Strength OCD: When OCD Targets Physical Adequacy and Performance Capability

The stigma that surrounds OCD tends to attach itself to some of its most visible symptoms — contamination fears, repeated checking of things, intrusive thoughts that feel alien and distressing. Increasingly, obsessive-compulsive subtypes are being recognised as a way to bring attention to the variable nature of these experiences, enabling greater awareness, encouraging discussion, and help-seeking. Recent research has shown that different subtypes are underpinned by divergent neurobiological pathways — involving distinct patterns of brain activity and dysregulation across multiple neurotransmitter systems — suggesting there is clinical value in this work beyond discussion alone (Proshina et al., 2025). I propose in this article that there is potentially another subtype of OCD which exists in the form of a socially acceptable experience that many professionals have not been encouraged to recognise. I argue that the failure to do so is not a matter of clinical oversight but representative of structural gaps in the way we screen for and conceptualise obsessive-compulsive presentations.

How the presentation organises itself

Strength OCD is an obsessive-compulsive presentation organised around the pursuit of a physical performance ideal. This obsession centres around inadequacy — not being muscular, strong, or physically capable enough — and on the terror of regression (returning to a body that feels vulnerable or exposed). The compulsive system that develops around these fears is maintained by exactly the same anxiety-relief mechanism that drives every other OCD presentation. The behaviour temporarily quiets the fear. The fear returns. The behaviour escalates.

What makes this presentation clinically invisible is that it develops inside a culture that certainly normalises, and likely at times even celebrates its symptoms. The compulsive training regimen looks like discipline, while dietary rigidity looks like commitment and supplementation stacks look like informed self-optimisation. The person experiencing this presentation does not, in most cases, initially experience it as a problem. They experience it as identity — which makes it difficult to screen for and easy to miss.

The five compulsive clusters

Why it doesn't get identified

Three independent failures converge to make this population clinically invisible.

Eating disorder instruments are directionally misaligned. The muscularity-focused presentation simply isn't what the questionnaire was built to find (Laskowski et al., 2023).

OCD instruments rely on distress as their primary signal. In the early and middle stages compulsions likely don't cause distress but instead produce social validation and a sense of identity coherence. Distress appears only when the behaviour is interrupted — but by that point, it is usually an injury or external crisis that has forced the interruption, not the compulsive system itself that has brought the person to seek help. This ego-syntonic quality — where the behaviour feels consistent with identity rather than alien to it — is a recognised feature of overvalued ideation in OCD, and a well-documented obstacle to detection and help-seeking (Demshuk, 2026).

Cultural normalisation makes recognition difficult. Without knowing to ask about the anxiety produced by deviation, the degree to which exercise performance has come to organise the entire social world — this will look like a very dedicated athlete.

The case for naming it

I'm not saying Strength OCD is a new disorder, but rather that it could represent an obsessive-compulsive phenotype with a specific cultural form — one whose mechanism maps cleanly onto established phenomenology (Proshina et al., 2025), and whose treatment follows from that mechanism. Exposure and response prevention, tolerance of uncertainty, inferential analysis of the reasoning errors driving the feared outcome — these are the active ingredients. The feared self which underlies this presentation is typically organised around vulnerability or inadequacy, often rooted in earlier experiences where physical capability carried social survival value (Aardema & Wong, 2020; Csigó et al., 2024).

The absence of a named construct has consequences. Without it, there is no validated screen and no clear referral pathway. The GP who encounters this person has nowhere to send them. The consequences of excessive exercise without adequate recovery, supplement misuse, and macronutritional rigidity are significant individually — their convergence within a highly anxious individual organised around a feared self is worth naming, if it meets threshold, like any other form of OCD.

The demographic is not small. Research on gym-going populations internationally finds that approximately 11.7% of gym users score above the cut-off for exercise addiction, 38.5% are at risk of body dysmorphic disorder, and nearly 40% use fitness supplements without medical consultation — with supplement users scoring significantly higher on compulsive exercise measures (Brez & Villeneuve, 2019). Among AAS users in gym populations, muscle dysmorphia symptoms are significantly more severe than in non-users (Cohen's d ≈ 0.45), and there is a moderate positive correlation between muscle dysmorphia severity and OCD traits across the broader population of people who lift (Yılmazer, 2025). These figures capture only those who meet criteria for existing diagnoses. The cohort I am describing is broader: people whose presentation organises around the same obsessional mechanism but who fall beneath every current threshold because the instruments were never built to find them.

That is the argument for naming this. Not to create a new disorder, but to give clinicians and the people sitting across from them a language for something that is already there.