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Reverse Anorexia in Bodybuilders

Bianca Hitt


Women compose the overwhelming majority of the reported cases of eating disorders. The, desire to be thin consumes many young women who idealize the false and unrealistic model form depicted in popular magazines. Recently, researchers have started to appreciate the role of exercise in the development of eating disorders. This shift has illuminated the striking influence of sports on body image satisfaction in men as well as women. The importance of a fit physique has grown increasingly salient to men in modem society as indicated by the rise of hypermasculine action heroes such as Arnold Schwartzenegger and Sylvester Stallone. One growing sport, bodybuilding, now has the sixth largest sports federation and has come to the attention of researchers. In the last few years, researchers have linked bodybuilding to an overwhelming drive for lean muscle mass coined "reverse anorexia" by Pope, Katz, and Hudson (1993) and "bigameraria" by Taylor(1985). The bodybuilders' obsessional behavior resembles anorexia nervosa with remarkable similarity except that the drive for enormous muscles replaces the drive for thinness. This alarming psychological syndrome may motivate bodybuilders and weightlifters, to a lesser extent, to relinquish friends, to give up responsibilities, to pursue unusual diets, to overtrain and to risk their health by abusing steroids.

Reverse Anorexia in Bodybuilders

Bodybuilders who exhibit reverse anorexia strive constantly to gain more lean body mass, but even when successful persist in believing their size is inadequate. Pope et al. (1993) found that 8% of their bodybuilder subjects insisted that they were ver small when they were really big and muscular. This belief affected their daily lives in a myriad of ways. Some of these bodybuilders stated that they would wear heavy clothing, even in the summer, to hide their inadequate size. The percentage of the bodybuilders in the study with a history of anorexia nervosa was 2.8% which is considerably more than the 0.02% rate currently recorded among all American men. The authors suggested that media idealizes the large muscular body form for men just as it endorses the waif-like appearance for women Unfortunately, the study lacks a control group with which to compare their results. The majority of the primarily qualitative data obtained in the experiment, through the Structured Clinical Interview (SCID), may be subject to a slight interpretative bias. Whether individuals prone to reverse anorexia are disproportionately attracted to bodybuilding or the sport actually encourages such behavior (or both) remains unclear. The study, however, provided preliminary evidence for the existence of a reverse anorexia syndrome arnon ,g bodybuilders.

Body Dissatisfaction in Bodybuilders

The fear of being too small leads to a high degree of body dissatisfaction among bodybuilders. Fussell (1991), in a book based on his experience as a former bodybuilder, laments, "It didn't occur to me then that too big might not be big enough" (P. 86). Fussell's account, although entirely descriptive, provided valuable insight and an in-depth analysis into the bodybuilders' world as witnessed by a man who was consumed by it. Fussell (1991) stated, "By making myself larger than fife, I might make myself a little less frail, a little less assailable and when it came down to it, a little less human" (p.25). Blouin and Goldfield (1994) performed a noteworthy experiment comparing bodybuilders, martial

artists, and runners on standardized measures including body dissatisfaction, drive for thinness, and drive for bulk. Bodybuilders were found to possess greater body dissatisfaction than either of the other groups. Bodybuilders also exhibited greater bulimic tendencies compared to martial artists and runners. The large difference in the mean ages of runners (m=37.9) compared to bodybuilders (m=26.6) and martial artists (m=27.6) represented one potential flaw in the study. Bodybuilders were also the least educated athletic group which may have influenced the results. Nonetheless, the authors have demonstrated a reasonable amount of evidence for a body image disturbance among their sample of bodybuilders. As evidenced in the literature, bodybuilders exhibit higher levels of body dissatisfaction than athletes in other solitary sports.

