Eating disorders are a stereotypically female condition, but with the global obsession on the ‘body beautiful’, more and more men are falling prey to this debilitating disease in their quest for the perfect male body.
Bigorexia, or reverse anorexia, is scientifically known as muscle dysmorphia and can best be described as an individual’s real or imagined perception of themselves being “small and skinny even if he/she is large and muscular” to the point that it causes significant emotional distress and impaired functioning in their psychosocial life.
In short, says clinical psychologist Linde Viviers, it’s the same distortion of body image from which anorexics suffer, but reversed. While anorexia sufferers believe that they are bigger than their actual size, bigorexia sufferers believe that they are smaller than their actual size.
Viviers practices at the Akeso Crescent Clinic in Randburg, a specialist psychiatric clinic that focuses on eating disorders which has gained a reputation for being one of the country’s foremost treatment facilities.
Read: Eating disorders on the rise
“Usually sufferers are not underweight or frail, they are actually well-built with perfect physique, but innately they believe their muscles and body are inadequate and begin to adopt so-called bigorexic behaviour – over-exercising, extreme dieting and the use and abuse of supplements and possibly steroids,” says Viviers.
Although she has personally seen an increase in the incidence of bigorexia, official statistics are hard to come by primarily because the disorder has yet to be defined in the Diagnostic and Statistical Manual of Mental Disorders, the standard classification of mental disorders used by mental health professionals. The controversy over the definition seems to stem from the fact that it could fall within the scope of at least three psychiatric disorders:
- Body Dysmorphic Disorder, as the patient becomes exceptionally preoccupied with specific parts of their bodies
- Obsessive Compulsive Disorder, due to the obsessive nature of the patient’s exercise routine, gym, thought rumination
- Eating Disorder Not Otherwise Specified due to the patient’s acute awareness of dietary intake and preoccupation with bodily weight and shape
Despite this controversy, however, common consensus is that the disorder is on the rise, most likely due to the increased focus placed on the male form and appearance in modern society.
Read: Body image – a loaded topic
“While women have been judged by their appearance for decades, men have typically been judged by their achievements,” says Viviers.
But with the increased exposure of the so-called ideal male body through modern media, men are becoming more aware of their appearance, and are beginning to judge not only their peers – but also themselves – according to male supermodel standards.
Steve Mululu, owner of lifestyle management centre Dream Body Fitness has styled his centre around the concept "lifestyle management" as opposed to a gym. Although he recognises that his clientele might be focused on creating the so-called perfect body, Mululu ensures that they look after their bodies both inside and out.
“Biologically, it is only possible to put on 4-5kg of muscle weight each year; anything above that comes at a risk to your health,” he says, commenting on the tendency of those seeking a "quick muscle fix" to abuse supplements, and even delve into the murky – and dangerous – world of steroids.
“If you manipulate muscle growth unnaturally, your organs can’t keep up with your muscle grow rate – and that’s a recipe for disaster,” says Mululu.
Read: Celeb body image idols
Despite this, Mululu agrees there is an increased tendency towards men wanting to be "bigger", although he believes that this is most prevalent in teenagers and younger men, who tend to believe that an extra 5kg of muscle weight will gain them the love and attention that they crave.
Increasing levels of dissatisfaction
Although there are no official statistics on the incidence of bigorexia, a study that explored body satisfaction amongst South African school boys in 2009 seems to point to increasing levels of dissatisfaction: 28.5% of boys claimed to be dissatisfied with their overall weight, while 26% were specifically unhappy with their mid torso, and 19.5% with their upper torso. In another study conducted in 2010, a massive 64% were dissatisfied with their arms, 61.3% with their chest and 54.5% with their legs. This mirrors international studies, which revealed that four out of five British males surveyed were dissatisfied with the muscularity and leanness of their bodies.
That said, it is important to draw a distinction between an unhealthy obsession with your body, and a healthy one. In this day and age when both men and women are increasingly health conscious, regular exercise and an awareness of healthy eating habits are the norm, not the exception. We should be wary of jumping to snap diagnoses, warns Viviers.
