Bigorexia: the obsession with the perfect physique

By Cristiano Antonino On Mar 15, 2023

Bigorexia, or vigorexia, is a psychological disorder that can be classified within the ‘new’ eating disorders, such as orthorexia (obsession with food that is considered healthy), drunkorexia (fasting in order to be able to consume alcohol in quantity without gaining weight), and pregorexia (eating as little as possible during pregnancy to avoid gaining weight); vigorexia is characterised by a serious bodily despair, opposite to that of anorexia nervosa, which leads the subject to always feel too thin, puny and slender, fearing to appear ‘small’, weak and even inadequate

There is a constant obsession with muscle tone, to be developed through exaggerated training and repeated exercise, and with lean mass, to be maintained through a low-calorie, high-protein diet.

Often the sport of choice is weight-lifting: according to some statistical research, bigorexia affects about 10% of body-building subjects

The use of dietary supplements (e.g. protein, creatine) is widespread, as is the abuse of anabolic steroid drugs, both of which are very harmful to health.

The bigorexic thinks constantly about fitness, about his body and his image, about nutrition; he attends gyms and sports centres compulsively, not as a habit to have fun, to relieve himself or to keep himself, simply, healthy and ‘in shape’, but as a real fixation that continually gives rise to stress, dissatisfaction and malaise.

He is terrified of losing the muscles he has built with so much sacrifice and of noticing any physical ‘sagging’.

This malaise, recently discovered in the field of psychology, is also called the ‘Adonis Complex’, named after the character in Greek mythology who represents the idea of male beauty, understood as physical perfection in aesthetic form; or, it can be defined as ‘Muscle Dysmorphia’ or rather ‘Reverse Anorexia’, according to its first description in a reliable scientific journal (1993), when this term was used to contrast it with anorexia nervosa.

In fact, vigorexics also suffer from a distorted perception of their bodies, but unlike those with anorexia nervosa, who always see themselves as too fat and/or heavy, they perceive themselves as flabby, untoned or petite, while in reality they possess muscular and hypertrophic physiques.

Bigorexia is particularly prevalent in the male population, however, according to the most recent statistical surveys, it is also becoming increasingly common among women; The age group certainly most affected is 25 to 35, followed by 18 to 24, but there is also a growing segment of adults, even over 40, who, unaware of the passing of time and driven by the idea of regaining their youth through training, gradually allow themselves to be attracted by increasingly hard and frequent workouts and an increasingly rigid diet, until they find themselves victims of vigorousness.

As for the causes of bigorexia, according to experts, these are to be found in a combination of factors of a different nature

These include psychological factors, social factors and biological factors.

It seems that self-esteem plays an important role, as these are individuals with a chronic dissatisfaction with their appearance and themselves in general, who feel the need to strengthen their physique also in order to strengthen their inner image.

They are insecure and constantly compare themselves to others.

Relevant is also the role of the media, which continually propose the myth of ‘beauty’ (understood in various aspects, such as thinness, tone, youthfulness, adherence to certain standards typical of the modern West, etc.) as the only model for achieving success, happiness, self-fulfilment and social recognition.

Articles in magazines, advertisements and TV programmes, videos and images on the web incite the pursuit of certain standards, condemning the slightest defect and instilling guilt and shame in those who are ‘different’.

It is curious to note, then, how the evolution of the concept of ‘physical perfection’ and that of available models have gone hand in hand, even in the world of children’s toys.

It was Harrison Pope himself, author of the first research on vigorexia, who observed the particular and obvious evolution of Big Jim, a character very much in vogue during the Barbie boom years. Initially (1964) he was, in fact, morphologically similar to an average man, fit but not excessively thin, nor hypermuscular; as the years went by, with the advent of the fitness business, while the Barbie doll became thinner and thinner until the 2000s, Big Jim grew more and more muscular, becoming similar to a classic body builder.

The symptoms of vigorexia are varied and range from psychological aspects, such as obsessive thoughts and fears, to abnormal behaviour

Here is a list of the most characteristic ones

worrying, obsessively and often unfoundedly, that one’s body is not sufficiently lean, muscular and athletic;
practising extreme exercise programmes, which take up many hours of the day and mainly consist of lifting weights;
having an excessive and maniacal focus on nutrition, which, specifically, should only include ‘healthy food’, low-calorie and high-protein foods;
putting sports training and looking after one’s body before family, social and working life;
devoting most of one’s time and a great deal of one’s economic resources to frequenting gyms/fitness centres/beauty centres and buying magazines that deal with body care and sports training aimed at muscle growth;
constantly looking in the mirror (like the Narcissus of Greek mythology, understood in the ‘classical’ sense and not in the current psychopathological sense), in search of some imperfection in the muscles. For the same principle, categorically avoid looking in the mirror during a period of physical inactivity due to force majeure;
train even in the presence of muscular injuries, which would discourage the practice of sport;
experience malaise, anxiety and discomfort if they cannot devote themselves to training as planned;
continually resort to food supplements; – use anabolic steroids to increase muscle mass.

