Taking a Look at Bigorexia – A Very Real Condition Affecting Mostly Men

When we think of someone with a distorted body image (known as body dysmorphia in the field of psychology), we tend to think of a frail young woman who eats very little (or not at all) in order to stay thin – a person with anorexia nervosa or another eating disorder.

But people of any gender can and do experience body dysmorphia. One type of body dysmorphia that’s not as well-known is bigorexia, or the obsession with having a large and muscular physique. Bigorexia can affect anyone, but it’s most common in boys and men. And the pervasiveness of “perfect,” often edited sculpted bodies on social media, is leading to bigorexia for some young males.

Just like other body dysmorphic disorders, bigorexia can be managed with professional treatment. But when left untreated, it can have vast and severe consequences for your life.

In this article, we’ll dig into this little-known condition and what you need to know if you think you or someone you love may have it.

What is bigorexia? Signs and symptoms

Bigorexia is also known as muscle dysmorphia^[1]. It first started to become known as a condition that primarily affects the bodybuilding community^[2]. However, we now know that bigorexia can affect anyone, although it does seem to affect more men than women.

The term “bigorexia” was first coined by a pair of twin bodybuilders, The Barbarian Brothers, in 1985. Although the twins were also comedians, they did not joke about bigorexia – they spoke about how deeply this affliction impacted them.

People with bigorexia have a distorted body image. They see themselves as small and weak, and they become preoccupied with building up their muscle mass.

Some other signs and symptoms of bigorexia include:

• Being preoccupied with muscularity and body shape/size
• Constantly checking your appearance in mirrors
• Spending excessive amounts of time at the gym or engaging in weightlifting or bodybuilding activities
• Using anabolic steroids or other performance-enhancing drugs to increase muscle mass
• Eating a diet that is excessively high in protein or calories to support muscle growth
• Engaging in extreme exercise regimens that can lead to injury or exhaustion
• Feeling anxious or depressed when you’re unable to exercise or follow a strict diet
• Withdrawing from social activities or events to prioritize exercise or bodybuilding
• Comparing your appearance to that of others
• Seeking reassurance from others about your body size or shape
• Feeling dissatisfied or unhappy with your body despite having a muscular physique

How is bigorexia diagnosed?

Bigorexia is included in the Diagnostic Statistical Manual (DSM) as a type of body dysmorphic disorder. However, it isn’t (yet) considered its own separate diagnosis.

It’s important to note that body dysmorphic disorders are not the same thing as eating disorders. Although bigorexia shares many traits with anorexia nervosa – and was even once referred to as “reverse anorexia” – people with bigorexia focus much more on exercise than on eating habits. Although disordered eating can absolutely come into play with bigorexia, the main characteristic is an obsession with becoming more and more muscular.

According to the DSM, the diagnostic criteria for body dysmorphic disorder are:

1. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear only slight to others
2. Repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking) or mental acts (e.g., comparing one’s appearance with that of others) in response to the appearance concerns
3. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
4. The appearance concerns are not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder

Your mental health provider will ask you questions and make observations about your symptoms to determine whether or not you meet the criteria for this diagnosis.

Keep in mind that even if you don’t meet the full diagnostic criteria, symptoms of bigorexia should be taken seriously – especially if they’re becoming harmful to your health.

What causes bigorexia?

Like most other mental health conditions, the causes of bigorexia are complex. Bigorexia and other types of body dysmorphic disorders aren’t caused by one single thing. But there are some factors that could put certain people at a higher risk of developing bigorexia.

You may be at higher risk for developing bigorexia if:

• You’re a man: Bigorexia is more commonly diagnosed in men than in women, although people of all genders can experience this condition.
• You’re genetically predisposed: There’s research that shows bigorexia may run in families. Studies have found people with a family history of anxiety, depression, OCD, or substance use disorders may be at increased risk for developing bigorexia.
• You’re exposed to unrealistic body standards: Sociocultural factors such as media portrayals of idealized body types, peer pressure, and societal expectations may contribute to the development of bigorexia.
• You’ve experienced trauma or abuse: Some people with bigorexia may have experienced physical, emotional, or sexual abuse, or other traumatic events. Being bullied about having a small stature may particularly increase your risk.
• You’re a perfectionist: Many people with bigorexia struggle with perfectionism, and have high expectations for themselves in terms of their physical appearance.
• You’re unhappy with your body image: People who are displeased with their body’s size or appearance, or who link their body image to their self-worth, may be more likely to develop bigorexia and other types of body dysmorphic disorders.
• You practice certain sports: Some studies have found that bodybuilders and weightlifters are more likely to report symptoms of bigorexia.

