Massachusetts. 1993. Anorexia Inversa.
Professor Harrison G. Pope held in his hands the latest issue of the magazine “Comprehensive Psychyatry” which published his research work on the obsessive preoccupation with muscle development that he had found in male frequents of gyms and bodybuilding circles.
Little could Professor Pope suppose that the disorders described in his research work were going to become, a few years later, a veritable social plague. Together with his team of collaborators, they had studied 108 bodybuilders and had found that a significant number of them believed that their bodies were skinny and not very muscular, when in fact they were strong people with considerable muscle mass.
These subjects were ashamed of their physical appearance, shunned social events and camouflaged their bodies with loose clothing to hide their body. Of course, they were not seen on beaches or pools. All these people, in addition to frequenting the gym regularly, were users of anabolic steroids to develop their muscles.
Dr. Pope taught as a professor at Harvard University School of Medicine. In his research work, he defended the thesis that these subjects suffered from a disorder that he called “reverse anorexia”. Like the anorexic patient who always looks fat, even though she is extremely thin, these subjects always looked skinny and weak, despite having good muscles.
Although a smile of satisfaction was marked on his face, the frown was frowning, hinting that this research work had just begun and there were still many questions to be resolved.
Madrid. 2020. Vigorexia.
The young JGR was sweaty after completing a double workout in the gym. He had squeezed himself out and done more sets of weightlifting than any other day. But his expression was not one of exhaustion from the effort or satisfaction with overcoming himself day by day. His face reflected annoyance, as he watched himself in the mirrors of the gym locker room.
JGR was a 26-year-old boy, tall, with a strong build, broad shoulders and a flat stomach. Anyone who had seen the young man’s athletic body would have easily guessed his fondness for gyms.
However, now in front of the mirror, JGR saw himself as a slim, heavy-shouldered boy with hardly any muscles. He was very upset, he beat himself up in the gym every other day, seeking to improve his deplorable physical appearance. Every day he demanded more, but the mirror gave him a pathetic image.
Anabolic steroids and a high protein diet.
He dressed in a loose tracksuit, so that others would not notice what was obvious to him (his scant musculature) and he approached with his large sports bag towards one of the corners of the gym, where he had a brief conversation with a guy, who secretly handed him a bag of pills after receiving some bills.
JGR had been using anabolic steroids for a few weeks to increase his muscle mass. Of course, he was following a rigorous high protein diet with amino acid and creatine supplements, but despite everything, he was disappointed by the result.
He left the gym with a brisk stride, thinking that when he got to his girlfriend’s house, a monumental row awaited him, for having arrived more than an hour late, just the time he had spent lifting weights in the gym.
He had met his girlfriend to see the new house of some friends, but an intense anguish had seized him when he looked at himself in some shop windows. At that time, he found no better way to eliminate his anxiety than to head to the gym, like so many other days, breaking promises and social commitments.
Vigorous or muscular dysmorphia.
It has been almost 30 years since Harrison Pope described reverse anorexia and today it has become a veritable social plague. Hundreds of young people like JGR pound themselves daily in gyms in a sterile and doomed struggle to achieve an image they will never be satisfied with.
Although initially, inverse anorexia was classified as an eating disorder because of its similarity (reversed) to anorexia, in 1997 new research by Pope and colleagues showed that these subjects better fit the description than the DSM-IV-R does. of body dysmorphic disorders. That is, it would not be an eating disorder but an alteration in the way they perceive their own bodies.
Initially, Pope’s group adopted the term vigorexia (Latinized deformation of the Anglo-Saxon term “Big Orexia”) to refer to this disorder. Soon after, he would replace it with Muscular Dysmorphia. They observed a great similarity with Body Dysmorphic Disorder (BDD) where there is a pathological concern for some part of the body. For this reason they used the term Muscular Dysmorphia or Muscular Dysmorphic Disorder (MDD) because in these cases the body concern appears centered on muscle development.
