Body Dysmorphia – When Lifestyle Changes Go Too Far
Close your eyes and think of your ideal physique. Chances are your mind went to a professional bodybuilder, elite powerlifter, Olympic athlete, or fitness model.
Most males reading this article want bulging biceps, cannonball delts, sweeping lats, a narrow waist, and legs as thick as tree trunks. Most female readers want sculpted arms and shoulders, a firm butt, a tight waist, shapely calves, and lean legs.
There’s nothing wrong with choosing someone else’s physique to be your target, but such a practice often leads to frustration and disappointment. I’m a big proponent of setting personal goals and challenges, but comparing your physique to others can be a dangerous game.
Many elite competitors started at a young age, have been training for decades, can dedicate 100% of their day to their sport because their livelihood depends on it, use chemical enhancement, and received one of the winning tickets in the genetic lottery.
Drive and passion are critical elements to achieving a goal, but obsessing over physical changes may lead to body dysmorphia, a body-image disorder “characterized by persistent and intrusive preoccupations with an imagined or slight defect in one’s appearance.”  In the weightlifting community most men want to build the biggest muscles possible and more commonly develop bigorexia whereas women more commonly develop anorexia due to their desire for a low-fat, slim, and toned physiques.
As a male that was diagnosed with and overcame anorexia in the past, I can vouch that these body-image disorders don’t discriminate based on gender. In many cases, it’s the non-traditional gender that receives the least amount of help and attention for a certain condition (e.g. anorexia for males and bigorexia for females).
This article explores the causes, symptoms, and impact of bigorexia, and anorexia. If you or someone you know someone is suffering from one of these conditions, then it’s critical that you reach out and ask for help as soon as possible.
Many weightlifters will tell you that the first day you step in to the gym to lift weights is the last day you ever feel big. Once you catch the iron addiction don’t be alarmed by your significantly increased focus on building muscle size, strength, symmetry, and vascularity. There is nothing wrong with striving to build a healthy, muscular, and injury-resistant physique, but don’t let a passion and hobby turn in to an obsession that detracts from your overall quality of life.
Bigorexia, also known as a Reverse Anorexia or Muscle Dysmorphia, is a body dysmorphic disorder characterized by the constant obsession and/or worry about being too small, weak, underdeveloped, and/or underweight.  These individuals exhibit obsessive-compulsive behaviors by hyper-focusing on minor physique imperfections. Those who typically exhibit symptoms of bigorexia aren’t ectomorphs, hardgainers, or underweight individuals, but rather individuals that already have significant muscle size and strength.
Bigorexia has significant negative effects on physical, emotional, mental, and social well-being. Muscle dysmorphia can affect both genders but males are more susceptible to the pressure of building muscle and strength so are more likely to have the disorder.
Unfortunately, most of the medical community does not currently recognize bigorexia as a legitimate and serious condition, so the condition has a limited body of research and analysis. BBC and the Alliance for Eating Disorders estimate that approximately 10% of regular male gymgoers have bigorexia but provide no estimates for females. 
A study of 648 male weightlifters with a mean age of 29.5 found strong indications that 17% of the population had muscle dysmorphia, 10.6% had body dysmorphic disorder, and nearly 34% had an eating disorder of some kind.  It should not be surprisingly that those who view their body as small and weak are also more likely to have an eating disorder although the inverse is not always true.
A smaller study of 88 male weightlifters with an average age of 27 found that 13.6% of weightlifters exhibited muscle dysmorphia, 42% of that 13.6% abused anabolic steroids, and 67% of that 13.6% used at least one non-steroidal substance to improve performance.  These individuals are extremely unsatisfied with their body so they’re willing to risk their health and well-being to eliminate the self-perceived shame and embarrassment. It certainly does not help that society places pressure on males to have an X-frame physique with broad shoulders, sweeping lats, bulging arms, a narrow waist, and a six-pack.
Researchers have yet to pinpoint exactly what triggers the development of bigorexia but they believe it may be a combination of genetics, brain chemical imbalances, and history of being bullied and/or abused.  Males with a history of mood, anxiety, and/or eating disorders have a significantly higher likelihood of developing bigorexia. 
There is no official list of symptoms to identify the development of bigorexia but the list below provides some of the most common symptoms and warning signs: 
- Missing social events, family gatherings, and work to work out instead
- Exhibiting depression, anger, and/or anxiety if a workout is missed
- Expressing constant displeasure about how much muscle mass they carry
- Working out even if injured or sick
- Spending an excessive amount of time in the gym, leading to overexertion
- Adhering to abnormal eating patterns and refusing to be somewhat flexible with their diet
- Using anabolic steroids
- Spending large sums of money on ineffective supplements
- Obsessively checking the mirror and comparing their physique to others
- Undergoing surgery to change their physical appearance
- Expressing concerns about other parts of the part like hair, skin, and penis size
In extreme cases those suffering from bigorexia may overdose on anabolic steroids or commit suicide due to the displeasure with their physical appearance. Bigorexia is a serious body dysmorphic disorder affecting both genders than can endanger your life as well as negatively affect those around you.
