Never big enough

"I'm a bodybuilder and spend at least three hours a day at the gym. I follow a high protein/low-fat diet and eat at least 45 eggs a day - during off-season obviously. The AAS I've been taking for the past five years have really made a difference. Any other tips to improve my performance?"

These are the words of Bud, on Health24's Bodybuilding forum. Then there is another posting:
"Stats:
24 yrs
90kg
1.73m
12% bf
1st cycle ever:
400mg test cyp/wk for 6wks;
20mg dianabol/day for 4wks;
maybe 200mg deca/wk for 6wks;
i intend on starting pct 12 (half-life) days after last shot, have nolvadex and pregnyl(1500iu) on hand, how do i construct pct, do i need clomid, will take liver support one week before orals until one week after the orals. Milk thistle any good anything else?" (D)

While it is known that bodybuilding is about building and toning muscles, the average reader might wonder: a) how does anyone manage to eat 45 eggs in one day? b) what on earth is D talking about? and c) Is Bud's rigorous routine, diet, and use of supplements and steroids a sign of healthy discipline and devotion, or a cause for real concern?

Those bodybuilders who become obsessed with how big their muscles are, may suffer from a disorder called muscle dysmorphia or "reverse anorexia nervosa". Like anorexics who cannot see their extreme and dangerous thinness as anything other than beauty; muscle dysmorphics - sometimes referred to as suffering from "bigorexia" - see exaggerated development the same way.

In a study at the Department of Psychiatry of the University of Stellenbosch, researchers found that muscle dysmorphia, a pathological preoccupation with muscularity, is highly prevalent, especially amongst men.

Impact on work and social life
After interviewing 24 male and four female competitors in an amateur bodybuilding competition in the Western Cape, the researchers found that over half of the male participants and three of the four women suffered from muscle dysmorphia.

Although there were no differences in bodybuilding activities between those with muscle dysmorphia and those without, the former visited doctors for a range of different complaints more frequently.

Those with muscle dysmorphia also reported significant impairment in important areas of functioning such as work and social life.

A third also met the diagnostic criteria for Body Dysmorphic Disorder (BDD) on grounds other than muscularity, in contrast to none of those without the condition.

BDD, or 'imagined ugliness', is a psychiatric disorder characterised by pathological preoccupation with a nonexistent or slight defect in body appearance.

Diagnosing muscle dysmorphia
According to the researchers, you recognise muscle dysmorphia when:

• 1. The person has a preoccupation with the idea that his or her body is not sufficiently lean and muscular. Characteristic associated behaviour includes long hours of lifting weights and excessive attention to diet.
• 2. This causes clinically significant distress, or impacts negatively in two or more of the following ways:
• (i) he or she frequently gives up social, occupational or recreational activities because of a compulsive need to maintain his or her workout and diet schedule
• (ii) they avoid situations where their body is exposed to others, or endures such situations with marked distress or intense anxiety
• (iii) the preoccupation causes clinically significant distress or impacts on their ability to function normally
• (iv) they icontinue to work out, diet or use ergogenic (performance-enhancing) substances even though they might know of physical or psychological consequences.

3. They're obsessed about being too small or inadequately muscular. This compares to the fear of being fat, as in anorexia nervosa, or a preoccupation with other aspects of appearance, as in other forms of BDD.

Watch for substance abuse
A number of studies have shown that there is an association between muscle dysmorphia and steroid abuse. The use of nutritional and other supplements may be a clue to the diagnosis, the researchers say.

For more information on muscle dysmorphia, contact the Mental Health Information Centre or the MRC Unit on Anxiety and Stress Disorders at (021) 938 9229. – (Ilse Pauw, Health24, updated January 2010)

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