Muscle dysmorphia is a condition characterized by an intense preoccupation with muscularity, significant dissatisfaction with one’s body or perceived lack of muscle mass, and impairment in social, psychological, or everyday functioning. Often described informally as a belief that one is never muscular enough, it has traditionally been studied in the context of body dissatisfaction, compulsive exercise, restrictive eating, and the pursuit of muscularity through training and, in some cases, performance-enhancing substances. The new study broadens that frame considerably. Its authors report that the condition’s symptoms were linked with difficulties including anxiety during sex, lack of sexual interest or enjoyment, lack of arousal, difficulty reaching climax, physical pain during sex, and difficulty getting or maintaining an erection. Only one of the eight sexual difficulties measured in the study was not associated with muscle dysmorphia symptoms, underscoring how pervasive the relationship appears to be across multiple dimensions of sexual functioning.

The study’s most striking finding concerns appearance-related distress. Within the cluster of muscle dysmorphia symptoms, greater dissatisfaction with appearance and greater discomfort with one’s own body were consistently linked with a wide range of sexual difficulties. The single strongest association observed was with feeling anxious during sex. This pattern makes conceptual sense within existing models of sexual response, which emphasize that attention, comfort, and a sense of safety are central to arousal and enjoyment. When cognitive resources are consumed by self-monitoring and evaluation of one’s body, the capacity to remain psychologically present during intimacy can be compromised, a phenomenon researchers often describe in terms of spectatoring, or mentally observing oneself from the outside rather than participating in the experience.

“One possible explanation is that intense body dissatisfaction and self-consciousness make it more difficult to be present and comfortable during sexual experiences,” said Ganson. “If someone is highly focused on how their body looks or worried about being seen by a partner, those thoughts may interfere with sexual interest, arousal, enjoyment, and functioning.” This mechanism, in which appearance anxiety disrupts the attentional and emotional conditions required for satisfying sexual experiences, aligns with a growing body of evidence connecting body image with sexual well-being more generally. Persistent body dissatisfaction, shame, self-consciousness, and preoccupation with appearance have all been shown in prior research to make it more difficult for individuals to feel comfortable, engaged, and emotionally available during sexual encounters.

The implications of the study reach beyond psychological mechanisms alone. The behaviors that frequently accompany the pursuit of muscularity may themselves contribute to sexual difficulties. Excessive exercise can produce physical fatigue and, when combined with restrictive eating, may leave the body without the energy reserves needed for healthy physiological functioning, including sexual response. More concerning still is the use of anabolic-androgenic steroids and other muscle-enhancing substances, which are known to disrupt the endocrine system. Exogenous steroid use can suppress natural testosterone production, and discontinuation can produce hormonal disturbances that affect libido, erectile function, and mood. The study’s authors note that such behaviors associated with muscularity pursuit may play a role in the sexual difficulties observed among those with greater muscle dysmorphia symptoms, although the cross-sectional nature of the data means the precise pathways require further investigation.

“Muscle dysmorphia is often understood in terms of body dissatisfaction, compulsive exercise, or the pursuit of muscularity, but our findings suggest that its impacts may extend into intimate and sexual experiences as well,” Ganson said. “Sexual health should be part of the conversation when clinicians are assessing boys and men with significant muscle dysmorphia symptoms.” This recommendation carries practical weight for clinicians working in eating disorder services, student health centers, sports medicine, and general mental health care, populations in which muscle dysmorphia and related muscularity-oriented behaviors are increasingly recognized. Sexual health assessments are not routinely incorporated into body-image treatment, and the study suggests that this omission may leave an important dimension of patient suffering unaddressed.

The demographic scope of the research is notable. By including sexually active participants as young as 15 and as old as 35, the study captures a developmental window that spans adolescence, emerging adulthood, and established adulthood, periods during which sexual identity, romantic relationships, and body image are all in active formation. Adolescence in particular is a time when appearance concerns can be especially acute, and when early sexual experiences may shape long-term patterns of sexual confidence and comfort. The finding that body dissatisfaction and appearance anxiety related to muscle dysmorphia may be especially important to the sexual health of boys and young men suggests that interventions delivered early could have benefits that extend across multiple domains of health and well-being.

