For most people, exercise is a positive thing that helps improve their mental and physical health and wellbeing. But for those with a condition known as muscle dysmorphia, exercise can become a type of illness, creating a myriad of health complications and psychological distress.
Here are the common signs and symptoms of compulsive exercise and muscle dysmorphia, plus a brief look at the health complications associated with the disorder.
What is Muscle Dysmorphia?
Body dysmorphic disorder (BDD) is a psychopathologic condition in which a person becomes obsessed with an imagined flaw in their body. While some people may assume BDD primarily affects women, research shows that a growing number of men are suffering from a subclass of BDD called muscle dysmorphia (MD) .
Muscle dysmorphia is a mental health condition characterized by an extreme preoccupation with being muscular. Previously known as “reverse anorexia,” individuals with muscle dysmorphia have irrational beliefs that their body lacks muscle and is too small, despite often being significantly more muscular than the average person.
This irrational belief leads them to engage in extreme behaviors in an attempt to build muscle. Though anyone can develop muscle dysmorphia, it is most commonly seen in males, especially in bodybuilders and those who regularly engage in muscle-building activities/sports .
Common signs and symptoms of muscle dysmorphia include:
- Spending hours at the gym
- Excessively exercising/lifting weights
- Using steroids and other performance-enhancing drugs
- Abusing substances
- Establishing rigid rules and routines around food and eating
- Spending excessive amounts of money on supplements
- Avoiding mirrors or excessively mirror-checking
- Avoiding certain social situations that may bring attention to the body (e.g., pool parties, beach days, etc.)
- Neglecting social life or daily obligations to spend more time working out
Compulsive Exercise & Muscle Dysmorphia
Though all of the above behaviors are commonly associated with MD, compulsive exercise is the core symptom defining muscle dysmorphia . While compulsive exercise is a somewhat broad and difficult-to-define term (after all, what may be unhealthy or excessive for one person may be normal for someone else like a professional athlete), it is typically defined by the following criteria:
- Exercise that interferes with important life activities
- Continuing to exercise despite injuries, medical issues, or illness
- Feeling distressed if unable to exercise
- Exercising for more than three hours a day
- Regularly exercising at inappropriate times and places
In short, a compulsive exerciser feels an urgent need to exercise, and they won’t let anything (bad weather, social obligations, illness, injury, etc.) stop them from doing so.
The Dangers of Compulsive Exercise
Compulsive exercise (also known as excessive exercise, exercise addiction, and exercise dependence) has long been recognized as a hallmark feature of eating disorders. In fact, in one of the earliest recorded medical descriptions of anorexia nervosa, William Withey Gull, M.D. lists compulsive exercise as a fundamental symptom of the illness .
Though muscle dysmorphia is not considered an official eating disorder diagnosis, it does share certain similarities and risk factors with EDs, namely compulsive exercise. For example, one study found that men with MD reported similar scores on the Compulsive Exercise Test when compared to the scores of men with anorexia nervosa .
Meaning men with muscle dysmorphia exhibited the same unhealthy behaviors around exercise (rigidity, avoidance-and-rule-driven behavior, and mood improvement) as individuals with anorexia nervosa.
Unfortunately, while compulsive exercise is usually easily recognized as an unhealthy and harmful behavior in people with EDs such as anorexia or bulimia, excessive exercise may go unnoticed or even applauded among individuals with muscle dysmorphia. One reason for this is that many individuals with muscle dysmorphia still appear healthy and within a normal (or above normal) weight range.
Therefore, the hours they spend weight lifting at the gym don’t seem to be as alarming as, for example, the hours a severely underweight anorexic might spend on the treadmill or elliptical. However, despite appearing healthy and “in shape,” individuals with muscle dysmorphia are still at risk of suffering the serious side effects that come with compulsive exercise.
Some of the complications and dangers associated with compulsive exercise and muscle dysmorphia include:
- Electrolyte imbalances
- Muscle wasting
- Heart problems
- Altered resting heart rate
- Chronic joint and bone pain
- Increased injuries
- Persistent soreness in muscles
- Frequent fatigue
- Relative Energy Deficiency in Sport (RED-S)
- Bone density loss
- Bone fractures
- Sudden death
- Increased risk of suicide 
The risk of health complications greatly increases if the individual is engaging in both compulsive exercise and disordered eating since bodies deprived of essential nutrients are more prone to injury and health complications.
And as research shows, a significant portion of men with muscle dysmorphia have a past eating disorder diagnosis, are currently engaging in disordered eating habits, or are in danger of developing an eating disorder .
Treating Compulsive Exercise & Muscle Dysmorphia
If left untreated, muscle dysmorphia can lead to a host of problems, including serious health complications, mental health struggles, poor quality of life, and relationship issues. The good news is, compulsive exercise and muscle dysmorphia can be treated.
If you or a loved one are exhibiting signs of compulsive exercise or muscle dysmorphia, reach out to a medical professional or mental health provider. Treatments such as cognitive behavioral therapy can reorient beliefs and habits around exercise and help create a more positive body image.
Resources: Leone, J. E., Sedory, E. J., & Gray, K. A. (2005). Recognition and treatment of muscle dysmorphia and related body image disorders. Journal of athletic training, 40(4), 352–359.  ibid.  Pope HG, Gruber AJ, Choi P, Olivardia R, Phillips KA. Muscle dysmorphia: an underrecognized form of body dysmorphic disorder. Psychosomatics. 1997;38(6):548–57. https://doi.org/10.1016/S0033-3182(97)71400-2  Gull WW. Anorexia nervosa (apepsia hysterica, anorexia hysterica). Obes Res. 1868;5(5):498–502. https://doi.org/10.1002/j.1550-8528.1997.tb00677.x.  Martenstyn, J.A., Touyz, S. & Maguire, S. Treatment of compulsive exercise in eating disorders and muscle dysmorphia: protocol for a systematic review. J Eat Disord 9, 19 (2021). https://doi.org/10.1186/s40337-021-00375-y  Smith AR, Fink EL, Anestis MD, et al. Exercise caution: over-exercise is associated with suicidality among individuals with disordered eating. Psychiatry Res. 2013;206(2-3):246-55. doi:10.1016/j.psychres.2012.11.004  Martenstyn, J.A., Touyz, S. & Maguire, S. Treatment of compulsive exercise in eating disorders and muscle dysmorphia: protocol for a systematic review. J Eat Disord 9, 19 (2021). https://doi.org/10.1186/s40337-021-00375-y
About the Author:
Sarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.
Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published March 11, 2021, on EatingDisorderHope.com
Reviewed & Approved on March 11, 2021, by Jacquelyn Ekern MS, LPC