http://menshealth.about.com/cs/menonly/a/bigorexia.htm Reverse Anorexia Being preoccupied with muscle development may involve a disturbance in body image similar to anorexia. Bigorexia (muscular dysmorphia) is now affecting hundreds of thousands of men. For some men muscle development is such a complete preoccupation that they will miss important events, continue training through pain or broken bones, even lose their job rather than interrupt their physical development schedule. Curiously, these same men are not in love with their bodies. Despite a well developed physique they are unlikely to show it off and will shy away from situations that expose their bodies. The term 'muscle dysmorphia' was coined in 1997 to describe this new form of disorder. Other people refer to the condition as 'reverse anorexia', and now more commonly 'bigorexia'. The causes are not known but two key ideas revolve around bigorexia as a form of obsessive compulsive behavior and secondly, the effect of the media putting the same type of pressure on men to conform to an ideal shape as has been the case with women for years. The main characteristic of bigorexia is the thought that no matter how hard you try your body is never muscular enough. The condition is recognized as more common with men although some women body builders have also been reported with similar symptoms. Most men with bigorexia are weight lifters, but this does not mean that most weight lifters are bigorexic. Compared to normal weightlifters who report spending up to 40 minutes a day thinking about body development, men with bigorexia report being preoccupied 5 or more hours a day thinking their bodies are under-developed. With the increase in gymnasium provision and attendance there is some speculation that this alone accounts for increased awareness of physical imperfection in men and a quest to attain the perfect body. Conservative estimates put bigorexia as affecting hundreds of thousands of men. Typical Features of Bigorexia mirror checking. Bigorexic men check themselves up to 12 times a day. This compares to roughly 3 times a day with other weight lifters. social & work events: important social events like birthdays, meeting friends, keeping appointments etc are overlooked because they interrupt the training schedule. Working hours may be seen as too long and some men have lost their jobs because they spend too long training during break periods. diet: very strict diets are important. Bigorexics will rarely eat at another person's house or at a restaurant because they are unable to control the dietary balance or know exactly what has gone into food preparation. It has been known for men to develop eating disorders such as bulimia. measuring up: bigorexic men constantly compare their own physique with that of other men. Invariably their perceptions are incorrect. Even when observing men of equal physique they will judge themselves as smaller. drugs: the use of anabolic steroids is common amongst bigorexics. Men continue using steroids despite experiencing side effects such as increased aggression, acne, breast enlargement, impotence, baldness, impotence and testicular shrinkage. fat: men with bigorexia typically worry about the percentage of body fat they carry rather than being overweight. Psychological Factors: Unlike many body builders who enjoy the opportunity to show their physique in public bigorexics do not. Many will hide away for days at a time because of embarrassment about their body shape. Research undertaken by Pope and others in 2000 found that one man avoided sex with his wife in case it used up energy he could apply to body building. Typically, men with bigorexia have a low self esteem. Many report having been teased at school about their physique leading to a focus on 'making good'. However, the attempt to catch up is never achieved and results in a poor sense of self and feelings of emptiness. Studies by Olivardia and others in 2000 also found that 29 per cent of men with bigorexia had a history of anxiety disorder and 59 per cent exhibited some other form of mood disorder. Treatment Options At the time of writing no systematic studies have been produced to compare the effectiveness of one treatment over another, either individually or in combination. A particular problem with the condition is that, rather like anorexics, men rarely see themselves as having a problem and are unlikely to come forward for treatment. The condition itself occurs partly as a response to feelings of depression and lack of self-esteem so coming forward for treatment is admitting defeat. Where men have come forward a combination of educational and psychotherapeutic techniques have begun to show promising results. Cognitive-behavioral techniques place an emphasis on identifying and changing patterns of thinking towards more realistic and achievable goals. Future treatment packages may well be informed by such approaches but more systematic studies are now required.