Obsessed with Size: ‘Bigorexia’ Sufferers Develop Unhealthy Compulsion to Exercise

By Hugh C. McBride

When Ken Clarke looks in the mirror, he sees a lot of areas that need improvement: His chest is too small, his arms are too thin, and no matter how hard he works, he can’t seem to make the progress he desires. Like thousands of other people, he’s continually frustrated by his scrawny stature.

Unlike most other people, though, Ken Clarke is a bodybuilder with bulging pectorals and softball-sized biceps.

“I’d like to be normal,” Clarke said in a 2006 Discovery Health Channel report about muscle dysmorphia, a condition that causes individuals like him to be continually (and unhealthily) dissatisfied with the size of their bodies. But no matter how much he works out, or how stringently he manages his diet, he said, he is unable to escape “this compulsion just to be bigger.”

ABOUT MUSCLE DYSMORPHIA

“This is not vanity,” said Arie Winograd, who was with the UCLA Obsessive-Compulsive Disorder Treatment Program when the Discovery Health segment was filmed. “This is a true psychiatric disorder.”

Now the director of the Los Angeles Body Dysmorphic Disorder Clinic, Winograd told the Discovery interviewers that individuals who are afflicted with muscle dysmorphia exhibit “a preoccupation with imagined defects in appearance.”
Because muscle dysmorphic individuals take their size-related obsessions to unhealthy extremes, the condition has been compared to anorexia nervosa, the condition that leads to self-starvation. As anorexia primarily affects women, though men can have the disorder, too, muscle dysmorphia – or “bigorexia,” as it has been dubbed – mostly afflicts men, though some women have been diagnosed with the disease.

It was not identified until long after anorexia nervosa had already become a recognized medical condition, but muscle dysmorphia has been the topic of considerable study since its initial diagnoses in the mid-1990s.

Dr. Roberto Olivardia, the lead author of one of those studies, described the disorder in terms that were very similar to Winograd’s words. Individuals with muscle dysmorphia, Olivardia wrote, develop “a pathological preoccupation with their muscularity.”

Olivardia’s study, which was published in the August 2000 edition of The American Journal of Psychiatry, analyzed 54 male weightlifters (24 who had muscle dysmorphia and 30 who did not). After evaluating the subjects with a variety of physical and psychiatric tests, the research group found a stark difference between the two groups.

The dysmorphic men, the researchers concluded, exhibited significant differences from the comparison group in the following categories:

• Body dissatisfaction and steroid use
• Lifetime prevalence of mood, anxiety, and eating disorders
• Shame and embarrassment
• Social and occupational impairment

NEVER BIG ENOUGH

Kerry Dulin, a competitive bodybuilder and founder of the Lift For Life website, has written on his site that within the bodybuilding community, muscle dysmorphia is “skittishly danced around and/or avoided completely.” But when Dulin discovered that his daughter had developed an eating disorder, he looked at his own behavior – and the actions of his fellow competitors – and wrote about what he saw:

“A competitive bodybuilder typically lives the sport. You don’t leave it at the gym, you don’t put it back in the bag like a golf club. …

While the general population is concerned with appearance, we are obsessed with it. …

I plan my meals. I time them. I don’t eat for the pleasure of it. I eat according to my current goal. …

As I sit here writing this, emotionally I refuse to accept that I have [muscle dysmorphia] and yet intellectually I recognize that I have many of its symptoms.”

As Dulin alluded to, many muscle dysmorphic individuals exhibit obsessive-compulsive attention to the tiniest details of their quest for an improved appearance. They follow strictly regulated diets – eating carefully planned meals according to rigid time schedules – and spend long hours in the gym, often working themselves past the point of exhaustion.

Their “dedication” often comes at the expense of social lives and personal relationships, as the combination of obsessive workouts and continued personal dissatisfaction renders them incapable of healthy interactions with others.

OBSTACLES TO TREATMENT

With muscle dysmorphia having a diagnostic history of just more than a decade, effective treatments for the disorder are still in the process of being established. Cognitive therapies, behavioral therapies, and combinations of the two are among the most prevalent means of addressing the disease, but no definitive approach has been identified.

James E. Leone, the lead author of a study that appeared in the Oct.-Dec. 2005 edition of The Journal of Athletic Training, wrote that the development of more effective treatments for muscle dysmorphia is hindered by the difficulties that health care professionals have with diagnosing the disorder.

“Although treatment options are limited, therapy and medication do work,” Leone wrote. “The primary issue is identifying the disorder, because it does not present like other psychobehavioral conditions such as anorexia or bulimia nervosa. Not only do patients see themselves as healthy, most look very healthy from an outward perspective.”

As Ken Clarke can attest, though, that outward appearance of health can stand in stark contrast to the inner torment that many “bigorexics” experience. In his interview with Discovery Health, Clarke theorized that winning a major bodybuilding competition might provide the self-esteem boost necessary for him to finally gain control over his body dysmorphia.

But seconds after expressing that hope, Clarke told his interviewer that even reaching this lifelong goal would probably not be enough to ease his obsession.
“I would still want to be bigger,” he said.