You started working out to feel better. Stronger. More confident. But somewhere along the way, the relationship with your body shifted. No matter how much muscle you build, it never feels like enough. You check the mirror constantly—not out of vanity, but out of anxiety. You’ve rearranged your entire life around training, meals, and body fat percentage, and the thought of missing a workout fills you with dread.

This isn’t discipline. This is muscle dysmorphia—sometimes called bigorexia, reverse anorexia, or the adonis complex. It’s a subtype of body dysmorphic disorder (BDD) that turns the pursuit of a muscular body into a source of significant distress. And it’s more common than most people realize—especially among men who would never think of themselves as having a body image problem.

At Therapy Group of DC, our therapists work with clients experiencing muscle dysmorphia and body image concerns. We understand this isn’t vanity—it’s a painful disconnect between how you see yourself and reality. We use psychodynamic, cognitive behavioral, and relational approaches to help you build a healthier relationship with your identity, your body’s appearance, and your daily life.

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Is Muscle Dysmorphia Therapy Right for You?

You might benefit from muscle dysmorphia therapy if you:

• Spend hours each day thinking about your muscularity, muscle mass, or whether you look “big enough”
• Feel intense anxiety or shame when you miss a workout or deviate from your meal plan
• Avoid social situations—dates, events, even the beach—because of how you perceive yourself
• Check mirrors compulsively or avoid them entirely
• Continue training through injury because the fear of losing muscle growth outweighs physical pain
• Use dietary supplements excessively or have considered anabolic steroids to gain muscle
• Feel that your body weight or leanness determines your worth
• Have noticed relationships, work, or finances suffering because of your training and eating habits
• Wear baggy clothing to hide your physique despite being objectively muscular
• Compare yourself to others constantly—at the gym, on social media, in everyday life

What to know:

• Muscle dysmorphia is classified under body dysmorphic disorder (BDD) in the Diagnostic and Statistical Manual, published by the American Psychiatric Association
• It is a recognized psychiatric disorder—not a personality flaw or vanity
• Muscle dysmorphia is associated with high rates of anxiety, depression, and suicide attempts
• Effective treatment addresses both the behavioral patterns and the underlying distortion
• With the right support, you can rebuild a healthy lifestyle that includes physical fitness without it consuming your identity

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Understanding Muscle Dysmorphia

Muscle dysmorphia is a body image disorder in which you become preoccupied with the belief that you’re not muscular enough—even when others see you as fit. It’s sometimes described as a secret crisis because people experiencing it often look healthy while suffering internally.

The condition shares features with obsessive compulsive disorder (repetitive behaviors, intrusive thoughts about one’s body) and eating disorders (restrictive eating, rigid eating behaviors, disordered eating). The American Psychiatric Association classifies it as a specifier of body dysmorphic disorder BDD, though its overlap with eating disorder symptomatology is well-documented.

The “moving target” phenomenon defines the experience. You reach a goal—hit a body fat percentage, build muscle to a target size—and immediately the goalpost shifts. No achievement brings lasting relief because the distortion exists in how the mind perceives the human body, not in reality. This is fundamentally different from healthy goal-setting in athletic training.

Muscle dysmorphia primarily affects men, particularly physically active men in bodybuilding, powerlifting, and sports where body size matters. But in DC’s achievement-oriented culture, we also see it in lawyers, consultants, and government professionals whose drive for control extends from the office to the gym. Men who have sex with men face increased risk due to pressures around physical attractiveness and sexual orientation. Muscle dysmorphia is rare in women but does occur, particularly among female bodybuilders including women rape victims—where building a muscular body may serve as an unconscious protective strategy.

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How We Treat Muscle Dysmorphia

Psychodynamic Therapy

We explore the psychological roots—how early experiences, attachment patterns, and identity formation shaped your relationship with your body. For many clients, the compulsive pursuit of muscularity serves an unconscious function: managing anxiety, maintaining control, or compensating for shame. Psychodynamic therapy helps you understand what the obsession is really about.

Cognitive Behavior Therapy

Cognitive behavior therapy addresses distorted thinking and compulsive behaviors. This includes challenging beliefs (“I’m too small,” “People are judging my physique”), reducing body-checking rituals, and building tolerance for anxiety when routines are disrupted.

Addressing Disordered Eating

Because muscle dysmorphia frequently involves rigid eating habits and disordered eating, treatment includes rebuilding a healthier relationship with food—with guidance from a medical specialist when appropriate.

Medication Considerations

Pharmacotherapy with SSRIs has shown support as a treatment option for muscle dysmorphia. We coordinate with psychiatrists and medical specialists who understand body dysmorphic disorder and related mental disorders. We don’t prescribe directly but facilitate referrals.

