Wanting to improve your body composition is not necessarily a bad thing. Indeed, we see many positives to health with an increase in muscle mass. However, when chasing muscularity goes too far, it can be detrimental to body image and overall health. What is this “drive for muscularity”, and why does it matter?

 Muscle Mass & Health

Sufficient muscle mass is essential for optimal health and normal physiological functioning ^[1]. Skeletal muscle is the primary storage site of amino acids, which we use for protein synthesis. Individuals with lower muscle mass have an increased susceptibility to a litany of co-morbidities, such as osteopenia, cancer risk, cardiovascular disease and organ failure ^[2].

Unsurprisingly so, we are encouraged to engage in behaviours that promote the maintenance and growth of our skeletal muscle. Such behaviours include engaging in resistance training and eating sufficient dietary protein ^[3,4].

Let it be clear from the outset, that engaging in these behaviours is not problematic. Please read that again. Indeed, for most people, exercise can a positive effect on our confidence and body image ^[5]. However, for some individuals, constantly chasing an increase in muscle mass can lead to body dissatisfaction and engagement in less “healthful” behaviours.

The Drive for Muscularity

In 2000, McCreary and Sousse proposed the concept of drive for muscularity, devising the Drive for Muscularity Scale ^[6]. This lead to the advancement of research into this area, which has led to some really interesting findings.

Historically, body image research has typically centred on female-specific concerns and behaviours, such as a drive for thinness ^[7]. The perceived “ideal” male physique is muscular, not thin [8] and consequently being “thin” is generally considered less important to men.  As we have used predominantly research to devise assessment methods of disordered eating/body image concerns, we have potentially underdiagnosed and underreported male body image concerns.

Drive for muscularity research aims to bridge this gap. Individuals affected by this drive for muscularity feel tension/distress when they perceive themselves to be insufficiently muscular ^[6]. As a result of these sensations, sufferers will often engage in “muscularity-increasing” behaviours to compensate for this, such as over-exercising or anabolic steroid use ^[9]. Big yikes.

It is incredibly important to note that the DFM doesn’t just mean adding size. The DFM involves both increasing lean muscle tissue, whilst simultaneously reducing body fat so that muscularity is visible ^[10].

Risk Factors for DFM

Of course, not everyone who wants glutes of steel or delts you could build a future on develops disordered eating behaviours or patterns. What differentiates a natural desire for self-improvement from a high-risk disordered eating behaviour?

Unlike some of the other risk factors for disordered eating, this drive for muscularity is not biologically driven. Rather, it is driven by a societal value on muscular physiques as the “ideal” body ^[10].

As a result, research has found that men are more predisposed to this drive for muscularity ^[11]. The societal expectation on men to possess a muscular physique is equivalent to the female expectation to be “thin/lean” ^[10]. In their systematic review, Edwards et al. ^[10] found that young males were at most risk. However, in their review, it is important to note that 79% samples in the studies included in this systematic review were male, and 80% were under 25. Of course, this is not equal representation of gender, or even all-age groups. So, whether this is truly accurate is a bit iffy in my opinion.

Furthermore, assessment methods are biased towards male presentations. The original DFM scale asks individuals to rank their arms and chest size, and only one ranking for the legs ^[6]. It also ranks the desire for “bulky” muscles. Again, these are obviously risk factors for DFM, but in females the desire for muscularity presents as a desire for muscle tone/definition, but not necessarily overall mass ^[12]. Other assessment methods such as the Swansea Muscularity Attitudes Questionnaire ^[13] were developed using entirely male samples and ask individuals to rank whether muscularity makes them feel less like a man. Obviously for females, this is not an accurate assessment metric, and using it to generate population-wide DFM scores potentially has huge room for error.

Of course, the higher rates of DFM indicate it is mostly men who suffer, but I think the lack of equal gender study is a point to bear in mind going forward, particularly as the “ideal” female physique has changed to a “lean muscular” ideal as opposed to solely thin ^[14].

