Body Dysmorphic Disorder (BDD) is characterized by obsessive preoccupation with perceived physical
flaws, often unnoticed by others. This preoccupation causes significant emotional distress, social withdrawal,
and functional impairment. Recent advancements emphasize the importance of integrating neurobiological
and behavioral perspectives in understanding BDD. This review synthesizes findings from
neuroscience and behavioral psychology to examine the brain-behavior relationship in BDD and explores
implications for treatment strategies. A narrative synthesis of current literature, including neuroimaging,
neurochemical studies, and behavioral research, was conducted. Evidence from clinical trials on pharmacological
treatments, cognitive-behavioral therapy, and neuromodulation techniques was analyzed.
Neuroimaging studies reveal hyperactivity in the orbitofrontal cortex, amygdala, and fusiform gyrus, contributing
to obsessive thoughts, heightened emotional responses, and distorted visual processing. Neurochemical
imbalances, particularly in serotonin, dopamine, and gamma-aminobutyric acid systems, perpetuate
cognitive distortions and compulsive behaviors. Cognitive patterns, including selective attention to
perceived flaws, catastrophic thinking, and overestimation of others’ judgments, interact with maladaptive
behaviors such as mirror checking, avoidance, and reassurance-seeking. Integrated treatments, including
selective serotonin reuptake inhibitors, cognitive-behavioral therapy, and transcranial magnetic stimulation,
address these interconnected mechanisms effectively. BDD arises from a complex interaction between
neurobiological dysfunction, cognitive distortions, and maladaptive behaviors. Effective treatment
requires a multidisciplinary approach targeting these domains. Future research should focus on longitudinal
brain plasticity studies, sex differences, and optimized neuromodulation protocols to enhance therapeutic
outcomes and personalized interventions.

Muscle dysmorphia (MD) is a subtype of body dysmorphic disorder characterized by an obsessive
belief that one’s body is insufficiently muscular. This review provides a comprehensive examination of
the addiction cycle in MD, particularly in the context of anabolic steroid and performance‑enhancing
drug (PED) use. Utilizing a systematic search across databases such as PubMed, PsycINFO, Scopus,
and Web of Science, the review draws on peer‑reviewed literature published in the past two decades
to uncover the roles of hormonal and neural alterations in perpetuating this cycle. Inclusion and
exclusion criteria were meticulously applied to ensure a robust analysis of relevant studies. The
article details the interaction between exogenous hormonal supplementation from steroids and PEDs
and brain receptors, which significantly disrupt neurotransmitter systems and affect mood, cognition,
and stress responses. The synthesis of data reveals that hormonal imbalances due to substance abuse
lead to profound changes in brain plasticity and function, instigating psychiatric disorders and
complicating withdrawal and treatment. Therapeutic strategies are critically assessed, with emphasis
on the success of cognitive‑behavioral therapy, the role of pharmacological management, and the
promise of emerging treatments targeting neuroendocrine disruptions. The review suggests an
integrated, holistic treatment model that includes hormonal therapy and neurological considerations,
underscoring the importance of personalized and sustained interventions. In conclusion, the intricate
cycle of addiction in MD, fueled by the hormonal effects of steroids and PEDs on the brain, calls for
an integrated approach to treatment. Future research should focus on the neuroendocrine impact of
these substances to refine therapeutic strategies for MD.