‘Bigorexia’ is thought to affect around 10% of men who work out, but as eating disorders and mental health issues go, it’s largely ignored. Here’s why it needs to be higher on the agenda, and how to spot it…

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Thor, Wolverine, hell, even James Bond. Have you noticed that Action Men types are staging quite the takeover? Perhaps it’s the arrival of 3D cinema, the growth of the global Crossfit  community or the ever increasing popularity of protein powders and supplements to achieve greater ‘gains’, but male fitness culture has very much been leaning towards the buff and brawny, rather than being being purely performance, speed, sport or stamina driven. Just as glossy magazines can’t be held solely accountable for the incidence of eating disorders in young women, there’s no one external factor to blame for men developing obsessive behaviour around gym training and body size, but the recent huge spike in reported steroid use ( up by a whopping 645% between 2010 to 2013 alone , and growing according to the National Institute for Health and Care Excellence ) is indicative of a worrying trend.

Muscle dysmorphia is a form of body dysmorphic disorder, which is defined by the NHS as ‘an anxiety disorder that causes a person to have a distorted view of how they look and to spend a lot of time worrying about their appearance’. Often termed ‘bigorexia’, to indicate that it could be considered as a type of inverse anorexia, sufferers can exhibit extreme gym or training tendencies, frequently prioritising workouts over social events, spending time with loved ones or work. Other indicators can include pushing on through punishing workouts despite injury, a dependence on supplements, protein shakes and/or anabolic steroids, mood swings, depression and secretive behaviour. Consultant Psychiatrist at T he Priory Group  Dr Janet Walsh underlines that ‘muscle dysmorphia really becomes a diagnostic problem when it affects other aspects of a person’s life.’ According to Dr Walsh, common markers, and side-effects, of muscle dysmorphia can be wide ranging:

“It could be associated with the breakdown of a relationship, constant ‘mirror checking, drug use...there’s not really an agreed definition. In general sufferers have unfounded and distorted views of themselves, doing high levels of gym work but never feeling satisfied with their results, and imposing strict rules around when and how they exercise.”

“Those prone to muscle dysmorphic behavior are usually vulnerable to risk, for instance they’re likely to suffer from low self-esteem, have a history of bullying or weight problems and generally feel a need to prove themselves and constantly strive for unattainable standards.”

“Such impossible ideals could be all consuming, or could be a preoccupation that’s less obvious; as with all disorders muscle dysmorphia exists on a continuum. There is also overlap with general eating disorders, for instance boys and men suffering from eating disorders often present with a mixed focus; they want to lose body fat, but they also want to retain muscle. We’re seeing this more and more with women too; ten or twelve years ago, the focus of most female patients was solely on keeping body weight low, but now being toned is a concern too.”

Despite the apparent propagation of muscle dysmorphia in gyms and the general community, Dr Walsh and her peers are seeing minimal self-presentation in clinics:

“Often it’s not seen as a problem, and many sufferers wouldn’t consider using mental health services. If they do come in the first place, that’s a huge obstacle conquered already in terms of recovery and treatment, and from there  CBT  would likely be the first port of call, possibly along with medication. Getting better is a gradual process, using similar techniques to those used to treat eating disorders.”

“More likely though, is that a patient comes to seek treatment for mood related issues, and we can identify muscle dysmorphia from there, especially if steroid use is a factor, as steroids can trigger mood problems in themselves. This means that muscle dysmorphia combined with taking steroids can be a vicious, perpetuating cycle, especially if a person starts taking them at a young age. I read recently that 25% of users started around the age of 21, so anywhere that you can break the habit and stop the cycle is a step forward.”

So what can we do to help, both on a larger scale and if you suspect someone close to you might be suffering? Dr Walsh has some sage advice:

“The main difficulty is getting the person themself to recognise that they have a problem. Remain open, listen and pick up on things they say. For example, if they mention ‘having’ to go the gym, gently question them or focus on another element of their behaviour that they themselves have identified. Stay calm and approachable, let them give you insight, and especially if you suspect that steroid use is an issue, read up on it as much as you can. There’s not nearly enough education out there about steroid abuse, so get to know the risks and encourage others around you to seek information too.”

“As steroids are legal for personal use, and categorised as a class C drug, we don’t currently have accurate data or sufficient awareness of steroid use, which poses huge risks. When have you ever seen a poster warning of the dangers of taking steroids? Gyms could do more in this area. The likes of Virgin Active, Fitness First and David Lloyd have introduced sharps bins, supposedly for razors and to accommodate for diabetic members, and all state that they do not tolerate the use of steroids in their gyms, but they’re in a unique position to promote education around steroids.”

Dr Walsh points out that a key deterrent for steroid users with muscle dysmorphia could be the potential impact that consistent use can have on the appearance and sterility. Side effects range from baldness, breast development, acne, reduced sperm count, shrunken testicles and infertility (not to mention increased risk of prostate cancer, heart attacks and liver and kidney problems).

As for the term ‘bigorexia’, it certainly garners attention and makes a link between well known eating disorders and muscle dysmorphia, but Dr Walsh argues that ‘as it sounds sensational, people may dismiss it as medicalising a trivial issue or fad, when in reality muscle dysmorphia is a serious condition’.

Whatever your stance on giving it a label, the fact that unhealthy behaviour around food and exercise in men is beginning to be recognised is a step forward. Now to address the steroid dealers, ‘normalised’ gym culture, supplement pushers and radio silence around men’s mental health issues…

To learn more about muscle dysmorphia and seek support, visit the  Body Dysmorphic Disorder Foundation

To learn more about or make an appointment with Dr Janet Walsh, visit  The Priory Group

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