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Muscle Dysmorphia Classification — MRCPsych Paper B MCQ

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HardEating DisordersMuscle Dysmorphia ClassificationMRCPsych Paper B

A 24-year-old man is markedly muscular but remains unshakeably convinced that his body is too small and insufficiently muscular. He repeatedly checks and compares his physique, exercises despite injuries, follows a rigid muscle-building diet and avoids social situations involving body exposure. These symptoms cause substantial occupational and social impairment. He has no fear of gaining weight, binge eating, compensatory weight-loss behaviour, hallucinations, unrelated delusions or use of anabolic steroids. According to contemporary diagnostic classification used in UK psychiatry, which diagnosis best accounts for this presentation?

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Correct answer: B — Body dysmorphic disorder

The correct answer is B. Muscle dysmorphia is a presentation of body dysmorphic disorder, characterised by pathological preoccupation that the body is insufficiently muscular, with repetitive checking, comparison, exercise or dietary behaviours and clinically significant impairment. Body dysmorphic disorder is grouped with obsessive-compulsive and related disorders in ICD-11. The rigid diet and exercise make a feeding or eating disorder plausible, but the primary psychopathology is perceived inadequate muscularity rather than fear of weight gain or another defining eating-disorder syndrome. Even an unshakeable dysmorphic belief does not require delusional disorder when it occurs within this characteristic syndrome. Obsessive-compulsive personality disorder requires a pervasive personality pattern, while anabolic-androgenic steroid use disorder requires actual problematic substance use.

Reference: Krebs G, Fernández de la Cruz L, Mataix-Cols D. Recent advances in understanding and managing body dysmorphic disorder, section 'How is BDD classified?', 2017. https://pubmed.ncbi.nlm.nih.gov/36449722/