Body dysmorphic disorder, muscle dysmorphia, weight and shape dissatisfaction and the use of appearance-enhancing drugs in the military: a systematic review

Abstract

BackgroundBody dysmorphic disorder (BDD) and muscle dysmorphia (MD) are common but often underdiagnosed disorders. These disorders have rarely been explored in the context of military personnel by mental health researchers despite the emphasis on physical fitness in military populations. We conducted a comprehensive systematic literature review on scientific studies of BDD and MD and the accompanying symptoms within the military.MethodsWe used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and used PubMed, Web of Science and PsycINFO as databases with “body dysmorphic disorder,” “muscle dysmorphia,” “body image,” “performance and image enhancing drugs,” “anabolic steroid,” military personnel,” “soldiers,” “navy,” “air force,” “army” and “armed forces” as search terms.ResultsA total of 20 eligible articles reporting data of 42 952 study participants were used. According to the identified literature, prevalence rates of BDD in the military are ~10% in men and ~20% in women, whereas ~15% of men and ~5% of women may suffer from MD. Further identified related problems in military populations were excessive bodybuilding, the use of anabolic drugs, the intake of stimulants, weight and shape concerns, and weight-control behaviours.ConclusionsBDD, MD, as well as the use of anabolic and stimulating drugs, are highly prevalent in military personnel. Despite the importance of these problems in the military, there are no military-specific treatment studies available. A pre-existing focus on physical appearance and fitness might contribute to the decision to pursue a professional military career. The military environment might be a maintaining factor of BDD or MD, but not the ultimate cause of the disorder in an affected individual.

At the Crossroads between Eating Disorders and Body Dysmorphic Disorders—The Case of Bigorexia Nervosa

“…Whenever cases of bigorexia nervosa are identified, patients should also be screened for physical and psychiatric comorbidities and complications, such as AAS use disorder, physical exercise addiction, other behavioral/substance use disorders, and mood disorders. This recommendation is supported by a large body of data reviewed in the current paper [14,20,[23][24][25]27,33,38]. The diagnosis criteria used for characterizing clinical manifestations of bigorexia nervosa are not yet unanimously accepted, highlighting the controversies around this nosological entity.…”

“…Based on a literature review (n = 34 articles), the lifetime prevalence rates of muscle dysmorphia in male weightlifters were between 13.6% and 44%, with variations in demographic variables and diagnostic criteria [ 32 ]. Another systematic review identified 5% (in women) and 15% (in men) prevalence of muscle dysmorphia in military personnel and associated problems such as excessive bodybuilding, use of anabolic steroids or stimulants, weight- and shape-related preoccupations, and dysfunctions associated with the desire to control body weight [ 33 ].…”

Randomized Controlled Trials to Treat Obesity in Military Populations: A Systematic Review and Meta-Analysis

“…Additionally, most studies have used body weight or BMI as outcome parameters to measure the success of weight loss programs. However, soldiers often endeavor to gain muscle mass in order to cope with the physical demands of their job or to appear physically fitter and more muscular, which can even become a mental health problem [105]. In fact, the comparatively smaller effect size of weight loss interventions in this population compared to general populations may be because of the different distribution of muscle mass and fat mass when considering the whole BMI composition in these populations.…”