Reverse anorexia, muscle dysmorphia, or bigorexia are all names for a type of body dysmorphic disorder that is characterized by an intense desire to increase one’s body size. Sufferers of reverse anorexia are constantly preoccupied with eating more food, and they engage in intense body-building exercises. Research shows that this disorder mostly impacts adolescents and young adult men with a mean age of onset of over 19 years old.

Individuals who struggle with reverse anorexia are often dissatisfied with their bodies and are hypercritical of their shapes. Despite their highly developed muscularity, they often complain about being “too small.” Many researchers compare their distorted self-image to that of individuals who struggle with anorexia nervosa. Further, individuals with both illnesses tend to show compulsive and ritualistic behaviors and extreme dissatisfaction with their bodies, to the point that they hide them under loose clothing.

Unfortunately, this disorder is common among male body builders. In a study conducted by Harrison Pope, David Katz, and James Hudson in 1993, the researchers noted that eight percent of body builders identified with the symptoms of reverse anorexia, including “feeling small and weak,” despite being muscular and strong.

A few months ago, after I signed up for a new gym membership, I met with one of the senior trainers for a complementary tour of the facility. After learning about what I do, he shared with me that he has been struggling with reverse anorexia for years. Although he has a built and muscular physique, he told me that he sees himself as “too small.” He told me that he feels disgusted whenever he looks at himself in the mirror.

He added that after finishing his 2–3 hours of weightlifting classes each day, he stays at the gym for additional hours to exercise and work out. Several times each day, he uses a scale that measures his weight, fat, muscle, and bone mass. He told me that he often passes up opportunities to hang out with his friends or go on dates because of his intense workout schedule.

There are many people fighting the same battle. The video below highlights some of the psychological struggles of men with reverse anorexia.

Some of the warning signs of reverse anorexia are:

• Jeopardizing one’s overall health through use of unproven bodybuilding supplements or injecting steroids
• Fixation on diet and exercise as a way to alleviate anxiety over not being adequately muscular
• Continuous engagement in exercise regardless of injury
• Prioritizing exercise over work and family obligations
• Profound body dissatisfaction

Reverse Anorexia & Steroids

A major issue associated with reverse anorexia is the misuse of anabolic-androgenic steroids (AAS). The use of AAS enables a person to become far leaner and muscular than is naturally possible. Research has shown that one to three million American men have used this substance.

In addition to the psychological distress associated with reverse anorexia, people who use anabolic androgenic steroids develop other psychological disorders due to its use, including:

• Extreme irritability
• Impaired judgment
• Paranoid jealousy

The National Institute on Drug Abuse (NIDA) has released a warning statement noting that individuals who use AAS are at risk for liver tumors, cancer, jaundice, high blood pressure, fertility problems, hair loss, and growing breasts.

Treatment for Reverse Anorexia

Studies show that psychotherapy, especially cognitive behavioral therapy, combined with medication management (e.g., the use of an SSRI), can effectively treat the symptoms of this psychiatric disorder. One challenge of treating this population is that they tend to be secretive and reluctant to share their obsessions. Additionally, since society promotes dieting and exercise, they are often able to mask their psychological disorder under the label of healthy life style.