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Body dysmorphic disorder, muscle dysmorphia, weight and shape dissatisfaction and the use of appearance-enhancing drugs in the military: a systematic review
  1. Briana Applewhite1,
  2. M Olivola2,3,
  3. C Tweed4,5,
  4. U Wesemann6 and
  5. H Himmerich1,4
  1. 1 Department of Psychological Medicine, King's College London, London, UK
  2. 2 Department of Brain and Behavioural Science, University of Pavia, Pavia, Italy
  3. 3 Department of Mental Health and Dependence, Azienda Socio-Sanitaria Territoriale di Pavia, Pavia, Italy
  4. 4 Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
  5. 5 Institute of Naval Medicine, Royal Navy, Gosport, UK
  6. 6 Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehrkrankenhaus Berlin, Berlin, Germany
  1. Correspondence to Dr H Himmerich, Department of Psychological Medicine, King's College London, London SE5 8AF, UK; hubertus.himmerich{at}


Background Body dysmorphic disorder (BDD) and muscle dysmorphia (MD) are common but often underdiagnosed disorders. These disorders have rarely been explored in the context of military personnel by mental health researchers despite the emphasis on physical fitness in military populations. We conducted a comprehensive systematic literature review on scientific studies of BDD and MD and the accompanying symptoms within the military.

Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and used PubMed, Web of Science and PsycINFO as databases with “body dysmorphic disorder,” “muscle dysmorphia,” “body image,” “performance and image enhancing drugs,” “anabolic steroid,” military personnel,” “soldiers,” “navy,” “air force,” “army” and “armed forces” as search terms.

Results A total of 20 eligible articles reporting data of 42 952 study participants were used. According to the identified literature, prevalence rates of BDD in the military are ~10% in men and ~20% in women, whereas ~15% of men and ~5% of women may suffer from MD. Further identified related problems in military populations were excessive bodybuilding, the use of anabolic drugs, the intake of stimulants, weight and shape concerns, and weight-control behaviours.

Conclusions BDD, MD, as well as the use of anabolic and stimulating drugs, are highly prevalent in military personnel. Despite the importance of these problems in the military, there are no military-specific treatment studies available. A pre-existing focus on physical appearance and fitness might contribute to the decision to pursue a professional military career. The military environment might be a maintaining factor of BDD or MD, but not the ultimate cause of the disorder in an affected individual.


Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable.

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  • Contributors CT and HH developed the research idea. BA and MO performed the literature search and the quality assessment; differences were resolved by HH. All authors contributed to the manuscript and agreed on its final version. HH is responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.