Motivation and emotion/Book/2014/Muscle dysmorphia (The Adonis Complex) and motivation

Overview
Body Dysmorphic Disorder (BDD) is a relatively common disorder that consists of an impairing preoccupation or brooding over imaginary or minute physical defects in appearance (Bjornsson, Didie, & Phillips, 2010). Body dysmorphic disorder is commonly classified as an obsessive compulsive spectrum disorder due it is sharing similarities in traits with obsessive compulsive disorder (Bjornsson et al., 2010). Severe cases of body dysmorphic disorder are associated with diminished quality of life, impairment of social, academic and occupational function, and increased suicidal rates (Bjornsson et al., 2010). DSM-IV classifies body dysmorphic disorder as a separately classified disorder, defining it as an obsession with an imaginary defect in physical appearance; if a minuscule physical irregularity is present, the person's concern is noticeably excessive (Phillips, 2004).

Body dysmorphic disorder is a more commonly known disorder that affects both men and women. However, not much attention is given to a very specific type of body dysmorphic disorder called "Muscle Dysmorphia (MD)" (Pope, Gruber, Choi, Olivardia, & Phillips, 1997). It is sometimes alternatively referred to as "The Adonis Complex". It is only in the past ten years that there has been a significant interest in research redirected at body dysmorphic disorder and associated behavioural dysfunction in the male gender (Cafri & Thompson, 2004, as cited in Cafri, Thompson, Ricciardelli, McCabe, Smolak, & Yesalis, 2005).

This book chapter aims to provide in-depth information regarding the following:
 * What Muscle Dysmorphia is, specifically in men
 * The relationship between intrinsic motivation and Muscle Dysmorphia
 * The relationship between extrinsic motivation and Muscle Dysmorphia
 * The possible causes of Muscle Dysmorphia in relation to theory
 * The lengths men will go to attain the ideal musculature/physique

A closer look at muscle dysmorphia
Men have been encountering an increasing amount of pressure from media to attain the perfect "super hero" physique which comprises of being very lean, muscular and symmetrical (Walker, Anderson, & Hildebrandt, 2009). With the increasing popularity of bodybuilding, research suggests that expanding number of young men are becoming discontented with their physical appearance/stature (Mosley, 2009). The nature of this discontentment does not stem from the desire of smaller and slimmer bodies, as is most often the case in women, but rather bigger, more muscular, and imposing physiques (Pope, Gruber, Mangweth, Bureau, deCol, Jouvent, et al., 2000, as cited in Mosley, 2009).

Pope, Katz and Hudson (1993) initially coined (as cited in Mosley, 2009) muscle dysmorphia as the "reverse anorexia" condition in a population of male bodybuilders in earlier literature. Reverse anorexia was initially conceptualised as a reverse form of anorexia nervosa, and comprises of behavioural and cognitive similarities, and a notably elevated incidence of previous anorexia nervosa (Pope et al., 1993, as cited in Murray, Rieger, Hildebrandt, Karlov, Russell, Boon, & Touyz, 2012). The men were particularly muscular yet they thought that they appeared distinctly small and frail (Mosley, 2009). They were unusually more muscular and larger than the general public (Phillips & Castle, 2001).

These men rejected social invitations, dressed inappropriately for the season (e.g. wearing heavy well covered clothing during the heat of summer), and declined to be seen at the beach (Mosley, 2009). People with muscle dysmorphia tend to avoid situations or places where they may be seen without clothing (if it is unavoidable then it causes them great amounts of distress) and often wear plenty layers of clothing to cover up their bodies, even in hot weather conditions (Choi, Pope, & Olivardia, 2002). These men indicated that they wanted to gain a greater amount of muscle while keeping body fat gains in check (Mosley, 2009).

Muscle Dysmorphia (MD) is a disorder in which the person (usually men), although holding high muscle mass, have a pathological view that they are not carrying enough muscle mass and are of very small musculature (Choi et al., 2002). Muscle dysmorphia has been observed to be a condition the primarily affects men, although it can be present in women (Choi et al., 2002). It is a peculiar type of body dysmorphic disorder where, instead of being pathologically discontented with a specific body part, the person is discontented with their body as a whole (Choi et al., 2002). The primary focus for the individual is to achieve a certain look in terms of muscularity, symmetry and leanness.

