Reclassifying Muscle Dysmorphia to Improve Care for Boys and Men

Muscle dysmorphia is a condition that affects males, causing them to become fixated on building muscles. According to Jason Nagata, an associate professor of pediatrics, this condition is often misunderstood and overlooked, particularly in boys and men. Nagata believes that reclassifying muscle dysmorphia as an eating disorder in the upcoming sixth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) could lead to better care and recognition for those affected.

Current Classification and Challenges

The current classification of muscle dysmorphia in the DSM is under obsessive-compulsive and related disorders. However, Nagata argues that this classification is problematic because it creates a mutual exclusivity with eating disorders. This means that individuals who meet the criteria for an eating disorder cannot also be diagnosed with muscle dysmorphia, even if they exhibit symptoms of both conditions. Nagata believes that this classification is outdated and that muscle dysmorphia should be recognized as a distinct eating disorder.

Connection to Eating Disorders

Muscle dysmorphia is often referred to as "bigorexia" or "reverse anorexia" because it involves a preoccupation with muscularity, rather than thinness. Individuals with muscle dysmorphia may engage in disordered eating behaviors, such as high-protein diets, cutting carbohydrates, and "biohacking" strategies like bulking and cutting. Nagata argues that these behaviors are similar to those seen in eating disorders and that muscle dysmorphia should be recognized as a distinct eating disorder.

Treatment and Insurance Challenges

The treatment process for muscle dysmorphia is often limited, with few specialists and treatment centers available. Individuals with muscle dysmorphia may be seen by general mental health providers or eating disorder treatment centers, but these providers may not have the necessary expertise to address the specific needs of individuals with muscle dysmorphia. Additionally, insurance companies may not cover treatment for muscle dysmorphia, as it is not currently recognized as an eating disorder.

Proposed Changes and Benefits

Nagata is advocating for changes to the DSM classification of muscle dysmorphia, as well as increased recognition of the condition within the eating disorder field. He believes that adding questions about supplement use, performance-enhancing drug use, and excessive exercise to eating disorder screening tools could help improve identification and earlier diagnosis. Additionally, Nagata argues that standardizing the diagnostic criteria for muscle dysmorphia could lead to more specific clinician training and more surveillance in national studies or surveys, which could ultimately lead to better treatment outcomes for boys and men affected by the condition.