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What to Expect

The first session is about understanding your experience—not asking you to stop training. Your therapist will want to understand what brought you in, how the concerns affect your life, and what you’re hoping for. Many people with muscle dysmorphia deny there is a problem or feel ambivalent about seeking treatment. We understand this.

The goal isn’t to stop caring about physical fitness. It’s to help the gym become a place of genuine health rather than extreme distress. Therapy helps you transition from compulsive behaviors to balanced routines—where exercise supports your life instead of consuming it.

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Our Muscle Dysmorphia Therapists

Our therapists bring experience with body image, identity, and the psychological factors that drive body dissatisfaction. They create a nonjudgmental space where you can be honest about behaviors you may have never discussed—including steroid use, extreme dieting, or how deeply this affects you.

Dr. Tyler Miles, Psy.D.

Dr. Miles specializes in helping high-functioning professionals who look “together” on the outside but are struggling on the inside. Her background in sport and performance psychology and her focus on body image makes her particularly well-suited for clients experiencing muscle dysmorphia. View Dr. Miles’s full profile →

Kevin Malley, MS, LPC, NCC

Kevin uses existential, relational, and person-centered approaches to help clients cultivate a healthier relationship with their emotions and self-worth. He creates a safe space for navigating the pressures that drive rigid patterns around training and identity. View Kevin’s full profile →

Dr. Keith Clemson, Ph.D.

Dr. Clemson draws on attachment-based and emotionally focused approaches. His work with relationships and self-esteem makes him a strong fit for clients whose muscle dysmorphia is affecting their partnerships, intimacy, or sense of connection. View Dr. Clemson’s full profile →

Dr. Kevin Isserman, Psy.D.

Dr. Isserman brings experience supporting individuals with body dysmorphia and body image concerns, including athletes navigating the intersection of identity and appearance. His affirming, self-compassion-focused approach helps clients feel safe exploring the shame that often accompanies muscle dysmorphia. View Dr. Isserman’s full profile →

Dr. Michael Burrows, Ph.D.

Dr. Burrows uses psychodynamic and relational therapy to help clients explore identity, self-esteem, and the patterns keeping them stuck. His insight-driven approach is well-suited for clients ready to look beneath surface behaviors at what’s really driving them. View Dr. Burrows’s full profile →

Xihlovo Mabunda, MS, LPC

Xihlovo’s practice is rooted in social justice and cultural identity, with particular attention to body image and how societal pressures shape self-perception. She creates a space where clients can explore their relationship with themselves authentically and without judgment. View Xihlovo’s full profile →

Dr. Jessica Hilbert, Psy.D.

Dr. Hilbert creates a safe, collaborative space where clients can face the feelings they’ve been avoiding. Her curiosity-driven approach helps clients uncover the emotional roots of their struggles and grow in ways they didn’t expect. View Dr. Hilbert’s full profile →

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Begin Muscle Dysmorphia Therapy in Washington DC

You’ve spent enough time trapped in a cycle of training harder, eating stricter, and still never feeling like enough. The mirror has become your critic, and the gym has stopped being a source of relief.

Muscle dysmorphia therapy at Therapy Group of DC can help you understand what’s driving the obsession, rebuild your self-image, and reclaim the parts of your life you’ve been sacrificing.

Schedule an Appointment →

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Frequently Asked Questions

What is muscle dysmorphia?

Muscle dysmorphia is a subtype of body dysmorphic disorder characterized by a persistent preoccupation with being insufficiently muscular or lean. Despite often being objectively muscular, individuals perceive themselves as small, weak, or inadequate. It’s classified under body dysmorphic disorder BDD in the DSM-5. The condition involves body image dissatisfaction that drives compulsive weight lifting, restrictive eating, and repetitive behaviors like mirror checking. It shares features with obsessive compulsive disorder and eating disorders including anorexia nervosa, making it a complex psychiatric disorder that requires specialized psychological treatment.

What is the meaning of bigorexia?

Bigorexia is a colloquial term for muscle dysmorphia, sometimes also called reverse anorexia, the adonis complex, or vigorexia. The term captures the condition’s central paradox: the person is often objectively large yet perceives themselves as not big enough. Like anorexia nervosa and bulimia nervosa, bigorexia involves a fundamental distortion in how someone perceives one’s body. It is recognized as a form of body dysmorphia—a male body obsession that goes far beyond normal interest in physical fitness or athletic training.

How do people with muscle dysmorphia see themselves?

