Мышечная дисморфия: разновидность расстройства образа тела.

Subtype of the obsessive mental disorder body dysmorphic disorder

Muscle dysmorphia is a subtype of the obsessive mental disorder body dysmorphic disorder, but is often also grouped with eating disorders. In muscle dysmorphia, which is sometimes called "bigorexia", "megarexia", or "reverse anorexia", the delusional or exaggerated belief is that one's own body is too small, too skinny, insufficiently muscular, or insufficiently lean, although in most cases, the individual's build is normal or even exceptionally large and muscular already. Muscle dysmorphia affects mostly men, particularly those involved in sports where body size or weight are competitive factors, becoming rationales to gain muscle or become leaner. muscle dysmorphia is especially difficult to recognize, since awareness of it is scarce and persons experiencing muscle dysmorphia typically remain healthy looking. Compared to other body dysmorphic disorders, rates of suicide attempts are especially high with muscle dysmorphia.

Although body dissatisfaction has been found in boys as young as age six, muscle dysmorphia's onset is estimated at usually between ages 18 and 20. According to DSM 5, muscle dysmorphia is indicated by the diagnostic criteria for body dysmorphic disorder via "the idea that his or her body is too small or insufficiently muscular", and this specifier holds even if the individual is preoccupied with other body areas, too, as is often the case. Those suffering from the disorder closely monitor their body and may wear multiple clothing layers to make it appear larger. Patient histories reveal elevated rates of diagnoses of other mental disorders, including eating disorders, mood disorders, anxiety disorders, and substance use disorder, as well as elevated rates of suicide attempts. Increased body mass may seem to reduce the threat of further mistreatment.

Low self esteem is associated with higher levels of body dissatisfaction and of muscle dysmorphia. Vulnerable narcissism has also been linked to heightened muscle dysmorphia risk. Increased body size or muscularity may seem to enhance the masculine identity. Since the 1980s, the number of fitness magazines and of partially undressed, muscular men in advertisements have increased. In college aged men, a strong predictor of a muscularity quest is internalization of the idealized male bodies depicted in media.

Athletes tend to share some psychological factors that may predispose to muscle dysmorphia, factors including high levels of competitiveness, need for control, and perfectionism, Athletes who also fail to their sports performance goals may escalate efforts to modify their builds, efforts that overlap those of muscle dysmorphia. Athletic ideals reinforce the social ideal of muscularity. Men who conform to conventional ideals of masculinity often report increased stress from not meeting the imposed standard of a masculine and muscular body. In a sample of 2,733 MSM who reported body dissatisfaction, only one in every 10 reported feeling no dissatisfaction with their muscularity. Dissatisfaction with muscularity had a stronger relationship with quality of life impairment when compared to dissatisfaction with body fat, height, and penis size. Those who identify as a sexual minority are at increased risk for victimization due to their identity. Having been a victim of homophobic bullying is associated with more symptoms of muscle dysmorphia. A possible cause for this relationship can be the increased feelings of paranoid ideation that a MSM individual can experience following homophobic bullying.

Treatment of muscle dysmorphia can be stymied by a patient's unawareness that the preoccupation is disordered or by avoidance of treatment.