People with the condition of muscle dysmorphia pursue the ideal picture of an extremely muscular appearance. This they try to reach compulsively. According to their disturbed view, they will never reach this goal, this look.

What is muscular dysmorphism?

In general, muscle dysmorphia (MD), also known as bigorexia (bigerexy), adonis or muscle addiction, is an expression of a disturbed self-image. Mostly affected are men, who consider their own muscle image inadequate because it does not correspond to their personal ideal.

Among the symptoms that define a muscle dysmorphism, also includes that the affected people despite a good state of training consider too weak and therefore often resort to health-threatening anabolic androgenic steroids. Also, the trained muscle tone does not seem sufficient and will continue to be trained as under duress.

They are convinced that they are not muscular despite superior muscle growth. The negative effects of excessive physical training, which is especially addressed the weight lifting, take the sufferers in buying, because they are in their opinion, the physical appearance beneficial.

In 1997, the researchers Pope, Gruber and Choi found a subclass of body dysmorphic disorders. Their research indicates that sufferers felt less attractive and healthy compared to their fellow trainers.


According to the psychologist Roberto Olivardia, four factors are responsible for muscular dysmorphism: a very high level of perfectionism, low self-esteem, one's own body image does not seem satisfactory and one has a negative or no relationship with the father.

If mental conflicts are not or only insufficiently processed, it can happen over time that those affected transfer their conflicts to their own bodies. Their conflicts give them the desired expressiveness with this behavior. In short, building muscle helps to reduce mental stress.

Those affected quickly realize that control can be exercised on the body more easily than on one's own emotionality. Also Fremdbilder (muscle-bound bodybuilders in the print media) can act as a trigger. In this case, these representations assume a role model for those affected.

Maybe because they lack role models in real life so far. Also a biological tendency is considered possible. In the area of ​​stress-related symptoms, the emotional and physical stress as a trigger for a muscular dysmorphism should be reconsidered.

Symptoms, complaints & signs

The course of the disease is often recognized even among medical specialists only after many years as a muscle dysmorphism. However, observing a variety of symptoms can lead to a diagnosis much earlier. Symptoms include heavy weight loss and greed for performance enhancing products (substances).

Also, the pursuit of not only regular, but excessive sport accompanied by an increasing loss of reality in relation to their own body image, to their own appearance, is another indication. Hormonal disorders and the formation of acne caused by anabolic steroids are also becoming increasingly common.

Social as well as professional contacts lose priority and are subordinated to an excessive training plan. Binge eating is also symptomatic by avoiding many foods in favor of diets that support muscle building. Public changing rooms, where attendees can see their bodies, are avoided.

In summary, it can be said that in the advanced stage no longer the maximum musculature and the washboard stomach, but the personal victory in the form of self-discipline over the own emotional world into the foreground.

Diagnosis & disease course

Since mental dysmorphism is a disturbed perceptual image due to mental factors, the symptoms mentioned are the basis of a diagnosis. On top of that, those concerned overly deal with the subject of food and still eat one-sidedly (everything must serve to build muscle). Weight loss with simultaneous muscle growth is another indication. Changes to the nipples are also common.


First and foremost, sufferers in a muscular dysmorphism from a very strong weight loss. This loss can have a very negative impact on the health of the person in question, leading to various complaints. Not infrequently, this also leads to a greatly reduced resilience of the patient and also to a permanent fatigue.

The everyday life of the person affected is significantly reduced. Furthermore, most sufferers suffer from acne and thus a reduced self-esteem or inferiority complexes. Those affected are often ashamed of the symptoms and also have hormonal disorders. Especially with anabolic steroids it can also lead to mental discomfort or a loss of reality, if no treatment is initiated.

The eating habits of the patients are greatly disturbed, so that there are deficiencies. Furthermore, those affected can lose consciousness. Likewise, muscular dysmorphism can also negatively affect social contacts, leading to tension or exclusion.

The treatment is carried out with the help of a psychologist and a nutritionist. The sufferer must follow a strict diet to counteract the weight loss. However, the success of this treatment is heavily dependent on the will of the patient. For this reason, there is not always a positive disease progression in the case of muscular dysmorphism.

When should you go to the doctor?

Muscle dysmorphism develops slowly over months or years. The disease can often be diagnosed only after years, usually after a concrete suspicion already exists. If there are indications such as a pathological self-image or hormonal complaints, medical advice is required. Those affected should talk to the GP early. He will first take a medical history and then initiate a physical examination.

Since the muscular dysmorphism is difficult to diagnose, a psychologist is also consulted in case of missing physical causes. Persons with mental health problems or pronounced personality disorders should inform the responsible doctor or therapist. In addition, the possible intake of medication should be checked and adjusted if necessary.