Mululu agrees that it’s too easy to judge people on appearance or lifestyle.
“If you want to maintain a certain level of health and body image, you need a system. For some people that means waking up every morning at 6am and going to the gym, and being aware of what they eat. Some might call that an obsession. I would call it a healthy routine,” he says.
The line between healthy and unhealthy routines appears to be a fine one, but Viviers says the symptomology for bigorexia is quite specific in that the distorted body image causes both emotional distress as well as impaired social functioning. Specifically, she says, bigorexia tends to describe a cluster of behaviours, which can include some or even all of the below:
- Missing social interaction due to exercise programme or fear of not being able to eat the right food
- Neglecting personal relationships due to time spend exercising and following eating plan
- Working out in spite of injury
- Never being satisfied with muscle mass
- Maintaining an extreme workout programme
- Maintaining an excessive high protein diet
- The excessive use of food supplements
- Steroid abuse and often resorting to plastic surgery to achieve the perfect body
The risks of bigorexia are many and include injuries due to over-exercising; self-loathing or punishing behaviour due to an inability to achieve the goal of perfection; acute anxiety due to rigid exercise and eating regime; a lack of functional behaviour due to excessive focus on body, exercise and food; as well as the many health complications that arise from excessive supplement and steroid use.
Unfortunately, however, official diagnoses of bigorexia are few and far between, due not only to the fact that the disorder is made up of a variety of inter-related behaviours, but also due to a combination of societal factors led by the reality of the effort needed to attain a perfect body is often regarded as normal.
Sufferers also tend to visit general practitioners or sports practitioners complaining of bodily pain due to excessive workouts, instead of seeking psychiatric help. In addition, because body dysmorphia disorders are typically associated with women not men, those suffering from bigorexia tend to feel a "double stigma", which tends to dissuade them from seeking professional help.
“Diagnoses should only be made by a professional,” Viviers warns.
Treatment plans would most likely consist of a combination of cognitive behaviour therapy to challenge distorted belief systems about the self and body, individual therapy to address any specific psychological issues, and medication for depression and/or obsessive compulsive behaviour if it is evident.
“Unfortunately, because bigorexia has yet to be officially defined and classified, there is no official prognosis regarding recovery,” says Dr Viviers.
Mululu believes that education is key to combating this increasing trend: “Men need to understand that there is only so much that their bodies can do, and that when it comes to muscle, it’s not a one day game, it’s a lifestyle. If you rush into it, you will damage yourself. We need to start training for vitality, and not vanity,” he concludes.
 Dalgliesh, J & Nutt, K (2013). Treating men with eating disorders in the NHS. Nursing Standard. Vol. 27 No. 35, pp42-46.
2 Murray, S & Touyz, S. (2012). Muscle dysmorphia: towards a diagnostic consensus. Austrailia and New Zealand Journal of Psychiatry. Vol 47, No 3. Pp 206 -207.
3 Specter, S & Weiss, D (2014). Muscle dysmorphia: where body image obsession, compulsive exercise, disordered eating and substance abuse intersect in susceptible males. Eating disorders, addictions and substance use disorders (T.D Brewerton & A.B Dennis eds).
4 2009; cited in Martin, 2010
5 Martin, J. (2010). “Mirror, Mirror on the wall, who’s the buffest of them all”: Traditional masculine role norms and body image discrepancy in Indian school going boys. Masters dissertation. University of KwaZulu Natal.
6 Dalgliesh, J & Nutt, K (2013). Treating men with eating disorders in the NHS. Nursing Standard. Vol. 27 No. 35, pp42-46.
7 Dalgliesh, J & Nutt, K (2013). Treating men with eating disorders in the NHS. Nursing Standard. Vol. 27 No. 35, pp42-46.
Parents help kids develop positive body image
'Listening to your heart' could improve body image
Talking about weight tied to poor self-imageImage: A man examining himself in the mirror from Shutterstock