What Is ‘Bigorexia’ Body Dysmorphia? Causes, Warning Signs and Treatment

Still, most experts agree that more research is needed to learn how bigorexia develops and should be treated, as well as how it may uniquely impact women — those polled by Good Housekeeping point to disagreement on the best way to diagnose and treat the disorder. Some care providers use a similar approach to treating an eating disorder, despite bigorexia being categorized as a form of body dysmorphia in the Diagnostic and Statistical Manual (DSM-5).

Editor’s note: Weight loss, health and body image are complex subjects — before deciding to go on a diet, we invite you to gain a broader perspective by reading our exploration into the hazards of diet culture.

What is bigorexia?

As the name “bigorexia” indicates, muscular body dysmorphic disorder causes those impacted to fixate on muscularity — and to consistently view their bodies as not strong enough. “Those with the condition become obsessed with becoming more muscular and are preoccupied with the fact that their body is too small, or is insufficiently muscular,” explains Allison Chase, Ph.D., CEDS-S, a regional clinical director at the Eating Recovery Center.

The hallmark issue of bigorexia is an unbalanced drive to work out excessively, pushing the body way beyond its natural limits. This obsession can be traced back to a desire to increase muscle mass as quickly as possible, as well as trying to maintain unrealistic gains with increasingly difficult routines.

In women with bigorexia, the condition may look a bit different: Women tend to have a skewed perception of singular features or specific body parts, related to muscular definition. Chase explains that a woman impacted by bigorexia may focus on her lower abdominal muscles or her biceps and deltoids specifically, determined to make these features look more cut or shredded.

One common misconception is that muscle dysphoria is only about overextend themselves and surpassing their physical limits in the gym. In fact, a person with bigorexia may also have food-related symptoms, following an unrealistic, unsustainable diet in an attempt to lose weight rapidly. Both men and women impacted by bigorexia will have distorted thoughts about their bodies, and often believe those closest to them are holding them to the same unrealistic standards.

What causes bigorexia?

There isn’t one issue alone that causes bigorexia, experts say — but there are known mental health issues that may put an individual at greater risk for developing the condition.

“Bigorexia is likely caused by a combination of several factors including a genetic predisposition and psychological factors,” says Chase. “These include perfectionism, depression or anxiety, low self-esteem and negative early life experiences.”

Being bullied and experiencing other adverse social events may increase your likelihood of developing body dysmorphia later on in life, according to materials published by the Mayo Clinic. And those who are already susceptible to disordered eating habits may also fixate on muscle definition; a 2019 study published in the International Journal of Eating Disorders suggests that 22% of male subjects and 5% of female subjects reported their eating patterns were spurred by the desire to become more muscular specifically. Many bigorexia sufferers would already be considered quite muscular and athletic by their peers, explains Mary Pardee, N.D., IFMCP, a naturopathic doctor and founder of a Los Angeles-based private functional medicine clinic.

The desire to look bigger and stronger may also lead to the use of performance-enhancing drugs. “Because they believe they are too small, there are higher rates of abuse of androgenic steroids,” adds Pardee. “It’s also common that people obsess over more than just their muscular appearance, they may obsess over other physical features, including skin or hair.”

Depression and general anxiety disorder symptoms often go hand in hand with bigorexia, Pardee says, and bigorexia is sometimes preceded by a diagnosis of eating disorders and/or obsessive-compulsive disorder (OCD). The symptoms that come with these particular mental health issues, especially when they are concurrent with body dysmorphia and its unique obsessive tendencies, may feel entirely life-consuming.

“These negative feelings are what fuels the compulsive behaviors,” that is, working out for hours every day, she tells Good Housekeeping.

What are common bigorexia warning signs and symptoms that lead to a diagnosis?

Like many other forms of body dysmorphia, many of the first warning signs and early symptoms associated with bigorexia are behavioral.

Because clinical research has shown the disorder is increasingly common among younger men, particularly teenagers, understanding warning signs can be important for caregivers; experts say that bigorexia may start to develop at a younger age and that parents may be able to spot the symptoms.

Of course, the hallmark of bigorexia is an obvious obsession with body appearance; the person may continually check their muscular development, spending hours in front of mirrors.

Other warning signs often include:

1. Spending hours at the gym on a daily or very frequent basis throughout the week
2. Frequent injuries as a result of these gym sessions
3. Prioritizing workouts over work commitments, family and friendly relationships, school work and other responsibilities around the home
4. Avoidance of situations that require public body exposure, such as swimming
5. A dramatic shift in dietary habits, including the overuse of over-the-counter supplements and nutritional products that are marketed for muscle development
6. Mood swings and unpredictable irritability, as well as the onset of new anxiety or depression symptoms

Pardee adds that bigorexia can trigger unsafe use of steroid products, and serious cases may also prompt thoughts of suicide due to the development of depression and other mental health issues. If you suspect that a loved one is exhibiting any of the symptoms above due to bigorexia, getting a qualified healthcare professional involved can prevent the likelihood of steroid use or suicide, among many other risks.

If you’re struggling with loneliness, anxiety or depression and need professional help, the American Psychological Association‘s Psychologist Locator tool can help you find a licensed therapist in your area.

Bigorexia and body dysmorphia treatment:

Bigorexia often goes undiagnosed and untreated for several reasons.

“Unfortunately, many people with bigorexia are so certain that they have something defective about them, they will not seek mental health professionals, but will instead seek plastic surgeons to fix their perceived faults,” Pardee says. “This is likely to further perpetuate the mental health condition,” since any surgery is addressing a superficial symptom, not the underlying reason for the disorder, which may persist even after body adjustments are made.

The most effective treatment for the condition focuses on a tailored combination of therapy and medication that’s unique to the individual. The right healthcare provider, who has experience in diagnosing and treating body dysmorphic disorders, can prescribe any of the following alongside continuing therapy:

• Selective serotonin reuptake inhibitors (SSRIs), which are commonly used antidepressants
• Clomipramine, which is also often used to treat OCD

How to cope with bigorexia:

But not all bigorexia patients use medication to recover — a certified healthcare provider may instead address unhealthy behaviors by helping patients change their perceptions through therapy alone.

“Cognitive behavioral therapy (CBT) is a treatment that helps identify and modify negative thought patterns and behaviors, creating new healthy behaviors,” Chase explains. “Exposure plus response prevention is a specific form of CBT that helps with challenging unhealthy behaviors and learning to better cope.”

Often, individuals in therapy will work to:

• Limit overexercise and workouts that trigger unhelpful habits.
• Stop the use of steroids and unbalanced, unsafe cocktails of various fitness supplements.
• Step away from severe dietary restrictions and work toward a balanced, wholesome diet.
• Target other problematic behaviors that serve as triggers for body dysmorphia, including drug and alcohol use.

And there are myriad other solutions for those living with bigorexia, including anxiety-related solutions and support groups for open discussion. The Anxiety and Depression Association of America estimates that 1 in 50 Americans will experience some form of body dysmorphia in their lifetime. With a brighter spotlight on the issue than ever before, mental health experts are hopeful they’ll only learn more about successfully treating muscular dysphoria — and soon.