often report increased stress from not meeting the imposed standard of a masculine and muscular body. In a sample of 2,733 MSM who reported body dissatisfaction, only one in every 10 reported feeling no dissatisfaction with their muscularity. Dissatisfaction with muscularity had a stronger relationship with quality of life impairment when compared to dissatisfaction with body fat, height, and penis size. Those who identify as a sexual minority are at increased risk for victimization due to their identity. Having been a victim of homophobic bullying is associated with more symptoms of muscle dysmorphia. A possible cause for this relationship can be the increased feelings of paranoid ideation that a MSM individual can experience following homophobic bullying. Treatment Treatment of muscle dysmorphia can be stymied by a patient's unawareness that the preoccupation is disordered or by avoidance of treatment. Scientific research on treatment of muscle dysmorphia is limited, the evidence largely in case reports and anecdotes, and no specific protocols have been validated. Still, evidence supports the efficacy of family-based therapy, cognitive behavioural therapy, and pharmacotherapy with selective serotonin reuptake inhibitors. Also limited is research on prognosis of the untreated. Prevalence Prevalence estimates for muscle dysmorphia have greatly varied, ranging from 1% to 54% of men in the studied samples. Samples of gym members, weightlifters, and bodybuilders show higher prevalence than do samples from the general population. Rates even higher have been found among users of anabolic steroids. The disorder is rare in women but does occur, and has been noted especially in female bodybuilders who have experienced sexual assault. Crossing cultures, muscle dysmorphia has been identified in China, South Africa, and Latin America. Nonwestern populations less exposed to western media show lower rates of muscle dysmorphia. History Muscle dysmorphia was first conceptualized by healthcare professionals in the late 1990s. In 2016, 50% of peer-reviewed articles on it had been published in the prior five years. Although muscle dysmorphia was initially viewed as anorexia nervosa's inverse—questing to be large and muscular instead of small and thin—later researchers fit the subjective experience to body dysmorphic disorder. The American Psychiatric Association recognized muscle dysmorphia with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. This DSM-5, published in 2013, classifies it under body dysmorphic disorder. Muscle dysmorphia is absent from the International Statistical Classification of Diseases and Related Health Problems''' present edition, the tenth, published in 1992. Reclassifications Muscle dysmorphia's