Muscle dysmorphia (MD) is a recently identified psychiatric condition, which is most centrally characterized by an intense fear that one is insufficiently muscular, and an excessive drive to enhance the visible appearance of muscularity. Accompanying behaviors include excessive working out behavior (oriented towards both building muscularity and reducing body fat, which obscures the visibility of muscularity), which takes precedence over other important areas of life, excessive regulation of dietary intake (over-regulation of protein intake, and/or the reduction of carbohydrates and fats), and use of appearance enhancing substances such as anabolic steroids. Body image disturbance is also a central feature of MD, and an intense level of shame around one’s body, body checking, body masking, in addition to extreme anxiety if one’s training or dietary regimen is interrupted.
However, it is important to note that extreme muscularity is not a defining feature of MD, and the core features may occur along a spectrum of widely varying degrees of muscularity. Early warning signs include increased rigidity around exercise and dietary practices, increased label checking on foods, the development of food rules, reassurance seeking and anxiety in the event of missed workouts, compensation in the events of missed workouts or meals, and an increasing emphasis on the importance of being muscular or ‘ripped’. MD typically onsets during late adolescence, and is much more common in males than females. To date, little is known about the medical complications of MD, although unfortunately, the risk of death due to suicide is elevated in those with MD.