New study highlights increasing prevalence of muscle dysmorphia among Canadian boys, young men

What is muscle dysmorphia? Professor Kyle Ganson lead research on muscle dysmorphia and how it impacts Canadian men and boys.

Canadian researchers are drawing attention to the increasing prevalence of “a pathological pursuit of muscularity” among Canadian boys and young men, with a new study that found one in four were at risk of developing what’s known as muscle dysmorphia.

The study, published Jan. 17 in the journal Body Image, said that Canadian health-care professionals “should be alerted” to the high occurrence of muscle dysmorphia (MD) symptoms in this population.

Muscle dysmorphia is the obsession with muscle size and definition, resulting in distress and a "significant drive" for muscularity, the study said. Some symptoms include compulsive exercise, specific dieting to build and maintain muscle, use of appearance-and-performance-enhancing drugs and substances and disruptions to daily life.

"It's colloquially known as reverse anorexia," Kyle Ganson, assistant professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work and lead author of the study, told CTVNews.ca in an interview. "Instead of driving for fitness, there's an intense drive for muscularity, and generally it's like bulk muscularity, significant strength, it can be about lean and cut defined features."

The study is one of the first to explore MD symptoms and prevalence in a larger sample of a broader population. In the past, most of the research focused on bodybuilders or smaller groups of people.

The study found that men and boys reported greater overall MD symptoms than women, transgender and gender non-conforming participants. Those who identified as South Asian or Middle Eastern reported higher MD symptoms than those who identified as white.

Without research on MD and other mental health disorders dealing with body image, health-care facilities and practitioners are not equipped to diagnose and provide treatment to people, the study states. The impact MD can have on individuals could increase the mental distress of a person, possibly leading to suicidal ideation and attempts, an article in Prim Psychiatry reads.

With the rise of eating disorders in Canada, which have similar symptoms as MD, researchers believe body dissatisfaction is "growing in prevalence."

MD is categorized under body dysmorphic disorders (BDD), characterized as dissatisfaction with one's appearance, particularly with a perceived flaw. MD and BDD fall under the obsessive-compulsive disorder (OCD) spectrum.

WHAT THE DATA SAYS

Researchers used data from the Canadian Study of Adolescent Health Behaviours, a survey investigating social and behavioural health of young people in Canada. Just over 2,000 people between the ages of 16 to 30, from all 13 provinces and territories, completed the survey.

A total of 13 questions were asked that corresponded with the muscle dysmorphia symptomatology and a score was given.

Participants had a mean age of 22.9. More than half (55.7 per cent) were women, 37.6 per cent were men and 6.7 per cent identified as transgender/gender non-conforming. The majority of people identified as white (61.5 per cent) and heterosexual (59.6 per cent).

According to the research, 17.2 per cent of the study sample was considered at risk for MD. Of that, 25.7 per cent were men and 18 per cent were transgender/ gender non-conforming.

People who reported a lifetime use of steroids to build muscles struggled more with negative feelings about muscle size which disrupted their daily activities, compared to those who did not use muscle-enhancing substances, the study found.

People who identified as South Asian and Middle Eastern reported higher MD symptoms than people who identified as white.

Those who identified as gay or lesbian had "significantly" higher MD symptoms. The data also showed that those who identified as queer and questioning had higher body image issues associated with MD symptoms, but that did not disrupt their daily lives.

POPULAR MEDIA TO BLAME FOR MUSCLE IDEALS

Ganson said social media is “a big perpetrator” of unrealistic body standards and harmful narratives that affect how some people see themselves.

"There's a lot of influencers on social media who provide information about the gym, or gym culture, or different exercise routines or eating routines. So you can get information very free (and) easily accessible and available."

Often, the male ideal is portrayed as white, with a "triangle-shaped" body: large arm muscles and a smaller torso.

While more research is needed to understand how and why MD impacts South Asian and Middle Eastern people in particular, the study says one reason for this may be the desire to adapt to "Western" body ideals.

Although MD is not an eating disorder, the links between them are clear. Eating disorders, which spiked among youth in Canada during the COVID-19 pandemic, were linked, in part, to unrealistic body ideals on social media.

Ganson participated in research published in September 2022 about the practice of bulking and cutting in the muscle-building and fitness communities. The diet tactic is characterized as alternating between consuming surplus calories (bulking) and restricting calories (cutting) to optimize the growth of lean muscle. Ganson said this research found links between MD and eating disorders.

"We did find relationships between bulking and cutting and eating disorder, psychopathology that includes not only thinking about body and weight and shape but also behaviours like binge eating, laxative use or excessive exercising," he said.

These behaviours are "well documented" on social media and in popular culture, Ganson explained in the press release.

Gym culture is heavily intertwined with use of performance substances and dietary supplements, Ganson said. The MD research found that those who took steroids to specifically build muscles had lower body dissatisfaction compared to those who did not take drugs. However, Ganson said the path from legal supplements to illegal steroids can be a slippery slope.

"If they're having significant distress around feeling like they're not big enough, that they're not strong enough, feeling like they look terrible, there are some people – not all– are going to turn to methods to change that, and that might be anabolic steroids," he said.

The distress transgender and gender non-conforming individuals feel when in a body they don't identify with can increase symptoms of MD, the study explains. There is an emphasis on appearing (or passing) as one's gender identity.

This can result in a "desire to change their body to be more muscular (i.e., trans men may desire a more muscular and masculine body)," the study states.

MORE RESEARCH AND AWARENESS NEEDED

This study is one of very few that explored symptoms of MD and where the distress comes from. To understand who is impacted by MD and other mental disorders, more research is needed, Ganson said.

"I'm calling it preliminary data because it's really a newer field that we're investigating, despite it being very common in popular culture," he said. "I'm really hoping that it will start to get into people's ears."

Ganson said if Health Canada or Statistics Canada invested resources into the topic, it would allow for a better understanding of the symptoms and awareness. The survey used in the MD study allowed researchers to publish multiple articles on different topics related to body image.

"We actually had about 900 participants take the survey again 12 months later," Ganson said. "And we asked a variety of similar questions, but actually some new questions around health-care utilization, or adverse health effects."

Ganson hopes the research will change the knowledge on MD screening and combat the stigma around men's and boys' body image issues.

"If there's a knowledgeable provider there who can screen or ask certain questions, they might actually be able to identify this and gear that person in the right treatment direction," Ganson said. "Which would certainly be really important given the really low diagnosis rate and really low treatment utilization rate."

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The following is a list of resources and hotlines dedicated to supporting people:

The National Eating Disorder Information Centre provides resources and referrals supporting people directly or indirectly affected by disordered eating.

Toll-free: 1-866-633-4220

Kids Help Phone offers free, anonymous and confidential professional phone counselling and online counselling, available 24/7 for kids and youth 20 years of age and younger.

1-800-668-6868

http://www.kidshelpphone.ca

The Canada Suicide Prevention Helpline is available for those who are in, or know someone who is in, immediate crisis or has suicide-related concerns.

1-833-456-4566 (24/7)

1-866-277-3553 in Quebec (24/7)

Text to 45645 (4 p.m. – Midnight ET). Text messaging rates apply. French text support is currently unavailable.