“Body image and sexual health are often treated as separate areas of health, but they may be deeply interconnected,” Ganson said. “For some boys and men, addressing distress about their bodies may also be important for understanding difficulties they are experiencing in their sexual lives.” This framing challenges the conventional siloing of sexual medicine, mental health, and body-image treatment. A young man presenting with erectile difficulties or low sexual desire might, in many clinical settings, be evaluated for vascular, hormonal, or pharmacological causes without any assessment of muscularity dissatisfaction or compulsive exercise. Conversely, a patient in treatment for muscle dysmorphia might never be asked about sexual functioning. The study suggests that each of these one-sided approaches risks missing connections that could be central to recovery.

For researchers, the findings open several avenues for future work. Longitudinal designs would help establish whether muscle dysmorphia symptoms precede sexual difficulties, follow from them, or reinforce one another in a reciprocal cycle. Studies that measure physiological indicators alongside self-reported difficulties could clarify how much of the association is psychological, how much is behavioral, and how much may be attributable to substance use. Research examining whether treatments that reduce body-image distress also improve sexual functioning would test the clinical significance of the association directly. The study’s publication in Body Image, a leading peer-reviewed journal in the field, reflects growing scientific interest in muscularity-oriented disordered eating and body-image concerns among males, populations that have historically been underrepresented in research that focused predominantly on thinness-oriented concerns among girls and women.

Overall, the study positions sexual functioning as a potentially important dimension of health for researchers and clinicians working with boys and young men experiencing muscle dysmorphia symptoms. Its message is straightforward but consequential: the distress produced by feeling insufficiently muscular does not remain confined to thoughts about appearance. It can follow young men into their most intimate moments, dampening interest, interfering with arousal, and generating anxiety precisely where comfort is most needed. Recognizing that connection, the authors argue, is a necessary step toward care that treats body image and sexual health not as separate territories, but as intertwined aspects of the same person’s well-being.

Subject of Research: Associations between muscle dysmorphia symptoms and sexual functioning among sexually active boys and young men

Article Title: Muscle dysmorphia symptoms linked with sexual difficulties among boys and young men

Article References: Muscle dysmorphia symptoms linked with sexual difficulties among boys and young men. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: muscle dysmorphia, body image, sexual health, sexual functioning, boys and young men, appearance anxiety, body dissatisfaction, anabolic steroids, compulsive exercise, University of Toronto, Body Image journal, adolescent health

The research, led by Chiara Lombardi and Maria Anna Donati of the University of Florence, together with colleagues including Giulia Fioravanti and Sara Bocci Benucci, set out to integrate two research traditions that have largely run in parallel. On one side sits the addiction literature, which has long identified impulsivity—a multidimensional trait encompassing tendencies toward rash action, lack of planning, and difficulty inhibiting responses—as a transdiagnostic vulnerability factor across substance and behavioral addictions. On the other side sits the body image literature, which links body dissatisfaction, the drive for thinness or muscularity, and diminished body appreciation to disordered eating and compulsive exercise. Until now, few studies had modeled how these two sets of variables operate together in predicting exercise addiction risk within a single statistical framework.

Exercise addiction itself remains a contested and under-studied phenomenon. It is not formally listed as a standalone diagnosis in the DSM-5-TR or the ICD-11, although compulsive exercise is recognized as a frequent feature of eating disorders and body dysmorphic disorder. Researchers typically define it through core addiction components: salience, in which exercise becomes the most important activity in a person’s life; mood modification, using workouts to alter emotional states; tolerance, requiring ever-greater doses of activity to achieve the same effect; withdrawal symptoms such as irritability and anxiety when exercise is missed; conflict, with exercise interfering with work, relationships, and other pursuits; and relapse, the rapid return to excessive patterns after attempts to cut back. Prevalence estimates vary widely by population and instrument, but risk appears elevated among endurance athletes, fitness-center clients, and individuals with eating disorder pathology.

To probe the pathways into this risk, the Italian team recruited 418 adults, 54 percent of whom were female, with a mean age of 30.76 years and a standard deviation of 13.08, yielding a broad sample spanning late adolescence through middle age. Participants completed a battery of validated self-report instruments measuring exercise addiction symptoms, multidimensional impulsivity, and a set of body image–related variables, including dysmorphic body image concerns, drive for muscularity, and body appreciation—the capacity to hold favorable opinions of one’s body regardless of perceived imperfections. The researchers then employed path analysis, a form of structural equation modeling that estimates direct and indirect pathways among variables simultaneously, while statistically controlling for gender and age.

