Individuals with the condition muscle dysmorphia pursue the ideal image of an extremely muscular appearance. They compulsively try to achieve this. According to their disordered view, they will never achieve this goal, this appearance.
What is muscle dysmorphia?
Generally, muscle dysmorphia (MD), also known as bigorexia (biggerexia), adonis complex or muscle addiction, is considered to be an expression of a disturbed self-image. Affected are mostly men who consider their own muscle image as insufficient because it does not correspond to their personal ideal. The symptoms that define muscle dysmorphia also include the fact that those affected consider themselves to be too slender despite a good training condition and therefore not infrequently resort to anabolic androgenic steroids that are hazardous to health. The trained muscle tone also appears insufficient and they continue to train as if under duress. They are convinced that they are not muscular despite superior muscle development. They accept the negative effects of excessive physical training, which refers mainly to weight lifting, because they believe it is beneficial to their physical appearance. In 1997, researchers Pope, Gruber, and Choi found a subclass of body dysmorphic disorders. Their research states that sufferers perceived themselves as less attractive and healthy compared to their peers who were also exercising.
Causes
According to psychologist Roberto Olivardia, four factors are responsible for muscle dysmorphic disorder: a very strong perfectionism, low self-esteem, one’s body image does not appear satisfactory, and a negative or no relationship with the father. If psychological conflicts are not processed at all or only inadequately, it can happen over time that those affected transfer their conflicts to their own bodies. With this behavior, they give their conflicts the desired expressiveness. In short, muscle building serves to reduce psychological suffering. Affected persons recognize very quickly that it is easier to exert control on the body than on one’s own emotionality. Images of others (muscle-bound bodybuilders in the print media) can also act as triggers. In this case, these portrayals take on a role model function for those affected. Perhaps because they lack role models in real life so far. A biological tendency is also considered possible. In the area of stress-related symptomatology, emotional and physical stress should be reconsidered as triggers for muscle dysmorphia.
Symptoms, complaints, and signs
The disease process is often not recognized as muscle dysmorphia until many years later, even among specialists. However, attention to a variety of symptoms can lead to an appropriate diagnosis much earlier. Symptoms include severe weight loss and craving for performance-enhancing products (substances). The practice of not only regular, but excessive sports accompanied by an increasing loss of reality in relation to one’s own body image, one’s own appearance, is another indication. Hormonal disturbances and the formation of acne, caused by anabolic steroids, also increase. Social but also professional contacts lose priority and become subordinate to an excessive training schedule. Symptomatic are also eating attacks by renouncing many foods in favor of diets that support muscle building. Public locker rooms, where those present can see their bodies, are avoided. In summary, in the advanced stage, the focus is no longer on maximum musculature and washboard abs, but on personal victory in the form of self-discipline over one’s own emotional world.
Diagnosis and course of the disease
Since muscle dysmorphia is psychologically caused by a disturbed perception, the symptoms mentioned are the basis of a diagnosis. In addition, those affected are excessively preoccupied with food and yet eat a one-sided diet (everything must serve to build muscle). Weight loss with simultaneous muscle gain is another indication. Changes in the nipples are also common.
Complications
First and foremost, those affected by muscle dysmorphia suffer from very severe weight loss.This loss can have a very negative effect on the health of the affected person and lead to various complaints. It is not uncommon for the patient’s ability to cope with stress to be greatly reduced, and also for permanent fatigue to occur. The daily life of the affected person is clearly restricted. Furthermore, most of those affected suffer from acne and thus from reduced self-esteem or inferiority complexes. Those affected are often ashamed of the symptoms and also exhibit hormonal disorders. Anabolic steroids in particular can also cause psychological complaints or a loss of reality if no treatment is initiated. The eating behavior of the patients is severely disturbed, so that deficiency symptoms also occur. Furthermore, those affected can also lose consciousness. Similarly, muscle dysmorphia can also have a negative effect on social contacts, leading to tension or exclusion. Treatment is carried out with the help of a psychologist and nutritional counseling. The affected person must follow a strict diet to counteract weight loss. However, the success of this treatment is strongly dependent on the will of the patient. For this reason, a positive course of the disease in muscle dysmorphia does not occur in every case.
When should one go to the doctor?
Muscle dysmorphia develops insidiously over the course of months or years. The condition can often be diagnosed years later, usually after a concrete suspicion has already been established. Should indications such as a pathological self-image or hormonal complaints arise, medical advice is required. Those affected should talk to their family doctor at an early stage. He or she will first take a medical history and then initiate a physical examination. Since muscle dysmorphia is difficult to diagnose, a psychologist is also consulted in the absence of physical causes. Persons suffering from psychological complaints or pronounced personality disorders should inform the responsible physician or therapist. In addition, any medication taken should be checked and adjusted if necessary. The actual treatment is lengthy and consists of medication and therapeutic measures. To ensure a rapid recovery, nutritionists, sports physicians and, if necessary, an internist should be involved in the treatment. In the case of severe muscle dysmorphia, a stay in a specialized clinic is indicated.