A possible explanation for this phenomena is that in our culture, the ideal male body type is increasing steadily to a more muscular build (Pope, Olivardia, Gruber, & Borowiecki, 1999). With the advancement of anabolic steroids in the last 30 to 40 years, it has made it possible for men to be much more muscular than is possible by natural ways without any enhancement (Pope et al., 1999).

A look into motivation
In order to address the association between muscle dysmorphia with extrinsic and intrinsic motivation, let us begin with a general description of motivation. Motivation refers to the factors that activate, direct and sustain people's goal-oriented behaviours (Nevid, 2013). Motives are the reasons or "whys" for behaviour - the needs or wants that trigger behaviour and explain why we do the things we do (Nevid, 2013). Motives are not necessarily observed; rather, inference is made that one exists based on observation of behaviour (Nevid, 2013).

The relationship between intrinsic motivation and muscle dysmorphia
Intrinsic motivation the act of doing a specific activity for its inherent satisfaction or pleasure without any distinct consequence (Ryan & Deci, 2000, as cited in Oudeyer & Kaplan, 2008). An intrinsically motivated person is driven to act for the enjoyment or challenge of a given task rather than external products, rewards or pressures (Ryan & Deci, 2000, as cited in Oudeyer & Kaplan, 2008). Intrinsic is not the same as internal, and it is not a synonym (Oudeyer & Kaplan, 2008). Since muscle dysmorphia is considered as a subcategory of body dysmorphic disorder which is a subcategory of obsessive-compulsive disorder (Leone, Sedory, & Gray, 2005), intrinsic motivation and muscle dysmorphia are related by opposing feelings and emotions. People with muscle dysmorphia often become depressed and obsessed (Leone et al., 2005). The intrinsic motivation aspect for the need to build more muscle would likely be better self-worth, confidence and temporary increase in aesthetics contentment.

The relationship between extrinsic motivation and muscle dysmorphia
Extrinsic motivation is a construct that prevails whenever a task is done in order to attain some distinct result (Ryan & Deci, 2000, as cited in Oudeyer & Kaplan, 2008). Extrinsic motivation refers to behaviour that is driven by external benefits such as fame, power, status, money and acknowledgment. Essentially, extrinsic motivation is a contrast of intrinsic motivation (Ryan & Deci, 2000, as cited in Oudeyer & Kaplan, 2008). Being that muscle dysmorphia is a pathological preoccupation with muscularity and leanness (Leone et al., 2005), its relationship with extrinsic motivation lies in all the physical factors such as muscularity, physical appearance and aesthetics. People constantly thinking that they have a muscular deficiency (Choi et al., 2002) tend to have the extrinsic motivation of attain their ideal physique goal, no matter how unrealistic.

Causes in relation to theory
Although causes of muscle dysmorphia do not seem definitive, some hypotheses can be made in relation to a few different theories in Psychology.

Psychodynamic theory
Psychodynamic approach rejects the notion that humans have free will and proposes that people's behaviours are dictated by their unconscious motives which are shaped by the interaction of drives, forces, and early childhood experiences (Sammons, 2009a; Burton, Westen, Kowalski, 2012). Behaviour is explained in terms of previous experiences and motivational factors; actions are regarded as originating from inherited instincts, biological drives, and strives to settle dispute between personal needs and social requirements (American Psychological Association, 2014).

Based on the notion of psychodynamic theory, it suggests the possibility of the development of muscle dysmorphia due to unresolved issues and difficult feelings during childhood (Olivardia, Pope, & Hudson, 2000). According to Freud, people have two instincts, namely sex and aggression (Burton et al., 2012), which may affect the individual's unconscious displacement of these instincts towards muscle dysmorphia.