Distorted Eating Behavior

In their quest to achieve the perfect physique, bodybuilders reach unparalleled extremes in manipulating their eating patterns to maximize muscle mass and definition. Pasman and Thompson (1988) found that obligatory weightlifters and obligatory runners demonstrated greater eating disturbance than controls, but were comparable to each other. Researchers measured eating disturbance with the Eating Disorders Inventory (EDI) which is a widely used and well-regarded assessment tool- Because bodybuilders performed similarly to runners, the extent to which individualistic sports in general, not just bodybuilding, produce eating disturbance remains unknown. One bodybuilder itemized his weekly grocery store list as including "70 eggs, 14 tins of tuna, 10.5 pounds of beef, I 0 pounds of chicken, 9 gallons of nonfat milk, 4 loaves of bread, and as many sacks of brown rice, whole wheat pasta, baking potatoes, and fruit as I could load into my shopping carts" (Fussell 7 199 1, p. 8 1). This enormous amount of food is not unusual for the bodybuilder seeking to put on muscle and illustrates a bizarre devotion to the consumption of high protein and low fat food. Any issue of "Muscle and Fitness" magazine confronts one with a barrage of advertisements for everything from special protein shakes to bizarre vitamin supplements which promise to enhance the bodybuilder's performance. Dobbins (1997) noted that the attempt to control their metabolism represents one of the hallmarks of a true bodybuilder. Bodybuilders may develop eating disturbance in their pursuit of a flawless form.

Bodybuilding and The Need for Control

The need to control their metabolism reflects a more generalized need for control among bodybuilders which resembles that illustrated by individuals with anorexia nervosa. Yates (I 99 1), based on a mini-review of the literature, asserted that "above all, they (bodybuilders) must control the body" (p.69). Schwartzenegger and Hall (1982) describe Amold's belief that he had "such absolute control over my body that I can decide what body weight I want and take myself up or down to meet it". Schwartzenegger and Hall's book, often called the "Bible" of bodybuilding, tries to paint Arnold as a hero of bodybuilding lore and a visionary who achieved his goal of a perfect physique plus fame and fortune. Due to this bias, readers should approach his bold statements with some skepticism although its popularity among bodybuilders would suggest a certain degree of accuracy. To the bodybuilder, the body represents clay which can be molded and carved into any desirable form with enough time, discipline, and energy. Dobbins (I997) emphasized the need for control as an obsession necessary to become a champion in the sport. Although this desire for control reaches its pinnacle during onstage judging, the bodybuilder actually lacks any tangible control over the process. Dobbins' account compliments the scientific literature with a more thorough account of the highly competitive bodybuilding universe. The consuming need to control the body seizes the bodybuilder from the moment he begins to lift weights in earnest to his pursuit of the Mr. Universe title.

The Social Isolation of the Bodybuilder

The competitive bodybuilder, like the individual with anorexia nervosa, engages in a social comparison process which may cause him or her to avoid others out of a sense of inadequacy. Bodybuilding attracts loners because of the high degree of individualism involved in the sport (Klein, 1985). In his ethnography based on a 3 year study of bodybuilding "culture", Klein explained how people in team sports who resent their lack of individual recognition see bodybuilding as the answer. Fussell (1991) wrote that he gave up his job, his friends, and his family to pursue bodybuilding. Bodybuilders must rely only on themselves because they have no coaches or teammates to assist them. Their bodies symbolize their playing fields and bodybuilders' minds replace coaches. Dobbins (1997) underscored that bodybuilders "often have no support systems, no outside guidance, no way of maintaining psychological stability" (p. 43). The isolated lifestyle of the bodybuilder reinforces the persistent pursuit of rippling muscles. Like the anorexic client, the bodybuilder struggles and frequently fails in interpersonal relationships.

Low Self-Esteem and Bodybuilding: Debunking the narcissicism myth

Bodybuilders, like individuals with anorexia nervosa, paradoxically display a high degree of confidence when in reality their self-esteem tends to be low. Men may be drawn to bodybuilding during their adolescent years as a result of feeling weak and helpless. "On the back pages of comic books, scrawny teens find advertisements for chin-up bars" (Fussell, 1991, p. 19). From these humble beginnings, bodybuilders learn to use their sport for protection creating a facade of invincibility. Klein (1995) acknowledged, in a book devoted to men's health, that "the more insignificant he feels on the inside, the more significant the bodybuilder strives to appear on the outside" (p. 1 14). To compensate for his insecurities, the bodybuilder escalates his weightlifting regime so he can appear more intimidating in a sort of vicious cycle. Likewise, the female with anorexia nervosa starves herself to become life-threateningly thin, but can never be thin enough for herself

