The lived complexity of phantom limb telescoping: insights from a qualitative study.

In a society where the ideal body is increasingly defined by muscularity and leanness [, ], the pursuit of a “perfect” muscular physique may, for some individuals, become pathological. This phenomenon is known as muscle dysmorphia (MD). According to the DSM-5 [], MD is a subtype of body dysmorphic disorder (BDD), characterized by an excessive preoccupation with perceived flaws in physical appearance, repetitive behaviors (e.g., mirror checking) or mental preoccupation (e.g., comparing oneself to others). It causes significant distress or impairment and is not better explained by concerns about body fat or weight, thus excluding individuals with an eating disorder. The specifier ‘with muscle dysmorphia’ applies when the main concern is being too small or insufficiently muscular. Pope et al. [] proposed more specific criteria that mirror the DSM-5 but include additional details to better capture the clinical features of MD and its distinct focus on muscularity. These criteria include -next to the belief that one’s body is insufficiently lean and muscular- behaviors such as excessive weightlifting and strict dieting, a disruption of daily routines due to compulsive exercise or dieting, continuation of these behaviors despite awareness of the negative consequences, clinically significant distress, and impairments in social, occupational, and recreational functioning (e.g., avoidance of situations where the body is exposed). Considering the importance of excessive training in MD, it is not surprising that this disorder is most commonly observed in samples of weightlifters and bodybuilders, with estimated prevalence rates ranging from roughly 17 to 58.3% across studies [–]. However, when broader population samples are examined, prevalence estimates appear considerably lower. Applying the Muscle Dysmorphic Disorder Inventory (MDDI []), a self-report questionnaire assessing MD symptoms, 25.7% of men, 11.2% of women, and 18.0% of transgender individuals were identified to be “at risk” for MD in a Canadian study []. Similar rates are observed among German “fitness enthusiasts”, with 25% of men and 16% of women []. However, the MDDI only identifies “at risk” populations and does not provide a clinical diagnosis. In contrast, when MD is operationalized in line with diagnostic criteria proposed by Pope et al. [], it more closely approximates a clinical diagnosis, yielding substantially lower prevalence estimates of 2.2−2.8% among adolescent boys and men and 1.4% among girls [, ]. Overall, these findings suggest that MD is more common in men than in women.