Muscle Dysmorphia Among College Men: An Emerging Gender‐Related Counseling Concern

Recent literature suggests that, like midrange eating disorders among college women, male muscle dysmorphia is emerging as a physical as well as a health concern among college men. The authors define the disorder, review diagnostic and etiological considerations, and discuss the added complication of creatine use to self-manage muscle dysmorphic symptoms. Implications for the college counseling practice are presented, and the need for a reliable knowledge base to guide practice is emphasized. ********** College counselors and health professionals are noting a growing presence of gender-related mental health concerns on college and university campuses (Arnstein, 1995). Among these concerns, the high incidence of eating disorders among college women has received close attention (Hoerr, Bokram, Lugo, Bivins, & Keast, 2002; Martin, 1993; Prouty, Protinsky, & Canady, 2002). Whereas cases of fully diagnosable anorexia and bulimia occur with some regularity on campus, subclinical disordered eating is even more common (Bishop, Lacour, Nutt, Yamada, & Lee, 2004). These subclinical behaviors, such as weight preoccupation, body image issues, and unhealthy dieting, may account for the reports from college counseling centers that eating-disordered behaviors are problematic (Bishop et al., 2004). College counseling centers and health services have reported increasing numbers of cases of college men with eating disorders and a sharp rise in the percentage of men who are dissatisfied with their bodies (Morgan, 2002). Evidence shows that more men are presenting to college counseling centers with low self-esteem, appearance concerns, and abnormal eating and exercising behaviors (Morgan, 2002); and research indicates that 95% of college men report dissatisfaction with some aspect of their bodies (Labre, 2002). Moreover, men increasingly are presenting to college counseling centers with manifestations of muscle dysmorphia: low self-esteem, shame, decreased social functioning, and anxiety regarding their appearance. This development, in association with the risk of creatine use and other adverse health behaviors, is creating a growing need for college counselors to better understand the issues facing college men with regard to their body dissatisfaction. In this article, the authors review recent literature focusing on the emergence of mental health issues related to male muscle dysmorphia. Studies focusing on muscle dysmorphia among college men are examined, diagnostic issues and some etiological considerations are described, and the added complication of creatine use to self-manage muscle dysmorphic symptoms is examined. Implications for college counseling practice are presented, and the need for research to develop a reliable knowledge base to guide practice is emphasized. Muscle Dysmorphia Diagnostic Considerations The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) provides criteria concerning anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (NOS). Along with the primary symptoms that relate to problematic eating and compensatory behaviors, a diagnosis of anorexia nervosa requires that a person experience intense fear of weight gain and a disturbance in body image, and a diagnosis of bulimia nervosa requires that a self-evaluation be unduly influenced by body image. The eating disorders NOS category may apply when the criteria for anorexia or bulimia are only partially met. The DSM-IV-TR (APA, 2000) also provides criteria for body dysmorphic disorder, previously known as dysmorphophobia, requiring that a person be consumed by an imagined or slight defect in appearance. Body build and muscularity were added as potential areas of concern in the text revision changes to the DSM-IV (APA, 1994, n.d.). Muscle dysmorphia is categorized as a type of body dysmorphic disorder because the men who have muscle dysmorphia are consumed by their appearance and perceived muscularity (Pope, Gruber, Choi, Olivardia, & Phillips, 1997). …