Although it’s on the rise, bigorexia is not the most common body dysmorphic disorder, but it still poses severe dangers to athletes of all stripes. In fact, researchers estimate that anywhere from 1 to 54 percent of male athletes experience this body image disorder, and those figures continue to rise. Keep reading to learn more about muscle dysmorphia and how to recognize its symptoms.
If you’ve never heard of this condition, you’re not alone. It’s uncommon as a whole and even less common in women. But bigorexia is an actual disorder that also goes by the names “megarexia” and “reverse anorexia.” Healthcare professionals first began to explore the topic in the late 1990s, and today numerous studies have highlighted the risks and symptoms of the disease.
Bigorexia or megarexia are alternate names for muscle dysmorphia, dysmorphia meaning a deformity or abnormality in the shape or size of a specific part of the body. However, not every person who focuses on building up muscle or achieving a particular leanness level has megarexia.
The definition of muscle dysmorphia is the “delusional or exaggerated belief” that one’s body is too small, too skinny, not muscular enough, or not lean enough. It lies on the extreme end of self-conscious feelings about one’s body, causing it to qualify as both a mental illness and an eating disorder.
Body dysmorphic disorder, which covers conditions that affect an individual’s perception of one’s body, includes bigorexia, anorexia, and others. Muscle dysmorphia is the clinical term for body dysmorphic disorder that involves a distorted view of one’s muscles, and it starts in the brain.
Internal feelings of self-consciousness, a history of being bullied, and simple biology all contribute to an individual developing body dysmorphic disorder, but researchers have yet to define a specific set of risk factors for this condition.
Also known as megarexia, this body image disorder often accompanies other diseases with similar symptoms, and that overlap can contribute to different levels of severity.
While muscle dysmorphia often overlaps with eating disorders, it technically does not qualify as an eating disorder on its own (https://bdd.iocdf.org/expert-opinions/muscle-dysmorphia/). However, people with the condition often adhere to excessively specific diets that target muscle mass and leanness.
People with body image disorders can have restrictive eating habits, bulimia nervosa, or even binge eating disorders. Unfortunately, these serve to worsen the effects of bigorexia as sufferers put further strain on their bodies through denying their systems proper nutrition.
Body dysmorphic disorder inhabits the category of “obsessive-compulsive related disorder” because its symptoms are so like those of obsessive-compulsive disorder (OCD) (https://www.verywell.com/ocd-and-body-dysmorphic-disorder-2510581). People with OCD have persistent and recurrent obsessive thoughts and exhibit repetitive compulsive behaviors, while muscle dysmorphia focuses in on the muscular components of the body rather than other body parts or environmental factors.
Overall, the comorbidity (the rate of the two conditions occurring together) of OCD and body dysmorphic disorder ranges from 3 to 43 percent.
Mood disorders like bipolar disorder and depression often reveal themselves when an individual is dealing with a body image disorder. Even Attention Deficit Hyperactivity Disorder (ADHD) can influence body dysmorphia and further complicate diagnosis.
Social anxiety disorder is another ailment that commonly occurs along with muscle dysmorphia. It stems from the feelings of inefficiency and low self-worth that muscle dysmorphia sufferers experience. Together, anxiety and body image disorders create a dysfunctional pair.
Because of the limited amount of information about bigorexia in the scientific literature, it’s difficult for medical professionals to define every risk factor for the disorder. However, early research indicates that some groups are at higher risk of developing muscle dysmorphia than others.
Overall, risk factors for developing megarexia relate to people’s internal feelings about themselves, from their self-confidence to their acceptance of their bodies, quirks included. For that reason, researchers have defined specific groups which are at higher risk of developing megarexia than other groups (http://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=4441&context=dissertations).
A combination of peer pressure and normal hormonal changes can cause adolescents to feel insecure about their bodies. These feelings can lead to efforts toward muscle growth or other body modifications through strenuous exercise and a specific diet.
Recreational bodybuilders, along with those who use steroids, have a higher prevalence of muscle dysmorphia than other athletes. While steroids have serious side effects, even bodybuilders without a history of using performance enhancers face a risk of body image disorder.
Other athletes who are highly competitive, desire control, and aim for perfectionism are more likely to be predisposed to muscle dysmorphia as well, even outside the realm of bodybuilding. Similarly, the expectation that athletes have a certain level of muscularity also contributes to athletes’ risk factors.