At present, the term vigorexia is the most used in the medical literature to describe this disorder, together with the term “Adonis complex” that began to be used after the publication in 2001 of the book “The Adonis complex. The secret crisis of the obsession of the masculine body ”of Pope and collaborators.
Diagnosis of vigorexia.
Not being recognized as an individualized disease entity by the DSM-IV-R, Pope’s group of researchers proposed the following diagnostic criteria:
“Worry about not being fat-free enough and not muscular enough. Associated characteristic behaviors include several hours of lifting weights and excessive attention to diet.
The concern manifests itself in at least two of the following four criteria:
The individual frequently abandons important social, work or recreational activities due to a compulsive need to maintain their muscular work schedule and diet.
The individual avoids situations where his body is exposed to other people or endures such situations with marked discomfort and intense anxiety.
Preoccupation with being lean or bulky causes significant clinical discomfort or interferes with your social, work, or other important areas.
The individual continues training, dieting or using ergogenic substances (enhancers of physical performance) despite knowing the adverse physical or psychological consequences. ” (Pope et al. 1997).
These criteria link vigorexia to obsessive compulsive disorders . In this sense we could say that the vigoréxico does not perform physical exercise to obtain pleasure, but that through the compulsive practice of exercise he is freed from the anxiety he feels. In vigorexia, anxiety would be conditioned by excessive social pressure on body image.
Vigorexia – Obsessive preoccupation with body image.
Since the last decades of the last century we have been observing a progressive increase in the cult towards body image. Commercials invade cities and the media with images of “perfect bodies.” The female body appears extremely slim and slim, while the male body appears with powerful and marked musculature.
The influence of this advertising body image in pathologies such as anorexia and bulimia nervosa has been widely established. But, just as it influences women trying to achieve beauty through extreme thinness, it also influences men by setting a canon of beauty that in some cases is extremely harmful to health.
Many adolescents and young adults are overwhelmed by not identifying with the image of the muscular, athletic man. In some cases these people embark on a long and painful pilgrimage in search of the desired muscle mass.
Our modern society has imposed stereotypes of beauty for both men and women. The motto of the new century could be “To happiness through the perfect body.” The person who does not fulfill these ideals is doomed to misery. All efforts are aimed at finding the dream body image, both for men and women. A new era of obsessions has begun.
Vigorexia – Seeking muscle mass gain
Vigorexia or Adonis complex goes far beyond the simple concern for body image. When we talk about vigorexia we are talking about a serious pathology, a mental disorder, which is defined as the obsession to achieve a muscular body.
The main way to reach this goal is the physical exercise carried out in an abusive and obsessive way. The first consequence of this obsession is a metabolic alteration. Everyone knows the feeling of well-being that usually accompanies the practice of some sport in a moderate way. This pleasant sensation is mediated by the secretion of brain endorphins and is the cause that “we get hooked on exercise.” In the case of vigoréxico, this action of endorphins enhances his obsessive condition and leads him to an increasing dependence on physical exercise to the point of neglecting his work, family or social tasks.
Although this is not always the case, in many cases exercise is accompanied by the harmful modification of eating habits. High protein diets, creatine supplements or the use of anabolics are the company of the person who spends many hours a day training in the gym to achieve their goal: to have a body free of visible fat and with perfectly sculpted muscles.
Vigorexia – Strictly Male Heritage?
Although in the beginning, the first cases described corresponded to male bodybuilders in gyms, this pattern has changed. Currently, vigorexia is a disorder also suffered by women, although to a lesser extent. The age most affected by vigorexia is the range between eighteen and forty years, and in Spain the number of affected is around one million people.
The difference between male and female vigorexia is the part of the body that is intended to hypertrophy: while men pursue the goal of adding volume to their biceps and widening their back, women are focused on achieving firm and striking buttocks. As for the abs, these are pursued by both genders, who work tirelessly to achieve marking this part of the body.
Consequences of vigorexia.
