PHARMACOTHERAPY IN MUSCLE DYSMORPHIC DISORDER: CLINICAL CONSIDERATIONS AND THE LIMITS OF EXTRAPOLATING EVIDENCE FROM BODY DYSMORPHIC DISORDER

Anna Łęczycka; Kinga Łysak; Kinga Haduch; Zuzanna Michalska; Nicole Aleksandra  Ordyczyńska-Mardyła; Izabela Zuzanna  Stranz; Aleksandra Stańczyk; Olga Chorąży; Joanna Strzelczyk; Amelia Kędziora; Iga Suchta

doi:10.31435/ijitss.2(50).2026.5359

Authors

Anna Łęczycka Independent Public Health Care Facility of the Ministry of Internal Affairs and Administration in Gdańsk, Poland; University of Warmia and Mazury in Olsztyn, Poland https://orcid.org/0009-0004-9068-5222
Kinga Łysak Copernicus Memorial Hospital, Gdańsk, Poland; Medical University of Gdańsk, Poland https://orcid.org/0009-0008-5002-4365
Kinga Haduch University Hospital in Kraków, Poland; University of Warmia and Mazury in Olsztyn, Poland https://orcid.org/0009-0004-4853-9395
Zuzanna Michalska Clinical Hospital of the Ministry of Internal Affairs and Administration with the Warmia-Mazury Oncology Centre in Olsztyn, Poland; University of Warmia and Mazury in Olsztyn, Poland https://orcid.org/0009-0005-8775-102X
Nicole Aleksandra Ordyczyńska-Mardyła District Hospital in Chrzanów, Poland; University of Warmia and Mazury in Olsztyn, Poland https://orcid.org/0009-0007-1502-8291
Izabela Zuzanna Stranz Ludwik Rydygier Provincial Hospital in Toruń, Poland; University of Warmia and Mazury in Olsztyn, Poland https://orcid.org/0009-0002-3689-0132
Aleksandra Stańczyk Clinical Hospital of the Ministry of Internal Affairs and Administration with the Warmia-Mazury Oncology Centre in Olsztyn, Poland; University of Warmia and Mazury in Olsztyn, Poland https://orcid.org/0009-0000-2356-7841
Olga Chorąży Independent Public Healthcare Center Myślenice, Poland; University of Warmia and Mazury in Olsztyn, Poland https://orcid.org/0009-0001-3094-2299
Joanna Strzelczyk Nicolaus Copernicus Provincial Multispecialty Center for Oncology and Traumatology in Łódź, Poland; University of Warmia and Mazury in Olsztyn, Poland https://orcid.org/0009-0006-8212-9431
Amelia Kędziora University of Warmia and Mazury in Olsztyn, Poland https://orcid.org/0009-0001-8883-4370
Iga Suchta District Hospital in Proszowice, Poland; University of Warmia and Mazury in Olsztyn, Poland https://orcid.org/0009-0005-5837-5790

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5359

Keywords:

Muscle Dysmorphism, Bigorexia Nervosa, Body Dysmorphic Disorder, Exercise Addiction Disorder, Eating Disorder, Pharmacotherapy

Abstract

Background: Muscle dysmorphic disorder is a specifier of body dysmorphic disorder (BDD) characterized by a tenacious belief of insufficient muscularity. Although currently classified within BDD, muscle dysmorphism exhibits distinct clinical and behavioral features, constituting compulsive exercise, rigid dietary practices, and use of performance-enhancing substances. Aforementioned differences raise concerns regarding applicability of pharmacotherapeutic strategies derived from BDD studies to patients with muscle dysmorphism. The aim of the study is to critically evaluate the existing literature on pharmacotherapy in body dysmorphic disorder and assess its clinical applicability to muscle dysmorphic disorder, with considerations of diverging neurobiological, phenomenological, and behavioral distinction limiting direct generalizability.

Methods: A broad literature search was conducted in three major databases: PubMed, Cochrane Library, and Google Scholar, utilizing search terms (“muscle dysmorphism” or “muscle dysmorphic disorder” or “bigorexia nervosa” or “body dysmorphic disorder”) and (“pharmacotherapy” or “treatment” or “medication” or “pharmaceutical”). References were screened for relevance, and a total of 20 studies published between 1996 and 2026 were included in the analysis.

Results: This review evaluates and summarizes established pharmacological strategies used in the treatment of BDD and examines their potential relevance for muscle dysmorphic disorder. Selective serotonin reuptake inhibitors (SSRIs) remain the most consistently supported pharmacological intervention, demonstrating meaningful reductions in symptom severity across several studies. Additional treatments, including clomipramine and serotonin–noradrenaline reuptake inhibitors, have shown potential benefits in selected cases. Emerging therapeutic approaches, such as glutamatergic modulators, intranasal oxytocin, and psychedelic-assisted therapy, remain experimental. However, no clinical trials have specifically examined pharmacotherapy in muscle dysmorphic disorder.