Biological theory
Behavioural Neuroscience/Biological Psychology is the study of the physiological, evolutionary, and developmental processes of behaviour and experience (Kalat, 2012).

Based on biological theory, irregular serotonin and dopamine function are believed to play a part in the development of body dysmorphic disorder, as shown by the fact that patients seem to react favourably to medications that adjust level of these neurotransmitters (Hadley, Newcorn, & Hollander, 2002, as cited in Crerand, Franklin, & Sarwer, 2006). People with body dysmorphic disorder seem to possess a chemical imbalance of the neurotransmitter serotonin, because they generally react well to administration of Selective Serotonin Reuptake Inhibitors (SSRI) type of antidepressants (Gabbay, O’dowd, Weiss, & Asnis, 2002). Case reports suggesting that body dysmorphic disorder may be set off by medical illnesses related to inflammatory processes that can disrupt with serotonin synthesis (Gabbay, O’dowd, Weiss, & Asnis, 2002).

Cognitive-behavioural theory
The cognitive-behavioural theory of human functioning is based on the proposition that thoughts, emotions, and behaviors are inevitably related and that each of these facets of human functioning continuously influence and effect the others (Nurius & Macy, 2008). Cognitive-behavioural theory postulates that thoughts regarding the self, relationships, the world, and the future mould emotions and behaviours (Dobson & Dozois, 2001; Beck, 2002). In turn, feelings and behaviours mould thoughts and thought processes in a somewhat repetitive feedback loop (Nurius & Macy, 2008). Cognitive-behavioural theory suggests that cognitive-affective-behavioural processes are alike and comparable between human beings and human experience but the subject within the cognitive-affective-behavioural processes is particular, distinctive and exclusive to the individual (Alford & Beck, 1997; DeRubis, Tang, & Beck, 2001; Nurius & Macy, 2008).

Based on cognitive-behavioural theory, muscle dysmorphia is affected by various factors such as culture, biological predisposition, psychological vulnerabilities and early childhood experiences (good and bad).

The public is exposed to muscular male images in different types of media each day and the different types of images place great unrealistic emphasis on muscularity, physical appearance and attractiveness (Pope et al., 1999). Some individuals affected by these cultural images/messages are more likely to develop muscle dysmorphia (Pope et al., 1999).

The lengths men will go to attain the ideal musculature/physique
The expectation of the perfect "super hero" physique puts men at risk for body discontentment, abuse of perfomance/physique enhancing drugs, an irregular/excessive eating and exercise behaviour (Walker, Anderson, & Hildebrandt, 2009).

Performance/physique enhancing drugs
Many people who are not able to attain their personal physique goals or handle the pressures of expectation from coaches (specifically for athletes) regarding an unfeasible ideal physical appearance may turn to anabolic steroids, various physique enhancing drugs or other dangerous substances to satisfy their physique desires (Pope, Phillips, & Olivardia, 2000, as cited in Leone, et al., 2005).

Anabolic steroids
Anabolic-androgenic steroids (AAS) are the most notorious and widely used substances by male athletes and those engaging in weight training for aesthetic reasons, to increase muscular size and strength (Cafri et al., 2005). The usage of anabolic steroids increase the rate of muscular development and aid in the improvement of physical appearance (Cafri et al., 2005). The use of AAS in men is somewhat comparable to food restriction among eating disordered women, given that both represent the advocacy of extreme behaviours to attain a specific ideal body type (Cafri et al., 2005). The rapid effects shown from the usage of anabolic androgenic steroids promote the likelihood of abusing the pharmacologic agents (Dawes & Mankin, 2004, as cited in Leone et al., 2005). Evidence from case studies provides support to the thought that anabolic steroids could be instrumental in the causal pathway of adverse health effects such as stroke, myocardial infarction, cardiomyopathy, and liver disease, although the frequency of these outcomes occurring is probably fairly low given the prevalence of anabolic steroids use (Friedl, 2000, as cited in Cafri et al., 2005). Physical changes resulting from anabolic-androgenic steroid use occur as well, such as acne, gynecomastia (i.e., growth of subareolar, button-like plaque of tissue in males), and stunted height growth in adolescent users (Pope, Phillips, & Olivardia, 2000).

