Muscle dysmorphia: Current research and potential classification as a disorder

ObjectiveTo review the literature for scientific evidence in support of inclusion of Muscle Dysmorphia (MD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).DesignThe criteria proposed by Blashfield, Sprock, and Fuller (1990) were used for determining whether scientific evidence supports the introduction of MD as a new disorder into a disease classification system.MethodPeer-reviewed journal articles were identified by searching databases for articles published (in print and electronically) from 2001 to 2011.ResultsThe search identified 59 journal articles that specifically focused on MD, of which 39 were empirical journal articles. There is ample literature on MD, including a common set of diagnostic criteria and assessment instruments to measure MD. However, questions remain about the diagnostic reliability and validity, including inter-rater reliability, and whether MD represents a disorder that consists of symptoms that frequently co-occur. Also, evidence of syndrome differentiation is lacking. Only two of the five criteria proposed by Blashfield et al. have been met.ConclusionLiterature suggests that MD is associated with several indicators of clinical significance and distinctiveness. However the current review has found significant limitations and gaps in the scientific literature on MD. Possible options regarding the status of MD in the DSM-5 are proposed, including introducing MD as an example of an eating disorder not otherwise specified, retaining MD as a body dysmorphic disorder, introducing MD as a new disorder, or introducing MD as a provisional diagnosis in need of further study.

► Some justification was found to support the inclusion of MD as a new disorder in DSM-5.
► Evidence of the validity of MD as a distinctive disorder was found.
► Evidence for the diagnostic reliability and validity of MD criteria is lacking.
► There is no research which addresses the coherence of MD symptoms.
► The review has implications for future revision of the DSM.