Muscle Dysmorphia / Reverse Anorexia / Bigorexia

What is it?

Muscle dysmorphia is whereby a person feels that they are too small and not muscular enough and they can become obsessively focussed on trying to change this.

Muscle dysmorphia can affect both men and women, although it is more common in men and in most cases, the person affected is not small or lacking in musculature.

Background

    • Also known as ‘reverse anorexia’ or ‘bigorexia’
    • The term ‘reverse anorexia’ was first used in a 1993 study with male bodybuilders.
    • Is linked to body dysmorphic disorder
    • Involves obsessive compulsive features similar to those seen in eating disorders.
Behaviours

Behaviours of concern, often involving men, may include an attempt to pursue a body figure that is ultimately unobtainable. They may focus unduly on an ideal body that is more muscular than their own. It is important, however, to distinguish between individuals for whom body building is a lifestyle from those for whom it is part of a distorted view of and fixation with their own body shape.

People with muscle dysmorphia resort to a variety of measures to try to focus on muscle mass:

  • Excessive exercise, rigorous fitness regimes
  • Weightlifting and other body building exercises
  • Engaging in abnormal eating patterns, excessive attention to diet, misuse of high protein diet
  • Misuse of steroids and other muscle-building drugs
  • Spending a significant amount of time at a gym, training through injury

A person with muscle dysmorphia will continue to work out and / or diet despite knowing that it is dangerous to their health and general well-being. Due to the distortion in self-perception it can be very difficult for the person to recognise that they need help.

Feelings and avoidance

People with muscle dysmorphia may feel shame, anxiety, guilt and embarrassment in association with their experiences. Intensive and pre-occupying thoughts and feel they have to punish themselves. The obsession with becoming more muscular takes over the person’s life to the extent that they may avoid places, people and activities because of their perceived body defect. This includes social, work related or recreational activities, connections with friends, families and partners. They may experience long bouts of social isolation. It is preferable, in their mind, to train even when injured, than to miss a workout.

The preoccupation causes major distress and can have a severe impact on relationships as the person’s life becomes restricted to the pursuit of an unattainable ideal body.

Owing to fears they that look too small, some people may:

  • Decline social invitations
  • Refuse to be seen at the beach
  • Wear heavy clothes in the heat of summer

Health consequences and treatment

Muscle failure, osteoporosis, heart and kidney failure are among some of the risks associated with muscle dysmorphia. Depression is often co-existent with the condition.

Treatment should involve medical evaluation and monitoring as well as psychological therapy. A cognitive behavioural approach is often used.

Muscle Dysmorphia Interview
Audio interview featuring a personal account of the condition know as Muscle Dysmorphia, sometimes referred to as reverse anorexia.

Click here to download the audio interview to your computer for playback. (MP3 file)

References: 

Cunningham, M.L. (2017) Muscle dysmorphia: An overview of clinical features and treatment options. Journal of Cognitive Psychotherapy, 31(4), 255-271.

Mosley, P.E. (2009) Bigorexia: bodybuilding and muscle dysmorphia. European Eating Disorders Review, 17(3), 191-198.

Murray, S.B. et al (2010) Muscle dysmorphia and the DSM-V conundrum: Where does it belong? A review paper. International Journal of Eating Disorders, 43(6), 483-91.

Murray, S.B. & Baghurst, T. (2013) Revisiting the diagnostic criteria for muscle dysmorphia. Strength and Conditioning Journal, 35(1), 69–74.

Olivardia, R. et al. (2000) Muscle dysmorphia in male weightlifters: A case-control study. American Journal of Psychiatry, 157(8), 1291-1296.

Pope H.G. et al. (1993) Anorexia nervosa and “reverse anorexia” among 108 male bodybuilders. Comprehensive Psychiatry, 34(6), 406-409.

Pope, H.G. et al. (2000) Body image perception among men in three countries. American Journal of Psychiatry, 157(8), 1297-1301.

Pope, C.G. et al. (2005) Clinical features of muscle dysmorphia among males with body dysmorphic disorder. Body Image, 2(4), 395-400.

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