Bodybuilders’ Image Problem May Be Mental

They wear baggy clothes to cover hugely muscled bodies--not because they are ashamed of being big and powerful, but because they feel they are small and weak.

Researchers say this thinking characterizes some bodybuilders, even ones in top physical shape. The researchers term it muscle dysmorphia.

“We are not saying there is something pathological about being a dedicated bodybuilder who goes to the gym six days a week,” said Dr. Harrison G. Pope. “The group we saw were far beyond someone who is a dedicated athlete. There was a clear impairment of social and occupational functioning.”

People with muscle dysmorphia “are pathologically preoccupied with the appearance of the body as a whole; they are concerned that they are not sufficiently large or muscular,” Pope and his colleagues reported in the psychiatric journal Psychosomatics.

The condition is not yet recognized as a psychiatric disorder, but the researchers believe it to be a subcategory of a recognized condition, body dysmorphic disorder.

That condition is characterized by a fixation on a specific body part; for example, it could be a preoccupation with the idea that the person’s nose is too big. In muscle dysmorphia, the feeling is that the person’s body is too small and weak, the researchers say.

The response is like anorexia in reverse. Instead of trying constantly to lose weight, experts say, people with muscle dysmorphia focus on gaining muscle.

These men and women concentrate so heavily on their weight training and their diets that little else matters in their lives, said Pope, a researcher at McLean Hospital in Belmont, Mass., and an associate professor of psychiatry at Harvard Medical School. They may give up on a career or a social life, he said.

“We found, like Dr. Pope, that competitive bodybuilders perceived themselves as smaller than they were,” said Gary S. Goldfield, a doctoral student in psychology at Carleton University in Ottawa.

People with muscle dysmorphia tend to avoid situations in which they have to let others see their bodies, Pope said. “They would not go out to a shopping center because, even with their clothes on, they are afraid people would notice,” he said. And they don’t seem to realize the great shape they generally are already in, he said.

In one case, a 27-year-old man who was massively muscled did not feel he was muscular even though he checked himself in the mirror 10 to 12 times a day, the journal article said.

Many of the people studied, who were recruited from Boston-area gyms, reported that even taking illegal anabolic steroids did not bulk them up as much as they wanted, Pope said.

“I would ask them what their ideal was, and some didn’t have a clear idea,” said researcher Roberto Olivardia, a graduate student at the University of Massachusetts in Boston.

The condition shows up among bodybuilders, but it also can be found among other power athletes, said Bob Goldman of Chicago, the head of sports medicine for the International Federation of Bodybuilders. “Look at the number of people who bodybuild,” he said. “It’s a small percentage.”

Exactly how many bodybuilders have muscle dysmorphia is unknown, and it could be difficult to determine. Many people with the condition would be too embarrassed to come forward, Pope said. Similarly, it would be hard to diagnose the severity of the disorder because tests to determine this have not been developed, he said.

Treatment theoretically is possible, although it has not been attempted, Pope said. People with muscle dysmorphia think of themselves as needing more training, not therapy, he said. And because the condition is not life-threatening, as anorexia can be, others will not force them into treatment, he said.