What Are the Causes of Bigorexia?

Symptoms of bigorexia (muscle dysmorphia) may include: 

• Methodically dieting (e.g., eat high-protein, low-fat meals) 
• Exercising too much (e.g., lifting weights)
  • The excessive exercise can damage joints or muscles
• Abuse of prescription drugs, often obtained without a prescription, with the goal of losing fat and building muscle, such as:
  • Androgenic steroids
  • Thyroid hormone
  • Selective estrogen receptor modulators
  • Human growth hormone
• Constantly looking at oneself in the mirror
• Avoiding mirrors
• Trying to hide a body part under a hat, scarf, or makeup
• Constantly grooming
• Making constant comparisons with others
• Always asking others if you look OK
• Not believing others when they say you look fine
• Avoiding social activities
• Not leaving home, especially in the daytime
• Seeing many healthcare providers with appearance concerns
• Having unnecessary plastic surgeries
• Feelings of shame
• Anxiety
• Depression
• Thoughts of suicide

If you or someone you know are in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential.  

Bigorexia (muscle dysmorphia) and other forms of body dysmorphic disorder are diagnosed by a mental health professional. 

Patients are evaluated based on criteria from The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), including:

• Preoccupation with at least one nonexistent or slight defect in physical appearance (e.g., thinks about the perceived defects for at least one hour per day)
• Concerns about appearance lead to repetitive behaviors (e.g., excessive exercise, mirror checking, excessive grooming) or mental acts (e.g., comparing one’s appearance with that of others) at some point during the course of the illness
• Clinically significant distress or psychosocial impairment resulting from the appearance concerns
• Appearance preoccupations are not better explained by an eating disorder

Treatment for bigorexia (muscle dysmorphia) may be based on:

• The extent of the problem
• The patient’s age, overall health, and medical history
• The patient’s tolerance for certain medications, procedures, or therapies
• Expectations for the course of the disorder
• The opinion of the healthcare providers 
• The patient’s opinion and preference

Treatment may include talk therapy and/or medications. Cognitive behavioral therapy (CBT) may be used to help a person replace negative thoughts and thought patterns with positive thoughts. Selective serotonin reuptake inhibitor (SSRI) antidepressants usually work best to treat forms of body dysmorphic disorder.