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Bigorexia: Bodybuilding and Muscle Dysmorphia

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    Mark flexed, as hard as he could, and looked in the mirror. Each of his massive, sweat-covered, vascular, steroid-built biceps, measuring 21 inches in diameter, gleamed under the light in his bathroom. After a few moments he un-flexed them, allowing them to fall back down to his sides and he mumbled to himself “still not big enough Mark”. This, of course, is a ludicrous statement. How could a man with such large, muscular arms think that they were “not big enough”?

    The fact is Mark suffers from a mental disorder called Muscle dysmorphia, popularly coined “Bigorexia”, which is a “form of body dysmorphic disorder in which individuals develop a pathological preoccupation with their muscularity” (Olivardia, Pope & Hudson, 2000). In other words, those affected can never be big or muscular enough, and when they look at themselves in a mirror they see someone much skinnier than they really are. In essence it is the reverse of what someone suffering from anorexia nervosa would experience.

    This is a disorder that has not been diagnosed, treated, or examined until recently. However, with the growth in popularity of bodybuilding and physical fitness, there has been and increasing interest in this disorder. How is “Bigorexia” diagnosed? What causes it? How is it treated? And finally what is the future of “Bigorexia” in today’s society? In order for “Bigorexia” to be examined and treated it must first be diagnosed and in order to be diagnosed, it must be characterized.

    In a study performed by the American Journal of Psychiatry comparing male weightlifters suffering from muscle dysmorphia to male weightlifters not suffering from muscle dysmorphia, the characteristics of muscle dysmorphia were identified. The disorder was first characterized by rating the subjects, whom were known to be suffering from the disorder, on their insight into their preoccupation in that they recognized that their perception of their own size was inaccurate. “(42%) were rated as showing “excellent” or “good” insight into their preoccupation in that they recognized that their perception of their own size was inaccurate. 50%) showed “fair” or “poor” insight, and (8%) subjects lacked insight altogether, in that they were completely convinced that they were small, even when repeatedly given evidence to the contrary” (Olivardia, Pope & Hudson, 2000). Thus one characterization or criterion, to be used in the process of diagnosing an individual in question with “Bigorexia”, would be whether or not the individual is aware of their physical size. Secondly, a body dysmorphic disorder modification to the Yale-Brown Obsessive compulsive scale was applied to the subjects.

    Using this scale it was found that, of those who suffered from the disorder, “(50%) reported that they spent more than 3 hours per day thinking about their muscularity. (58%) reported “moderate” or “severe” avoidance of activities, places, and people because of their perceived body defect. (54%) reported “little” or “no” control over their compulsive weightlifting and dietary regimens. Two subjects reported giving up well-paying professional jobs to work at gymnasiums where they could lift weights themselves” (Olivardia, Pope & Hudson, 2000).

    Therefore another criterion for the diagnosis of an individual with “Bigorexia” would be whether or not the individual’s perception of their muscularity affects them on a daily basis at the mental and/or behavioral level. Finally, one of the common behaviors exhibited in men with muscular dysmorphia is substance use/abuse, namely anabolic-androgenic steroid use. In the case of men with “Bigorexia” there is a high correlation between the men who have the disorder and whether or not they have used anabolic-androgenic steroids or AAS.

    In a study done by The American Journal of Psychology it was reported that 46 percent of male weightlifters, in the study, suffering from muscular dysmorphia, used steroids. By comparison, of the male weightlifters who did not suffer from muscular dysmorphia, only 7 percent reported the use of anabolic-androgenic steroids (Olivardia, Pope & Hudson, 2000). Therefore, men who use steroids are that much more likely to suffer from “Bigorexia”, recognized or unrecognized, and that is a criterion that can and should also be noted when diagnosing the disorder.

    Based on these criterions, a conclusive diagnosis of “Bigorexia” can be prescribed to an individual. Now that muscular dysmorphia or “Bigorexia” can be diagnosed, it begs the question, what causes this disorder? This question, in fact, can be answered in a number of different ways and that is why I have my own opinion on the matter, or the answer I prefer to give to this specific question. I believe that society or more specifically the media is completely to blame for the proliferation of this disorder, especially among young men.

    It is quite obvious that media focusing on the human physique effects the way people view and feel about their own physiques. For example in a study performed by the Journal of Applied Behavioral Research college aged women were asked to complete a body-image questionnaire, they were then subjected to fitness advertising for a week, after that week they again filled out a body image questionnaire but this time scored lower in the sense that they no longer viewed their bodies as positively as they had the previous week (Sabiston & Chandler, 2009).

    That is just one of many studies proving the effect of media on the way we as people perceive our bodies, which drives the way we feel about them and in turn, ourselves. In the aforementioned study by the American Journal of Psychiatry it was found that the mean age for the onset of muscular dysmorphia among men was 19. 4 years of age (Olivardia, Pope & Hudson, 2000). Those things being said, I believe that the trend in advertisements and the glamorization of a muscular male physique has taken its toll on young men today.