People with muscle dysmorphia experience genuine perceptual distortion—they see themselves as significantly less muscular than they actually are. This isn’t false modesty. The gap between perception and reality causes real distress and drives compulsive behaviors to “fix” a perceived inadequacy that others simply don’t see. Psychology research on body image disorders shows this distortion parallels what occurs in other body dysmorphic disorder presentations, where the perceived flaw is minimal or nonexistent to outside observers.

What are the signs I might have muscle dysmorphia?

Key muscle dysmorphia symptoms include: preoccupation with body size and muscularity that dominates your thinking, exercise dependence and significant anxiety when missing workouts, rigid eating habits and restrictive eating patterns, compulsive mirror checking or avoidance, use of anabolic steroids or dangerous substances, sacrificing relationships and other interests for training, and body dissatisfaction despite objective muscularity. The onset typically occurs in young adults between ages 18 and 20, and risk factors include experienced childhood trauma, media influences promoting unrealistic body types, competitive gym environments, and psychological factors like perfectionism and low self-esteem.

Who is at risk for muscle dysmorphia?

Muscle dysmorphia primarily affects male populations, particularly physically active men involved in bodybuilding and sports where body size is competitive. Prevalence is even higher among users of anabolic steroids. Men who have sex with men face increased risk due to pressures around sexual orientation and physical attractiveness. Research across a south african sample and other international studies confirms the condition exists globally, not just in Western cultures. Individual differences in childhood trauma, body types, and mental health vulnerabilities all contribute. Muscle dysmorphia is rare in women but occurs among female bodybuilders, including women who have experienced sexual assault. Body dissatisfaction related to muscularity has been identified in boys as young as six, and media influences—especially social media—have accelerated male body image problems among young adults and male populations broadly.

What is the best therapy for muscle dysmorphia?

Cognitive behavior therapy is considered the gold-standard psychological treatment, addressing the body image distortion and repetitive behaviours similar to OCD treatment. Psychodynamic therapy addresses the deeper psychological factors—including experienced childhood trauma and identity issues—that drive the condition. Pharmacotherapy with SSRIs is supported as an additional treatment option. The most effective approach typically combines methods tailored to individual differences. Family-based therapy has also shown efficacy. Support groups and education about healthy body ideals can supplement individual treatment, and coordination with a medical specialist is important when anabolic drug abuse or substance abuse is involved.

Is muscle dysmorphia an eating disorder?

Muscle dysmorphia is classified as a subtype of body dysmorphic disorder, not as an eating disorder in the Diagnostic and Statistical Manual—though the overlap is significant. Many people with muscle dysmorphia meet criteria for an eating disorder diagnosis due to eating disorder symptomatology and rigid eating behaviors focused on muscle growth and body fat percentage. The condition shares features with anorexia nervosa and bulimia nervosa while being clinically distinct. Treatment addresses both the body image distortion and the disordered eating patterns, which is why seeking treatment from a therapist familiar with both body image disorders and eating disorders matters.

What to say to a man with body dysmorphia?

Avoid minimizing with statements like “you look great” or “just stop worrying about it”—reassurance rarely helps with body dysmorphic disorder because the distortion means your words can’t override their perception of one’s body. Instead, express concern without judgment: “I’ve noticed how much stress this causes you—I’m here for you.” Encourage seeking treatment from a mental health professional rather than trying to convince them their perception is wrong. Men are often discouraged from seeking treatment for body image problems due to cultural norms around masculinity—raising awareness and normalizing help-seeking matters. The condition is a secret crisis for many men, and substance abuse involving anabolic steroids or dietary supplements may co-occur, making professional support even more important.

How much does muscle dysmorphia therapy cost?

Therapy Group of DC is an out-of-network practice. We provide documentation to help you seek reimbursement from your insurance provider. Session rates vary by therapist—contact us for current pricing. We offer both in-person sessions at our Dupont Circle office and telehealth throughout DC, Maryland, and Virginia.

Can muscle dysmorphia affect your mental health long-term?

Yes. Muscle dysmorphia is associated with significantly higher rates of anxiety, depression, and suicide attempts than the general population. The condition carries high comorbidity with substance abuse, other mental disorders, and eating disorders. Without treatment, the compulsive behaviors and body dissatisfaction typically escalate, affecting occupational functioning, relationships, and overall quality of everyday life. The repetitive behaviours and exercise dependence associated with muscle dysmorphia can lead to physical harm as well as psychological distress. Other factors like social isolation and the pursuit of the ideal male body compound the damage over time. Early psychological treatment produces better outcomes, which is why recognizing risk factors and seeking treatment matters—even when the condition is trivialized as simply caring about a healthy lifestyle.

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This page provides general information about therapy. It is not a substitute for professional mental health advice, diagnosis, or treatment.