In this disorder there are visible consequences, which are lighter and less harmful, as well as others that are not obvious, but are more serious and can reduce the quality of life of those who suffer from it.
Minor consequences of vigorexia.
The most obvious consequences are:
- Be aware of the mirror.
- Spend long hours in the gym.
- Disagreement with the image returned by the mirror.
- Excessive practice of physical exercise.
- Weigh yourself several times a day.
Serious consequences of vigorexia
The main and most serious alterations that appear in vigorexia are conditioned by the consumption of anabolic steroids.
- Virilization in women.
- Cardiac ischemia.
- Damage to the joints and the spine.
- Muscle tears
- Loss of social life.
- Distortion of body image.
- Irritability and depression.
Virilization of women.
The use of anabolic steroids is especially serious in women who suffer a whole series of virilizing effects, among which we can highlight the appearance of a deeper voice, a reduction in the size of the breasts, hair loss, increased body hair, hypertrophy of the clitoris and menstrual cycle alterations, which can lead to amenorrhea or the appearance of polycystic ovaries.
On the other hand, these substances are particularly harmful to both men and women when it comes to heart health. Steroids cause an increase in muscle mass and this can translate into hypertrophy of the cardiac ventricles.
This increase in the size of the heart is not accompanied by a parallel increase in cardiac circulation, which is why serious complications of coronary ischemia may appear, such as angina pectoris or myocardial infarction.
Other organs are also compromised. Liver and kidney function abnormalities may appear. Impotence can appear in men and in women, as we have seen, serious difficulties in conceiving.
One of the most frequent alterations that can appear in vigorexia is dehydration. In a properly hydrated body, water hides muscle turgidity. For this reason, bodybuilders in competitions or patients with vigorexia, may systematically resort to diuretics or not consume the amount of water required for good health.
Muscle tears and joint injuries.
Another problem that the vigorous person faces is joint, muscle and spinal damage. These problems are the direct consequence of excessive exercise, which in most cases is carried out outside of a training controlled by a professional. It is not uncommon for exercise abuse to lead to muscle tears and strains, joint sprains, and even herniated discs.
In turn, these physical injuries also have an emotional impact, since it forces the person to stay away from exercise, thereby losing the muscle mass gained and plunging into a deep depression.
At the same time, we are faced with another problem no less: the loss of social life. Vigorexia keeps people in the gym for several hours a day. Since we are talking about people who work or study, spending four to seven hours in a weight room takes them away from their friends and family.
Training becomes his priority, so he does not hesitate to refuse to go out for a beer with his friends or attend a family celebration. The worst thing is that, if they are pressured to do it, the feeling of guilt towards their own body will not allow them to enjoy.
Finally, we cannot ignore the fact that all the sacrifice that vigoréxico accepts of its own free will responds to a worrying body distortion. This makes your goals unattainable.
This translates into irritability and frustration, which makes your social life even more difficult. If we add to this that muscle mass is naturally reduced over the years, the possibility of falling into depression is very high.
Causes of vigorexia.
Vigorexia is a pathology with a multifactorial origin.
Socio-cultural aesthetic canon.
We have previously discussed the importance of social pressure and beauty standards. The advent of the Internet and social networks has alarmingly increased social pressure on the most vulnerable people. Although not all advertising body images appeal to the cult of the body, those that do so penetrate deep into the self-esteem of those who do not have a strong enough personality to take them for what they are: images to sell.
Advertising provides us with an inexhaustible vein of images treated with Photoshop to generate the desire to buy in the consumer. This generates in the person with low self-esteem the desire to have a body similar to the one they see, so it does not take a minute to contact a gym. However, we omit a fundamental fact: that body is not real so frustration is assured.
Certain deficiencies in personality.
A strong and defined personality does not feel threatened by not having a sculpted body. However, a weak personality is more likely to succumb to the desire to have a spectacular physique.
The person with affective deficiencies finds in the exercise a narcissistic defense. You mistakenly believe that exercise and a muscular body will bring you happiness and solve all your latent problems.
