Do You Suffer From Muscle Dysmorphia? Date: Wed, 26 Nov 1997 19:43:34 -0700 (MST) Subject: "Puny" Syndrome Hits Muscle Bound NEW YORK (Reuters) -- Some muscled people may be seriously distressed by a pathological worry that they look puny, according to researchers in the United States and England. In the condition, which experts dub "muscle dysmorphia," individuals are embarrassed about their bodies and are often consumed by weightlifting. The syndrome is also associated with the abuse of anabolic steroids in a quest for bigger muscles. "The essential feature of muscle dysmorphia is a chronic preoccupation that one is insufficiently muscular (or sometimes, especially in the case of women, both muscular and lean)," write researchers led by Dr. Harrison Pope, Jr., of Harvard Medical School's McLean Hospital in Belmont, Massachusetts. "Characteristically, this preoccupation persists and causes significant impairment or distress, even though the individual is far more muscular than average." According to their report in the journal Psychosomatics, the researchers state that even people with "good insight into the problem," who recognize objectively that they are muscular, are not reassured by this knowledge. Like others with less insight, "such individuals may go to great lengths to avoid having their bodies seen in public." To avoid "great distress," they may wear baggy sweatpants, sweatshirts or layers of clothes even in summer, and avoid beaches, swimming pools, locker rooms, and other places where their bodies might be seen. "The only exception to this pattern is in bodybuilding contests, where the individual may appear after weeks of rigorous preparation, and only when in peak condition," the authors state. Body-image preoccupations with muscle dysmorphia may also impair personal relationships, and has led some to abandon careers and jobs, Pope and his colleagues note. "To achieve their desired body image, many individuals with muscle dysmorphia adopt an all-consuming lifestyle revolving around their workout schedule and meticulous diet," the researchers state. "Many spend so much time in the gymnasium that they forgo intimate relationships or occupational opportunities." The researchers say the prevalence of the disorder "is difficult to estimate." But they point to the increasing popularity of weight lifting "among both genders in the United States" which suggests that "muscle dysmorphia may become more common." "It appears that the disorder produces substantial morbidity (illness), together with maladaptive behaviors such as anabolic steroid abuse, and thus may have important implications for public health," the authors state. They recommend further research into the problem. SOURCE: Psychosomatics (1997;38) ------------------------------ Subject: Re: 20/20 Obsession From: "matao ushijima" Date: Mon, 9 Mar 1998 03:34:42 -0800 The behavior called muscular dysmorphia has only recently been described in the scientific literature. It will take several years of additional research before the medical community arrives at a consensus in characterizing and accepting or rejecting this as a disorder. In the interim, one should keep an open mind and look to the scientific literature; and not to dismiss off hand what appears in the popular media. Muscle dysmorphia is primarily a psychiatric disturbance. It manifests itself by the chronic intrusive thoughts, compulsive behavior, and excessive preoccupation with body appearance of those affected; and not by their actual physical size. You don't have to be huge to be ill. Neither is the validity of the ABC News 20/20 story reflected by the reporter's physique. Don't confuse the message with the messenger. The individual who has done the most work in this area is Harrison G. Pope, M.D. of Harvard Medical School. It is his data that should be scrutinized. Should one judge his medical credibility by his published work or by his physique? For those interested in examining the scientific evidence, see: * Pope HG, Gruber AJ, Choi P, Olivardia R, Phillips KA: Muscle dysmorphia an underrecognized form of body dysmorphic disorder. Psychosomatics 1997;38:548-557. * Pope HG, Katz DL: Psychiatric and medical effects of anabolic-androgenic steroids: a controlled study 160 athletes. Arch Gen Psychiatry 1994;51:375-382. * Pope HG, Katz DL, Hudson JI: Anorexia nervosa and "reverse anorexia" among 108 male bodybuilders. Compr Psychiatry 1993;34:406-409. For a popular press less scientific account, see: * Clive, T: The big betrayal. Muscle and Fitness, Sept 1997, p. 102. Subject: Re: Exercise addiction From: "Brian and Terri Williams" Date: Sun, 31 Oct 1999 08:34:22 -0800 Sorry this is a bit late - just returning to normal... Muscular dysmorphia and such aside, an obsession is generally considered to be a disorder when it has a negative effect on the subject's lifestyle. In the case of a "gym addict" I would think that if family, career, or health were compromised by gym lifestyle that it would fit. Has the behavior been progressive? Has it become an undue monetary burden? There is often a fine line covered in defining hobby as mania - prejudices on the part of the evaluator may skew a diagnosis - consider the individual who may have a negative view of the activity being discussed. Along with the more basic lifestyle changes, there may be physical symptoms as well to