Anorexia nervosa and "reverse anorexia" among 108 male bodybuilders

Two disorders of body image encountered in a study of 108 bodybuilders are described. In a study of the psychiatric effects of anabolic steroids, structured interviews were administered to 55 bodybuilders who had used anabolic steroids and 53 non-user controls. Three (2.8%) of the subjects reported a history of anorexia nervosa--a rate far higher than the 0.02% rate typically reported among American men (P < .001). Nine (8.3%) of the subjects, two of whom were former anorexics, described a "reverse anorexia" syndrome, where they believed that they appeared small and weak even though they were actually large and muscular. Reverse anorexic subjects reported that they declined social invitations, refused to be seen at the beach, or wore heavy clothes even in the heat of summer because they feared that they looked too small. All nine reverse anorexia cases occurred among steroid users; none occurred among non-users (P < .003). Four subjects reported that their reverse anorexic symptoms contributed to their decision to start using steroids. Disorders of body image, including both anorexia nervosa and its reverse form, may occur frequently in men who lift weights regularly. Reverse anorexia may precipitate or perpetuate the use of anabolic steroids in some individuals.