At the Other End of the Spectrum: Bigorexia as an Emerging Cardiovascular Phenotype in Adolescents

Bigorexia, or Muscle Dysmorphia, is an increasingly recognized body image disorder among adolescents, characterized by an excessive drive for muscularity and distorted self-perception. Although its psychological dimensions are well described, its cardiovascular implications remain underexplored. This review examines the association between bigorexia-related behaviors and early cardiovascular injury, and proposes a conceptual framework for this evolving phenotype.

A comprehensive narrative review was conducted using PubMed, Scopus, and Web of Science. Search terms included "muscle dysmorphia," "bigorexia," "anabolic androgenic steroids," "energy drinks," "high-protein diet," "cardiovascular risk," "left ventricular hypertrophy," "atherosclerosis," "arrhythmia," "adolescents," and "young adults," used individually and in combination.

Bigorexia is associated with high-risk lifestyle exposures-including anabolic androgenic steroid use, excessive energy drink intake, and high-protein diets-particularly prevalent among adolescent and young adult males in competitive sports and fitness-oriented environments. Their convergence contributes to a distinct cardiovascular phenotype characterized by premature atherosclerosis, pathological left ventricular hypertrophy, endothelial dysfunction, and increased arrhythmogenic risk. Evidence suggests synergistic interactions between these exposures, accelerating vascular aging and myocardial remodeling beyond what each factor produces independently. Behavioral reinforcement and absent screening protocols further amplify risk.

Bigorexia represents not only a psychiatric condition but a potential driver of early cardiovascular disease. Integrating cardiovascular screening into management of at-risk adolescents may enable early detection, risk stratification, and preventive intervention, mitigating long-term cardiovascular morbidity.