Regardless of my beef with the direction research has been lead in, other risk factors for DFM are a little more clear-cut. DFM is associated with appearance anxiety, social physique and anxiety and shame ^[10]. DFM was not significantly linked with vanity ^[10], which is a point I thought was really interesting. This pathological obsession with muscularity may be written-off by observers as the individual being “full of themselves” or narcissistic, when there is actually something a lot deeper going on underneath the surface.

Predictably, social media use and exposure to “fitspo” imagery is associated with an increased risk of DFM in men [15]. This is likely due to internalisation of these “body ideals” which affects both men and women. Exposure to so-called “ideal” bodies reinforces the demand and drive to achieve these socially-envied bodies ^[16].

Engaging in behaviours that affect muscularity can also be a risk factor ^[10]. Now, this requires some cop-on on your part, dear reader. Weight training is an effective means of increasing muscle mass, but lifting weights doesn’t automatically place you at risk for DFM. In fact, resistance training is typically associated with improved body image ^[17]. So, we need to be cautious about interpreting these findings. I would challenge this statement, and suggest it is excessive engagement in weight training that drives this DFM. I’m talking if you train twice a day and immediately run to the mirror to check for muscle growth. That will place you at risk of DFM, more so than doing a few deadlifts on a Saturday afternoon.

Other behaviours that certainly drive DFM include use of anabolic steroids and other performance-enhancing drugs ^[18,19]. Now, keep your hat on if you take steroids. Taking steroids won’t automatically give you muscle dysmorphia, but it may make you more likely to suffer from it. And let’s be real, you wouldn’t be taking anabolics if you weren’t focusing on chasing muscularity, would you?

Consequences of DFM

DFM has many undesirable consequences that hugely impair the quality of life of an individual. Pathologically chasing gains is associated with exercise dependence, anabolic steroid misuse, depression and muscle dysmorphia ^[10]. All of these impact the social and occupational functioning of the individual.

DFM exists on a spectrum, and its impact on individuals is unique.

As most of the research focuses on men, I think it pertinent to highlight just how detrimental this pedestalisation of muscularity can be. DFM can greatly impact male body image and overall self-esteem ^[20]. I think it is vital to draw on the findings of Eik-Nes et al.’s prospective cohort study of young men ^[21]. Men with high DFM at baseline were more likely to be depressed, have poorer health and engage in binge-drinking in later years.

With male mental health basically in the gutter these days, and support services for mental health even further in the gutter, I think this is an incredibly important finding that we cannot overlook. We have neglected male mental health awareness for a horrendous amount of time. Now we have data that shows a clear link between a DFM and mental health. An awareness of the consequences of engaging in high-risk behaviours needs to be spread. In my opinion, if we aren’t going to support those with mental health issues in this country, we can at least try and stop these issues from happening.

Conclusions

DFM is a really interesting (albeit highly depressing) research area. The findings are stark, and really offer us a lot to think about. Choosing what we deem to be “risky” for developing DFM is not really clear-cut, and risk factors generally need to be considered in the context of an individual. Overall, we want to look out for:

• Excessive emphasis on muscularity
• Body checking (flexing/pinching the body to assess for muscularity at regular intervals)
• Obsession with “fitspo” content on social media
• Anabolic steroid use
• Excessive weight training

You will notice that these risk factors are very broad and subjective. That is because risk factors are both broad and subjective. Please, don’t put words in my mouth and try cancel me for saying lifting weights will give you body image issues.

Overall, I think this DFM needs to be given a lot more attention, both in research (in terms of designing interventions) and amongst the general public (make us aware pls).

As always, I am very interested to hear your thoughts on the research.

Recommended Reading

As a starting point, obviously the original McCreary and Sousse paper is excellent. However, as this was pioneered on adolescents, the research has changed a lot since then. I think a more beneficial read, that ties together current thinking is the systematic review from Edwards et al (2014). Both of these papers can be found via the references below.

