Muscle Dysmorphia
What is muscle dysmorphia?

Sometimes called bigarexia, muscle dysmorphia is the opposite of anorexia nervosa. People with this disorder obsess about being small and undeveloped. They worry that they are too little and too frail. Even if they have good muscle mass, they believe their muscles are inadequate.

In efforts to fix their perceived smallness, people with muscle dysmorphia lift weights, do resistance training, and exercise compulsively. They may take steroids or other muscle-building drugs, a practice with potentially lethal consequences.

Who gets muscle dysmorphia?

Both men and women. So far there are no statistics available, but researchers suspect the disorder is more common in males since the culturally defined ideal male is big and strong while the ideal female is small and thin.

Consequences of muscle dysmorphia -

The constant preoccupation with perceived smallness interferes with school and career accomplishments. It robs friendships and romantic relationships of spontaneity and enjoyment. Since the person is exceedingly self-conscious at all times, s/he cannot relax and enjoy life without worrying about how other people may be seeing, and criticizing, the perceived smallness.

In almost all cases, people with muscle dysmorphia is not small at all. Many have well-developed musculature, and some even compete in body building competitions.

Muscle dysmorphia may be one kind of obsessive-compulsive disorder. People with this problem cannot or will not stop their excessive exercise even when they are injured. They will not give up their unhealthy steroid use even when they fully understand the risks involved.

Treatment of muscle dysmorphia -

Many people with this problem resist getting treatment stating that they are content with the way they are. Some admit they are afraid that if they give up the drugs and exercise, they will wither away to frailty.

Family members and concerned friends may be able to persuade the person to at least get an evaluation by focusing on the problems caused by the behaviors, such as job loss, relationship failure, and physical harm.

Nonetheless, about half of people with this problem are so convinced of their perceived smallness that they refuse help and continue their excessive exercise and steroid use.

For those who enter treatment, cognitive-behavioral therapy combined with medication holds promise. The best place to start is an evaluation by a physician trained in sports medicine. Ask for a referral to a mental health counselor who also works with athletes. After both professionals have completed their evaluations, consider their recommendations and choose a course of action that is in your own best interests.

Related to Anorexia?

Andy is a classic example of what Dr. Harrison Pope calls "muscle dysmorphia." Pope, chief of the biological psychiatry laboratory at McLean Hospital in Belmont, Mass., says there's nothing inherently pathological about being an avid gym-goer, but it shouldn't take over your life.

He suspects the disorder may somehow be related to anorexia nervosa. "They are both disorders of body image," he says. "The preoccupations simply go in opposite directions."

Muscle dysmorphia isn't as acutely life-threatening as starving yourself, Pope says, but its victims are more likely to take other risks with their health, such as using steroids or other bodybuilding drugs. One muscle dysmorphic woman was hospitalized for kidney failure, brought on by her high-protein diet and steroid use. Within months of her release from the hospital, she was back on the drugs and unhealthy diet.

In a 1993 study of steroid use among weightlifters, Pope noticed that a substantial number—10 percent of the 156 men he interviewed—saw themselves as punier than they really were. His curiosity piqued, he later launched another study comparing 24 muscle dysmorphic men to 30 healthy bodybuilders.

The study is ongoing, but so far he's found that the men who think they're too small are much more likely to have histories of other mental disorders, such as depression, anxiety, eating disorders and obsessive-compulsive behavior.

Men More Vulnerable?

That makes sense to people like Charles Staley of the International Sports Sciences Association. He's worked as a strength coach for years, and says he's noticed the disorder not just in weightlifters but also among shot-put, discus and javelin throwers. He traces it to a lack of self-esteem.

"Bodybuilding can be a way for people with low self-esteem to call attention to themselves," he says. "If someone doesn't have much else going on in their life, their whole self-image gets caught up in their body."

Guys may be more vulnerable, because social stereotypes dictate that men should be muscular, but Pope says it's not just a guy thing. Another study, this one of 38 competitive female bodybuilders, found that 32 of the women had symptoms of the disorder.

Who's Got It?

Since muscle dysmorphia is still gaining recognition among psychiatrists—and because many people who have it refuse to seek treatment—it's difficult to estimate how widespread the problem is. But with so many people working out at home and at health clubs, the number could be substantial.

"There are probably more than 10 million people who lift weights," he says. "Even if only 1 percent suffered from muscle dysmorphia, that would be 100,000 people."

Even in recognizing the disorder as something worthy of established diagnostic guidelines, Pope isn't optimistic that much can be done for these patients. Like anorexics, they often refuse to get help. And the likely treatment—antidepressants like Prozac or Zoloft—might not go over well if the patients thought the pills might affect their ability to work out.

Signs of Muscle Dysmorphia

Harrison Pope and several other researchers put together this set of criteria for diagnosing muscle dysmorphia:

1. The person is preoccupied with the idea that their body is not lean and muscular. They spend long hours lifting weights and pay excessive attention to diet.

2. This preoccupation causes major distress or impairs the person's social or professional life. The person may forego important social, work-related or recreational activities. They may avoid situations where their body will be exposed. The person continues to work out or diet even when they know it could hurt their health or well-being.

3. The focus of the person's concerns is on being too small or not muscular enough, as opposed to concerns about being fat.
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