For many gay men, when it comes to muscles, one mantra continues to hold sway: The bigger the better.
However, becoming obsessed over the size of your muscles, or going to extreme lengths to get bigger biceps, can become unhealthy.
Bigorexia, also known as muscle dysphoria or reverse anorexia, is a type of body dysmorphic disorder. It is defined by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) as a preoccupation with the idea that your body is too small or not muscular enough.
So when does going to the gym regularly and dreaming of a bigger body cross the threshold into potential bigorexia?
Dr. Jason Nagata, assistant professor of pediatrics with the University of California, specializes in eating disorders and muscle dysmorphia.
“Muscle dysmorphia may develop when a man becomes preoccupied with his appearance, body size, weight, food, or exercise in a way that worsens his quality of life,” he told Queerty. “He may withdraw from his usual activities or friends because of concerns with body size and appearance.”
“Muscle dysmorphia occurs when an individual becomes obsessed with becoming muscular. They may view themselves as puny even if they are objectively muscular.
“People with muscle dysmorphia may use anabolic steroids or other appearance – and performance-enhancing drugs to become more muscular. They may engage in excess exercise.”
Nagata says he’s known some men with bigorexia to exercise for up to five hours a day.
Michael Padraig Acton is a psychological therapist, counselor & author who divides his time between Fort Lauderdale and London. He tells Queerty he works out every morning and feels guilty if he skips workouts. However, he emphasizes that does not mean he has bigorexia. He draws a parallel between social drinking and alcoholism.
“If we go to the pub four times a week and have a couple of drinks, and we’re functioning fine, that’s great. If we’re binge drinking or not functioning in our lives, that’s not great. That’s where the line is between healthy working out and bigorexia.”
He says that with an eating disorder such as anorexia, it’s usually easy to see if someone is in trouble. They often look emaciated and unwell. It’s harder to spot someone with bigorexia as they usually look very fit.
However, “It’s when someone puts working out and building muscle above everything else,” he says. “If they’re abusing supplements, using steroids, not eating a balanced diet, and just taking lots of protein in order to make sure they’re building the muscle. Unfortunately, with the use of steroids, etc, to build muscle, along comes anxiety and depression as a result of that.”
Overuse of anabolic steroids has also been linked to erectile dysfunction, acne, high blood pressure, and heart, liver, and kidney problems.
Acton also points to people neglecting relationships with family and friends or being late for other commitments to work out as potential red flags. In short, if your exercise is having negative consequences on other areas of your life, you’ve got a problem.
He says being a bodybuilder, for example, doesn’t necessarily mean you have bigorexia.
“One or two of them could have bigorexia, but it doesn’t go hand in hand with professional bodybuilders. Bigorexia is more a psychological issue. And again, it’s about crossing that line into dysfunction. Professional bodybuilders are often doing it for a business. They’re athletes. Someone with bigorexia is somebody who feels very low about themselves or may have deeper worries.”
Last year, Nagata and colleagues published research suggesting eating disorders like anorexia and bulimia were more common among LGBTQ people. They suggested stress linked to homophobia and transphobia could play a role in this. Would he expect gay men to also be more likely to experience bigorexia?
“Gay men are more likely to experience body dissatisfaction and eating disorders than heterosexual men,” he confirms.
“Gay men may experience discrimination, prejudice, and stigma which may lead to body dissatisfaction and muscle dysmorphia. Peers, social media, and the media influence gay men’s perception of the ideal body. Constant exposure to unattainable body ideals may lead to body dissatisfaction, eating disorders, and muscle dysmorphia.”
“One-third of young men report trying to bulk up and 22% report taking supplements, steroids, or eating more to bulk up. A perceived mismatch between one’s body and one’s ideal body can lead to body dissatisfaction and bigorexia.”
Acton says he less convinced that gay men are more likely to suffer from bigorexia. In his experience, it cuts across age, sexuality, and gender. He also thinks more LGBTQ may find time to go to the gym simply because they’re less likely to have kids and other family commitments.
He says the causes of bigorexia can be wide and varied: from bullying when younger for being perceived as weak and puny, to negation.
“Negation in psychological terms is when we cannot cope with our emotions or we cannot cope with our world. Therefore what we do is we become compulsive about something to fill up our world, so we don’t have to think about that.”
He points to people that have been through a bad relationship breakup or some other sort of trauma.
“Or people who have given up smoking. They will find something to replace that, to negate it, so a lot of people who give up smoking will do nothing but hill walking and exercise. And every time they want a cigarette they’ll do more exercise. So it’s a way of negating whatever issues are going on in life.”
Such negation can become dangerous or unhealthy in the long run.
One thing both men agree upon is the damaging effect of social media.
“Men’s bodies are on display more than ever on social media, especially through influencer accounts,” says Nagata. “The idealized physiques that influencers post may be heavily filtered or the best of hundreds of photos. Constant comparisons to these idealized bodies may lead to body dissatisfaction and bigorexia in some LGBTQ people.
“Men who post on image-based social media may receive positive reinforcement for their appearance. They may be more likely to engage in muscle-enhancing behaviors to achieve a certain body ideal, and the positive feedback they receive from followers may lead to a vicious cycle and bigorexia.”
So what can you do if you think you may be suffering from bigorexia?
“People with muscle dysmorphia should seek help from their doctor or a mental health professional,” says Nagata. “People who exercise in excess without increasing their nutritional intake to match their energy output can become critically ill and need to be hospitalized for malnutrition.”
“The only way you can self-diagnose is to think, ‘Is this working for me anymore?’,” says Acton.
“It’s a simple but powerful question. How is it impacting my life? And if you really feel it’s not working, it can be managed, but you will need support. That’s either seeing somebody like myself or a therapist or counselor that specializes in eating disorders or addiction because it is an addiction.
“You don’t have to give it up, but we can find ways of managing change so it’s more healthy and more in balance with the rest of your life.”