The actual treatment is tedious and consists of medical and therapeutic measures. To ensure a speedy recovery, nutritionists, sports physicians and, if necessary, an internist should be included in the treatment. In cases of severe muscular dysmorphism, a stay in a specialist clinic is indicated.

Treatment & Therapy

Muscular dysmorphism requires professional therapy in a psychosomatic clinic. There, through a competence network that specializes in the interrelations of mental and physical complaints, a targeted therapy can be carried out. It is necessary to build up a normal eating behavior with weight stabilization. Furthermore, those affected learn under guidance to put an autonomous and self-confident life-orientation into the focus of their personal perspective.

Outpatient or inpatient therapy includes five key points:

  • Weight gain and at the same time treatment of physical illnesses
  • parallel to this an individual psychotherapy
  • Nutrition consultation with accompanying therapy
  • Involving the family in therapy
  • Treatment of other disorders that have occurred over time, sometimes over years

The duration of treatment is difficult to define in advance. However, according to experience, it is between one month and half a year. The amount of therapy sessions is usually determined by the therapist together with the patient. As a rule, the statutory health insurance funds pay 25 sessions.

Applying for an extension is just as possible as applying for more hours from the beginning. For example, when there is a need for psychoanalysis.

Outlook & Forecast

Muscular dysmorphism has a good chance of recovery once the disease is treated professionally and a diagnosis and treatment are made early. For most patients, behavioral therapy significantly improves their health. Treatment can be inpatient or outpatient. When the treatment is used in conjunction with drug therapy, patients quickly experience significant relief of their symptoms.

However, the sole use of drugs without psychotherapy has proved to be less successful. Most patients will often relapse as soon as prescribed drugs are discontinued. Therefore, the best prospects for a cure are the combination of therapy and the administration of medicines. The treatment often takes several months or even years. Complaints gradually recede until complete freedom of complaint has been achieved.

Untreated, muscle dysmorphism can skip over into chronic progression. As a result, the forecast deteriorates significantly. Spontaneous healing is unlikely. The symptoms of the disease may vary in intensity during the course of the disease. At the same time, the symptoms increase the longer the disease persists. Increasing the symptoms increases the suicidal risk of those affected. To avoid a life-threatening situation, timely therapy is essential.


Contact with a preventive youth welfare service for children, adolescents and families or specialist counseling for addiction prevention of the relevant school office can help. The Association for Labor and Education Aid e. V. with its specialist office for prevention is regarded as a target-oriented contact point not only for young people. Children and adolescents should be accompanied with the necessary seriousness on their journey of self-discovery. Not infrequently is the "lifting off" of the crowd in the foreground, which can quickly lead to an exaggerated body cult.

A healthy body and self-esteem, a safe self-efficacy and a realistic self-concept is considered the best prevention against exaggerated body cult.


The therapy of a muscular dysmorphism is considered difficult. So far, the disease has been little researched and there are almost no generalized approaches to treatment emerged. These conditions - and because it is a mental disorder - often require a lengthy aftercare required.

The easy accessibility of building substances and the medially generated ideal image of a man require a longer therapy. Patients experience sustained stabilization through aftercare. Therapists try to prevent complications such as alcoholism, depression and decreased self-esteem. The type and extent of the sessions depends on the extent of the muscular dysmorphism.

Many doctors also prescribe psychotropic drugs to increase the success of treatment. Basically, a successful therapy leads to the end of the medical examinations. However, as certain mental illnesses are likely to relapse, scheduled appointments are advisable.

Patients with recent muscle dysmorphism should therefore consult their doctor on a quarterly basis during the first few years. In the ongoing investigations it can be discussed how they fall back into old patterns. In addition, regular participation in self-help groups for addicts is also recommended. A doctor mediates appropriate contacts. This results in some control by other stakeholders.

You can do that yourself

People who suffer from a muscular dysmorphism require professional therapy. The therapeutic measures can be supported by some changes in everyday life. First, the diet must be changed so that a rapid stabilization of weight can be achieved. An individualized diet also allows the patient to develop a normal eating behavior. Accompanying this diet counseling can be claimed. Under the guidance of a specialist, those affected learn to develop a positive outlook on life.

Muscle dysmorphism is often due to a mental illness or occurs in connection with other mental complaints. Therefore, accompanying psychological behavior therapy is always advisable. The therapist can assist the patient in dealing with underlying causes and thus contribute to a speedy recovery. Equally important is the help of friends and relatives. Often, the therapy takes place with the involvement of the family, or the person involved participates in the psychological counseling at a self-help group.

What action the sufferer can otherwise take depends on the type and severity of the muscular dysmorphism. Therefore, a comprehensive medical history and a physical examination by the family doctor and a therapist should take place before each therapy.

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