A preoccupation with physical appearance can also contribute to the development of body dysmorphic disorders. Specifically, “maladaptive views” are related to reverse anorexia that begins with adolescents.
Some studies indicate that people who have experienced abuse or bullying may develop “muscular obsession.” Because many victims tend to view bullying as a sign that they are inadequate, enhancing their physique often seems a sensible way to fight back.
For years, studies have suggested that popular media is a substantial influence on people’s lives, particularly adolescents who are impressionable. Since the media often portrays unrealistic views of the human body, it makes sense that sufferers of body dysmorphia would point to the television, movies, and advertisements as indicators of how a body “should” look.
In general, women experience body dysmorphic disorders at higher rates than men. However, men can experience male eating disorders and muscle dysmorphia at much higher rates than women. That said, female sufferers of megarexia often have underlying risk factors that men do not.
One study found that as high as 13 percent of female weightlifters have experienced a sexual assault. For the majority of those women, starting or increasing weight lifting activities after said assault was a way of creating protection against future attacks (https://www.ncbi.nlm.nih.gov/pubmed/10428186/).
Similarly, men with body image disorders or male eating disorders often report past assaults and turn to extreme bodybuilding to protect themselves and intimidate would-be attackers.
According to some research, one of the causes of muscle dysmorphia includes a genetic predisposition to this condition and other obsessive behaviors. The NHS notes that a chemical imbalance in the brain may be responsible for some cases of body dysmorphic disorder (https://www.nhs.uk/conditions/body-dysmorphia/).
At the same time, people’s social environments, along with other environmental factors, also have a significant impact on their perceptions of their bodies. For one megarexia sufferer, a combination of depressive episodes, psychological abnormalities, and media influence in the form of muscle magazines contributed to his development of muscle dysmorphia (www.dailymail.co.uk/news/article-2396498/Doctors-warn-rise-number-men-suffering-bigorexia.html).
Unfortunately, the personal trainer didn’t avoid significant injury, but he did later receive treatment for the condition. He also went on to publicize his story to help others avoid the same circumstances.
However comical the word might sound, true medical risks, along with sociological impacts, accompany bigorexia. While not all people who experience symptoms suffer serious health repercussions, these health dangers are unfortunately common.
Studies show that adolescents with body dysmorphic disorders have trouble interacting with friends and intimate partners, and that effect extends to adults as well. A person who is extremely self-conscious and internally focused has a difficult time developing and maintaining interpersonal relationships (https://www.anred.com/musdys.html).
Because this body image disorder leads people to tackle extreme, compulsive workouts and continuously analyze their muscles and body, sufferers often turn to artificial means of boosting performance. That includes taking supplements, drinking protein shakes and even using anabolic steroids to artificially enhance muscles (www.independent.co.uk/life-style/health-and-families/health-news/bigorexia-what-is-muscle-dysmorphia-and-how-many-people-does-it-affect-10511964.html).
Not only does steroid use lead to addiction, but they can also cause side effects both men and women that affect mental and physical health (https://www.nhs.uk/conditions/anabolic-steroid-misuse/). Risks include:
Muscle dysmorphic disorder often accompanies depression, meaning that people with the condition have a higher risk of suicide than other populations. In fact, studies report that megarexia itself can lead to depression, steroid abuse, and suicide.
The thousands of people who live with muscle dysmorphia often feel bad about themselves to the point of becoming hopeless and depressed, and a lack of supportive interpersonal relationships only contributes to their tendency to become reclusive and even suicidal.
Many celebrity athletes and bodybuilders deal with body image disorders, including male eating disorders. Unfortunately, some have even become cautionary tales as they have passed away following struggles with mental health and the after-effects of overexertion and substance abuse.
Rich Piana started bodybuilding at age 18, and he publicly admitted to abusing steroids and synthetic human growth hormones 25 years into his career (https://en.wikipedia.org/wiki/Rich_Piana). While the former Mr. Teen California cautioned other bodybuilders against following in his footsteps, he noted that he accepted the risks of using steroids and that he was happy with his choice.
Piana died at age 46 from sudden cardiac arrest, which may have resulted from his long history of abusing steroids and other performance-enhancing drugs. His autopsy showed his organs were twice the average size and that he had significant heart disease at the time of death.
