Now imagine you’re a bodybuilder, weightlifter or fitness elite. Most other people think you’re in peak physical condition. But this only adds to your unease because what you see seems sub-standard or repulsive. You increase your dosage or cycles of steroids, trying to allay fears around body image.
Or you’re fairly new to building muscle. Your goal is to look fitter – to match images you see on magazine covers and in adverts. As you increase muscle mass and reduce body fat, you get a rush. You increase your training schedule and start taking steroids to speed up the process. But as time goes on, it’s harder to quieten your dissatisfaction. You feel depressed more than you feel motivated or satisfied. No matter what other people say about your body, you don’t believe them.
Also known as reverse anorexia, people with muscle dysmorphia often turn to anabolic steroids to enhance their physique and performance. It’s most common amongst young men – however, women and older people are also affected.
Home Office data from the Crime Survey for England and Wales 2018-19 shows the extent of anabolic steroid use. 62,000 adults (16-59 years old) took anabolic steroids in the past year. Of these, almost 30% of steroid users were aged 16-24. 
Anabolic steroids are Class C drugs. It is legal to possess steroids for personal use – however, they are prescription-only drugs in the UK.
Steroids are illegal to manufacture, supply or sell on the black market. The maximum sentence is up to 14 years in prison, an unlimited fine, or both. 
For many, regular workouts boost their health, wellbeing and self-confidence. Even when bodybuilding is the main focus of one’s professional or personal life, it still doesn’t mean it’s an obsessive and compulsive disease.
Here are 5 common signs of muscle dysmorphia.
People who have muscle dysmorphia, including those addicted to steroids, have a much higher incidence of anxiety, depression and low self-worth than healthy bodybuilders. In fact, most people who have muscle dysmorphia suffer with depression. 
In most cases, these painful feelings of insecurity and unworthiness precede muscle dysmorphia and steroid use. At some stage, building muscle mass gets associated with gaining external validation, reducing psychological pain or improving self-esteem.
Victims of bullying or childhood trauma, for example, might go on to develop muscle dysmorphia in adolescence or young adulthood – if they associate being big with not being hurt again.
Using steroids to build muscle is not necessarily a sign of muscle dysmorphia. However, all regular steroid users will experience physical and mental effects – some of which can be very unpleasant, unwanted or harmful.
Steroids are addictive drugs. This means you can develop a tolerance to them as your body adapts. Over time, you’re likely to need more to maintain or increase your size. If you’ve taken steroids for a while and you stop abruptly, you’re likely to get moderate to severe withdrawal symptoms. These include anxiety, fatigue, muscle and joint pain, insomnia, headaches, irritability and strong cravings to use more.
With steroid abuse or addiction, there are always harmful or undesired side effects, along side loss of control of how much you use. People can desperately want to stop using but they still find it difficult to imagine life without steroids. Even the thought of losing muscle mass can seem unbearable.
Your physical health may be seriously affected by steroid abuse – including cardiovascular disease, stroke and liver disease. Steroid users can also develop skin conditions including acne. Up to half of male steroid users get testicular atrophy (shrunken testicles).  Erectile dysfunction, decreased sperm count, breast development and infertility can affect men too. In women, an enlarged clitoris, increased body and facial hair, breast reduction, irregular or no periods and infertility are possible side effects.
Steroid addiction is associated with a wide range of psychiatric conditions too – including personality disorders, paranoia, psychosis and high levels of aggression.
People with bigorexia often have an obsessive and detrimental focus on eating the right foods at the right times, as well as taking supplements. The aim is to increase muscularity and reduce body fat.
Some clinicians have argued that muscle dysmorphia should be seen as an eating disorder – particularly if there are regular cycles of binge-eating, forced eating, purging, starvation or excessive supplementation.
Whilst most bodybuilders plan their meals carefully – including weighing food, counting calories, learning about macro-nutrients and preparing meals to take out – if extreme reactions around food set in, then it can be a sign of illness. For example, if you become aggressive or violent when your eating plans are disrupted, then seek specialist help.
Taking more than the recommended dose of supplements such as high-protein powders can be harmful to health over time. Using illegal supplements comes with a high risk – because like all illicit substances, whatever they’re marketed as, you don’t actually know what’s in them or how you’ll react.
If you lift weights everyday, does that mean you have muscle dysmorphia? Not necessarily. Regular physical activity has many benefits for health and wellbeing, including preventing the most common preventable diseases – such as heart disease, diabetes, depression and cancer.
With exercise addiction, the rigorous adherence to training regimes becomes harmful to you and often other people. Your health and relationships are likely to suffer. And the joy or satisfaction you once got from exercise dwindles or disappears entirely.
So, you might feel compelled to lift weights when you’re ill, injured or very tired. Or if you miss a training session, you feel incredibly guilty, anxious or self-critical. Perhaps you’ve lost an important relationship to you because of your exercise schedule. As with other process addictions, the signs of exercise addiction will be unique to you.
Most people check themselves in the mirror each day – getting ready to go out or washing their face at night. With muscle dysmorphia, there are two main differences – the length of time you spend studying your physical appearance and how you feel and act before, during and after checking yourself in the mirror.
So, you might feel compelled to look in the mirror, believing it will help you spot and fix problems with your body. Or you might actively avoid looking in the mirror – because you are repelled by the way you look. Scrutinising faults, alongside overlooking anything you like about your appearance, can build your sense of shame.
Whether you speak to your GP or you go into a drug detox facility, it’s important to get the right advice and support when you stop taking steroids. They’re addictive drugs with a wide range of side effects – including in withdrawal.
It’s recommended to get therapeutic support as you withdraw. Residential rehabilitation or outpatient counselling will improve your chance of recovery. You need to understand the drivers of steroid abuse, in order to prevent relapse.
If you have a co-morbid condition like muscle dysmorphia, depression or anxiety, you will probably need ongoing treatment. This might include specialist therapy or medication for a period of time. The goal is to improve your underlying body image or mental health problems, so you don’t return to steroid addiction.
Most recovering addicts benefit from a peer group – people who have direct experience of what they’re going through. Finding other people who have quit steroids and maintained drug-free status will improve your coping strategies.
If you successfully complete our 90-day inpatient treatment program, we guarantee you'll stay clean and sober, or you can return for a complimentary 30 days of treatment.