What is Muscle Dysmorphia, Bigorexia, Reverse Anorexia?

Doctors sometimes refer to muscle dysmorphia as bigorexia or reverse anorexia. The term, muscle dysmorphia, refers to a subtype of body dysmorphic disorder (BDD), which is a type of obsessive-compulsive disorder. Research shows that men have become increasingly dissatisfied with their perceived body images.

Body dysmorphic disorder in men sometimes manifests in the form of muscle dysmorphia. With muscle dysmorphia, men become obsessed with the size of their muscles and have excessive concerns about appearing physically weak or underdeveloped. These men (and occasionally women) have an excessive preoccupation with their muscle size and experience great distress over these concerns.

Bigorexia in Men

Men with bigorexia spend excessive amounts of time working out in the gym, dieting, checking themselves in a mirror, comparing themselves to others, and seeking reassurance from others about their appearance. Many of them also abuse anabolic steroids in an effort to build muscle mass and foster more lean muscle tissue.

As a subtype of BDD, which falls under the DSM-5 category of Obsessive-Compulsive and Related Disorders, doctors can effectively treat bigorexia in much the same way they treat the different types of OCD. It's important to recognize the signs of bigorexia and differentiate them from behaviors of those who simply exercise and work out every day to stay fit and healthy.

Signs of Muscle Dysmorphia

If you or someone you know exhibits the signs of muscle dysmorphia, it's important to seek professional help. Left untreated, this disorder can significantly reduce quality of life and result in severe depression. People with this condition may exhibit the following signs:

• Constantly worry about muscle size
• Spend excessive amounts of time working out that interferes with social life or performance at school and work
• Constantly scrutinizing muscles in the mirror
• Weighing several times a day
• Take great care to avoid looking at self in mirror
• Wear baggy clothing in public to keep others from seeing his body
• Feel great anxiety and distress when they miss a workout or deviate slightly from their strict diet
• Other people feel they are too concerned with appearance and working out
• Abuse anabolic steroids or take supplements to gain muscle mass and reduce body fat

Causes of Muscle Dysmorphia or Bigorexia

Experts don't have a clear understanding of the causes of muscle dysmorphia or bigorexia. Like other obsessive-compulsive disorders, research indicates that it could arise from a combination of factors including:

• Genetics – people with a relative that has bigorexia are more likely to develop the disorder, pointing to a genetic component.
• Brain differences – people with muscle dysmorphia may have insufficient levels of serotonin, an important neurotransmitter in the brain that affects mood and well-being.
• Environment – childhood and adolescent environment, family issues, bullying, emotional trauma, and cultural factors may increase the risk that a person will develop muscle dysmorphia.

Treatments for People with Muscle Dysmorphia

There are effective treatments available for people with muscle dysmorphia. Doctors and clinicians treat muscle dysmorphia in much the same way they treat other types of body dysmorphic disorder. The first line of treatment includes cognitive behavioral therapy (CBT) and antidepressant medications called selective serotonin reuptake inhibitors (SSRIs). A list of antidepressant medications can be found here.

When used in combination, SSRIs and CBT can effectively treat the symptoms of muscle dysmorphia and reduce the obsessive thoughts about their appearance. This treatment approach also helps people gain more control over their compulsive behaviors like excessive working out or mirror checking.

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