Conclusions: Pharmacological strategies developed for BDD may provide partial therapeutic benefit, important differences in clinical presentation and potential neurobiological mechanisms limit direct extrapolation to muscle dysmorphic disorder. Future research should prioritize clinically controlled randomized trials exploring targeted pharmacological treatments for this condition.

References

Abdalla, M., Mukhtar, R., Elgamal, S. E., Elshoeibi, A. M., Elsayed, B., Chivese, T., & Khaled, S. M. (2026). The efficacy of cognitive behavioural therapy in the management of body dysmorphic disorder: A systematic review and meta-analysis. Clinical Psychology & Psychotherapy, 33(1). https://doi.org/10.1002/cpp.70218

Allen, A., Hadley, S. J., Kaplan, A., Simeon, D., Friedberg, J., Priday, L., Baker, B. R., Greenberg, J. L., & Hollander, E. (2008). An open-label trial of venlafaxine in body dysmorphic disorder. CNS Spectrums, 13(2), 138–144. https://doi.org/10.1017/S1092852900016291

Burmeister, M. A. (2025). Bigorexia nervosa review. US Pharmacist, 50(6), 4–11.

Byrne, E. H., Pikoos, T. D., & Rossell, S. L. (2026). A meta-analysis and systematic review examining efficacy, acceptability and patient retention in psychotherapy studies for the treatment of body dysmorphic disorder. Body Image, 56, 102025. https://doi.org/10.1016/j.bodyim.2025.102025

Castle, D., Beilharz, F., Phillips, K. A., Brakoulias, V., Drummond, L. M., Hollander, E., Ioannidis, K., Pallanti, S., Chamberlain, S. R., Rossell, S. L., Veale, D., Wilhelm, S., Van Ameringen, M., Dell’Osso, B., Menchon, J. M., & Fineberg, N. A. (2021). Body dysmorphic disorder: A treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders and the Obsessive Compulsive and Related Disorders Network of the European College of Neuropsychopharmacology. International Clinical Psychopharmacology, 36(2), 61–75. https://doi.org/10.1097/YIC.0000000000000342

Dong, N., Nezgovorova, V., Hong, K., & Hollander, E. (2019). Pharmacotherapy in body dysmorphic disorder: Relapse prevention and novel treatments. Expert Opinion on Pharmacotherapy, 20(10), 1211–1219. https://doi.org/10.1080/14656566.2019.1610385

Fang, A., Porth, R., Phillips, K. A., & Wilhelm, S. (2019). Personality as a predictor of treatment response to escitalopram in adults with body dysmorphic disorder. Journal of Psychiatric Practice, 25(5), 347–357. https://doi.org/10.1097/PRA.0000000000000415

Grace, S. A., Labuschagne, I., Castle, D. J., & Rossell, S. L. (2019). Intranasal oxytocin alters amygdala-temporal resting-state functional connectivity in body dysmorphic disorder: A double-blind placebo-controlled randomized trial. Psychoneuroendocrinology, 107, 179–186. https://doi.org/10.1016/j.psyneuen.2019.05.022

Hoffman, R., & Parmar, M. (2025, December 9). Fluvoxamine. In StatPearls. StatPearls Publishing.

Hollander, E., Allen, A., Kwon, J., Aronowitz, B., Schmeidler, J., Wong, C., & Simeon, D. (1999). Clomipramine vs. desipramine crossover trial in body dysmorphic disorder. Archives of General Psychiatry, 56(11), 1033. https://doi.org/10.1001/archpsyc.56.11.1033

Dhaliwal, J. S., Spurling, B. C., & Molla, M. (2023, May 29). Duloxetine. In StatPearls. StatPearls Publishing.

Hudson, J. I. (2015). An open label trial of memantine in the treatment of bulimia nervosa and body dysmorphic disorder. McLean Hospital. https://ClinicalTrials.Gov/Show/NCT01038128

Kumar, A., Maini, K., & Kadian, R. (2023, December 3). Levetiracetam. In StatPearls. StatPearls Publishing.

Nagata, J. M., Hur, J. O., Murakami, K., Ganson, K. T., He, J., Murray, S. B., & Lavender, J. M. (2026). Muscle dysmorphia in adolescents and young adults. The Lancet Child & Adolescent Health, 10(2), 122–134. https://doi.org/10.1016/S2352-4642(25)00283-4

Nakaaki, S., Murata, Y., & Furukawa, T. A. (2008). Efficacy of olanzapine augmentation of paroxetine therapy in patients with severe body dysmorphic disorder. Psychiatry and Clinical Neurosciences, 62(3), 370–370. https://doi.org/10.1111/j.1440-1819.2008.01813.x

Nicewicz, H. R., Torrico, T. J., & Boutrouille, J. F. (2025). Body dysmorphic disorder.

