• What is muscle dysmorphic disorder?

A subtype of body dysmorphic disorder, which in itself is a variant of obsessive-compulsive disorder. Sometimes called bigorexia, muscle dysmorphia is the opposite of anorexia nervosa. People with this disorder obsess about being small and undeveloped. They worry that they are too little and too frail. Even if they have good muscle mass, they believe their muscles are inadequate.

New research indicates that people with MDD really do see themselves as small. Apparently something has gone awry with the brain’s ability to map body boundaries.

In efforts to fix their perceived smallness, people with muscle dysmorphia lift weights, do resistance training, and exercise compulsively. They may take steroids or other muscle-building drugs, a practice with potentially lethal consequences.

• Who gets muscle dysmorphic disorder?

Both genders, but more males than females. Perhaps part of the reason for this discrepancy is related to the fact that the culturally defined ideal male is big and strong while the ideal female is small and thin. Almost everyone with MDD also suffers from depression.

• Consequences of muscle dysmorphic disorder

The constant preoccupation with perceived smallness interferes with school and career accomplishments. It robs friendships and romantic relationships of spontaneity and enjoyment. Since the person is exceedingly self-conscious at all times, s/he cannot relax and enjoy life without worrying about how other people may be seeing, and criticizing, the perceived smallness.

In almost all cases, people with muscle dysmorphia are not small at all. Many have well-developed musculature, and some even compete in body building competitions.

People with MDD cannot or will not stop their excessive exercise even when they are injured. If they abuse steroids in service of building bulk, they will not give up this unhealthy practice even when they fully understand the risks involved.

• Treatment of muscle dysmorphic disorder

Many people with this problem resist getting treatment stating that they are content with the way they are. Some admit they are afraid that if they give up the drugs and exercise, they will wither away to frailty.

Family members and concerned friends may be able to persuade the person to at least get an evaluation by focusing on the problems caused by the behaviors, such as job loss, relationship failure, and physical harm.

Nonetheless, about half of people with this problem are so convinced of their perceived smallness, so ruled by a true delusion, that they refuse help and continue their excessive exercise and steroid use.

For those who enter treatment, cognitive-behavioral therapy combined with medication holds promise. The same combination can also target co-existing depression. The best place to start is with an evaluation by a physician. Ask for a referral to a mental health counselor who is familiar with these disorders. After both professionals have completed their evaluations, consider their recommendations and choose a course of action that is in your own best interests. Best wishes