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I would like to raise a concern with regard to the article “Muscle dysmorphia: a new syndrome in weightlifters” by Choi et al.1 Although chronic obsessive behaviour related to fitness and weightlifting is genuinely a concern for both sexes, Choi et al fail, in my opinion, to present a valid argument for the construction of “muscle dysmorphia” as being a separate and distinct subcategory of body dysmorphic disorder. Inclusion criteria and procedures in the study by Choi et al were identical with those used in the study by Olivardia et al2—they used identical study populations. Both Choi et al and Olivardia et al claim that differences exist between their cases (weightlifters preoccupied with their body image, namely insufficient muscularity) and controls (weightlifters not preoccupied with their body image) with respect to body image and a variety of other characteristics. However, in both studies, the aim of which was to distinguish muscle dysmorphia as a distinct clinical entity, individuals were classified as cases or controls on the basis of their body image perception. It is therefore hardly a surprise to find that men who obsess about their body image and who perceive themselves to be insufficiently muscular differ with respect to their body image and their perception of being insufficiently muscular from men who do not have the perception of being insufficiently muscular. Olivardia et al discuss this limitation, stating that, although this tautology exists, there are other factors that separate the two groups (higher lifetime prevalence of mood and anxiety disorders, use of steroids and other drugs, and higher scores on many Eating disorders inventory subscales). However, this evidence alone is not sufficient to indicate that these characteristics distinguish a muscle dysmorphia construct, as it is possible that, within this target population (male weightlifters), the proposed muscle dysmorphia characteristics in fact distinguish the other observed disorders. I would advise readers to take the conclusion of Choi et al that “ . . .muscle dysmorphia may be one negative consequence of physical exercise behaviour . . .” with extreme caution, as its validity as a distinct clinical entity has not yet been proven.
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