Muscle dysmorphia among trans and non-binary individuals

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People of all different backgrounds and identities experience muscle dysmorphia, but some populations may be more prone than others. Muscle dysmorphia is of particular concern among the trans and non-binary community.

Last updated on 
December 2, 2021
In this article

What is muscle dysmorphia?

Muscle dysmorphia is a subtype of Body Dysmorphic Disorder that is characterized by a pathological pursuit of muscularity. People struggling with muscle dysmorphia have an intense fear about their muscles being too small and have an obsessive drive to gain muscle. (1)

Someone with muscle dysmorphia may become fixated on their muscle size, so much that this preoccupation interferes with their ability to function in their daily life. 

Signs of muscle dysmorphia

Muscle dysmorphia is different from simply wanting to increase muscle mass. People with this disorder have an excessive preoccupation with their perceived flaw of having insufficient muscle. Some common signs of muscle dysmorphia may include: (1,2)

  • Excessive workouts
  • Constant mirror checking
  • Disordered eating behaviors
  • Shame about perceived muscular flaws
  • Excessive worry about appearance
  • Intrusive and pervasive thoughts about appearance
  • Feeling upset about appearance

Those with muscular dysmorphia may also often have co-occurring mental health conditions, including anxiety and mood disorders, substance addictions, disordered eating behaviors, eating disorders and suicidal behaviors. (1) 

The connection between muscle dysmorphia and gender minorities

It’s been well-documented that cisgender men and boys often struggle with muscle dysmorphia, likely due to internalization of societal messages promoting hyper-muscular bodies as ideal for men. (3) However, less research has been conducted on its prevalence among transgender men and gender-expansive people (including genderqueer, non-binary, agender, bigender, etc.). 

Transgender people

Recent research has revealed that transgender men have the highest muscle dysmorphia symptoms followed by gender-expansive or non-binary people, with trans women having the lowest prevalence of muscle dysmorphia symptoms out of the study sample. (1)

Another study showed that transgender and cisgender men scored equally high on drive for muscle size. This may be because transgender men feel the same societal pressures as cisgender men to meet certain masculine ideals, especially if they have anxiety or stress about “passing”—which means they tend to be perceived as cisgender men. (3)

Many transgender men may develop a preoccupation with muscle size in order to affirm their gender, a preoccupation which could progress into muscle dysmorphia, disordered eating, and other issues.

Another reason some trans men may struggle with muscle dysmorphia is due to the desire to transform their body shape to be more consistent with male body image ideals, such as having a more muscular chest. Researchers also posit that trans men may overexercise to decrease what they perceive to be “feminine” fat, such as fat around the hip area.

This desire to affirm one’s gender may be responsible for trans women experiencing the lowest degree of muscle dysmorphia symptoms—because societal norms for women tend to focus on thinness or muscle tone as opposed to large muscles. (1) Of course, this “ideal” body image for women is problematic as well, as these pressures can lead to poor self-esteem, poor body image, and eating disorders.

Gender expansive individuals

Research has revealed that gender-expansive people reported muscle dysmorphic scores that fell between those of trans men and trans women. The range and variability of these symptoms was much broader than those of binary trans men and women, which can be expected given the variation of gender identity and expression within this group.

Some people in this population expressed concerns about chest size or genitals, while others expressed a motivation to achieve what they perceive to be a gender fluid or androgynous appearance, a balance of feminine and masculine traits. (1) People who don’t fall into the binary (men and women) may be at a significant risk for being a victim of violence, self-harm behaviors, mental health comorbidities, sexual assault and harassment, and social stressors, all of which may be risk factors for body image issues. (1) 

Affirming treatment for muscle dysmorphia

Given the unique challenges that transgender and gender-expansive individuals experience, they require compassionate and affirming treatment from mental health professionals who understand trans and non-binary issues, such as:

  • Being rejected by family and/or peers
  • Fear and anxiety about coming out, in various aspects of life
  • The stress of being misgendered
  • Discrimination 
  • Bullying
  • Violence, especially sexual violence
  • Co-occurring psychiatric conditions
  • Comorbid substance use disorders

Affirming treatment for gender minorities experiencing muscle dysmorphia as well as any related issues like eating disorders is extremely important, as it means these individuals have a safe space for recovery. It is vital that they won’t have to worry about having to correct their pronouns, being misgendered, or experiencing prejudice during their course of treatment.

At Within Health, patient safety is a top priority, which is why we offer specialized, inclusive treatment for eating disorders presenting in trans and non-binary patients, as well as other members of the LGBTQIA+ community. Our treatment program is entirely virtual, which means patients can feel comfortable receiving treatment, no matter where they are.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Nagata, J.M., Compte, E.J., McGuire, F.H., Lavender, J.M., Brown, T.A., Murray, S.B., Flentje, A., Capriotti, M.R., Lubensky, M., Obedin-Maliver, J. & Lunn, M.R. (2021). Community norms of the muscle dysmorphic disorder inventory (MDDI) among gender minority populations. Journal of Eating Disorders, 9(87). 1-10.
  2. Nieuwoudt, Johanna E.; Zhou, Shi; Coutts, Rosanne A.; Booker, Ray. (2015). Symptoms of Muscle Dysmorphia, Body Dysmorphic Disorder, and Eating Disorders in a Nonclinical Population of Adult Male Weightlifters. Journal of Strength and Conditioning Research 29(5): 1406-1414.
  3. Amodeo, A. L., Esposito, C., Antuoni, S., Saracco, G., & Bacchini, D. (2020). Muscle dysmorphia: what about transgender people?Culture, health & sexuality, 1–16. Advance online publication. https://doi.org/10.1080/13691058.2020.1814968

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