Elsevier

Clinical Psychology Review

Volume 25, Issue 2, February 2005, Pages 215-239
Clinical Psychology Review

Pursuit of the muscular ideal: Physical and psychological consequences and putative risk factors

https://doi.org/10.1016/j.cpr.2004.09.003Get rights and content

Abstract

Developing a lean muscular figure for the purposes of sports and/or appearance has become a central issue for males. Concern has been raised because the desire to develop such a body build may lead to the adoption of numerous health-threatening behaviors. Consequently, this review presents a comprehensive analysis of the physical and psychological consequences that result from the use of steroids (legal and illegal), ephedrine, and deleterious dieting strategies specific to males. Putative risk factors for these behaviors will be identified, and the clinical disorder associated with the extreme abuse of these behaviors, muscle dysmorphia, will be examined.

Introduction

Historically, the field of body image and eating disorders has been dominated by research that has focused on an examination of females (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). Although researchers have periodically focused on males (e.g., Andersen, 1990), it is only in the past 10 years that a good deal of attention has been redirected at body image disturbance and related behavioral dysfunctions of boys and men (Cafri & Thompson, 2004). Importantly, research suggests that body change behaviors designed to enhance muscularity, whether for aesthetic or athletic reasons, have deleterious physical and psychological sequelae (Yesalis & Bahrke, 2002a). Additionally, emerging evidence indicates that certain biological and environmental variables may predispose some individuals to engage in these high-risk behaviors (e.g., McCabe & Ricciardelli, 2004a). In this review, we detail the physical and psychological consequences of three behaviors used by males to enhance muscularity: steroid use, ephedrine use, and dieting. Additionally, we address the harmful outcomes related to relatively novel behaviors, such as the use of prohormones. Furthermore, we discuss emerging work on the identification of putative risk factors and clinical dysfunction related to body-change behaviors. Throughout the review, we highlight methodological shortcomings and gaps in the literature that future research should address.

It is important to emphasize that the research and treatment of the behaviors described in this paper and their proposed risk factors fall appropriately within the domain of clinical psychology. The cognitive–behavioral nature of the pursuit of a muscular body suggests that clinical psychologists are effectively prepared to conduct research, assessment, and treatment in this area. Although it is quite apparent that psychologists are well qualified to treat the proposed clinical disorder arising from an extreme pursuit of muscularity, muscle dysmorphia (Pope, Gruber, Choi, Olivardia, & Phillips, 1997), they are also well trained to address other specific problems, such as abuse of muscle enhancing substances (Miller & Brown, 1997). The ultimate purpose of this paper is to better inform psychologists about the relatively novel phenomenon of the pursuit of muscularity.

Section snippets

Muscular enhancement strategies and their consequences

There are a variety of techniques used by men and boys to increase their muscularity. In this review, we discuss three of the most prevalent behaviors: steroid use, ephedrine use, and dieting. In the first section, we dichotomize steroid use into illicit steroids, commonly referred to as anabolic–androgenic steroids, and legal steroids that are less potent substances that are sold over-the-counter, often regarded as prohormones. The subsection on illicit anabolic–androgenic steroids presents a

Methodological considerations

In this section, we review putative risk factors of some of the behaviors reviewed in the previous section. In order to better orient the reader, we have developed a model (Fig. 1) that diagrams the relations among variables examined in this section along with other variables thought to contribute to dysfunctional body change behaviors in boys and men. Although the model is somewhat empirically based, given that it is consistent with the findings of studies reviewed below and is derived from

Muscle dysmorphia

The clinical disorder that may result from the use of body-change behaviors aimed at improving the appearance of muscularity is muscle dysmorphia (MD), a proposed subtype of body dysmorphic disorder (Pope et al., 1997). According to Pope et al. (1997), sufferers of MD experience a kind of body dysmorphic disorder whereby they become “…pathologically preoccupied with their degree of muscularity, which may cause them to suffer severe subjective distress, impaired social and occupational

Conclusions

Body change behaviors geared toward the pursuit of a muscular ideal have received increased attention in recent years, due largely to the increasing prevalence of pathology at the clinical and sub-clinical levels. In an attempt to characterize certain pathological behaviors, we review the implications of the use of steroids, ephedrine, and certain eating behaviors. It was concluded that these three types of behaviors represent a significant risk to psychological and physical health. It was also

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