References

1. Wolfe RR (2006) The underappreciated role of muscle in health and disease. Am J Clin Nutr 84(3), pp. 475-482.
2. Sartori R, Romanello V, Sandri M (2021) Mechanisms of muscle atrophy and hypertrophy: implications in health and disease. Nature Comm 12(330).
3. Schoenfeld BJ, Ogborn D, Krieger JW (2016) Dose-response relationship between weekly resistance training volume and increases in muscle mass: A systematic review and meta-analysis. J Sport Sci 35(11), pp. 1073-1082.
4. Tagawa R, Watanabe D, Ito K et al. (2021) Dose-response relationship between protein intake and muscle mass increase: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 79(1), pp. 66-75.
5. Hausenblas HA, Fallon EA (2005) Exercise and body image: A meta-analysis. Psychol Health 21(1), pp. 33-47.
6. McCreary DR, Sousse DK (2000) An Exploration of the Drive for Muscularity in Adolescent Boys and Girls. Coll Health 48, pp. 297-305.
7. Karazsia BT, Murnen SK, Tylka TL (2017) Is body dissatisfaction changing across time? A cross-temporal meta-analysis. Psychol Bull 143(3), 292-320.
8. Thomas A, Tod DA, Edwards CJ et al. (2014) Drive for Muscularity and Social Physique Anxiety Mediate the Perceived Ideal Physique Muscle Dysmorphia Relationship. J Strength Cond Res 28(12), pp. 3508-3514.
9. Bergeron D, Tylka TL (2007) Support for the uniqueness of body dissatisfaction from drive for muscularity among men. Body Image 4, pp. 288-295.
10.  Edwards C, Tod D, Molnar G (2014) A systematic review of the drive for muscularity research area. Int Rev Sport Ex Psychol 7(1), pp. 18-41.
11.  Blashill AJ (2011) Gender roles, eating pathology, and body dissatisfaction in men: A meta-analysis. Body Image 8(1), pp. 1-11.
12.  Kyretjo JW, Mosewich AD, KC Kowalski et al. (2008) Men’s and women’s drive for muscularity: Gender differences and cognitive and behavioral correlates. Int J Sport Ex Psychol 6(1), pp. 69-84.
13.  Edwards S, Launder C (2000) Investigating muscularity concerns in male body image: Developing the Swansea Muscularity Attitudes Questionnaire. Int J Eat Disord 28(1), pp. 120-124.
14. Bozsik F, Whisenhunt BL, Hudson DL et al. (2018) Thin Is In? Think Again: The Rising Importance of Muscularity in the Thin Ideal Female Body. Sex Roles 79, pp. 609-615.
15.  Seekis V, Bradley GL, Duffy AL (2021) Social networking sites and men’s drive for muscularity: a revised objectification model. Psychol Men Masc 22(1), pp. 189-200.
16.  Pritchard M, Cramblitt B (2014) Media Influence on Drive for Thinness and Drive for Muscularity. Sex Roles 71, pp. 208-218.
17.  SantaBarbara NJ, Whitworth JW, Ciccolo JT (2017) A Systematic Review of the Effects of Resistance Training on Body Image. J Strength Cond Res 31(1), pp. 2880-2888.
18.  Nagata JM, McGuire FH, Lavender JM et al. (2022) Appearance and performance-enhancing drugs and supplements (APEDS): Lifetime use and associations with eating disorder and muscle dysmorphia symptoms among cisgender sexual minority people. Eating Behav 44.
19.  Rohman L (2009) The relationship between anabolic androgenic steroids and muscle dysmorphia: a review. J Treat Prev 17(3), pp. 187-199.
20.  Hobza CL, Rochlen AB (2009) Gender role conflict, drive for muscularity and the impact of ideal media portrayals on men. Psychol Men Masc 10(2), pp. 120-130.
21.  Eik-Nes TT, Austin SB, Blashill AJ et al. (2018) Prospective health associations of drive for muscularity in young adult males. Int J Eat Disord 51(10), pp. 1185-1193.