Competitive Bodybuilding: Fitness, Pathology, or Both?

Competitive Bodybuilding: Fitness, Pathology, or Both? / Ian H Steele, Harrison G. Pope, Gen Kanayama. - (Harvard Review of Psychiatry 27 (2019) 4 (July/August); p. 233–240). -

  • PMID: 31219882
  • DOI: 10.1097/HRP.0000000000000211


The sport of competitive bodybuilding requires an intense regimen of weightlifting and dieting, often aided with muscle-building or fat-burning drugs, and culminating in an on-stage posing competition. Despite these rigorous demands, competitive bodybuilding is popular, with thousands of competitions performed annually around the world. Although many studies have addressed the psychological features of various sports and the athletes who compete in them, few have examined the psychological aspects of bodybuilding. Even fewer studies have specifically examined competitive bodybuilders, as opposed to the much larger group of "recreational" bodybuilders who do not compete. The limited available literature suggests that competitive bodybuilders may show an increased risk for four categories of psychopathology: muscle dysmorphia, eating disorders, abuse of appearance- and performance-enhancing drugs, and exercise dependence. However, in each of these categories, one must carefully distinguish between the planned and dedicated behaviors required for success in the sport, as opposed to frankly pathological behaviors that impair social or occupational function, cause subjective distress, or lead to adverse health consequences. Future work should attempt to better assess the nature and prevalence of these conditions among competitive bodybuilders, with perhaps greatest attention to the issue of drug use.


20 June 2019
Kanayama, Gen
Pope, Harrison G. Jr.
Steele, Ian H.
United States of America
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Beth Israel Deaconess Medical Center (BIDMC)
Brigham and Women's Hospital (BWH)
Harvard Medical School (HMS)
McLean Hospital
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Body Dysmorphic Disorder
Health effects
Gym/fitness environment
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Date generated
23 October 2019
Date of last modification
2 December 2021
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