Muscle dysmorphia (MD) is a mental health condition in which a person believes that their muscles are not large or developed enough.

MD typically begins in adolescence or early adulthood. Symptoms may include excessive exercise, calorie counting, and a preoccupation with obtaining a muscular appearance.

On the surface, a preoccupation with building muscle may seem harmless. However, symptoms of MD can negatively affect a person’s life, such as by making it difficult for them to maintain relationships or a career.

People with MD may also experience feelings of shame, low self-esteem, and (in some cases) an increased risk of suicide.

This article will discuss MD — including its symptoms, causes, risk factors, diagnosis, and treatment — and answer two frequently asked questions.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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People with MD experience persistent feelings of dissatisfaction about the development of their muscles.

As a result, they may engage in excessive behaviors aimed at building muscle, including:

People with MD may fixate on increasing their muscle size regardless of the true state of their physique. It is possible for a person of any size, including those who already have well-developed muscles, to experience MD.

It is also possible for a muscular person to exercise regularly and not live with MD. However, people with MD typically prioritize diet and exercise to build muscle at the expense of important aspects of life, such as their relationships or career.

In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), MD is a specifier for body dysmorphic disorder (BDD).

This means that when healthcare professionals diagnose BDD, they specify whether MD is part of a person’s condition. Some people with BDD do not experience co-occurring MD.


MD prevalence can vary among demographics. For example, a 2022 study of 3,618 Australian teenagers, ages 11–19 years, found that 2.2% of boys and 1.4% of girls lived with MD.

The study authors suggested a marginal association of MD with older age but not with gender or socioeconomic status.

By comparison, a 2018 study of 120 bodybuilders found that 58.3% had high Muscle Dysmorphia Disorder Inventory (MDDI) scores. The MDDI is a symptom measurement scale for MD.

According to a 2020 study, data on MD prevalence is limited.

However, older research suggests that MD or high levels of its symptoms may affect 1–54% of the population, with a lower prevalence in the overall population than in bodybuilding or weightlifting populations.

MD symptoms may include:

  • spending excessive amounts of time exercising
  • exercising despite injury risk
  • exercising through pain
  • wearing baggy or layered clothing to hide perceived imperfections
  • wearing clothing that accentuates certain areas of the body
  • prioritizing physical appearance
  • scheduling other activities around workouts
  • sacrificing a career, relationships, finances, and other interests for exercise
  • believing that one’s muscles should be larger
  • counting calories
  • being fixated on food content
  • maintaining a rigid dietary schedule
  • obsessing about or avoiding mirrors
  • using steroids or performance-enhancing drugs

According to the International OCD Foundation (IOCDF), there is no specific cause of MD. However, factors such as the following may contribute to this condition:

  • biology
  • childhood teasing or bullying
  • cultural or media influences
  • low self-esteem
  • social isolation
  • loneliness

People who participate in appearance-related sports may have a higher risk of developing MD. A small 2018 study suggests that MD occurs more often among bodybuilders than among strength athletes or fitness practitioners.

The researchers found that bodybuilders with symptoms of social anxiety and orthorexia nervosa had a greater chance of experiencing MD symptoms.

People with perfectionist tendencies may also be at risk of developing MD.

Perfectionism can affect a person directly by driving them to obtain what they perceive to be a perfect body. Indirect perfectionistic thinking may cause them to be dissatisfied with the body they currently have.

MD and other mental health conditions

According to the IOCDF, MD commonly occurs alongside the following mental health conditions:

The association between eating disorder symptoms and MD symptoms is positive and statistically significant, according to a 2019 review.

The review authors also noted a link between MD symptoms and OCD obsessions and compulsions:

  • Obsessions: People with MD have a preoccupation with the size of their muscles.
  • Compulsions: People with MD perform repetitive and compulsive behaviors, such as checking themselves in mirrors or mentally assessing their appearance in comparison to others.

The DSM-5 places BDD and the related MD specification in the category of obsessive-compulsive and related disorders.

MD is a subtype of BDD, so a diagnosis may initially focus on BDD. Healthcare professionals typically use a modified version of the Yale-Brown Obsessive-Compulsive Scale to diagnose BDD.

They may ask how a person feels about their appearance, whether these feelings affect their quality of life, and whether the person experiences repetitive or compulsive thoughts and behaviors.

If a person shows signs of BDD, a doctor may ask further questions to diagnose the MD subtype. For example, they may use the MDDI, which assesses for MD symptoms and categorizes them into three groups:

  • drive for size
  • appearance intolerance
  • functional impairment

Treatment options for MD may include:

Treatment may involve a mix of psychotherapy and medication. Typically, surgical treatment to adjust the perceived imperfections is not effective and may worsen symptoms of MD.

A person’s treatment team may also include an endocrinologist if they have used steroids.

People with MD might not seek treatment because they might deny or not recognize that they are experiencing a mental health condition.

However, if a person is showing symptoms of MD, they may benefit from speaking with a healthcare professional.

The IOCDF recommends contacting a healthcare professional who specializes in BDD, body image disorders, or OCD.

People with BDD may have an increased risk of suicide. A 2021 study suggests that this extends to MD. People should speak with a healthcare professional if they experience suicidal thoughts or an intention to harm themselves.

People can also contact the 988 Suicide and Crisis Lifeline 24 hours a day at 988. People who are hard of hearing can use their preferred relay service or dial 711 then 988.

The following are two frequently asked questions about muscle dysmorphia.

Is muscle dysmorphia becoming more common?

A 2020 study found that the rate of body dysmorphia among adolescents is rising. When the researchers surveyed 186 people ages 16–18 years about the aspects of their bodies they were most concerned about, males most often expressed concern about their muscular build.

The authors cite social media as a possible influencing factor.

What is the difference between bigorexia and muscle dysmorphia?

“Bigorexia” is another name for MD. People may also refer to this condition as “reverse anorexia.”

Muscle dysmorphia is a mental health condition involving a preoccupation with increasing the size of one’s muscles.

People with MD may prioritize building muscle at the expense of important aspects of life, such as their career, relationships, or overall health.

Although anyone can develop MD, participation in appearance-oriented sports such as bodybuilding may increase a person’s risk. Treatment typically includes therapy and medication.