Bigorexia: the latest bump in the road to beating body dysmorphia

Despite body dysmorphia, a persistent anxiety of perceived flaws or defects in physical appearance, being more common among women, the gender split is a lot more balanced than many might believe.

Four in ten people with the condition are men, with bigorexia becoming a growing concern.

For Men’s Health Awareness Month, Onyx Health looks at the condition, its telltale signs and how to find a healthy, sustainable approach to fitness and exercise.

What is bigorexia?

A form of body dysmorphia, bigorexia is a type of obsessive-compulsive disorder (OCD) and mental health condition. People with bigorexia fixate on building muscle and believe they are too small or not muscular enough. It was first recognised in a 1993 study of bodybuilders and mental illness, which referred to it as “reverse anorexia”. Participants believed they appeared small and weak, despite their large builds. (Pope et al. 1993)

Symptoms of bigorexia

A person with bigorexia, according to UK eating disorder charity Beat, will experience “feelings of distress about appearance, fixation about exercise routines, excessively restricting their diet or using steroids to try and achieve a particular body shape or size”.

These symptoms may be clearly recognisable, but there are also less obvious symptoms, including anxiety, depression, substance abuse and eating disorders.

The following factors could indicate an unhealthy reliance on exercise and possibly bigorexia, and should be discussed with a healthcare professional:

• Exercising when injured or poorly
• Not getting proper rest and recovery between sessions
• Feeling guilty for missing sessions or not exercising enough
• Relationships, work and hobbies being affected by reliance on exercise
• Feeling low or depressed, regardless of how much you exercise

What’s the difference between bigorexia and body dysmorphic disorder?

Bigorexia is a form of body dysmorphic disorder (BDD), which is a mental health condition. It’s characterised by perceived flaws or defects that a person sees in themselves but are often unnoticeable to others. Although it’s most common in teenagers and young adults, people of any age can have BDD.

Despite the idea that women are more affected by body image than men, more recent research shows it’s a much wider concern. (Delfabbro et al. 2011) In reality, about 40% of BDD sufferers are men. Looking at strength training in particular, another study found that 22% of young men have disordered eating patterns, compared to just 5% of women. (Nagata et al. 2019)

It also presents differently between genders, with women more commonly concerned about their breasts and thighs and men more concerned with their muscularity. (Malcolm et al. 2020) BDD risk is increased for younger men; an American study found that nine in 10 teenage boys exercised to increase muscle mass or tone. What is more alarming is that one in 20 admitted to using steroids.

What’s fuelling the rise in bigorexia?

Image and video-based social media platforms are readily accessible in 2023. Through platforms such as Instagram, TikTok and YouTube, amateur bodybuilders and influencers are getting greater exposure, promoting high-protein diets and high-intensity weightlifting.

In the pursuit of unrealistic body images that are broadcast on many of these channels, aspiring bodybuilders may turn to nutritional supplements and even anabolic steroids. (Mosley 2009)

While there are influencers openly talking about their steroid use, like David Rau, it’s unclear how common they are. Dr William Shanahan, a clinical director of addictions at Priory’s Roehampton Hospital in London, believes the UK is in danger of a steroid addiction crisis: “Ten years ago, there were an estimated 50,000 users of image and performance-enhancing drugs in the UK, but we suspect this number may now be rocketing above 500,000.”

Dr Shanahan also speaks of the side effects associated with steroid use: “Users suffer from increased anxiety levels, depression and impaired cognitive abilities. There are physical health dangers too, from increased acne and hair loss to erectile dysfunction and fertility issues, development of male breasts, heart problems, liver damage, kidney damage, damage to the nervous system, prostate cancer, and so much more.”

Men are at the highest risk, with Priory estimating at least 92% of anabolic steroid users are male.

How much exercise is too much?

Exercise itself is not bad for you. As with many things, a balanced approach to exercise offers many benefits; it can reduce the risk of major illnesses, such as type 2 diabetes and cancer, and boost self-esteem, mood and sleep. Strength training has even been associated with reducing the risk of depression and dementia. (Duchowny et al. 2022)

However, an unhealthy reliance or obsession with working out can lead to exercise addiction. Although this may not be as widely understood as other forms of addiction, it can be just as damaging for the body and mind.

Channing Tatum, who himself followed strict training programmes to play on-screen stripper, Magic Mike, has spoken on the dangers of unnatural and unhealthy body image ideals.

Finding the right balance with healthy exercise

As we’ve covered, the benefits of exercise and weight training specifically can have a huge positive impact, both physically and mentally. It’s all about moderation and finding what works for you without overdoing it.

For adults aged 19-64, the NHS recommends 150 minutes of moderate activity a week (or 75 minutes of vigorous activity) and strength training of the major muscle groups at least twice a week.

For children and young people aged 5-18, the recommendation is an average of 60 minutes of moderate or vigorous activity per day across the week. It’s also especially important to choose exercises that are suitable for the age, ability and experience of a child. Any new exercises should be started slowly and gradually increased in intensity.

If you think you, or someone you know, may be suffering from body dysmorphia or bigorexia, we recommend speaking with a healthcare professional to diagnose the issue and guide you towards a healthy approach to exercise.

References

Delfabbro PH, Winefield AH, Anderson S, Hammarström A, Winefield H. Body Image and Psychological Well-Being in Adolescents: The Relationship Between Gender and School Type. The J of Genetic Psychology. 2011;172(1):67-83. Available from https://www.tandfonline.com/doi/abs/10.1080/00221325.2010.517812 [Accessed: 16 November 2023]

Duchowny KA, Ackley SF, Brenowitz WD, Wang J, Zimmerman SC, Caunca MR, et al. Associations Between Handgrip Strength and Dementia Risk, Cognition, and Neuroimaging Outcomes in the UK Biobank Cohort Study. JAMA Network Open. 2022;5(6):e2218314. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793510 [Accessed: 21 November 2023]

Malcolm A, Pikoos TD, Castle DJ, Rossell SL. An update on gender differences in major symptom phenomenology among adults with body dysmorphic disorder. Psychiatry Res. 2020;295:113619. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0165178120332807 [Accessed: 16 November 2023]

Mosley PE. Bigorexia: bodybuilding and muscle dysmorphia. European Eating Disorders Review. 2009;17(3):191-198. Available from: https://onlinelibrary.wiley.com/doi/10.1002/erv.897 [Accessed: 20 November 2023]

‌Nagata JM, Murray SB, Bibbins-Domingo K, Garber AK, Mitchison D, Griffiths S. Predictors of muscularity-oriented disordered eating behaviors in U.S. young adults: A prospective cohort study. The Int. J of eating disorders [Internet]. 2019;52(12):1380-1388. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31220361 [Accessed: 16 November 2023]‌

Pope H. Anorexia nervosa and “reverse anorexia” among 108 male bodybuilders. Compr. Psychiatry. 1993;34(6):406-409. Available from: https://www.sciencedirect.com/science/article/abs/pii/0010440X9390066D?via%3Dihub [Accessed: 16 November 2023]