whit... When I was a teenager, I became heavily involved in the martial arts. I'd never been involved in any sports before, so the MA was a first for me. My sifu was both surrogate father and brother. At my peak after a couple of years of training, I was spending 3-4 hours per day in the gwoon, 6 days per week. This while attending college full time - up to 20 quarter hours per term - and finishing high school as well. Sleep was optional then, and looking back on it, I was practically in a fugue the whole time. My evenings in Kajukenbo were my sole release - I'd forsaken any social life for my studies - I was entering the military and used that as an excuse not to get close to people. I began to notice that if for some reason I missed a workout - be it due to finals or whatever - I would become physically ill. If I'd eaten, I would vomit within 30 minutes or so, and if I lasted any more I would have violent cramps and diarrhea. I could not sleep at all if I missed a workout - I would get the shakes and was nervous and irritable. On June 6th, 1986 I entered the army weighing only 106 pounds at 5'6." I gained nearly 20 pounds in basic training. Apparently there is some value to resting and recovery in training. New concept to me then. All of that said, I don't see an addiction until I see damage. Most of the more hard-core lifters aren't much more obsessed than I am about lifting, hunting, and fly fishing. We all have our muses, we just need to remember to be in charge of them. Brian Williams http://www.geocities.com/Colosseum/Bench/4492/ Mental Illness Drives Bodybuilders? .c The Associated Press WASHINGTON (AP) - What drives some bodybuilders is a form of mental illness that can be treated with drugs, a researcher says. These people have a type of body dysmorphic disorder, a condition which is characterized by a preoccupation with an imagined or slight defect in appearance, said Dr. Eric Hollander of Mount Sinai School of Medicine in New York. ``Body dysmorphic disorder affects probably 1 to 2 percent of the U.S. population, but among men in particular there is a sort of subclassification called `bigorexia,' which is sort of the opposite of anorexia,'' Hollander said. Anorexics think they are too fat, no matter how thin they are - and bigorexics think themselves too small, no matter how big they are, he said. Bigorexia, more properly termed muscle dysmorphia, is not yet formally recognized as a psychiatric condition, Hollander said. But the coming revision of the American Psychiatric Association's Diagnostic and Statistical Manual will describe the condition, he said. Bodybuilding can be a healthy competition, but these people take muscle development to the point at which it interferes with ordinary living, including holding a job or staying healthy, Hollander said. ``They will continue to exercise even after they have dislocated a shoulder,'' he said. As an expression of body dysmorphic disorder, muscle dysmorphia is an obsessive-compulsive spectrum disorder, Hollander said. People with OCD are driven to do things such as repeatedly check their appearance in mirrors and perform ritualistic movements. ``An exaggerated sense that something doesn't look right'' seems to have origins in brain chemistry, Hollander said. He and his colleagues reported in Archives of General Psychiatry on the effects of the drug clomipramine on the brain chemical serotonin. One of serotonin's normal roles seems to be in turning off brain processes that signal when ``things don't fit our conceived notions,'' Hollander said. If serotonin levels are abnormally low, however, it can't turn off the mental alarm bell that rings when things don't seem right, and the bell keeps on ringing even when things are right, he said. Clomipramine helps the brain raise serotonin levels by interfering with the body's ability to destroy the chemical, he said. Hollander and his colleagues wanted to be sure clomipramine was producing improvements in the behavior of people with body dysmorphic disorder, and that the patients were not improving simply because they knew they were getting treatment and therefore expected themselves to improve. So the researchers compared clomipramine with another drug, desipramine, which had similar side effects but does not affect serotonin. Clomipramine treatment was significantly better in reducing patients' repetitive movements and obsessive preoccupation with perceived flaws, the study found. But it is not a cure, Hollander said. ``Don't think about symptoms going down to zero,'' he said. ``They were 25 to 35 percent improved.'' There was, however, a significant improvement in their ability to go back to school or function at work, and a significant drop in their thoughts of suicide, he said. Although this study did not focus on muscle dysmorphia, treatment for body dysmorphia has been shown to work on muscle dysmorphia, Hollander said. And a clinician who was not involved in the study said she found the drug to work, especially in combination with psychological therapy. ``I don't feel behavior therapy is sufficient, and certainly medications are not efficacious alone either,'' said Fugen Neziroglu, senior clinical director of the Bio-Behavioral Institute in Great Neck, N.Y. Neziroglu has treated a number of people with muscle dysmorphia. ``I had one who just left, an attractive, nice, 44-year-old man, he's