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Journal of Athletic Training 2005;40(4):352–359 by the National Athletic Trainers’ Association, Inc

Recognition and Treatment of Muscle Dysmorphia and Related Body Image Disorders
James E. Leone*; Edward J. Sedory†; Kimberly A. Gray*
*Southern Illinois University Carbondale, Carbondale, IL; †University of Virginia, Charlottesville, VA
James E. Leone, MS,LAT, ATC, CSCS; Edward J. Sedory, MEd, ATC; and Kimberly A. Gray, MS, ATC, CSCS, contributed to conception and design; acquisition and analysis and interpretation of the data; and drafting, critical revision, and final approval of the article. Address correspondence to James E. Leone, MS, LAT, ATC, CSCS, Southern Illinois University Carbondale, Department of Physical Education, 1075 S. Normal Avenue,Mailcode 4310, Carbondale, IL 62901. Address e-mail to Objective: To present the reader with various psychobehavioral characteristics of muscle dysmorphia, discuss recognition of the disorder, and describe treatment and referral options. Data Sources: We conducted a comprehensive review of the relevant literature in CINAHL, MEDLINE, SPORT Discus, EBSCO, PsycINFO, and PubMed. Allyears from 1985 to the present were searched for the terms muscle dysmorphia, bigorexia, and reverse anorexia. Data Synthesis: The incidence of muscle dysmorphia is increasing, both in the United States and in other regions of the world, perhaps because awareness and recognition of the condition have increased. Although treatment options are limited, therapy and medication do work. The primaryissue is identifying the disorder, because it does not present like other psychobehavioral conditions such as anorexia or bulimia nervosa. Not only do patients see themselves as healthy, most look very healthy from an outward perspective. The causes of muscle
dysmorphia are not well understood, which reinforces the need for continued investigation. Conclusions: Muscle dysmorphia is an emergingphenomenon in society. Pressure on males to appear more muscular and lean has prompted a trend in the area of psychobehavioral disorders often likened to anorexia and bulimia nervosa. Athletes are particularly susceptible to developing body image disorders because of the pressures surrounding sport performance and societal trends promoting muscularity and leanness. Health care professionals need tobecome more familiar with the common signs and symptoms of muscle dysmorphia, as well as the treatment and referral options, in order to assist in providing appropriate care. In the future, authors should continue to properly measure and document the incidence of muscle dysmorphia in athletic populations, both during and after participation. Key Words: morbidity, muscularity, psychobehavioraldisorders, psychology

ody image disorders such as anorexia nervosa (AN) and bulimia nervosa (BN) have been well documented in the clinical literature.1,2 Societal pressures ranging from media advertisement campaigns to sports icons often dictate the way an ‘‘ideal’’ body should look. For several decades, much of the focus on body image disorders has centered on women. In American society, the feminineideal is to appear thin. Males, however, are encouraged to be muscular and ‘‘ripped.’’ We have witnessed a gradual shift in how males perceive their bodies3,4 and a growing trend toward a condition called reverse anorexia or bigorexia. Dysmorphia or dysmorphism is defined as an anatomical malformation.5 As attention grows in this area of psychopathology, the clinically appropriate term of muscledysmorphia (MDM) has come into usage. In cases of reverse anorexia, bigorexia, or muscle dysmorphia, the primary focus is not on how thin a person can get but rather on how large and muscular.3,6–9 The perceived ‘‘malformation’’ is a lack of size or strength. Unfortunately, despite the growing attention, in comparison with AN and BN, few interventional strategies have been explored.3 Much like...
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