Editing Muscle dysmorphia (section)

==Signs and symptoms==

Although body dissatisfaction has been found in boys as young as age six, muscle dysmorphia's onset is estimated at usually between ages 18 and 20.<ref name="Tod16"/><ref name="McCabe04">McCabe MP & Ricciardelli LA (2004), "Body image dissatisfaction among males across the lifespan: A review of past literature", ''Journal of Psychosomatic Research'' '''56'''(6):675–685.</ref> According to ''DSM-5'', muscle dysmorphia is indicated by the diagnostic criteria for body dysmorphic disorder via "the idea that his or her body is too small or insufficiently muscular", and this specifier holds even if the individual is preoccupied with other body areas, too, as is often the case.<ref name="DSM"/>

Further clinical features identified include excessive conduct of efforts to increase muscularity, activities such as dietary restriction, [[overtraining]], and injection of growth-enhancing drugs.<ref name="Pope97"/> Persons experiencing muscle dysmorphia generally spend over three hours daily pondering increased muscularity, and may feel unable to limit weightlifting.<ref name="Tod16"/> As in anorexia nervosa, the reverse quest in muscle dysmorphia can be insatiable.<ref>{{Cite journal|author=Mosley PE|date=2009|title=Bigorexia: Bodybuilding and muscle dysmorphia|journal=European Eating Disorders Review|language=en|volume=17|issue=3|pages=191–198|doi=10.1002/erv.897|pmid=18759381|s2cid=20128770 |issn=1099-0968}}</ref> Those suffering from the disorder closely monitor their body and may wear multiple clothing layers to make it appear larger.<ref name="Tod16"/>

Muscle dysmorphia involves severe distress at having one's body viewed by others.<ref name="Pope97"/> Occupational and social functioning are impaired, and dietary regimes may interfere with these.<ref name="Tod16"/> Patients often avoid activities, people, and places that threaten to reveal their perceived deficiency of size or muscularity.<ref name="Tod16"/> Roughly half of patients have poor or no insight that these perceptions are unrealistic.<ref name="Tod16" /><ref name="Cafri08">Cafri G, Olivardia R & Thompson JK (2008), "Symptom characteristics and psychiatric comorbidity among males with muscle dysmorphia", ''Comprehensive Psychiatry'' '''49'''(4):374–379.</ref> Patient histories reveal elevated rates of diagnoses of other mental disorders, including eating disorders, [[mood disorders]], [[anxiety disorders]], and [[substance use disorder]],<ref name="Cafri08"/><ref name="Pope05"/><ref name="Hitzeroth11">Hitzeroth V, Wessels C, Zungu-Dirwayi N, Oosthuizen P, & Stein DJ (2001), "Muscle dysmorphia: A South African sample", ''Psychiatry and Clinical Neurosciences'' '''55'''(5):521–523.</ref> as well as elevated rates of suicide attempts.<ref name="Tod16"/>