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Muscle dysmorphia (also known as "megarexia", "bigorexia", or "reverse anorexia nervosa") is a disorder that is characterized by a fear of being too small, and perceiving oneself as small and weak even when one is actually large and muscular. Sometimes referred to as the Adonis Complex, muscle dysmorphia is a very specific type of body dysmorphic disorder. In this disorder a person is preoccupied with thoughts concerning appearance, especially musculature.
As with other forms of body dysmorphic disorder, muscle dysmorphia is strictly connected with selective attention: individuals selectively focus their attention on perceived defect (too skinny body, underweight etc.). They are hypervigilant to even small deviations from perceived ideal and they ignore information that their body image is not consistent with reality.
Sociologist Anthony Cortese views muscle dysmorphia as an obsessive compulsive disorder that reflects the dysfunctionality of gender roles in post-modern society. Cortese identifies muscular dysmorphia as a primarily a male disorder that mirrors the feminized anorexia nervosa, Cortese says: "These men are obsessed with attaining an unrealistic cultural standard of muscularity as masculinity.
A diagnosis of muscle dysmorphia requires that a person exhibit symptoms of the type and degree outlined in the Diagnostic and Statistical Manual for body dysmorphic disorder, and not merely appear over-interested in physique or engage in compensatory behaviors considered irrational and unhealthy.
Muscle dysmorphia is most common in males and often starts in the late teens, although sometimes, they can be older. Olivardia and others found in a 2000 study that the average onset age was 19.4 years. It most often occurs in those whom others already consider muscular, and is often accompanied by depression.
A few risk factors may contribute to this disorder: family disharmony, perfectionism, severe stress, aesthetic focus and negative influence of mass culture that promotes an idealized body.
Several hypotheses try to explain the origins of muscle dysmorphia. The cognitive theory is one of the most common explanations. It searches for possible causes of the disorder in a cognitive vicious circle of dysfunctional thoughts. When a person has a negative appraisal of internal body image, it influences the external representation of appearance. That triggers processing self as an aesthetic object, which results in negative internal body image.
The psychodynamic theory states that these are unresolved conflicts from childhood and extremely difficult feelings that are responsible for the disorder. The disorder provides a means for people to express their emotions that otherwise would be too difficult to express. In this case emotions are converted into more tolerable physical symptoms. The purpose of such conversion is to communicate extreme feelings in 'physical language'. Therefore a preoccupation with musculature could be treated as an individual's unconscious displacement of sexual or emotional conflict (or feelings of guilt, or even poor self-image).
According to the biological theory a serotonin irregularity is mostly responsible for the disorder. In addition, neuroimaging research has consistently changes in the brain's limbic system that may contribute to the emotional distress that muscle dysmorphia causes.
Finally, the cognitive-behavioral theory holds that muscle dysmorphia is influenced by several factors including culture, biological predisposition, psychological vulnerabilities (e.g. low self-esteem) and early childhood experiences (e.g. bullying and teasing). Cultural factors manifest themselves in an exaggerated emphasis on appearance, physical strength and attractiveness. For instance, people compare themselves with idealized cultural figures such as unattainably muscular heroes in children's books and action figures (e.g. G.I. Joe).
There is also a hypothesis that individuals repeat negative and distorted self-statements concerning their appearance to such an extent that they become automatic. Muscle dysmorphia influences a person's mood, often causing depression or feelings of disgust. This is often connected with constant comparing of a person's body to an unattainable ideal.
Several treatment options are typically pursued for muscle dysmorphia:
- Psychodynamic therapy or physical therapy
- Behavioral therapy
- Cognitive therapy (mostly cognitive restructuring)
- Cognitive-behavioral therapy
However, it is argued that the largest impediment to treatment is the reluctance to admit a problem.
- Pope, H. G., Katz, D. L., & Hudson, J. I. (1993). Anorexia nervosa and “reverse anorexia” among 108 male bodybuilders. Comprehensive Psychiatry, 34(6), 406-409. doi:10.1016/0010-440X(93)90066-D
- "'Bigorexia': Muscle dysmorphia 'now affects one in 10 gym-going men'". BBC News. Retrieved 21 September 2015.
- Cortese, Anthony J. (2007). Provocateur: Images of Women and Minorities in Advertising. Rowman and Littlefield. p. 72. ISBN 0742568768.
- Pope, Harrison (2000). The Adonis Complex: The Secret Crisis of Male Body Obsession. New York: Simon & Schuster.