Treatment and therapy
Muscle dysmorphia requires professional therapy in a psychosomatic clinic. There, a competence network that specializes in the interrelationship of mental-spiritual and physical complaints can provide goal-oriented therapy. The aim is to establish normal eating behavior with weight stabilization. Furthermore, those affected learn under guidance to focus on an autonomous and self-confident life orientation. The outpatient or inpatient therapy includes five essential points:
- Weight building and simultaneous treatment of physical diseases.
- In parallel, an individual psychotherapy
- Nutritional counseling with accompanying therapy
- Inclusion of the family in the therapy
- Treatment of other disorders that have arisen in the course, sometimes over years.
The duration of treatment is difficult to define in advance. However, according to experience, it is between one month and half a year. The extent of therapy sessions is usually determined by the therapist together with the patient. As a rule, 25 sessions are paid for by the statutory health insurance. It is possible to apply for an extension, just as it is possible to apply for more hours from the outset. For example, if there is a need for psychoanalysis.
Outlook and prognosis
With muscle dysmorphia, there is a good chance of recovery once the condition is treated professionally and diagnosis and treatment take place early. Most patients experience a significant improvement in their health with behavioral therapy. Treatment can take place on an inpatient or outpatient basis. If the treatment is used in conjunction with drug therapy, patients quickly experience significant relief of their symptoms.However, medication alone without psychotherapy has been shown to be less successful. Most patients often experience a rapid relapse of symptoms once prescribed medications are discontinued. Therefore, the best chance of recovery is a combination of therapy and medication. Treatment often takes several months or even years. Complaints gradually recede until complete freedom from symptoms is achieved. If left untreated, the muscle dysmorphia can progress into a chronic course. This significantly worsens the prognosis. Spontaneous recovery is rather unlikely. Symptoms of the disease may fluctuate in intensity during its course. At the same time, the complaints increase the longer the disease persists. The increase in symptoms increases the risk of suicide among those affected. Timely therapy is essential to prevent a life-threatening situation from occurring.
Prevention
Contacting a preventive youth welfare service for children, adolescents and families or the specialist counseling service for addiction prevention of the responsible school authority can help. The Verein für Arbeits- und Erziehungshilfe e. V. (association for work and educational assistance) with its specialist prevention center is considered a target-oriented point of contact not only for young people. Children and adolescents should be accompanied on their path of self-discovery with the necessary seriousness. It is not uncommon for the focus to be on “standing out” from the crowd, which can quickly lead to an exaggerated body cult. A healthy body and self-esteem, a secure self-efficacy and a realistic self-concept is considered the best prevention against exaggerated body cult.
Aftercare
Therapy for muscle dysmorphia is considered difficult. To date, little research has been done on the condition, and almost no universally applicable approaches to treatment have emerged. These realities – and because it is a mental disorder – not infrequently necessitate lengthy follow-up. Also, the easy accessibility of anabolic substances and the ideal image of a man created by the media necessitate prolonged therapy. Patients experience sustained stabilization through aftercare. Therapists try to prevent complications such as alcoholism, depression, and lowered self-esteem. The type and extent of sessions depend on the extent of muscle dysmorphia. Many doctors also prescribe psychotropic drugs to increase the success of treatment. In principle, successful therapy leads to the end of medical examinations. However, since certain mental illnesses are likely to relapse, scheduled appointments for consultation are advisable. Patients with a past muscle dysmorphia should therefore see their doctor every quarter for the first few years. In the examinations that take place, it can be discussed to what extent they are falling back into old patterns. Regular participation in self-help groups for addicts is also recommended. A doctor can arrange appropriate contacts. This results in a certain degree of control by other sufferers.
What you can do yourself
Individuals suffering from muscle dysmorphia require professional therapy. The therapeutic measures can be supported by some changes in everyday life. First, the diet must be changed so that a stabilization of the weight can be achieved quickly. An individually adapted diet also enables patients to develop normal eating behavior. This can be accompanied by nutritional counseling. Under the guidance of a professional, those affected learn to develop a positive outlook on life. Muscle dysmorphia is often due to a mental illness or occurs in connection with other mental complaints. Therefore, further psychological counseling is always indicated to accompany behavioral therapy. The therapist can help the patient work through deeper causes and thus contribute to a rapid recovery. The help of friends and relatives is equally important. Often, the therapy involves the family, or the patient takes part in a self-help group to accompany the psychological counseling. The other measures that can be taken by the sufferer depend on the type and severity of the muscle dysmorphia. Therefore, a comprehensive medical history and a physical examination by the family doctor and a therapist should take place before any therapy.