A growing number of seemingly fit and disciplined gymgoers are developing dangerous fixations on muscularity.

Muscle dysmorphia, also known as vigorexia or the Adonis complex, is emerging as a significant clinical concern associated with body image distortion and self-destructive behaviours.

Muscle dysmorphia is characterised by a distorted body perception and pathological obsession with increasing muscle mass and achieving an idealised physique.

It combines altered body image with compulsive exercise, mainly strength training, and significant metabolic risks.

​​The condition often involves rigid routines, low-calorie and high-protein diets, and the use of anabolic substances that endanger both physical and mental health.

These behaviours pose metabolic and psychiatric risks and increase the pressure on primary care and mental health services.

Recent studies show a rise in muscle dysmorphia-related symptoms among young Europeans, affecting mainly men but increasingly affecting women. Research has linked this trend to intensive social media, body image pressure, and steroid use.

Studies published in European Eating Disorders Review and The British Journal of Nursing have highlighted the need for clinical monitoring, health education, and motivational support to address this condition.

In Spain, approximately 10% of men are thought to meet the diagnostic criteria; however, this condition is often overlooked because it is not classified as an independent disorder and is typically included in body dysmorphic disorders. Early detection is essential to prevent serious physical and mental harm.

Social Pressure

Muscle dysmorphia does not begin in the gym but in a culture that fuels it. Media advertising, streaming content, and social media continue to project an idealised male image (hypermuscular, lean, and in control), linking appearance to success, strength, and social validation.

Studies have shown that such ideals create frustration and constant comparison, especially when athletes, actors, and musicians project the same image of physical perfection onto social media platforms.

A study involving young adults from Spain and Venezuela found that higher BMI, female sex, frequent use of Instagram, and a moralising approach to food were associated with symptoms of body dysmorphia. Although the research did not focus specifically on muscle dysmorphia or include a large sample, it strengthens the evidence connecting social media exposure with body image disturbance.

Constant exposure to “fitness lifestyle” content and hypermuscular bodies on platforms such as Instagram, TikTok, and YouTube increases the risk of developing symptoms of muscle dysmorphia and body dysmorphic disorder. This ongoing social comparison, reinforced by likes and followers, deepens body dissatisfaction among affected individuals.

Beyond the Screen

Beyond social media, peer pressure and the sports environment also contribute. Studies have identified gyms as spaces where physical competition and aesthetic validation reinforce dysmorphic behaviour. Even seemingly harmless comments such as “you look stronger” or “you’ve really changed” can trigger constant comparison and excessive self-criticism.

Family attitudes centred on appearance and the lack of diverse body role models further strengthen the belief that self-worth depends on physical appearance. Psychological traits such as low self-esteem and perfectionism also increase the risk for muscle dysmorphia.

A recent report by the Instituto de la Mujer (Women’s Institute) in Spain and data from several Spanish mental health observatories showed a clear gender bias in media body representation. Men face pressure to achieve a hypermuscular ideal, whereas women remain confined to a thin, flawless body image, a contrast that reinforces gender-specific patterns of body dysmorphia.

Bullying and body stigma are also linked to compensatory behaviours, including compulsive exercise and obsessive body monitoring. Physical appearance often becomes a defence against humiliation or rejection.

Steroid Dependence

During this vigorexic cycle, excessive exercise often leads to fatigue, muscle and joint pain, and soreness. Many turn to substance misuse to relieve discomfort, build muscle mass, reduce exhaustion, and overlook health risks.

Up to 50% of people with muscle dysmorphia are estimated to use anabolic steroids to enhance performance, a practice frequently promoted or normalised in social and sports settings that glorifies the idealised body.

A 2025 meta-analysis in Behavioural Sciences found that anabolic steroid users reported significantly more muscle dysmorphia symptoms than nonusers, with a medium-to-large effect size (Cohen’s d, 0.45).

A BMC Psychiatry study among male weightlifters found a strong association between steroid dependence, body dissatisfaction, compulsive exercise, and social anxiety.

Anabolic steroids, which are synthetic forms of testosterone, are the most commonly used substances associated with muscle dysmorphia. Prolonged or unsupervised use can cause severe physical and psychological harm, including liver damage, cardiovascular problems, hormonal imbalance, infertility, acne, and hair loss, and neuropsychiatric effects such as irritability, aggression, depression, and anxiety.

Psychological dependence on these substances creates a vicious cycle: Body dissatisfaction drives use, which deepens body distortion. The result is a marked decline in quality of life and worsening of disordered eating behaviours.

Nursing At the Core

Recent evidence has highlighted the need for comprehensive prevention, education, and treatment strategies. Within this framework, nursing plays a central role in both clinical and community responses to muscle dysmorphia.

Through structured interviews and direct observation, nurses assessed their body perception, motivation, emotional well-being, screening for nutritional risk, and substance use. Early intervention enables referral to specialised services and prevents seemingly healthy habits from developing into dysmorphic disorders.

In health education, nurses lead programs in schools, families, and communities to promote body acceptance, build self-esteem, and challenge the appearance standards set by social media.

A school-based program published by REESME, Spain’s National Network for School Mental Health Promotion, describes a nurse-led intervention in secondary schools designed to improve body image among adolescents and build a critical awareness of media and social influence.

Coordinated Care

During treatment, nurses work within multidisciplinary teams to provide cognitive behavioural therapy, monitor physical and emotional health, and coordinate referrals to psychiatry, psychology, nutrition, sports medicine, and toxicology. They also collaborated with dietitians, nutritionists, and physiotherapists to promote healthy routines and prevent overtraining.

Nursing involvement at the family and community level is essential. Through education and guidance, nurses help families strengthen their emotional bonds and prevent relapse through consistent support that sustains recovery. Experts recommend establishing standardised referral pathways and positioning nursing at the centre to ensure coordinated and continuous care across all specialties.

This story was translated from El Medico Interactivo.