Her initial athletic pursuits involved triathlons, but the formerly petite Rene Campbell attended a bodybuilding competition and immediately knew that was the sport she would pursue. However, she almost immediately developed bigorexia (www.cosmopolitan.com/uk/reports/news/a39236/female-bodybuilder-bigorexia-rene-campbell/).
Campbell became obsessed with getting as big as possible, adhering to a specific workout routine and planning her meals nearly a month in advance. She also says that she likes her large muscles and that she feels “more comfortable” at a larger size.
Campbell admitted that she finds it hard to maintain relationships because of her strict routine and that she has had to pull out of competitions to allow her body to recover from the stress it manages during training and everyday life. Megarexia practically consumes her life, showing that although women are at a lower risk of reverse anorexia, its consequences are serious when it occurs.
It can be challenging to identify and diagnose reverse anorexia because many people with the condition are reluctant to admit they are struggling. Seeking treatment clashes with muscle dysmorphia’s goal of earning praise and acknowledgment for massive muscle growth, so many people avoid seeking help (https://www.eatingdisorderhope.com/blog/muscle-dysmorphia-signs-symptoms-and-prevalence). Therefore, it’s essential to pinpoint the symptoms of body dysmorphia and encourage sufferers to get help, even if the sufferer is you.
While many symptoms are invisible, particularly anxiety and compulsive thoughts, there are visible signs of reverse anorexia.
At either extreme or the other, continually checking or consistently avoiding looking at oneself in the mirror are both indicators of body dysmorphia. If an individual is in the advanced stages of muscle dysmorphia and likes what they see, they’ll flex in front of the mirror and admire their work.
If someone is just beginning to embark on a muscle-developing journey thanks to reverse anorexia, they’ll avoid looking in the mirror and may even become reclusive until they reach their ideal body standard.
Many athletes with muscle dysmorphia ignore their bodies’ signs of illness or injury, instead choosing to “work through the pain” and adhere to their strict workout regimens. They may experience anxiety if they have to miss a workout, and would rather subject their bodies to further stress rather than take a break.
In severe cases, undergoing surgery may seem like a simple solution for people with severe muscle dysmorphia. Opting for surgery to enhance one’s appearance isn’t always a sign of body dysmorphia, but if the goal is to increase muscle mass or appearance, then this is a worrisome sign.
Hitting the gym regularly is healthy for all of us, but maintaining a strict workout schedule that doesn’t leave time for recovery or life’s other pursuits is not. Avid gymgoers who avoid social gatherings or even mealtimes in favor of working out more may be experiencing body dysmorphia.
Many beneficial supplements can help athletes achieve their fitness goals. However, reliance on multiple supplements, or substituting said supplements in the place of healthy food, may be a sign of unhealthy behavior related to reverse anorexia.
Professional consultation is the only way to confirm muscle dysmorphia, but strategies for diagnosis vary. However, one study developed a set of criteria through multiple evaluations and assessments. Their work resulted in a model that considers the components of inadequacy, preoccupation, compulsivity, muscularity drive, increased muscularity, body anxiety, social sacrifice, and persistence (https://digitalcommons.wku.edu/theses/479/).
These eight components help professionals to recognize and diagnose symptoms of muscle dysmorphia in a clinical setting, which can help them to establish treatment plans that aid recovery.
Although there are treatment methods that can help manage muscle dysmorphic disorder, there is no known cure. Therefore, a lifelong commitment to recovery and a robust support system are required to help people deal with the condition. Here are a few common treatments for muscle dysmorphia.
An evaluation of the existing case series, studies, trials, and meta-analyses of cognitive and behavioral treatment approaches to body dysmorphic disorder found that individual and group cognitive behavior therapies are optimal for body dysmorphia management (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589080/).
Addressing the harmful thought and behavior patterns of body dysmorphia uses cognitive restructuring to “re-set” the brain and its impulses. This means that therapy focuses on resetting an individual’s perception of body image and body-related beliefs. Replacing irrational thoughts with body-positive ones is the first step in managing body dysmorphia.
You may not be able to stop a compulsive mirror-checker from checking the mirror, so the ideal place to start managing their derogatory self-image is to neutralize the negative feelings they experience as they look in the mirror. Along with cognitive restructuring, people with dysmorphic disorders learn to reprogram their brains for positive and self-affirming thoughts instead of detrimental ones.
