Perfectionistic tendencies may explain why some men develop muscle dysmorphia

A new study published in Clinical Neuropsychiatry has shed light on why some men develop muscle dysmorphia, a condition characterized by an obsessive desire to be more muscular. Researchers found that vulnerable narcissism, a form of narcissism marked by feelings of inadequacy and sensitivity to criticism, is linked to an increased risk of muscle dysmorphia. This risk appears to be driven by perfectionistic tendencies, suggesting that the pursuit of an unattainable ideal physique may be a way for men with vulnerable narcissism to cope with their insecurities.

Muscle dysmorphia, sometimes referred to as “reverse anorexia,” is a mental health condition where individuals become fixated on the idea that they are not muscular enough, even when they are objectively very muscular. People with muscle dysmorphia often experience significant distress and engage in excessive exercise, dieting, and sometimes the use of performance-enhancing drugs in their pursuit of muscularity.

Although it is classified as a subtype of body dysmorphic disorder, some experts argue that it shares more similarities with eating disorders. Muscle dysmorphia is more commonly reported in men, especially those involved in bodybuilding or weightlifting, and it can have serious negative impacts on mental and physical well-being. Recognizing the potential harm associated with muscle dysmorphia, scientists are working to better understand the factors that contribute to its development.

Previous research has suggested a possible link between narcissism and muscle dysmorphia. Narcissism, often associated with arrogance and a need for admiration, is a complex personality trait. It is increasingly understood to have two main forms: grandiose narcissism and vulnerable narcissism. Grandiose narcissism involves an inflated sense of self-importance and a desire for attention, while vulnerable narcissism is characterized by low self-esteem, sensitivity to judgment, and feelings of shame. While some studies have explored the connection between narcissism and muscle dysmorphia, the specific role of vulnerable narcissism has become a focus, as it appears more closely related to body image concerns and anxieties.

Furthermore, perfectionism, the tendency to demand flawlessness and set excessively high standards, has also been implicated in muscle dysmorphia. Individuals striving for an “ideal” body may exhibit perfectionistic traits in their pursuit of muscularity. Researchers theorize that perfectionism might act as a bridge between vulnerable narcissism and muscle dysmorphia. Men with vulnerable narcissism, feeling inadequate and imperfect, might turn to perfectionistic behaviors in their pursuit of muscularity as a way to compensate for these feelings. However, the precise way in which perfectionism might connect vulnerable narcissism to muscle dysmorphia risk has not been thoroughly examined until now.

Free daily newsletter

To investigate this potential connection, researchers in Turkey conducted a study involving 135 men who regularly went to the gym. The participants, with an average age of 25, were recruited from various gyms in Istanbul. The majority were single and held bachelor’s degrees. The study was approved by the Ethics Committee of a relevant institution, and all participants provided informed consent. They were told the study was about understanding men’s eating and exercise habits. Each participant completed a set of questionnaires under the supervision of the research team, which took approximately 20 minutes. To ensure privacy, each participant was assigned a unique code.

The questionnaires included several measures designed to assess different aspects of the participants’ psychology and behaviors. First, participants filled out a basic information sheet detailing their age, marital status, and education level. They were also asked about their gym habits, including the type and frequency of their training, participation in competitions, eating habits (number of meals and snacks per day), and use of anabolic steroids and nutritional supplements.

To measure muscle dysmorphia risk, the researchers used the Muscle Dysmorphic Disorder Inventory. This questionnaire contains 13 questions assessing symptoms of muscle dysmorphia across three areas: the drive for size (e.g., “I think my chest is too small”), intolerance of appearance (e.g., “I wear loose clothing so that people cannot see my body”), and functional impairment due to muscle dysmorphia (e.g., “I pass up social activities because of my workout schedule”). Participants rated each item on a scale from “strongly disagree” to “strongly agree.” Higher total scores on this inventory indicate a greater risk for muscle dysmorphia. A score of 39 or higher is considered indicative of being at risk for muscle dysmorphia.

