The growing relevance of bigorexia nervosa in sport and fitness settings: current evidence and clinical implications

Abstract

Introduction: In recent years, bigorexia has gained increasing attention as a mental health issue closely linked to the rise of contemporary fitness culture promoting extreme muscularity, reduced body fat, and appearance-oriented lifestyles. The condition involves a distorted perception of one’s physique, accompanied by a persistent belief of being inadequately muscular despite often having a well-developed body.

Aim: This review aimed to summarize and critically discuss current findings on bigorexia, focusing on its epidemiology, contributing risk factors, symptomatology, diagnostic challenges, and available treatment strategies.

Review findings: Bigorexia predominantly affects individuals participating in bodybuilding and other strength-focused activities, especially men, although emerging evidence suggests that women may also be affected more frequently than previously recognized. The disorder is frequently overlooked in clinical practice, partly because its symptoms overlap with other psychiatric conditions such as depressive disorders, anxiety disorders, eating disorders, and occasionally psychotic spectrum disorders. Accurate differential diagnosis is therefore crucial. Although evidence regarding treatment remains limited, psychotherapy constitutes the cornerstone of management, with cognitive-behavioral therapy demonstrating the greatest effectiveness. In some patients, pharmacological support may additionally be considered.

Conclusions: Greater awareness of bigorexia among clinicians and society is necessary to facilitate earlier identification and more effective intervention. Additional research is needed to better define the disorder, clarify gender-related differences, and develop evidence-based therapeutic approaches.