Avoiding relapse requires ongoing treatment and symptom management, so participation in a maintenance program can help people from relapsing into self-deprecating and self-harming behaviors. In fact, studies show that people who join maintenance programs are better able to manage symptom fluctuations and therefore avoid relapse.
Research suggests that taking medication can help treat the symptoms of body dysmorphic disorder (https://bdd.iocdf.org/expert-opinions/medication-faq/). These medicines include serotonin reuptake inhibitors (SRIs), which also go by the name selective serotonin reuptake inhibitors (SSRIs).
The medications are antidepressants but also reduce obsessive thoughts and compulsive behaviors. However, the FDA does not currently approve these medications for treating body dysmorphic disorder. That said, with appropriate dosing and comprehensive cognitive behavioral therapy, symptoms of muscle dysmorphia should lessen.
Also, if people who have muscle dysmorphia also have conditions such as depression, bipolar disorder, or OCD, treating those diseases separately from and before muscle dysmorphia therapy can improve a patient’s prospects for recovery.
If you or someone you know has megarexia, there are steps you or they can take immediately to help stop self-destructive behaviors. This 5-step action plan will put you on the path toward body positivity and a reduction in body dysmorphic symptoms.
Becoming educated on the topic of megarexia is the first step in helping yourself or someone you love to recognize and address the condition. Beyond stuffy medical journals, there are tons of comprehensive educational resources to help you understand muscle dysmorphia.
This article contains a preliminary rundown of symptoms, but some signs are more difficult to recognize. Whether you suspect a friend or family member has megarexia, or if you think you may have it, knowing the full range of symptoms and how to recognize them will help you to take action and reduce the chances of serious health and social repercussions.
Self-help books can help people reach personal goals ranging from smoking cessation to relationship repair, and the same is true of books about body dysmorphia. Reading about others’ experiences and success stories can help you to recognize what comes next in your body image disorder journey.
Whether for you or a friend, approaching the situation honestly is important. Short of staging an intervention, you should approach others with sensitivity and an attempt to understand where they’re coming from if you suspect body dysmorphia.
That said, the harsh truth can sometimes inspire people to take action whereas softer attempts see no results. If self-help is your goal, acknowledging your self-deprecatory rituals and addressing any drug use is vital for reestablishing mental and physical health.
Doctors and therapists are not the enemies if you’re dealing with body dysmorphia. They hold the tools that can help you to overcome challenges and live a healthier life. Therefore, seeking professional help should come next in your treatment plan.
Your primary physician not only knows your medical history, but he or she likely knows you on a personal level as well. It’s normal to feel uncomfortable approaching your doctor and disclosing supplement or steroid use, but it’s critical for your treatment.
If you feel intimidated or nervous, take a friend or family member along to diffuse the tension and offer moral support. They can also encourage you to be honest and straightforward with your doctor.
You might think that visiting with a mental health counselor or psychiatrist is unnecessary given the physical nature of muscle dysmorphia, but this is the primary step toward seeking cognitive behavior therapy. Without a specialist, you won’t be able to access therapy techniques and helpful treatment.
Alongside your medical team, you will create a treatment plan that addresses your mental and physical wellbeing. This treatment plan may include any of the below strategies, plus other recommendations based on your unique situation.
Especially if you receive a diagnosis of OCD or another underlying condition, taking your prescribed medication will help set things in motion and maintain consistency.
Recognizing how you’re feeling and what behaviors stem from those feelings can show your doctor more about your condition than you’re willing to verbalize. Journaling can also feel therapeutic.
Stick with the diet that you and your physician or specialist develop, and make sure you’re getting adequate rest.
Having emotional and social support from friends and family will help ease your journey toward better mental and physical health. There’s no shame in joining support groups or teaming up with nutritionists or counselors, either.
Ultimately, studies have proven that peer support is vital in recovery from myriad mental conditions (https://www.ncmhr.org/downloads/References-on-why-peer-support-works-4.16.2014.pdf). Since body dysmorphia falls into this category, there’s no reason why people with the disorder shouldn’t enjoy community support as they work toward recovery.
I started building a home gym out of necessity following my divorce. I quickly learned that I could build-out a complete workout space for cheaper than it would cost me for a multi-year gym membership. I enjoy trying out new equipment and evaluating different products to expand my gym and learn more about home-based workouts.