Remember, these are risk factors, not causes – so it doesn’t mean everyone who belongs to these groups will definitely have bigorexia. It also doesn’t mean you’re safe from bigorexia if you don’t have any of these risk factors. If you identify with the symptoms of bigorexia, then it’s important to seek treatment, regardless of whether or not these risk factors describe you.

What are the negative effects of bigorexia?

At first glance, you might think that bigorexia doesn’t come with any real consequences. After all, we might think, people with bigorexia are obsessed with gaining muscle mass, and strength training is a healthy habit.

But this is an incorrect assumption. Although bigorexia may not be as life-threatening as some eating disorders like anorexia, it can have very serious effects for both your physical and mental health. This is especially true if you use anabolic steroids to grow muscle mass. When it’s left untreated, bigorexia can significantly bring down your quality of life.

Some of the health consequences of bigorexia (including the risks of misusing anabolic steroids) include:

• Muscle strains and injuries
• Dehydration
• Kidney and liver damage
• Cardiovascular problems, including increased risk of blood clots and stroke
• Increased risk of high blood pressure, high cholesterol, and heart disease
• Gastrointestinal problems, such as constipation and bloating
• Hormonal imbalances
• Decreased fertility in men
• Increased risk of prostate cancer in men
• Irregular menstrual cycles and fertility problems in women
• Hair loss and acne
• Increased risk of infections from sharing needles or other equipment when misusing anabolic steroids
• Increased risk of death, especially from heart failure or suicide
• Increased risk of depression, anxiety, OCD, and other mental health concerns

On top of these health consequences, living with bigorexia can also have significantly negative impacts on every area of your life.

For example, you may start to withdraw from friends and family in order to focus on weight-lifting. You could cut off relationships with people who express concern about your steroid use or exercise habits.

Bigorexia can also cause you to develop depression or anxiety. You could also develop substance use problems. These mental health conditions can make it extremely difficult to concentrate at school and work. In extreme cases, this could lead to academic failure or job loss.

Treatment for bigorexia

Bigorexia can be treated – but it’s important to talk to a qualified mental health professional about treatment options. Treatment can vary from person to person based on the exact nature, and severity, of their symptoms. Mental health providers will also take into consideration any other physical or mental health symptoms you have that need to be addressed.

Some of the most common treatment methods and support options for bigorexia include:

1. Therapy: Certain types of psychotherapy, like cognitive-behavioral therapy (CBT), are effective treatments for bigorexia. CBT focuses on helping individuals recognize and challenge their unhelpful thoughts and behaviors related to body image and muscle size.
2. Medications: Antidepressants and anti-anxiety medications may be prescribed by a healthcare professional to help manage the symptoms of bigorexia. These medications should always be used in conjunction with therapy.
3. Nutritional counseling: Many people with bigorexia have an unhealthy relationship with food, which can exacerbate their symptoms. Nutritional counseling can help you develop a healthy and balanced diet that meets your physical needs without contributing to your distorted body image and behaviors.
4. Support groups: Joining a support group can provide you with a safe and supportive community where you can share their experiences and struggles with people who understand what you’re going through.

If you’re dealing with bigorexia – or any other type of body dysmorphic disorder or eating disorder – then our team at The Center • A Place of HOPE can help. We specialize in treating all forms of eating disorders. At The Center, you will find a safe and respectful environment where you can focus on bigorexia and emerging as your true and best self.

Our unique Whole Person Care approach ensures that your treatment will address the physical, emotional, intellectual, relational, and spiritual elements of your life.

We can help you find ways to manage bigorexia and build a healthier relationship with your body. Contact us today to learn more about how we can help you and your family.

[1] https://pubmed.ncbi.nlm.nih.gov/18759381/
[2] https://pubmed.ncbi.nlm.nih.gov/18759381/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731454/