    For example look at the difference between the action figures of Luke Skywalker in 1977 compared to an action figure of him from the year 2000: – 1977 action figure (thestrong. org) – 2000 action figure (jedi-buisness. com) It is rumored that when shown these figurines, actor Mark Hamill (Luke Skywalker) commented “my god they’ve put me on steroids”, while there is no official record of this comment it is entirely justified based on the obvious change in muscularity of the figure over the course of a couple decades.

    Granted most 19 year olds do not play with action figures, however I personally take this as an almost comical example of the way society is telling men, primarily young men, how they are supposed to look i. e. big and strong. I believe it is this exact message that is the driving force behind the body-image disorder known as “Bigorexia”. Now that there is characterization, and criteria for the diagnosis of “Bigorexia” as well as an explanation for the cause of the disorder, the final question is how can it be treated? Firstly, in order for treatment to be administered, those suffering from muscular dysmorphia must be reached.

    Unlike other body-image disorders such as anorexia nervosa, the appearance of the individual will not necessarily spark concern, due to the fact that someone suffering from “Bigorexia” will likely appear quite healthy, at least for the short-term. Also someone with this disorder, just like other people with body-image disorders, will not come searching for help. In most cases, for example subjects mentioned in the study conducted by the American Journal of Psychiatry, those affected do not see themselves as being afflicted i. e. ot having insight into the reality of the size of their own physique. Because if those men couldn’t even see themselves for what they were, what would ever make them assume that they, in fact, had a problem? Barriers aside, in the case that “Bigorexia” is recognized and diagnosed then there are a couple general methods to go about treating the condition. According to the Journal of Athletic Training, “Currently, no specific programs have been developed to help people with MDM, although several general approaches have made headway.

    Those who have responded best have been treated with antidepressant medications such as fluoxetine (Prozac; Eli Lilly and Co, Indianapolis, IN), alone or in combination with cognitive behavioral therapy” (Leone, Sedory & Gray, 2005). The article suggests the prescription drug Prozac as a treatment route because according to Drugs. com, “Prozac affects chemicals in the brain that may become unbalanced and cause depression, panic, anxiety, or obsessive-compulsive symptoms” (http://www. drugs. com/prozac. tml, 2012) and since muscular dysmorphia is characterized by obsessive-compulsive behaviors, a drug which positively effects those behaviors would be ideal. The second treatment option that the article suggests, to be used in combination with the first, is cognitive behavioral therapy or CBT. This type of therapy would be ideal to treat “Bigorexia” because according to nacbt. com (National Association of Cognitive Behavioral Therapists) “Cognitive-behavioral therapy is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events.

    The benefit of this fact is that we can change the way we think to feel / act better even if the situation does not change” (http://www. nacbt. org/whatiscbt. htm, 2013). Therefore this would make an ideal treatment solution for “Bigorexia” because it would address the way the subject thinks about themselves and their appearance, which truly is the heart of the problem. In conclusion, you can see that the characterization of this disorder has been clearly identified and the criterion for diagnosis has been set, as well as the causation recognized, and a general treatment plan has also been laid out.

    As for the future of the disorder in today and tomorrow’s society, I believe that “Bigorexia” will only become more wide-spread. The bright spot of course being that as awareness is gradually raised then more and more cases will be diagnosed and, in turn, treated. However the proliferation of “Bigorexia” will only become more and more of a problem as the media continues to push a “standard” for the “ideal” or “desirable” physique. Works Cited 1. Olivardia, R. O. , Pope, H. G. P. , & Hudson, J. I. H. (2000). Muscle dysmorphia in male weightlifters: A case-control study.

    American Journal of Psychiatry, 157(8), 1291-1296. Retrieved from http://ajp. psychiatryonline. org/article. aspx? articleid=174271 2. http://www. jedi-business. com/figureDetails. aspx? id=1106 3. http://www. thestrong. org/online-collections/nmop/1/12/110. 7831 4. SABISTON, C. M. , & CHANDLER, K. (2009). Effects of Fitness Advertising on Weight and Body Shape Dissatisfaction, Social Physique Anxiety, and Exercise Motives in a Sample of Healthy-Weight Females. Journal of Applied Behavioral Research, 14(4), 165-180. doi:10. 1111/j. 751-9861. 2010. 00047. x 5. Leone, J. E. , Sedory, E. J. , & Gray, K. A. (2005). Recognition and treatment of muscle dysmorphia and related body image disorders. Journal of Athletic Training, 40(4), 352-359. Retrieved from http://www. ncbi. nlm. nih. gov/pmc/articles/PMC1323298 6. Drugs. com [Internet]. Prozac; c1996-2012; [Updated: 2012-10-22; Cited: 2013-3-26]. http://www. drugs. com/prozac. html. 7. Nacbt. org [Internet]. Cognitive-Behavioral Therapy; c1996-2010; [Cited: 2013-3-27]. http://www. nacbt. org/whatiscbt. htm.

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