telling me he has flab on his sides,'' she said. ``You look at him and you know he has no flab.'' Medications help to stabilize patients with muscle dysmorphia, but therapy is needed to retrain habits and thought patterns needed to make the improvements last, Neziroglu said. Clomipramine is one of the better drugs, she said. And therapy alone may be adequate treatment, said James Rosen, a clinical psychologist and professor at the University of Vermont. The cognitive-behavioral approach teaches patients to realize when their thoughts are unrealistic, recast their self-image into more neutral terms, and adapt to situations that could set off the compulsion, he said. For muscle dysmorphia, this could include easing away from the idea that the exercisers would lose control of themselves if they skip a workout, Rosen said. However, one bodybuilding promoter said he couldn't tell whether bodybuilders have this condition. High-level bodybuilders are like other athletes in paying extremely close attention to what they eat, how much they exercise and where they fall short of their own goals, said James Lorimer of the Arnold Schwarzenegger Fitness Weekend, Feb. 22-27 in Columbus, Ohio. ``I can't say I place these particular athletes outside the normal range of people who are trying to be the best they can be in whatever sport they are in,'' Lorimer said. ``You can say it's excessive, it's unusual, but (I) can't say whether it is disordered or not.'' Copyright 2000 The Associated Press. --------------- Summary of an article in the August 2000 issue of the American Journal of Psychiatry First Controlled Study of Muscle Dysmorphia Library: MED Keywords: MEN MUSCLE DYSMORPHIA PHYSIQUE PSYCHIATRY Description: The first controlled study of muscle dysmorphia found that weightlifters with the disorder differed strikingly from normal weightlifters on many measures, including body dissatisfaction, eating attitudes, prevalence of anabolic steroid use, and lifetime prevalence of mood, anxiety and eating disorders (American Journal of Psychiatry, 8-00). July 20, 2000 Release No. 00-35 Kimberly Cordero 202/682-6394 KCordero@psych.org First Controlled Study of Muscle Dysmorphia Published The first controlled study of muscle dysmorphia found that weightlifters with the disorder differed strikingly from normal weightlifters on many measures, including body dissatisfaction, eating attitudes, prevalence of anabolic steroid use, and lifetime prevalence of mood, anxiety and eating disorders. The study is published in the August 2000 American Journal of Psychiatry. Muscle dysmorphia is an individual's chronic preoccupation with the notion that he or she is not sufficiently muscular. People with the disorder, dubbed in previous studies as "reverse anorexia nervosa," display traits similar to individuals with eating disorders, "in that the pursuit of 'bigness' shows remarkable parallels to the pursuit of thinness," according to the study. Muscle dysmorphia can impair social and occupational functioning, cause subjective distress, and can lead to a chronic use of performance-enhancing drugs. (It is a subtype of body dysmorphic disorder in which subjects are preoccupied with the imagined ugliness of a specific body part.) When asked if they spend more than three hours per day thinking about their muscularity, 50 percent of the group with muscle dysmorphia agreed. When asked if they had little or no control over their compulsive weightlifting and dietary regimens, 54 percent of the group concurred. The enjoyable activities the group most frequently reported avoiding were social gatherings with friends, family and significant others. "One subject missed his high school reunion for fear that people would mock his 'smallness,'" the authors noted. The researchers conclude that most weightlifters do not exhibit elevated levels of psychopathology, whereas those with muscle dysmorphia exhibit prominent impairment. They suggest future research should explore the epidemiology of the "often-secret" syndrome and potential treatments for it. ["Muscle Dysmorphia in Male Weightlifters: A Case-Control Study," by Roberto Olivardia, Ph.D., Harrison G. Pope, Jr., M.D., et. al., p. 1291, American Journal of Psychiatry] ------------ Date: Sun, 6 Aug 2000 17:10:48 EDT From: Mcsiff@aol.com Subject: Strength_List: DYSMORPHIA & NORMS If we examine the concept of "muscle dysmorphia" (exaggerated perception that you don't have enough muscle), then we will note that it is one of many such syndromes which reflect some sort of dissatifaction that afflicts the human being. Its inverse, "anorexia nervosa", has already been commented upon, but if we scan through the learned literature, the popular media articles and the records of various medical professionals such as cosmetic surgeons, we discover that the human may exhibit dissatisfaction (pathological or otherwise) with some perceived structural or functional 'ugliness' or undesirability of the human condition, including: Structural Characteristics Body Size (too large or too small) Body Proportions Skin colour (hence the tanning 'psychosis') Breast size and shape Hips Waist Thighs Calves Ankles Feet (size, shape and appearance) Face (nose, lips, eyes, ears etc) Height (too short or too tall) Hair (baldness, texture or colour) Penis Butt size and shape Skin appearance and texture (basis of the cosmetics