Narcissism was measured using a Turkish version of the Pathological Narcissism Inventory. This questionnaire is designed to assess both grandiose and vulnerable narcissism. It includes 40 items across seven factors, such as exploitativeness, contingent self-esteem, denial of dependency, grandiose fantasy, entitlement rage, self-sacrificing, and self-enhancement. For this study, the researchers focused specifically on the vulnerable narcissism aspect of the inventory, using a scale derived from the questionnaire that specifically measures vulnerable narcissism.

Perfectionism was assessed using the Multidimensional Perfectionism Scale, adapted for use in Turkish. This 45-item questionnaire measures three dimensions of perfectionism: self-oriented perfectionism (setting high standards for oneself, e.g., “When I am working on something, I cannot relax until it is perfect”), other-oriented perfectionism (setting high standards for others, e.g., “Everything that others do, must be of top-notch quality”), and socially prescribed perfectionism (perceiving that others have high expectations, e.g., “I find it difficult to meet others’ expectations of me”). Participants rated each item on a scale from “strongly disagree” to “strongly agree,” with higher scores indicating greater perfectionism.

The researchers analyzed the collected data using statistical methods to determine the relationships between vulnerable narcissism, perfectionism, and muscle dysmorphia risk. They used a specific statistical technique called mediation analysis to see if perfectionism acted as an intermediary factor in the relationship between vulnerable narcissism and muscle dysmorphia risk.

The study revealed that a significant portion of the gym-going men, 37.8% or 51 out of 135 participants, were identified as being at risk for muscle dysmorphia based on their scores on the Muscle Dysmorphic Disorder Inventory. When comparing the group at risk for muscle dysmorphia with the group not at risk, some interesting differences emerged. The muscle dysmorphia risk group was less likely to participate in fitness competitions, even though they exercised more frequently each week. They also reported consuming more main meals per day and were more likely to use or consider using anabolic steroids and nutritional supplements. Interestingly, the muscle dysmorphia risk group was more likely to be married compared to the group not at risk, although this finding may require further investigation to understand its meaning.

The core finding of the study was that perfectionism does indeed appear to mediate the relationship between vulnerable narcissism and muscle dysmorphia risk. This means that vulnerable narcissism indirectly increases the risk of muscle dysmorphia through its influence on perfectionism. In other words, men with higher levels of vulnerable narcissism tend to be more perfectionistic, and this perfectionism, in turn, increases their risk of developing muscle dysmorphia. While vulnerable narcissism alone was initially associated with muscle dysmorphia risk, this association became weaker when perfectionism was taken into account, suggesting that perfectionism plays a key role in explaining this link.

These findings suggest that for men struggling with vulnerable narcissism, the drive for muscularity might be fueled by a deep-seated need to attain an unattainable ideal of physical perfection. Feelings of inadequacy and self-doubt, core features of vulnerable narcissism, may be projected onto their bodies, leading to an obsessive pursuit of muscularity as a way to compensate for these feelings. Perfectionism, in this context, becomes the mechanism through which this narcissistic vulnerability translates into muscle dysmorphia risk. The constant striving for a perfect physique, driven by perfectionistic tendencies, can become a self-defeating cycle, potentially leading to the harmful behaviors associated with muscle dysmorphia.

As with all research, there are some limitations. Because the study only looked at a snapshot in time, it cannot prove cause and effect. Future research could follow people over time to understand how these factors interact and how muscle dysmorphia develops. The study also relied only on questionnaires, which can be influenced by self-serving biases. Using more objective methods like observing behavior or conducting interviews would be helpful in the future.

The study, “Muscle Dysmorphia in Gym-Going Men: The Role of Narcissism Vulnerability and Perfectionism,” was authored by Hasan Emre Kandemir, Annarosa Cipriano, Marco Scotto Rosato, Barış Önen Ünsalver, Margherita Stabile, and Stefania Cella.