Muscle dysmorphia and the DSM-V conundrum: where does it belong? A review paper.

OBJECTIVE Muscle dysmorphia is a relatively recently identified psychological condition that, since its inception, has been variously conceptualized as an eating disorder and subsequently as a type of body dysmorphic disorder within the somatoform disorders. This review aims to inform and encourage ongoing debate surrounding the diagnostic placement of this disorder. METHOD We present a review and synthesis of the extant literature with a view to informing future decisions regarding the conceptualization of muscle dysmorphia. RESULTS The validity of muscle dysmorphia as a clinical entity has been empirically demonstrated. While the condition bears little semblance to somatization as currently conceptualized, the research suggests a strong conceptual similarity with anorexia nervosa. However, future research needs to utilize more appropriate measures of male eating disorder pathology. Muscle dysmorphia is also inclusive of obsessive compulsive features that are typical to those seen in eating disorder presentations. DISCUSSION We suggest that muscle dysmorphia be reanalyzed through the lens of an eating disorder spectrum. Recognition of muscle dysmorphia as an eating disorder may offer more clinical utility in recognizing the male experience of eating disorder pathology and also help reduce the number of current male cases falling into the EDNOS category.

[1]  A S Kaplan,et al.  Views on Classification and Diagnosis of Eating Disorders , 1995, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[2]  R. Dalle Grave,et al.  Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features, and treatment outcome. , 2008, Comprehensive psychiatry.

[3]  C. Meyer,et al.  Excessive exercise in the eating disorders: a need for less activity from patients and more from researchers... , 2008, European eating disorders review : the journal of the Eating Disorders Association.

[4]  K. Phillips,et al.  Body dysmorphic disorder: an obsessive-compulsive spectrum disorder, a form of affective spectrum disorder, or both? , 1995, The Journal of clinical psychiatry.

[5]  R. Dalle Grave,et al.  Is amenorrhea a clinically useful criterion for the diagnosis of anorexia nervosa? , 2008, Behaviour research and therapy.

[6]  F. Grieve,et al.  Etiology, Assessment, and Treatment of Muscle Dysmorphia , 2009, Journal of Cognitive Psychotherapy.

[7]  Dan J Stein,et al.  Muscle dysmorphia: A South African sample , 2001, Psychiatry and clinical neurosciences.

[8]  K. Phillips.  The broken mirror : understanding and treating body dysmorphic disorder , 1996 .

[9]  J. Thompson,et al.  The tripartite influence model of body image and eating disturbance: A replication with adolescent girls. , 2006, Body image.

[10]  H. Pope,et al.  Anabolic steroid users' attitudes towards physicians. , 2004, Addiction.

[11]  B. Chung.  Muscle Dysmorphia: A Critical Review of the Proposed Criteria , 2001, Perspectives in biology and medicine.

[12]  C. Davis,et al.  A psychological comparison of females with anorexia nervosa and competitive male bodybuilders: body shape ideals in the extreme. , 2000, Eating behaviors.

[13]  Obsessive compulsive disorder as a cause of atypical eating disorder: a case report. , 2009, European eating disorders review : the journal of the Eating Disorders Association.

[14]  G. Kemmler,et al.  Body Image and Psychopathology in Male Bodybuilders , 2001, Psychotherapy and Psychosomatics.

[15]  M. Fisher,et al.  Three case reports on the relationship between anorexia nervosa and obsessive compulsive disorder , 2002, International journal of adolescent medicine and health.

[16]  E. Rieger,et al.  Muscle dysmorphia symptomatology during a period of religious fasting: a case report. , 2011, European eating disorders review : the journal of the Eating Disorders Association.

[17]  R. Olivardia,et al.  Mirror, mirror on the wall, who's the largest of them all? The features and phenomenology of muscle dysmorphia. , 2001, Harvard review of psychiatry.

[18]  C. Fairburn,et al.  Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment. , 2003, Behaviour research and therapy.

[19]  Thomas F. Cash,et al.  In Pursuit of the Perfect Appearance: Discrepancies Among Self‐Ideal Percepts of Multiple Physical Attributes 1 , 1994 .

[20]  William Menard,et al.  Comorbidity of body dysmorphic disorder and eating disorders: severity of psychopathology and body image disturbance. , 2006, The International journal of eating disorders.

[21]  S. Touyz,et al.  Anorexia Nervosa in Males: A Report of 12 Cases , 1993, The Australian and New Zealand journal of psychiatry.

[22]  D. Katz,et al.  Psychiatric and medical effects of anabolic-androgenic steroid use. A controlled study of 160 athletes. , 1994, Archives of general psychiatry.

[23]  J. Rodin,et al.  The Embodiment of Masculinity , 1986 .

[24]  S. Armstrong,et al.  The Classification of Muscle Dysmorphia , 2005 .

[25]  F. Grieve,et al.  Are anxiety and obsessive-compulsive symptoms related to muscle dysmorphia? , 2009 .

[26]  W. Kaye,et al.  Males with anorexia nervosa: a controlled study of eating disorders in first-degree relatives. , 2001, The International journal of eating disorders.

[27]  H. Pope,et al.  Muscle dysmorphia in male weightlifters: a case-control study. , 2000, The American journal of psychiatry.

[28]  J. Thompson,et al.  Symptom characteristics and psychiatric comorbidity among males with muscle dysmorphia. , 2008, Comprehensive psychiatry.