industry) Nudity (a central focus of many laws, religions and rituals) Functional Characteristics In sport and health, individuals may perceive imperfection, deficit or 'ugliness' in various functional indicators of human ability: Coordination and motor skills ( 'clumsiness' deters many children from taking part in sport) Sports competition (Winning, losing and belonging to a team) Posture (high heeled shoes are one of many 'solutions') Cardio fitness (massive focus of sports medicine and the sports industry) Ageing Vocal features Social or group acceptability ("social anxiety" is selling a new class of drugs) Work performance (job output, publications, earnings etc) Status (ranking relative to one's peers) This list may be extended, but it suffices to illustrate that we humans display an inordinate degree of dissatisfaction with some structural or functional aspect of being alive among a group of fellow humans who are feared to be judging your worth in terms of such characteristics. Psychologists and scientists such as Abraham Maslow, Alderfer, Olds, and McLelland have examined human behaviour and produced models to identify and understand the role of needs in life, with Maslow's "Hierarchy of Needs" becoming well known in many circles. These models have stressed that we are driven or motivated by any perceived need, be it physiological, safety, social, self-esteem or self actualisation. What all the models have in common is that we have to experience stress created by need or the perception of need ("want") if we wish to be motivated to do anything in life. This raises some interesting implications for the entire concept of "dysmorphia" or other aspects of perceived 'ugliness' relative to a given situation or group. Suppose that we all felt totally satisfied with all structural and functional aspects of our being - would there be any motivation to achieve anything in life, other than be driven by sheer physiological need to eat, drink, have sex, move and sleep? Probably many will answer something like this: " Yes, we do need some needs, be they real or imagined, otherwise the human would be no better than the lowest form of life, but it is when the need or want becomes exaggerated that the problems arise. And, as we all should know, an exaggerated want or preoccupation with something in life becomes an obsession or psychosis. It is just that one must maintain the right balance to stay sane and happy." If we apply this to sport, then we immediately sense a contradiction. If a top level athlete does not show exceptional motivation and dedicate a large part of daily life to preparing for sport, then progress will halt and winning surely will become a memory. So, at what stage does passionate dedication and devotion to achieve a goal become an obsession, a dysfunction, a pathological condition? Ah, we might say, that is easy to recognise, because these disorders become apparent when they dominate above most other interests in life and often cause physiological signs of dysfunction. The critic might retort: "But that is just a sign of imbalance in one's life, not necessarily a psychosis or a disease. Regarding the accuracy of physiological indicators, there are many distance athletes who frequently are very weak, thin and almost chronically fatigued." If we return to the above list, we will note that it is probably very difficult to find anyone who is entirely satisfied with her/his body and its function. It would appear that we all perceive some deficit in what we look like and what we do, largely because we are inordinately concerned with what others think of us. That raises the age-old question of what exactly is normal and who decides what is not normal or acceptable. If we lie at either extremes at both sides of some Gaussian distribution, we are deemed to be "abnormal"; if we show characteristics which fit into the "majority" interval, then we are "normal", with no need to be treated, exterminated, legislated against, medicated or incarcerated. In the medical world those who fit into one of the extreme categories may be deemed to be suffering from a psychosis or pathology, the reference framework being the society in which we live, replete with many subjective laws, perceptions, religious undertones, biases and operational models. Yesterday's psychosis and obsession may become today's norms (and vice versa), such as the Western preoccupation with sport and fitness, earning a large salary, owning a large home, using cosmetics to "look more attractive", wearing fashionable clothes, listening to"canned" music, relying on psychologists to resolve personal problems, eating "health foods" and going on vacation. The entire fashion industry is founded upon the perceived need by humans to look attractive according to some totally arbitrary standards. The acceptability of the naked body in public has been legislated against so vigorously by State and religious organisations that it has almost become the ultimate symbol of depravity and ugliness (unless indulged in the privacy of one's bedroom). To some, this fear of public nakedness is a sign of severe national and religious psychosis, to others quite the norm. The symbolism here is that we often fear physical nakedness because we are terrified of our minds being exposed naked for all to see. In short, how accurate and universally applicable is it to identify