If you find yourself or those you know exhibiting many of these symptoms, then please visit your health care professional as soon as possible.
Society places an immense amount of pressure on females to have a low-fat physique with a narrow waist, flat stomach, defined (but not bulky) arms, and shapely legs. Bodyweight is a taboo topic in many social circles.
Those who gain weight, specifically fat, may be shamed, berated, or excommunicated. Those who lose weight may be praised, encouraged, and idolized. Societal pressures, paired with the internal drive to be thin, can lead to the development of anorexia nervosa in both males and females.
Anorexia nervosa is an emotional eating disorder characterized by the severe restriction of calorie, macronutrient, and micronutrient intakes. Researchers propose that underlying conditions like perfectionism and the desire to gain control of the surroundings are primary drivers for developing anorexia. 
Those with anorexia directly correlate their self-worth with their weight. When they gain weight, they feel ashamed, unhappy, and defeated. When these same individuals lose weight, even if they’re already underweight, experience happiness and a sense of control over their situation.
Several risk factors may increase your likelihood of developing anorexia nervosa. The list below highlights some of the most impactful and common risk factors: 
- Being female – between 0.5 and 1% of all American women have anorexia and 90 to 95% of those diagnosed are female. 
- Being under the age of 40 – the condition most commonly develops in early to mid-adolescence. 
- Losing substantial amounts of bodyweight in a relatively short timeframe.
- Displaying an anxiety disorder or eating problem(s) during childhood.
- Having a negative focus on weight, shape, and self-image.
- Undergoing puberty or big life changes like moving, changing jobs, and divorce.
- Currently undergoing or having a history of sexual abuse, depression, obsessive compulsive, or other anxiety disorder.
- Commonly exhibiting pessimism, negatively, and worry during stressful situations.
- Engaging in activities that emphasize lean physiques such as dance, gymnastics, running, modeling, and wrestling.
- Having a first-degree relative currently battling or previously diagnosed with anorexia – nearly 20% of individuals diagnosed with anorexia have at least one family member with a history of the disorder. 
The most common symptom of anorexia is severe and often rapid weight loss followed by the continued reduction in weight below a healthy level. The American Psychiatric Association diagnoses anorexia if an individual restricts food intake, exhibits a fear of gaining weight, and has issues with body image.  The list below provides some of the most common physical, emotional, and behavioral indicators for anorexia: 
- Extreme weight loss
- Cold intolerance
- Discoloration of the fingers and dry or yellowish skin
- Irregular heartbeat and low blood pressure
- Insomnia and fatigue
- Binging and self-induced vomiting – bulimics are individuals that binge and purge but maintain a normal or above normal weight whereas anorexics binge and purge to further reduce their weight below a healthy level.
- Frequent use of laxatives, diet aids, diuretics, and/or enemas
- Excessive exercise
- Obsession with food and fear of gaining weight
- Refusal to eat, denial of hunger, and lies about how much food they’ve consumed
- Social withdrawal, reduced sex drive, depression, and thoughts of suicide
- Use of the bathroom immediately after meals
- Refusal to eat around other people and when forced, will cut food in to small pieces and move it around the plate rather than eat it
The above symptoms are merely a sample of what an individual with anorexia may exhibit. It’s worth emphasizing that a focus on eating right and exercising is healthy so long as it doesn’t lead to negative body image issues, severely restricted eating, social isolation, and severe changes in body composition.
Anorexia nervosa is a serious condition that if left untreated, can become deadly. It can cause a severe hormone imbalance due to malnutrition in both males and females. The most common complications arising from anorexia include low iron levels in the blood (anemia), heart problems, gastrointestinal issues like constipation and diarrhea, electrolyte abnormalities, and kidney problems. 
Suffers of anorexia may also develop an abnormally slow heart rate, low blood pressure, muscle loss, dehydration, fainting spells, dry hair and skin, as well hair loss.  As someone who overcame anorexia over 10 years ago, I can vouch that some of these issues still affect me and are a concern today.
Anorexia places you at a significantly higher risk for irreversible reduced bone density in the short-term and osteoporosis in the long-term.  The development of anorexia during puberty can significantly hinder bone accrual and normal height growth. 
Females may also experience delayed, infrequent, or absent menstrual periods.  Males typically experience significantly decreases testosterone levels.  Low testosterone levels can cause loss of muscle mass, depression, and countless number of health complications.
An estimated 5 to 20% of individuals with anorexia will die, with the likelihood of death significantly increasing as the duration the individual has the condition increases.  The most common causes of death include heart failure, electrolyte imbalance, and suicide. 
Anorexia is a serious condition that deserve immediate medical attention. Please seek help if you or someone you know exhibits symptoms of anorexia nervosa. It could just save your or their life.
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