This is an article I wrote in 2002 for a newspaper in Northern Colorado.  It is based on a paper I wrote when I was in college in 1987 (yes – I am old…).

As I write for a number of publications regarding physical fitness and ultimate health, I have a nagging concern that many people place to strong an emphasis on ‘body image’ vs. ‘ideal health’.  I think it is very important to understand that the quest for the ultimate body can be self-defeating.  In 1988, I wrote an article that descried what I was observing in a number of friends and fellow regulars at the gym.  Since that time other physicians and authors have written similar descriptive ideas, including potential medical and psychiatric diagnosis, to describe analogous concepts.   I am republishing a portion of my original article, as I want people to be aware that, along with eating disorders such as anorexia and bulimia, ones passion for ‘ideal body image’ can be pathologic.  I am not pointing fingers, offering advice or a treatment, just providing information.

Knowledge and human power are synonymous. -Francis Bacon

A number of psychiatric diagnoses have been conceived to describe a variety of disorders that deal with individuals preconceived belief and thought process concerning some flaw in their body structure.  A few of the somatoform disorders including Body Dysmorphic Disorder as well as some of the eating disorders such as Anorexia Nervosa and Bulimia Nervosa all have components that include an overly strong, irrational preoccupation with body shape and structure.

A sub-type of Body Dysmorphic Disorder has been devised to describe a specific population and sub-culture that is affected by overly excessive preoccupations and imagined body structure inadequacies.  The term that will be used to describe this sub-type of Body Dysmorphic disorder is Physique Structure Dysmorphia.  The distinctive population that will be discussed here is the throng of individuals that can be classified as bodybuilders.  By definition, a ‘bodybuilder’ is one who wishes to enhance or change his or her physic through modification in muscular development through the modalities of exercise, be it resistance training (weight training), or aerobic in nature, as well as the use of nutrition and supplements for attainment of this said enhancement of change.

The identification of Physique Structure Dysmorphia can be reached when an individual has a fervently held belief that the body as a whole or body part (of the musculoskeletal system) is inadequate in form and/or shape and/or size and therefore inadequate in appearance.  Also present is an overwhelming preoccupation with this imagined imperfection.  This state of mind can cause any one of the following to occur:

  • Majority of each day is spent with this preoccupation on one’s mind.
  • Time and effort to change this perceived inadequacy take priority over other daily activities, duties, and responsibilities. For example: one chooses exercise, diet needs, or recovery time over work, friends, and social interaction.
  • A fear of social judgment or ridicule is present and causes one of the following:
  • Avoiding social situations where the individual may be forced to expose his or her conceived structural inadequacy. I.e. swimming.
  • Goes to all efforts to hide the conceived inadequacy without regard to personal comfort or safety. I.e. wears a large sweatshirt on a hot day.
  • Is willing to take personal risks to health and well being in order to change said inadequacy. I.e. willingness to take drugs or medications without any thought or fear of potential short and long term side effects or health risks.
  • Willingness to face potential quandary and disciplinary action with authority figures in order to change conceived inadequacy. I.e. using illegal drugs.

The epidemiology of this particular disorder is questionable.  It appears to not be limited to a particular age group or sex.  However there does appear to be a slight predominance in a younger population (less than 35 years of age).

The etiology or exact cause of such a flawed perception or overly unsound fixation on ones body structure is unknown at this time.  However, a number of biological, psychological, and environmental factors are implicated in the natural progression of the disorder.

Biologically, correlation between organic changes in obsessive-compulsive disorder and depression could be implicated in Physic Structure Dysmorphia.  It may be a reaction or a requirement of an adolescent for more self-assurance and increased social and sexual functioning.  A developed preoccupation or obsession with body structure may take precedence over other normal social pursuits in the false belief that obtaining the desired characteristics will enable increase social and sexual functioning.

Enviromentally, people with Physique Structure Dysmorphia find support for their beliefs and practices in society’s emphasis on looking good and the need for exercise and physical fitness to meet the demands of everyday interaction be it social or occupational.

Onset is insidious.  Belief about inadequacy in structural appearance develops over time or can be related to a specific incidence in which the person felt socially shunned due to a perceived musculoskeletal characteristic.

Again, the purpose of this brief report is to raise awareness of potential problems in those of us with ‘exercise addiction’.  If you have questions or thoughts about anything mentioned above, please do not hesitate to contact me at doc@drwilley.com.  Until next time “Train with your Brain”!

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