[29]  K. Brownell,et al.  Weight loss, psychological, and nutritional patterns in competitive male body builders. , 1995, The International journal of eating disorders.

[30]  A S Kaplan,et al.  The prevalence of high-level exercise in the eating disorders: etiological implications. , 1997, Comprehensive psychiatry.

[31]  T. Tylka,et al.  College Men's Perceptions of Ideal Body Composition and Shape. , 2005 .

[32]  S. Finnie,et al.  Motivational antecedents of obligatory exercise: the influence of achievement goals and multidimensional perfectionism. , 2007 .

[33]  F. Grieve.  A Conceptual Model of Factors Contributing to the Development of Muscle Dysmorphia , 2007, Eating disorders.

[34]  H G Pope,et al.  Muscle dysmorphia. An underrecognized form of body dysmorphic disorder. , 1997, Psychosomatics.

[35]  W. Menard,et al.  Clinical features of muscle dysmorphia among males with body dysmorphic disorder. , 2005, Body image.

[36]  T. Moffitt,et al.  Obsessive-compulsive disorder in a birth cohort of 18-year-olds: prevalence and predictors. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[37]  L. Ricciardelli,et al.  Body image and body change methods in adolescent boys. Role of parents, friends and the media. , 2000, Journal of psychosomatic research.

[38]  Donald R. McCreary,et al.  An Exploration of the Drive for Muscularity in Adolescent Boys and Girls , 2000, Journal of American college health : J of ACH.

[39]  B. Walsh.  DSM-V from the perspective of the DSM-IV experience. , 2007, The International journal of eating disorders.

[40]  A. Rissanen,et al.  Lifetime anorexia nervosa in young men in the community: five cases and their co-twins. , 2008, The International journal of eating disorders.

[41]  R. Gee,et al.  Obsessive-compulsive disorder and anorexia nervosa in a high school athlete: a case report. , 1999, Journal of athletic training.

[42]  J. Cole,et al.  A preliminary investigation into the relationship between anabolic-androgenic steroid use and the symptoms of reverse anorexia in both current and ex-users , 2003, Psychopharmacology.

[43]  Stefanie Teri Greenberg,et al.  Males and Eating Disorders: Gender-Based Therapy for Eating Disorder Recovery , 2008 .

[44]  G. Goldfield,et al.  Are bodybuilders at risk for an eating disorder , 1998 .

[45]  J. Leone.  Muscle Dysmorphia Symptomatology and Extreme Drive for Muscularity in a 23-Year-Old Woman: A Case Study , 2009, Journal of strength and conditioning research.

[46]  P. Mosley,et al.  Bigorexia: bodybuilding and muscle dysmorphia. , 2009, European eating disorders review : the journal of the Eating Disorders Association.

[47]  J. Rosen,et al.  A comparison of eating disorders and body dysmorphic disorder on body image and psychological adjustment. , 1998, Journal of psychosomatic research.

[48]  H. Doll,et al.  The severity and status of eating disorder NOS: Implications for DSM-V , 2007, Behaviour research and therapy.

[49]  D L Katz,et al.  Anorexia nervosa and "reverse anorexia" among 108 male bodybuilders. , 1993, Comprehensive psychiatry.

[50]  Zhaoping Li,et al.  Are high-protein, vegetable-based diets safe for kidney function? A review of the literature. , 2007, Journal of the American Dietetic Association.

[51]  W. Menard,et al.  Gender similarities and differences in 200 individuals with body dysmorphic disorder. , 2006, Comprehensive psychiatry.

[52]  T. F. Cash,et al.  Body Image - A Handbook of Theory, Research and Clinical Practice Thomas F Cash Body Image - A Handbook of Theory, Research and Clinical Practice and Thomas Pruzinsky Guilford Press 380pp £22 1593850158 1593850158 [Formula: see text]. , 2005, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[53]  C. Fairburn,et al.  Thinking afresh about the classification of eating disorders , 2007, The International journal of eating disorders.

[54]  R. Palmer,et al.  Males assessed by a specialized adult eating disorders service: Patterns over time and comparisons with females. , 2008, The International journal of eating disorders.

[55]  R. Olivardia,et al.  Muscle Dysmorphia: Characteristics, Assessment, and Treatment. , 2007 .

[56]  J. Jolanta,et al.  The links between body dysmorphic disorder and eating disorders , 2000 .

[57]  K. Phillips,et al.  Multidimensional body image comparisons among patients with eating disorders, body dysmorphic disorder, and clinical controls: a multisite study. , 2009, Body image.

[58]  G. Goldfield,et al.  Body image and steroid use in male bodybuilders. , 1995, The International journal of eating disorders.

[59]  G. Kiziltan,et al.  Eating attitudes and their psychological correlates among Turkish adolescents. , 2004, Adolescence.

[60]  G. Goldfield.  Body Image, Disordered Eating and Anabolic Steroid Use in Female Bodybuilders , 2009, Eating disorders.

[61]  D. Schlundt,et al.  Presence of muscle dysmorphia symptomology among male weightlifters. , 2006, Comprehensive psychiatry.

[62]  A. Friedman.  High-protein diets: potential effects on the kidney in renal health and disease. , 2004, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[63]  J. Walberg,et al.  Menstrual function and eating behavior in female recreational weight lifters and competitive body builders. , 1991, Medicine and science in sports and exercise.