore, 58 percent said the pandemic had negatively affected how they feel about their body, and only a quarter said that they were happy with how they look.
Viren Swami Researcher and Professor of Social Psychology at Anglia Ruskin University
Treatment Of Muscle Dysmorphia And Associated Eating Disorders
It’s not always easy to seek help when you’re dealing with an eating disorder or body image issue, but the best thing you can do is talk to someone about it. Use your resources to find a local psychiatrist or other qualified healthcare practitioner.
Cognitive behavioral therapy is highly effective for treating anxiety-related conditions, and requires no medication. Some individuals may respond well to prescription anxiolytics or antidepressants, but generally, it’s best to start with therapy and counseling before resorting to medication.
And lastly, surround yourself with people who encourage you and push you to be better, and do the same for them. Fitness and bodybuilding are intrapersonal pursuits, but they don’t have to be lonely. The camaraderie and support of like-minded peers can help you push past the limitations you set for yourself.
The goal is to be the best you can be it’s time we acknowledge that as a universal objective of anyone who sets foot in a gym, regardless of how they look or their physical capability.
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How Is Muscle Dysmorphia Treated
There hasnt yet been much research into the best way to treat MD. Current opinions in the medical community are shaped largely by anecdotes and case reports.
CBT is a type of talk therapy that can be done on your own or in a group. CBT targets the psychological factors that may have led to the development of MD. Youll work with your therapist to build strategies to address toxic beliefs about masculinity and find ways to deal with your feelings.
SSRIs are a type of antidepressant used to treat BDD. Your doctor may recommend them if you have moderate or severe BDD or MD. These medications may take up to 12 weeks to become effective.
If you have begun using steroids or other performance-enhancing drugs as a result of MD, you may also need endocrine treatment to rebalance your hormones.
A 2015 case study found that family-based therapy was successful at treating a 15-year-old boy with MD.
Doctors and scientists in the medical community are in the early stages of understanding MD and how best to treat it. More extensive studies are needed.
Moderator Analyses Of The Relationships Between Md And Ed Symptomatology
The effect sizes showed a large amount of heterogeneity . Consequently, the researchers conducted statistical analyses to identify the study characteristics that might explain this heterogeneity. Specifically, we used weighted ANOVAs and simple meta-regressions for categorical and continuous moderator variables, respectively, taking the correlation coefficients between MD and ED symptomatology as the dependent variable.
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Bdd Can Often Be Confused With An Eating Disorder However The Two Conditions Are Different
The main difference between eating disorders and Body Dysmorphic Disorder is someone with an eating disorder is worried about their body weight and shape, which lead to behaviours that are aimed at trying to lose or control weight. While BDD usually doesnt involve worries about being too fat or weighing too much. BDD tends to be focused on specific areas of concern and restricted eating may be employed to try and alter those perceived flaws.
Some people have both BDD and an eating disorder. An additional diagnosis of an eating disorder and BDD can occur when an individual fulfils criteria for one of the eating disorders and is also preoccupied and distressed by perceived defects in their appearance, which is unrelated to their weight and shape .
A distorted body image is a feature of both BDD and eating disorders, which also share many other symptoms, such as low self-esteem. A preoccupation predominantly focused on being too fat or overweight may lead patients to check frequently in reflective surfaces or camouflage their body. Such behaviour does not usually meet the criteria for BDD when it is associated with periods of disordered eating such as dietary restriction or other compensatory strategies to control weight or shape.
Some individuals may not fulfil the criteria for anorexia or bulimia nervosa, but may be diagnosed as having an Unspecified Feeding or Eating Disorder.
Appendix B: Characteristics Of The Studies Or Independent Samples Included In The Systematic Review And/or Meta
Note. MD: muscle dysmorphia ED: eating disorder ES: effect size statistics NR: not reported. Ethnicity: A: Asian AA: African American AsA: Asian American C: Caucasian EA: European American H: Hispanic I: Indian LH: Latin Hispanic MR: multiracial NA: Native American O: others. Sexual Orientation: H: heterosexual G: gay, B: bisexual. Muscle dysmorphia: ACQ: Adonis Complex Questionnaire MDS-Q: Muscle Dysmorphia Symptom Questionnaire MASS: Muscle Appearance Satisfaction Scale MDDI: Muscle Dysmorphic Disorder Inventory MDI: Muscle Dysmorphia Inventory MD-Q: Muscle Dysmorphia Symptom Questionnaire MDS: Muscle Dysmorphia Scale SCID-NP: structured clinical Interview for DSM-IV Non patient version SCID-P: structured clinical interview for DSM-IV Patient version. Eating disorders: CHAA: Cuestionario de Hábitos de Alimentación Alterados EAT-26: Eating Attitudes Test EDE-Q: Eating Disorder Examination Questionnaire EDE-Q Modified: Eating Disorder Examination Questionnaire Modified EDI: Eating Disorders Inventory MEBBIE: Male Eating Behavior and Body Image Evaluation .
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