Clinical features of muscle dysmorphia:
(1) preoccupation with being muscular and lean, resulting in long hours of body building and an excessive attention to diet
(2) 2 or more of the following criteria:
(2a) a compulsive attention to workout and diet schedule, which results in giving up of important social, occupational or recreational activities
(2b) distress or anxiety at showing the body to others, resulting in avoidance behaviors
(2c) distress related to feelings of inadequate body size (feelings of inadequacy because "not large enough") no matter how well developed
(2d) continued exercise and diet despite knowledge of adverse consequences
Barriers to recovery:
(1) poor insight
(2) use of performance enhancing (ergogenic) substances (which are essential to get to "the next level" of muscular size)
Differential diagnosis:
(1) anorexia nervosa (fear of being fat)
(2) exercise dependence
(3) other forms of body dysmorphic disorder (obsession with other aspects of appearance)
