Muscle Dysmorphia (MD), a subtype of Body Dysmorphic Disorder, is characterized by obsessive concerns about muscularity, rigid exercise and dietary routines, and often long-term steroid use. A pilot case series previously published by Çınaroğlu and colleagues (2024) reported positive short-term outcomes following a 12-session manualized Cognitive Behavioral Therapy (CBT) intervention with seven Turkish male gym-goers diagnosed with MD and a history of anabolic steroid use. This study presents the 6- and 12-month follow-up outcomes to assess the durability and limitations of those therapeutic gains.


All seven participants completed both follow-up assessments. Thematic analysis of participant feedback revealed five major trajectories: (1) body image distortion showed partial recalibration, though fragile under social and performance pressures; (2) compulsive exercise and dietary routines were conditionally regulated, with relapse often triggered by stress or stagnation in physical appearance; (3) steroid use declined initially, but one participant resumed use by 12 months, indicating an ambivalent recovery pattern; (4) emotional and social avoidance decreased, yet body-exposure situations continued to provoke anxiety in some; and (5) identity narratives shifted toward a more nuanced understanding of masculinity, though pressure to embody a muscular ideal remained.


While most participants maintained significant improvements, minor relapses in behavior and cognition were common, especially under stress. The findings underscore the chronic and identity-linked nature of MD and suggest that while CBT fosters substantial progress, long-term support and booster sessions may be necessary to prevent regression. This follow-up study provides rare longitudinal insight into the lived experience of recovery from MD and contributes to the clinical understanding of how therapeutic change evolves in the context of body image, masculinity, and behavioral addiction.