In the case of vigorexia, all this is often accompanied by self-punishing behaviour, such as inflicting heavy, often very long training sessions on oneself, which lead instead of progress to a state of overtraining, with the due psycho-physical consequences.

Too much sport, without rest days and with extreme loads, can have the opposite effect on the muscular system, weakening it and making it more susceptible to injury.

Drastic and very strict diet regimes also contribute to what can be described as a form of social ‘selfisolation’: this emerges, for example, when one goes out in a group, even rarely, and is terrified of having to order ‘normal’ food, such as pizza and beer, in order not to stand out from the others.

All this can lead to states of anxiety and real mood disorders, such as depression, even to suicidal thoughts.

The only people who are considered worthy of esteem, capable and competent are those who share the same lifestyle, and who may have already achieved more on the physical side.

The desire to emulate becomes so great that one is willing to take any path, including illicit ones

If not adequately treated, vigorousness can have serious repercussions on the subject’s quality of life and health, as the use of anabolic steroids, especially if ill-considered, is responsible for serious side effects, such as testicular atrophy, gynaecomastia, cardiac hypertrophy, liver intoxication, etc.; while high-protein diets overtax the kidneys, so much so that the latter may suffer serious damage in the long run.

In order to arrive at a diagnosis of vigorexia, certain (diagnostic) criteria are required, appropriately recognised by experts, which concern both obsessive preoccupations and abnormal behaviour, which can be detected by clinical interviews, patient observation and test/questionnaire instruments.

Specifically, there are 4:

1st criterion: the individual with vigorexia puts exercise and attention to diet before anything that might, in some way, make him or her give up an exercise session or make him or her eat in a way that is inappropriate to his or her habits;

2nd criterion: the individual avoids showing his body to others, out of the often unfounded fear of not being sufficiently thin or athletic. If he cannot avoid it at all, showing himself in public leads him to develop anxiety, stress and discomfort;

3rd criterion: the obsessive preoccupation with muscle tone and training is such that it leads to social isolation, loss of job, etc.; and

4th criterion: the individual continues in the practice of physical exercise, even in spite of injuries, and in the use of anabolic agents, despite being aware of the harmful effects the latter have on his or her health.

In order to be able to speak of bigorexia, it is sufficient that the preoccupation with the body manifests itself with even just two of these four diagnostic criteria

Making the diagnosis, however, is quite complex, as sufferers tend to conceal their problems or, even worse, do not realise that they have a distorted view of their bodies.

For this very reason, it is believed to be an underestimated disorder.

On the other hand, when we have before us is a particularly toned and muscular subject, who appears to be ‘bursting with health’, we are more likely to feel admiration (if not envy), we hardly consider him as a potential sick person, in need of treatment as, on the contrary, someone suffering from anorexia may appear to the eye.

There is a lack of real awareness of the problem and, in talking about it, one runs the risk of being misunderstood, as if the message sent is a hymn to sedentariness.

Being a psychological disorder, the treatment of first choice for the treatment of vigorexia consists of psychotherapy, preferably cognitive-behavioural, combined with SSRI (selective serotonin reuptake inhibitors) drug therapy.

Having said this, it should be noted that treating it can be very difficult, as the patient is often not aware of it and, first of all, must realise that he or she is suffering from a pathology and that he or she is leading a maladaptive life, a source of harm in the social and work spheres (and also dangerous for his or her health, if he or she abuses illicit substances).

The support of family and friends is always essential, as they can help him understand the negative consequences he is suffering and motivate him on his path.

The fundamental aim of psychotherapy is to teach the patient how to identify distorted thoughts and misbehaviours related to his distress, in order to prevent them and/or replace them with other, more effective ways.

If the patient agrees to undergo treatment and gives continuity to cognitive-behavioural psychotherapy sessions, vigorexia tends to have a positive prognosis.

Compromising the outcome, sometimes, even in spite of adequate treatment, may be the prolonged use of anabolic steroids.

In fact, one must remember the serious long-term side effects, even irreversible consequences, of these substances.

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