Increasing Prevalence Of Muscle Dysmorphia Among Young People

Muscle dysmorphia (MD) is a form of body dysmorphic disorder (BDD) that is defined as being preoccupied with worries that one’s body is too small or not muscular enough despite having a normal or an objectively muscular physique that leads to engaging in repeated behaviors or mental reviewing in response to their perceived flaws or defects. MD is sometimes called bigorexia or reverse anorexia, and it may have some overlap with eating disorders, but is not an eating disorder. Although women can develop MD, it is largely seen in men.

Those with MD often follow an extremely precise, time-consuming, and painstakingly picky diet, driven by the all-consuming concern of improving the mass and leanness of their muscles. Those with severe MD are known to sacrifice relationships, financial stability, careers, and other interests to get bigger muscles, making important life decisions based on how it will impact their workout schedule. Alarmingly those with MD are at a risk for suicidal behaviors when they are not able to reach their goals and lose hope that their muscles will never look the way they want or think they should. 

This study surveyed over 900 young adults and adolescents and found that those reporting greater symptoms of MD reported fewer hours of sleep with greater difficulty falling to sleep or staying asleep more than half of the time over a two-week period. 

“Poor sleep can have significant negative impacts for adolescents and young adults, including increased negative mental health symptoms,” says lead author Kyle T. Ganson, PhD, MSW, assistant professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work. “Poor sleep among those who experience muscle dysmorphia symptoms is concerning as it may exacerbate the functional and social impairment these individuals commonly report, as well as increase suicidal thoughts and behaviors.”

Previous research indicated that on average young adults and adolescents are sleeping less than the recommended 7-10 hours a night. Other research has found that poor sleep is a marker of mental diagnoses and is associated with symptoms of depression, anxiety, and psychosis. This study set out to investigate the relationships between sleep and muscle dysmorphia. 

The mechanisms connecting greater MD symptomatology and poor sleep may well be multifaceted. For example, those with higher intolerance for their perceived appearance who engage in obsessive thinking and experience anxiety related to their appearance and muscularity may experience sleep impairment. Additionally, for some, their sleep may be displaced by physical activity as the individual engages in muscle-building exercises during the night, so it doesn’t interfere with occupational responsibilities. 

“Individuals experiencing symptoms of muscle dysmorphia may be more likely to use and consume dietary supplements that are marketed for improving workouts, increasing muscle mass, and accelerating muscle recovery,” says Ganson. “These products tend to have high levels of caffeine or other stimulants which may negatively impact sleep. In addition, anabolic-androgenic steroids, which are commonly used among people with muscle dysmorphia, have also been shown to negatively impact sleep.”

Another study published in the journal Body Image of over 2,000 people between the ages of 16-30 years old asking questions corresponding to muscle dysmorphia symptomatology found that 17.2% of the participants were at risk for MD. 

"It's colloquially known as reverse anorexia," Kyle Ganson, assistant professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work and lead author of the study, told CTVNews.ca in an interview. "Instead of driving for fitness, there's an intense drive for muscularity, and generally it's like bulk muscularity, significant strength, it can be about lean and cut defined features."

The researchers believe that social media is a serious contributor to the growing prevalence of body dissatisfaction, unrealistic body standards, and harmful narratives that affect how some people view themselves. 

“There's a lot of influencers on social media who provide information about the gym, or gym culture, or different exercise routines or eating routines. So, you can get information very free (and) easily accessible and available."

Gym culture can be intertwined with the use of performance-enhancing substances and dietary supplements. Those who take steroids to specifically build muscles generally have lower body dissatisfaction, leading to a potentially dangerous path from legal supplements to illegal steroids.

"If they're having significant distress around feeling like they're not big enough, that they're not strong enough, feeling like they look terrible, there are some people – not all– are going to turn to methods to change that, and that might be anabolic steroids," said Ganson.

Given the continued societal emphasis on the muscular body ideal and pursuits of muscularity among young adults and adolescents, healthcare professionals should watch for symptoms of muscular dysmorphia in young patients experiencing difficulty sleeping.

"We actually had about 900 participants take the survey again 12 months later," Ganson said. "And we asked a variety of similar questions, but actually some new questions around health-care utilization, or adverse health effects." 

"I'm calling it preliminary data because it's really a newer field that we're investigating, despite it being very common in popular culture," said Ganson. "I'm really hoping that it will start to get into people's ears."