Pallanti, S., & Koran, L. M. (1996). Intravenous, pulse-loaded clomipramine in body dysmorphic disorder: Two case reports. CNS Spectrums, 1(2), 54–57. https://doi.org/10.1017/S1092852900002650

Phillips, K. A., Albertini, R. S., & Rasmussen, S. A. (2002). A randomized placebo-controlled trial of fluoxetine in body dysmorphic disorder. Archives of General Psychiatry, 59(4), 381. https://doi.org/10.1001/archpsyc.59.4.381

Phillips, K. A., Dwight, M. M., & McElroy, S. L. (1998). Efficacy and safety of fluvoxamine in body dysmorphic disorder. The Journal of Clinical Psychiatry, 59(4), 165–171. https://doi.org/10.4088/JCP.v59n0404

Phillips, K. A., Keshaviah, A., Dougherty, D. D., Stout, R. L., Menard, W., & Wilhelm, S. (2016). Pharmacotherapy relapse prevention in body dysmorphic disorder: A double-blind, placebo-controlled trial. The American Journal of Psychiatry, 173(9), 887–895. https://doi.org/10.1176/appi.ajp.2016.15091243

Phillips, K. A., & Menard, W. (2009). A prospective pilot study of levetiracetam for body dysmorphic disorder. CNS Spectrums, 14(5), 252–260. https://doi.org/10.1017/s1092852900025414

Phillips, K. A., & Najjar, F. (2003). An open-label study of citalopram in body dysmorphic disorder. The Journal of Clinical Psychiatry, 64(6), 715–720. https://doi.org/10.4088/jcp.v64n0615

Pope, C. G., Pope, H. G., Menard, W., Fay, C., Olivardia, R., & Phillips, K. A. (2005). Clinical features of muscle dysmorphia among males with body dysmorphic disorder. Body Image, 2(4), 395–400. https://doi.org/10.1016/j.bodyim.2005.09.001

Schneier, F. R., Feusner, J., Wheaton, M. G., Gomez, G. J., Cornejo, G., Naraindas, A. M., & Hellerstein, D. J. (2023). Pilot study of single-dose psilocybin for serotonin reuptake inhibitor-resistant body dysmorphic disorder. Journal of Psychiatric Research, 161, 364–370. https://doi.org/10.1016/j.jpsychires.2023.03.031

Sharbaf Shoar, N., Fariba, K. A., & Padhy, R. K. (2023, November 7). Citalopram. In StatPearls. StatPearls Publishing.

Shrestha, P., Fariba, K. A., & Abdijadid, S. (2023, July 17). Paroxetine. In StatPearls. StatPearls Publishing.

Singh, D., & Saadabadi, A. (2024, February 26). Venlafaxine. In StatPearls. StatPearls Publishing.

Sohel, A. J., Shutter, M. C., & Patel, P. (2024, February 28). Fluoxetine. In StatPearls. StatPearls Publishing.

Trichas, M., Janniger, C. K., & Schwartz, R. A. (2025). Body dysmorphic disorder: 21st century challenges. International Journal of Dermatology, 64(8), 1342–1348. https://doi.org/10.1111/ijd.17708

Uzun, Ö., & Özdemir, B. (2010). Aripiprazole as an augmentation agent in treatment-resistant body dysmorphic disorder. Clinical Drug Investigation, 30(10), 707–710. https://doi.org/10.2165/11536730-000000000-00000

Varigonda, A. L., Jakubovski, E., & Bloch, M. H. (2016). Systematic review and meta-analysis: Early treatment responses of selective serotonin reuptake inhibitors and clomipramine in pediatric obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 55(10), 851–859.e2. https://doi.org/10.1016/j.jaac.2016.07.768

Vasiliu, O. (2023). At the crossroads between eating disorders and body dysmorphic disorders—The case of bigorexia nervosa. Brain Sciences, 13(9), 1234. https://doi.org/10.3390/brainsci13091234

Wilson, M., & Tripp, J. (2024, August 24). Clomipramine. In StatPearls. StatPearls Publishing.

Yao, Y., Guo, D., Lu, T.-S., Liu, F.-L., Huang, S.-H., Diao, M.-Q., Li, S.-X., Zhang, X.-J., Kosten, T. R., Shi, J., Bao, Y.-P., Lu, L., & Han, Y. (2024). Efficacy and safety of psychedelics for the treatment of mental disorders: A systematic review and meta-analysis. Psychiatry Research, 335, 115886. https://doi.org/10.1016/j.psychres.2024.115886

Zhu, X., Zhang, C., Hellerstein, D., Feusner, J. D., Wheaton, M. G., Gomez, G. J., & Schneier, F. (2024). Single-dose psilocybin alters resting state functional networks in patients with body dysmorphic disorder. Psychedelics, 1(1), 25–31. https://doi.org/10.61373/pp024r.0028