The methodological rigor of the analysis deserves emphasis. Path analysis allowed the team to test whether impulsivity and body image variables each contributed uniquely to exercise addiction risk, and whether their effects were better understood as independent channels or as interconnected routes—for example, whether impulsive individuals who also harbor body image concerns face compounded vulnerability. Fit indices such as the comparative fit index, the Tucker-Lewis index, and the root mean square error of approximation were used to evaluate how well the hypothesized model reproduced the observed covariance structure, following conventional thresholds established in the structural equation modeling literature. Bootstrapping procedures provided confidence intervals for indirect effects, a technique recommended for mediation testing because it avoids relying on assumptions of normality in the sampling distribution of product terms.

The central finding was clear: both impulsivity and body image–related variables were significantly associated with exercise addiction risk. In other words, the psychological machinery of addiction—the tendency to act without adequate forethought and to experience difficulty stopping a rewarding behavior—contributes to vulnerability, but so does the motivational engine rooted in how people perceive and feel about their own bodies. Individuals with heightened dysmorphic concern, a stronger drive for muscularity, and lower body appreciation reported more exercise addiction symptoms, consistent with the idea that for many people, exercise functions as a body-shaping or anxiety-regulating behavior rather than purely a health behavior. The coexistence of these two pathways suggests that exercise addiction may arise through multiple etiological routes, mirroring what has been observed in eating disorders, where both trait impulsivity and sociocultural body ideals play documented roles.

Because men and women often differ in both impulsivity profiles and body image concerns—women historically reporting more drive for thinness and body dissatisfaction, men more drive for muscularity and muscle dysmorphia symptoms—the researchers went a step further and tested whether their model held equally across genders. Using multi-group path analysis, they examined structural invariance, asking whether the same pathways operated with the same strength for men and women. This is a critical but frequently skipped step in behavioral research; models estimated on mixed samples can mask meaningful gender differences or, conversely, overstate them. The invariance testing in this study provides a more nuanced picture of how risk unfolds differently, or similarly, across genders, and the authors report that gender differences were present in the data, prompting the formal comparison of group-specific models.

The findings carry practical implications for screening and prevention. Fitness professionals, sports coaches, and clinicians are increasingly encouraged to view excessive exercise not as admirable discipline but as a potential red flag when accompanied by distress, rigidity, and life interference. If impulsivity marks one vulnerability channel, brief screening tools derived from the UPPS-P impulsive behavior tradition could help identify at-risk exercisers in gyms and athletic settings. If body image concerns mark another, interventions that cultivate body appreciation and challenge internalized appearance ideals—approaches already validated in the body image field—may reduce the motivational fuel for compulsive training. Integrated prevention programs that address both trait-level self-regulation and appearance-related cognition could plausibly outperform approaches targeting either factor alone.

The study also contributes to an ongoing conceptual debate. Some researchers argue that exercise addiction is best understood through interactional models that emphasize the paradox of exercise: a behavior that is beneficial in moderation becomes pathological only in specific psychological and social contexts. Others caution that measurement limitations, reliance on self-report, and the absence of longitudinal designs have hampered the field. The present study acknowledges these constraints; its cross-sectional design cannot establish causal direction, and self-report measures are susceptible to social desirability bias, particularly in domains like exercise where excessive behavior may be culturally rewarded. Still, by modeling pathways rather than simple correlations, and by testing invariance across genders, the work moves the field toward the kind of mechanistic understanding needed to design effective interventions.

Ultimately, the message for the public is nuanced. Exercise remains one of the most powerful tools available for preventing chronic disease and supporting mental health, and the overwhelming majority of people who train regularly benefit enormously. But the Florence study is a reminder that the same behavior can serve very different psychological masters. For individuals high in impulsivity, exercise may become another arena for dysregulated reward seeking; for those struggling with body dissatisfaction or a relentless drive for muscularity, the treadmill and the weight rack can become instruments of appearance anxiety. Recognizing these dual pathways is a step toward ensuring that the pursuit of fitness stays, for everyone, genuinely health-promoting rather than quietly addictive.

Subject of Research: Psychological risk factors for exercise addiction, focusing on impulsivity and body image–related variables

Article Title: Exploring the Pathways to Exercise Addiction Risk: The Role of Impulsivity and Body Image–Related Variables

Article References: Lombardi, C., Fioravanti, G., Bocci Benucci, S., & Donati, M. A. (2026). Exploring the Pathways to Exercise Addiction Risk: The Role of Impulsivity and Body Image–Related Variables. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-026-01721-4

Image Credits: AI Generated

DOI: 10.1007/s11469-026-01721-4

Keywords: exercise addiction, impulsivity, body image, drive for muscularity, body appreciation, behavioral addiction, path analysis, eating disorders, mental health, physical exercise, gender differences, University of Florence