Rethinking Muscle Dysmorphia: Autonomy, Normativity, and Epistemic Injustice

Abstract

Muscle dysmorphia is currently defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, as a specifier of Body Dysmorphic Disorder and characterized by preoccupation with insufficient muscularity, repetitive appearance-related behaviors, and significant distress or impairment. However, many of the behaviors treated as symptoms are also central to bodybuilding as a normative practice. This raises a conceptual difficulty: distinguishing pathology from intentional, value-guided participation in a culturally specific discipline. Drawing on Fricker’s notion of epistemic injustice, this paper argues that the current diagnostic understandings of muscle dysmorphia risk misinterpreting the experiences and commitments of bodybuilders. Testimonial injustice arises when practitioners’ self-reports are discounted due to stereotypes concerning narcissism, insecurity, or poor insight. Hermeneutical injustice emerges when psychiatric frameworks lack the conceptual resources to recognize the normative structure of bodybuilding, thereby rendering its practices intelligible only as manifestations of a disorder. The paper further develops a conceptual analogy with the diagnostic history of gender dysphoria. Just as earlier clinical models misclassified transgender self-understanding by imposing external norms of gender, so the framing of muscle dysmorphia relies on culturally dominant assumptions about bodily appearance and a “balanced” lifestyle. The shift from “transition” to “affirmation” in gender discourse highlights how bodily modification can be understood as a legitimate form of self-definition rather than pathology. The paper concludes by outlining how a more epistemically just orientation to diagnosis could distinguish pathological distress from normative commitments in bodybuilding.