Prohormones
Prohormones have similar chemical structure to that qualifies them as steroid hormones, technically they are not illegal substances and are sold over the counter just like any other regular sports supplement (Cafri et al., 2005). Prohormones are widely available these days, and it should be a cause for concern (Cafri et al., 2005). Prohormones may poses similar side effects to anabolic-androgenic steroids (Cafri et al., 2005). Some prohormones out in the market are recursors to specific types of anabolic-androgenic steroids.

Extreme dieting
In order to sufficiently gain muscle mass, it is important to consider alternative eating habit that might be used compared a skinny physique goal (Cafri et al., 2005). More anecdotal work indicates that for some males, there may be a very complex method of dieting, one that includes specific quantities and frequencies of macronutrient intake, cycling through different dieting phases, and extreme dieting practices that necessitate restriction to a few group of foods based on their macronutrient requirements (Gruber & Pope, 1998; McDonald, 1998, as cited in Cafri et al., 2005). Prevalent in bodybuilding circles, people alternate between two phases of food consumption with the aim of increasing muscularity while reducing body fat (Cafri et al., 2005). In the first part, usually termed the "bulking" phase, the aim is to put on muscle mass through a caloric surplus that is above maintenance level (Cafri et al., 2005). Of course, during a bulking phase both body fat (adipose tissue) and muscle gains are to be expected (Cafri et al., 2005). To reduce the amount of body fat (adipose tissue), the person typically goes through a cutting phase, in which the goal is to reduce body fat while holding on to as much lean muscle mass as possible through a calorie deficit that is below maintenance levels (Cafri et al., 2005). These bulking and cutting phases may promote a disordered eating pattern and/or an eating disorder, stressful dieting and other obsessive-compulsive rituals (Dawes & Mankin, 2004, as cited in Leone et al., 2005).

Excessive exercise
In an evolving culture where men’s bodies are becoming more visible alongside an increased interest of physical exercise as a beneficial activity, muscle dysmorphia in men may be one negative ramification of excessive physical exercise behaviour, particularly weight training, being motivated primarily/solely by muscularity and an aesthetically pleasing physique (Choi et al., 2002). Due to the eagerness to attain the ideal physique, people with muscle dysmorphia are likely to overtrain, train despite the presence of injuries or miss out on social functions for the sole purpose of working out (Dawes & Mankin, 2004, as cited in Leone et al., 2005).

Conclusion
This book chapter explored muscle dysmorphia, motivation and the lengths men would go to in order to achieve the ideal physique. Muscle Dysmorphia (MD) is a disorder in which the person (usually men), although holding high muscle mass, have a pathological view that they are not carrying enough muscle mass and are of very small musculature (Choi et al., 2002). It is a peculiar type of body dysmorphic disorder where, instead of being pathologically discontented with a specific body part, the person is discontented with their body/musculature as a whole (Choi et al., 2002). The primary focus of the individual is to achieve a certain look in terms of muscularity, symmetry and leanness. It affects boys and men all over the world. A better understanding of muscle dysmorphia and its relationship to motivation provides more insight and information regarding the pathological disorder.

Quiz: Test your knowledge
{ Muscle dysmorphia is a subcategory of which disorder? - Schitzophrenia
 * type=""}

+ Body dysmorphic disorder - Diabetes - Alcoholism

{ Muscle dysmorphia is ? - A type of missing limb disorder - A type of therapy - A type of motivation + A disorder in which the person (usually men), although holding high muscle mass, have a pathological view that they are not carrying enough muscle mass and are of very small musculature
 * type=""}

{ Bulking = ______ & Cutting = ______
 * type=""}

- Big & tall + Caloric surplus & Caloric deficit - Young & beautiful - None of the above

{ Signs of excessive exercise are:
 * type=""}

- Overtraining - Training despite the presence of injuries or illness - Missing out on social functions for the sole purpose of working out + All of the above.