University of Queensland (UQ) anthropologist Mair Underwood has worked with bodybuilders for much of the past decade.
Initially focusing on body image and performance-enhancing drug use, Dr Underwood began to see issues with muscle dysmorphia emerge so often that she switched to investigating the disordered way of thinking.
Also called reverse anorexia or bigorexia, muscle dysmorphia is characterised by obsessive thoughts, compulsive behaviours and body image distortion, with sufferers seeing themselves as smaller than they are.
New research from UQ by Dr Underwood and Harvard University's Roberto Olivardia found people lifting weights for aesthetic reasons had a greater risk of developing muscle dysmorphia.
The study is the first to include an insider's perspective on the disorder.
Dr Underwood said muscle dysmorphia was first identified in bodybuilders, the people who were also most likely to suffer from it.
"Bodybuilding is a risk environment for mental health, and with so many young people building their bodies to look good, the dangers of developing muscle dysmorphia can't be ignored," she said.
The study found all men who immersed themselves in bodybuilding described themselves as having some degree of muscle dysmorphia and some sufferers attempted suicide.
While some women have been found to suffer from muscle dysmorphia, men were especially at risk.
The study found some bodybuilders try to manage the disorder by weighing and measuring themselves, taking photographs and asking others for feedback.
"Unfortunately, these management strategies are actually all symptoms of muscle dysmorphia, so it is vital people get guidance to develop strategies that will help them, instead of making the disorder worse," Dr Underwood said.
Focus on body alarming
As part of her research, Dr Underwood set a goal to achieve defined abdominal muscles to help understand the study participants.
"I was counting macronutrients, I had a personal trainer, a nutritionist, and I got into the best shape of my life," she said.
"But my hatred for the little bit of roundness on my stomach got out of proportion."
Dr Underwood said her focus on her body and diet was "changing my relationship with my body and food".
"And I'm a middle-aged woman, happily married; not a young man thinking your worth is based on how you look."
Study to urge management of condition
Funded by a UQ early career researcher grant, the study was conducted over the past four years in online communities frequented by bodybuilders who use image and performance enhancing drugs.
Dr Underwood said she hoped the study would encourage collaboration with the bodybuilding community to development management strategies for those with the disorder.
She said there were many people suffering and most did not go to a doctor with the issue.
"I do think someone could approach it like a sport and think, 'Let's see what my body can do', and remain somewhat detached," Dr Underwood said.
"But how you manage to do that is something I don't know, and the bodybuilding community doesn't know because their strategies often don't work and seem to be more sinking into the disorder.
"But by collaborating with bodybuilding communities, we can develop ways to help sufferers manage their disorder and prevent people developing it in the first place."
Dr Underwood said while some people were attracted to bodybuilding to overcome something they perceived as a physical flaw, she did not think all participants had undiscovered mental health issues.
