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Bigorexia is sometimes called "the male eating disorder". What happens when being muscular and lean isn't enough?

Singer Karen Carpenter died of anorexia when she was only 32 years old in 1983. Her death cast a spotlight on eating disorders, especially anorexia and bulimia. For the past 30 years, other celebrities from Jane Fonda to Demi Lovato have offered their own struggles with anorexia. Many people who suffer from eating disorders also suffer from body dysmorphia.

The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) describes body dysmorhpia as a "preoccupation with an imagined defect in appearance" and adds that "if a slight physical anomaly is present, the person’s concern is markedly excessive".

Many people with body dysmorphia become so distraught and apprehensive that it leads to disordered eating and social isolation. Psychiatrists consider body dysmorphia a serious mental illness. Patients are even at risk of suicide. The majority of people diagnosed with eating disorders and body dysmorphia are female, but not all.

There are males who suffer with eating and body disorders too, some with anorexia and bulimia. However, there is a little-known disorder mainly diagnosed in males called bigorexia or muscle dysmorphia. Sometimes called reverse anorexia, the obsession is not how small or skinny you can be, but how big and muscular you look. Like anorexics, a bigorexic is never satisfied with the way he looks. This goes beyond the normal fine tuning that a professional bodybuilder would make in a physique. It's a damaging, all-consuming lifestyle.

The DSM-5 describes muscle dysmorphia (MD) as:

"An individual preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case."

Years ago, I was the head fitness trainer at a large commercial gym. Lee was a fellow fitness trainer. Six feet tall and well over 200 pounds of muscle with very low body fat, Lee was a specimen. Far and wide, people admired him for his amazing physique. The fact he was nearly 40 years old made him stand out all the more. He could not walk into a room without people looking and even asking about his workout routines and diet.  

I knew things about Lee that others didn't. He was unhappy and constantly dissatisfied with himself. Being middle-aged, he had aches, pains and constant nagging injuries. He knew he needed rest and recovery, but he couldn't stop himself from working out. He would work out with sprains and tendonitis, which would keep most people sidelined. 

Even more alarming, he would miss parties, birthdays and work if they interfered with his gym schedule. His professional goal was to become a police officer, but he injured himself so severely during a workout that he failed the police physical. This prompted his girlfriend to leave him. His life was a mess.

I confronted him one day after a work luncheon. Though the company had healthy catered meals when we had company- wide meetings, Lee would arrive with his own salad from home. When I asked why, he said he didn't know what was in their salad and he couldn't risk eating it. This was before the internet and eating disorders weren't widely talked about in men, so while I thought it was odd, I didn't think of it as a disorder. I was wrong. 

Recognized since 1997, muscle dysmorphia is becoming more prevalent. This is to due the pressures men are also starting feel from society regarding having the "perfect" body or size. One of the hallmarks of the disorder is the constant comparison of themselves to others.

Here are 10 things you should know about MD:

  • Most men with bigorexia are bodybuilders, but most bodybuilders are not bigorexic. 
  • People with muscle dysmorphia are usually diagnosed with other mood or anxiety disorders. Depression is also common. 
  • Unrealistically low body fat levels with muscularity is usually the ultimate goal (which they do not meet).
  • Steroid abuse is common among men with muscle dysphoria. Damaging side effects do not deter them. 
  • They will continue to lift weights even with severe injury. They refuse to schedule normal rest periods. 
  • Working out becomes paramount over work, relationships and social activities.It becomes an addiction.
  • Occupation with comparing themselves to others.They are overly influenced by the media.
  • Obsession with perfection, which causes social isolation and low self-esteem. 
  • Emotional distress associated with eating and food.They refuse to enjoy any food not on their plan. 
  • Compulsion to look in the mirror constantly

What can you do to help if you suspect someone you know has bigorexia?

Though I was not privy to Lee's mental or medical state, he outwardly showed enough signs for concern. What can you do if you suspect someone you care about show signs of body or muscle dysmorphia? It's important to approach your loved one with care and concern. Men with this disorder rarely feel they have a problem and will resist help. 

Rather than criticize, ask questions regarding their meals and workouts that you know will help them open a conversation about a very personal and difficult issue. Open-ended questions work best. These are questions that require more than a yes or no answer. Pick a time when the person is relaxed and not involved in eating or working out. Ask how they feel, and listen. Use their own words to guide the conversation. Listen for any words that suggest a compulsion or obsession. 

If you see any of the above signs of MD or your conversation leads you to believe a person you care about has this disorder, make sure they contact a licensed professional. There haven't been many studies done yet on treating bigorexia, but treatment for general body dysmorphia has shown treatment with behavioral therapy and medication can work well.

Your loved one will be very resistant to help and change. Eating and body disorders can be very serious, so let them know you  are concerned and would like to help them get the professional assistance they need. 

  • Olivardia R, Pope HG Jr, Hudson JI. Muscle Dysmorphia in Male Weightlifters: A Case-Control Study. American Journal of Psychiatry. 2000 Aug
  • 157(8):1291-6.
  • Photo courtesy of SteadyHealth

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