This topic was extensively discussed in the article on the motivations underlying anorexia nervosa . Something similar happens in the case of vigorexia, but using physical exercise, instead of refusing food, as a way to happiness.
We have already discussed the similarity between obsessive thoughts and vigorexia. The subject with vigorexia feels the need to exercise as a way to appease his anxiety . He does not do it to enjoy exercise, he does it to ease his distress.
One of the causes of indulging in compulsive exercise is natural introversion. The introvert finds an excellent refuge in exercising to isolate himself from his social obligations.
Feelings of guilt.
The feelings of guilt that appear in vigorexia are more the consequence than the cause of the disease. They appear intimately linked with the images of the perfect body with which we are bombarded.
When comparing our body with that which was created to sell a product, we see a difference that we do not like and that we want to minimize. Therefore, the simple act of eating or enjoying a moment of leisure, sets off a strong feeling of guilt for not doing everything possible to achieve a perfect body.
The low self – esteem makes them particularly vulnerable subjects to vigorexia suffer. Not loving or accepting oneself is the germ of many personality problems that lead to habits that are very harmful to our well-being. When I don’t accept myself, anyone else seems better to me than me. Therefore, when an image that exhibits a perfect body is presented before me, I will despise my own in order to try to achieve the desired image of the other.
Vigorexia or just love of physical exercise?
As we have seen, vigorexia is not doing exercise every day with great enthusiasm and with the goal of improving my body and my health, but it consists of obsessing about it, which means that I transform exercise and its results into the purpose of my life.
It is unlikely that a vigoréxico person will become aware of his disorder, since his perception of his body is altered, it will seem that everything he does is justified. It is easier for a third party to realize that a person suffers from vigorexia because they will see objectively that the distortion of the body image of the vigoréxico does not correspond to reality.
The factors to which we must be particularly attentive and that can alert us to a possible vigorexia in a close person:
- Increase in physical activity that leads to altering the social habits of the person.
- Alteration of eating habits showing special concern for diet.
- Negative feelings in that person that does not correspond to an objective vision of it.
How can I help a person with vigorexia?
If we observe the signs described above in a person close to us, it is time to seek professional help.
It is of little use to try to convince or force the vigoréxic to give up his exercises. The problem must be attacked at the root by treating the causes that have originated it. This goes through a detailed study of the person to find out the motivations that underlie their need for exercise.
Once the possible reasons have been ascertained, the professional must develop an action plan to act on them: improve self-esteem, reinforce body image, increase social skills, decrease introversion, decrease feelings of guilt, etc.
- Cabrera Y, Fanjul C. Influence of advertising models in adolescence: anorexia and vigorexia. RASE: Journal of the Association for the Sociology of Education 2012; Link.
- Hernández Rodríguez, José, & Licea Puig, Manuel Emiliano. (2016). Some aspects of interest on vigorexia. Cuban Journal of Comprehensive General Medicine , 32 (3). Link . Retrieved on January 23, 2020, from.
- 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. Enlace.
- Pope, Gruber, Choi, Olivardia y Phillips. (1997). “Muscle dysmorphic an unrecognised forms of body dysmorphic disorder”. Psychosomatics 1997; 38: 548-557.
- Pope H. et al. (2001). “The Adonis Complex. The secret crisis of male body obssesion”. USA: Bargain Books.
- Rivera Otero, C. (2010). The Adonis Complex: Masculinity and Body Image. Analysis , 16 (1), 31-47. Link .
Alexa Clark specializes in Cognitive Behavioral Therapy. She has experience in listening and welcoming in Individual Therapy and Couples Therapy. It meets demands such as generalized anxiety, professional, love and family conflicts, stress, depression, sexual dysfunction, grief, and adolescents from 15 years of age. Over the years, She felt the need to conduct the psychotherapy sessions with subtlety since She understands that the psychologist acts as a facilitator of self-understanding and self-acceptance, valuing each person's respect, uniqueness, and acceptance.