Muscle Mania: Understanding "Bigorexia"

By Sophie Brink

Published on March 26, 2008

Most of us have a part of our body we wish were bigger, smaller, or otherwise different. However, men with muscle dysmorphia (MD), also known as reverse anorexia or "bigorexia," are so tormented by the idea that they appear weak and scrawny that they may withdraw from social interaction, resort to steroid use, or, in severe cases, commit suicide.

Many men who have MD work out numerous times a day to maintain a chiseled physique. Yet, no matter how often people assure them that they are lean and muscular, men with MD cannot perceive themselves to be anything other than proverbial 90-pound weaklings. Daily life for men afflicted with MD can be mentally exhausting, as they expend energy that could be used in academic or professional pursuits and meaningful interpersonal relationships on obsessing over their appearance. It can also prove to be physically draining when they force themselves to work out excessively - sometimes despite illness or broken bones.

What Is Muscle Dysmorphia?

Muscle dysmorphia is a form of body dysmorphic disorder (BDD) that is found most often in members of the male population. According to the OCD Center of Los Angeles, BDD is characterized by a fixation on one's physical appearance. Typically, people living with BDD are obsessed with a real or imagined deformity of a particular part of their body, such as the skin, nose, or hair. For men with MD, the perceived deformity in question is a lack of sufficient muscular definition.

Thoughts of being insufficiently muscular can haunt sufferers of MD to distraction. These constant thoughts may make it difficult to concentrate on work or school. Even social occasions may be a source of discomfort or despair, as many men with MD may not wish to be viewed by others as not measuring up to other men. They may also feel that social events, and even important commitments, may interfere with their workout schedule. Missing even a single workout could, in their mind, result in muscle shrinkage.

It is important to make a distinction between bodybuilders who religiously adhere to a regular workout schedule and men with MD. While bodybuilders may seem obsessive in their quest to develop sculpted pecs, massive biceps, and glorious glutes, those afflicted with MD often cannot control their obsession. Additionally, they may take no joy in their impressive physique. According to Dr. Roberto Olivardia, clinical instructor of psychology at Harvard Medical School and co-author of The Adonis Complex: The Secret Crisis of Male Body Obsession, men with MD are prisoners of their obsessions and their self-esteem is dependent solely upon their body image.

What Causes Muscle Dysmorphia?

As with many disorders that do not present a clear physical cause, the origin of MD has proved somewhat difficult to pinpoint. Theories range from the biological to the psychological and the sociological. The biopsychosocial model incorporates all three of these theories and is widely supported among clinicians.

The Psychology of MD

Dr. Olivardia says that many men with MD have issues with their masculinity. These issues may stem from experiences they may have had during their childhood and teenage years. Men who were teased for being overweight or underweight as boys or teenagers may have developed low self-esteem. This may partially explain why many men with MD constantly compare their muscular definition to that of other men.

The Biology of MD

Because muscle dysmorphia - and other manifestations of BDD - is partially characterized by a fanatical fixation on one's appearance, many who have studied the condition believe that it belongs to the spectrum of obsessive compulsive disorders (OCDs). Other conditions in this spectrum include obsessive compulsive disorder (OCD) and Tourette's syndrome - conditions that have been linked to biological factors that may run in some families.

This theory has been, at least in part, validated by the fact that medications such as Paxil®, Prozac®, and Zoloft® can be effective in treating OCD, Tourette's, and MD. These medications are serotonin reuptake inhibitors (SSRIs), which address abnormalities in serotonin activity. Serotonin is a neurotransmitter that affects mood and behavior.

The Sociology of MD

For decades, researchers have warned that images of thin female figures in the media can negatively affect women's body images. Far less research has been dedicated to finding out whether media depictions of muscular men may affect the way men feel about their bodies. The results of the few studies that examine male body image, however, reveal a correlation between exposure to muscular male images and lower levels of self-esteem in men.

In a study of muscle dysmorphia at University of Central Florida, researchers exposed a group of male volunteers to TV commercials depicting men with the "ideal" male physique. The men who viewed the commercials featuring lean, muscular men experienced more dissatisfaction with their own physique than those that didn't.

Breaking Free of MD

Perhaps the most tragic aspect of MD is that sufferers are often too embarrassed to seek professional help. Others may not realize that they have a problem. By recognizing the symptoms of MD and realizing that there are others who suffer from the disorder, men may be able to take the first step towards a richer, fuller, less anxious life.