a psychosis which is based upon one's perception of the human body and its functions, when those who decide upon the definitions are part of the system itself? If we liberally apply an analogy of Gšdel's Incompleteness Theorems to society, we might humbly caution one another to state that we cannot truly explain a system if we have to rely on constructs that are part of that system. On the other hand, as some wag once said: "It takes one who has a problem to recognise that problem!" This is what Hofstadter (in his fascinating book, "Gšdel, Escher, Bach") had to say about the implications of Gšdel's work (which is often ranked alongside Einstein's Theory of Relativity and Heisenberg's Uncertainty Principle in terms of fundamental scientific importance.) " How can you figure out if you are sane? ... Once you begin to question your own sanity, you get trapped in an ever-tighter vortex of self-fulfilling prophecies, though the process is by no means inevitable. Everyone knows that the insane interpret the world via their own peculiarly consistent logic; how can you tell if your own logic is "peculiar' or not, given that you have only your own logic to judge itself? I don't see any answer. I am reminded of Gšdel's second theorem, which implies that the only versions of formal number theory which assert their own consistency are inconsistent. The other metaphorical analogue to Gšdel's Theorem which I find provocative suggests that ultimately, we cannot understand our own mind/brains ... Just as we cannot see our faces with our own eyes, is it not inconceivable to expect that we cannot mirror our complete mental structures in the symbols which carry them out? All the limitative theorems of mathematics and the theory of computation suggest that once the ability to represent your own structure has reached a certain critical point, that is the kiss of death: it guarantees that you can never represent yourself totally." Mel Siff Dr Mel C Siff Denver, USA mcsiff@aol.com Subject: Re: muscular dysmorphia/bigorexia From: "Brian Williams" Date: Mon, 17 Jul 2000 05:48:30 -0700 Thanks for the links Mel - I had heard that muscular dysmorphia was to be added in some form to DSM in the next edition, but this is the most recent I've seen. As an aside, I wonder how this one will be applied by the mainstream. The primary forms of dysmorphia that the public is aware of are those associated with thinness. The examples of anorexia nervosa and bulimia in particular have received much media attention, particularly since Karen Carpenter's untimely death. The attention paid to these disorders has made them a part of our pop culture, and this attention has both positive and negative connotations. Nowadays people who are very thin are often referred to as anorexic and/or bulimic without regard to whether it may be a natural body type - witness the media attention Calista Floxhart has received on this very issue. What I foresee is the potential for over-zealous application of bigorexia as an excuse to explain and/or exploit people who are passionate about fitness. Remember that homosexuality was considered a mental disorder in the first half of the twentieth century, and was fairly recently removed from the DSM. The article by Ms. Cavalko demonstrates this blanket application of the term "disorder." A mental health professional needs to be cautious about determining what exactly construes a disruption in a patient's life that could be defined as a disorder - with overly loose application, the definition Dr. Pope refers to could apply to many of us. Things like interference with social life are up to wide variation - imagine the example of a weightlifter who dissociates him/herself from family members who lead unhealthy lifestyles. The family members may see the "obsession" with training as disruptive while it is perfectly healthy behavior on the part of the trainer. The sociological context is that often repeated precept that "what is normal behavior is not necessarily what is healthy." I feel that the focus on diagnosis of these disorders must hinge on whether there is degradation of physical health and/or manic behaviors that effect the other aspects targeted, such as social interaction. If the individual becomes agoraphobic, that should be dealt with directly, not as a symptom of the bigorexic. Treatment of the patient as agoraphobic would allow for behavior modification allowing the individual to remain comfortable with a predominately healthy lifestyle, without a greater disruption of other aspects of his/her life. At the extreme end of things, imagine the potential impact on the industry. It is a short step to saying that supplements should be regulated or banned, since only the "hard-core" athletes are using them, and they are more likely to comprise many of the bigorexic crowd. While this is certainly a slippery-slope argument at best and is logically flawed, it was one of the arguments successfully used in the regulation of the gambling industry and prohibition. Imagine having to obtain a license to by a squat rack. Surgeon's general warnings may need to be posted at the entrance to all gyms. Internment of anyone who has visible triceps. The horror! I don't really think that this would happen (at least I hope not...) but it is at least food for thought. Perhaps greasy fast-food, but food nonetheless. Regards, Brian