The need for precision research on muscle dysmorphia: Special issue call for research on clinically diagnosed samples

A descriptive analysis of scoring patterns on clinically relevant questionnaires in 26 adults with diagnosed muscle dysmorphia

OBJECTIVE

Few studies have recruited adults with a formal diagnosis of muscle dysmorphia (MD), a psychological illness defined by preoccupation that one lacks muscularity and/or leanness, combined with significant functional impairment. This study presented descriptive statistics for a range of clinically relevant questionnaires in one of the largest samples of adults with confirmed diagnoses of MD.

METHOD

We recruited 29 adults who met diagnostic criteria for MD as determined by semi-structured diagnostic interviews and administered a battery of questionnaires assessing MD symptomology, compulsive exercise, and disordered eating. Descriptive statistics were calculated for both total and subscale scores for each questionnaire. Raincloud plots are included to show the distribution of total scores.

RESULTS

Of the 29 participants, 26 completed all questionnaires. Mean scores were high across all questionnaires and broadly consistent with results in past studies that also recruited a clinical MD sample. Most participants scored above proposed clinical cut-off scores for questionnaires assessing compulsive exercise and disordered eating.

CONCLUSIONS

This study adds to the small body of published questionnaire data in clinical MD samples. We stress that questionnaire scores should not be used alone to infer the presence of MD, but could be considered as a useful adjunct to a comprehensive clinical interview.

Investigating anabolic-androgenic steroid dependence and muscle dysmorphia with network analysis among male weightlifters

BACKGROUND

Anabolic-androgenic steroid (AAS) dependence has numerous adverse health consequences, and may be driven in part by body image concerns, primarily muscle dysmorphia. This study aims to further understand and identify potential clinical targets using network analyses of AAS dependence and muscle dysmorphia symptoms in males who used AAS and weightlifting controls.

METHODS

A sample of 153 men who currently or previously used AAS and 88 weight-lifting controls were recruited through social media and relevant online forums, and via posters and flyers distributed in select gyms in Oslo, Norway. Symptoms of AAS dependence and muscle dysmorphia were assessed using clinical interviews and standardized questionnaires. Severity of muscle dysmorphia symptoms were compared between the groups using independent samples t-tests. The following symptom networks were computed using Gaussian graphical modeling or mixed graphical modeling: (1) AAS dependence symptoms among men with AAS use (2) muscle dysmorphia symptoms among men with AAS use and weight-lifting controls in two separate networks, which were compared using a network comparison test, and (3) AAS dependence and muscle dysmorphia symptoms among men with AAS use.

RESULTS

In a network of AAS dependence symptoms, continuing use despite physical and mental side effects, using longer than planned, tolerance, and work/life interference were the most central symptoms. When comparing symptom structures of muscle dysmorphia between those who used AAS and controls, the most central symptoms in each group were exercise dependence and size/symmetry concerns, respectively. Men with AAS use demonstrated elevated muscle dysmorphia symptoms compared to controls, indicating that both the severity and structure of symptoms differ between these groups. In a network including both AAS dependence and muscle dysmorphia symptoms, no significant connections between symptom groups were identified.

CONCLUSIONS

AAS dependence is complex, with correlated somatic and psychological challenges driving the symptom network, indicating that alleviating physical and mental health concerns during both AAS use and cessation is an important clinical target. Muscle dysmorphia symptoms related to taking action (diet, exercise, and supplement use) appear to cluster together more for those who use AAS than those who do not.

A qualitative investigation of the phenomenology of muscle dysmorphia: Part 2

Muscle dysmorphia (MD) is a mental disorder characterised by preoccupation that one lacks muscularity and/or leanness, leading to substantial functional impairment. This article is the second of a two-part qualitative study examining the phenomenology of MD among 29 adults with diagnosed MD. We used reflexive thematic analysis to generate five themes which capture the role of exercise in the lives of people with MD. In summary, participants were highly motivated by a constant desire to progress their strength and appearance, and bad or missed workouts which threatened to derail their progress were associated with acute mental health impairment. Most participants scheduled rest days and modified workouts, both for muscle building-related goals and to reduce the risk of injuries, but often continued to exercise when sick. Alongside appearance-driven motivations, participants reported exercising for a variety of non-appearance-related reasons, including to structure their daily lives, boost self-esteem, regulate affect, and gain a sense of control from being able to manipulate their body composition. Exercise was often regarded as a core part of one's identity and overwhelmingly perceived as a net positive behaviour. Sample participant resistance training and cardio routines are described in detail within this article.

A qualitative investigation of the phenomenology of muscle dysmorphia: Part 1

Muscle dysmorphia (MD) is a psychological disorder defined by preoccupation with one's perceived lack of muscularity and/or leanness, causing significant functional impairment. Studies of individuals with diagnosed MD are rare and no large-scale qualitative studies of the disorder exist. We conducted a qualitative study exploring the lived experiences of 29 individuals with diagnosed MD. Using reflexive thematic analysis, we generated five themes capturing the core features of MD. We identified two distinct phenotypes of MD: a "muscular/lean phenotype" focused on both gaining muscle and remaining lean, and a "muscular phenotype" with a sole preoccupation of increasing muscle mass. Participants also described their physique goals as never-obtained "moving goalposts", differed in their desire for muscularity versus leanness, and experienced fluctuations in body dissatisfaction during "cutting" versus "bulking" phases, and pre- versus post-workout. Almost all participants reported avoiding public body exposure and compulsively mirror-checking. Most were rigorous dieters who meticulously tracked their caloric and macronutrient intake, and were obsessive about meeting protein targets. Disruptions to dieting and training were often minimised by compromising their social lives. Low self-esteem appeared a predisposing factor for MD, while social comparison, body image distortion, and integration of MD into one's self-identity may represent maintaining factors. Additional clinically valuable insights into MD's phenomenology are discussed in detail.