Why Bodybuilders Turn to Steroids

The astronomical rate of steroid use among male bodybuilders shows that they, similar to people with anorexia nervosa, engage in deadly practices to obtain their goal with relatively little hesitation. Steroid use has been linked to a variety of physical illnesses including cardiac disorders, elevated blood pressure, and problems with the liver to name a few. Pope and Katz (1988) studied bodybuilders and football players who admitted to anabolic steroid use. Using widely accepted DSM criteria, 22% of the 41 subjects were diagnosed with an affective syndrome and 5% suffered from psychotic symptoms while using steroids. Although the relatively small sample size limits generalizability, one can conclude that steroids are associated with mental disorders in this sample. Despite these grave risks bodybuilders continue to employ steroids to gain size. Most bodybuilders succumb to the steroid temptation because it provides them with an extra edge and more all-powerful muscle.

Yates (1991) stated of those with activity disorders, "they seem bent on destroying the body, but they also love the body very much" (p. 177). The steroid use among bodybuilders could be equated to a similar phenomenon whereby the user jeopardizes his most precious possession to achieve the next level of strength. Steroid use becomes the ultimate means of control for the bodybuilder who can manipulate the dosage to achieve the desired results.

The limited research available on this topic indicates that bodybuilding both attracts individuals susceptible to and perpetuates a pattern of reverse anorexia. The muscle-bound action heroes rival the gorgeous Cindy Crawford's for cultural icons in modem society. Such images prey on skinny adolescent boys around the world teased by school bullies who resolve to fight back. They begin in a frenzy of weightlifting seeking to attain size above all else forsaking family and fiends in their quest. When these bodybuilders become muscular kings, they still feel their size is not large enough. This fuels body dissatisfaction, low self-esteem and a desire to control their bodies amongst bodybuilders. They will try anything even bizarre eating practices and steroids to mold their bodies into the perfect unreachable body. As bodybuilders become ensnared in the muscle trap, they grow socially isolated. The combination of these factors leads to a perpetuation of the cycle over the course of a bodybuilder's lifetime. Most of the literature on this subject is descriptive not quantitative and the number of studies which have been specifically conducted to test for reverse anorexia are minimal. Interest in this topic appears to be on the rise and more research is needed to show conclusive evidence for the existence of reverse anorexia.


Blouin, A. G., & Goldfield, G. S. (1995). Body image and steroid use in male bodybuilders. International Journal of Eating Disorders, 18, 159-165.

Dobbins, B. (1997, February). You have to be obsessed. Muscle and Fitness, 40-43.

Fisher, S. (I 986). Development and Structure of the Body Image. Hillsdale, N.J.: Lawrence Eribaum Associates, Publishers.

Fussell, S. W. (I 99 1). Muscle: Confessions of an unlikely bodybuilder. New York: Avon Books.

Klein, A. M. (I 985). Pumping iron. Society, 22, 68-75.

Klein, A. M. (1995). Life's too short to die small. In D. Sabo, & F. D. Gordon (Eds.), Men's health and illness (pp. 105-120). London: Sage Publications.

Lucas,A R, Beard, -C. M., O'Fallon, W. M., Kurland, L. T. (1991). 50-Year trends in the incidence of anorexia nervosa in Rochester, Mn.: A population-based study. American Journal of Psychiatry, 148, 917-922.

Pasman, L., & Thompson, J. K. (19-8-8). Body and eating disturbance in -obligatory runners, obligatory weightlifters, and sedentary individuals. International Journal of Eating Disorders, 7, 759-769.

Pope, H. G., & Katz, D. L. (1988-)., Affective and. psychotic syndromes associated with

use of anabolic steroids. American Journal of Psychiatry, 145, 487-490.

Pope, H. G., Katz, D. L., & Hudson, J. 1. (1993). Anorexia nervosa and "reverse anorexia" among 108 male bodybuilders. Comprehensive Psychiatry, 34(6), 406-409.

Schwartzenegger, A., & Hall, D. K. @ 19-82). Arnold- The education a builder. New York: Pocket Books.

Taylor, W. N. (1985). Hormonal Manipulation: A new era of monstrous athletes. Jefferson, N. C.: McFarland.

Yates, A. (I991). Compulsive Exercise and the Eating disorders. New York: Brunner/ Mazel, Inc.


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