{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:10:51Z","timestamp":1792199451910,"version":"4.4.0"},"reference-count":55,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T00:00:00Z","timestamp":1692835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Bigorexia nervosa (BN) is a controversial nosological entity, considered either a feeding\/eating disorder (FED) or a subtype of body dysmorphic disorder (BDD). This rapid review aims to explore the characteristic features of BN and identify evidence-based therapeutic interventions for this condition. Three electronic databases (PubMed, Cochrane, and Google Scholar) were searched for relevant information about BN, and 26 reports were reviewed in detail. The results showed that bodybuilders, weightlifters, and other populations involved in athletic activities are the most vulnerable to the onset of this disorder. Patients with BN should also be screened for physical and psychiatric comorbidities and complications, such as anabolic steroid use disorder, physical exercise addiction, and depressive or anxiety disorders. The main differential diagnoses for BN are schizophrenia spectrum disorders, depressive disorders, anxiety disorders, bodily distress disorder, and obsessive\u2013compulsive disorders. Using validated screening instruments is considered very important from a clinical perspective, with the aim of providing early identification of this disorder. Therapeutic interventions for patients with BN are still in the early phases of development, and no specific pharmacological treatment has yet been identified. Since it is similar to the obsessive\u2013compulsive spectrum, cognitive behavioral therapy has been suggested as a useful intervention; however, it has not yet been validated in large-scale clinical trials. In conclusion, based on the reviewed data, clarifying the concept of BN is of practical importance for constructing adequate prevention strategies and validating proper therapeutic interventions.<\/jats:p>","DOI":"10.3390\/brainsci13091234","type":"journal-article","created":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T10:06:48Z","timestamp":1692871608000},"page":"1234","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["At the Crossroads between Eating Disorders and Body Dysmorphic Disorders\u2014The Case of Bigorexia Nervosa"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6345-3478","authenticated-orcid":false,"given":"Octavian","family":"Vasiliu","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Dr. Carol Davila University Emergency Central Military Hospital, 010816 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/S0140-6736(03)12378-1","article-title":"Eating disorders","volume":"361","author":"Fairburn","year":"2003","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/S0140-6736(20)30059-3","article-title":"Eating disorders","volume":"395","author":"Treasure","year":"2020","journal-title":"Lancet"},{"key":"ref_3","first-page":"18","article-title":"The genetics of eating disorders","volume":"1","author":"Berrettini","year":"2004","journal-title":"Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.eatbeh.2007.10.002","article-title":"The sociocultural model of eating disorder development: Application to a Guatemalan sample","volume":"9","author":"Gibbons","year":"2008","journal-title":"Eat. Behav."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"429","DOI":"10.3389\/fpsyg.2018.00429","article-title":"Sociocultural appearance standards and risk factors for eating disorders in adolescents and women of various ages","volume":"9","author":"Izydorczyk","year":"2018","journal-title":"Front. Psychol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1038\/mp.2009.50","article-title":"Meta-analysis of the dose-response relationship of SSRI in obsessive-compulsive disorder","volume":"15","author":"Bloch","year":"2010","journal-title":"Mol. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1007\/s13311-017-0535-x","article-title":"Emerging treatments in eating disorders","volume":"14","author":"Lutter","year":"2017","journal-title":"Neurotherapeutics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1002\/eat.20164","article-title":"The mortality rate from anorexia nervosa","volume":"38","author":"Birmingham","year":"2005","journal-title":"Int. J. Eat. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1080\/10640266.2012.715512","article-title":"Eating disorders in men: Underdiagnosed, undertreated, and misunderstood","volume":"20","author":"Strother","year":"2012","journal-title":"Eat. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1176\/ajp.154.8.1127","article-title":"Eating disorders in males: A report on 135 patients","volume":"154","author":"Carlat","year":"1997","journal-title":"Am. J. Psychiatry"},{"key":"ref_11","unstructured":"Morgan, J. (2008). The Invisible Man: A Self-Help Guide for Men with Eating Disorders, Compulsive Exercise, and Bigorexia, Routledge."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.bodyim.2007.04.006","article-title":"The effects of exposure to muscular male models among men: Exploring the moderating role of gym use and exercise motivation","volume":"4","author":"Halliwell","year":"2007","journal-title":"Body Image"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1002\/erv.897","article-title":"Bigorexia: Bodybuilding and muscle dysmorphia","volume":"17","author":"Mosley","year":"2009","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/0010-440X(93)90066-D","article-title":"Anorexia nervosa and \u201ereverse anorexia\u201d among 108 male bodybuilders","volume":"34","author":"Pope","year":"1993","journal-title":"Compr. Psychiatry"},{"key":"ref_15","unstructured":"Pope, H.G., Phillips, K.A., and Olivardia, R. (2000). The Adonis Complex: How to Identify, Treat and Prevent Body Obsession in Men and Boys, Touchstone."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.bodyim.2005.09.001","article-title":"Clinical features of muscle dysmorphia among males with body dysmorphic disorder","volume":"2","author":"Pope","year":"2005","journal-title":"Body Image"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1002\/eat.20828","article-title":"Muscle dysmorphia and the DSM-V conundrum: Where does it belong? A review paper","volume":"43","author":"Murray","year":"2010","journal-title":"Int. J. Eat. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.bodyim.2012.01.008","article-title":"A comparison of eating, exercise, shape, and weight related symptomatology in males with muscle dysmorphia and anorexia nervosa","volume":"9","author":"Murray","year":"2012","journal-title":"Body Image"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/S0033-3182(97)71400-2","article-title":"Muscle dysmorphia. An underrecognized form of body dysmorphic disorder","volume":"38","author":"Pope","year":"1997","journal-title":"Psychosomatics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1176\/appi.ajp.157.8.1291","article-title":"Muscle dysmorphia in male weightlifters: A case-control study","volume":"157","author":"Olivardia","year":"2000","journal-title":"Am. J. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Arlington, American Psychiatric Publishing. [5th ed.]. Available online: https:\/\/dsm.psychiatryonline.org\/doi\/10.1176\/appi.books.9780890425787.x10_Feeding_and_Eating_Disorder.","DOI":"10.1176\/appi.books.9780890425787"},{"key":"ref_22","unstructured":"World Health Organisation (WHO) (2023, February 12). ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioral Disorders. Available online: https:\/\/icd.who.int\/browse11\/l-m\/en."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1080\/10640260902848477","article-title":"The relationship between anabolic androgenic steroids and muscle dysmorphia: A review","volume":"17","author":"Rohman","year":"2009","journal-title":"Eat. Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1176\/ajp.2006.163.4.697","article-title":"Body image and attitudes towards male roles in anabolic-androgenic steroid users","volume":"163","author":"Kanayama","year":"2006","journal-title":"Am. J. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1007\/s00213-002-1352-3","article-title":"A preliminary investigation into the relationship between anabolic-androgenic steroid use and the symptoms of reverse anorexia in both current and ex-users","volume":"166","author":"Cole","year":"2003","journal-title":"Psychopharmacology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1186\/s12967-014-0221-2","article-title":"University courses, eating problems and muscle dysmorphia: Are there any associations?","volume":"12","author":"Bo","year":"2014","journal-title":"J. Transl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1556\/JBA.3.2014.001","article-title":"Muscle dysmorphia: Could it be classified as an addiction to body image?","volume":"4","author":"Foster","year":"2015","journal-title":"J. Behav. Addict."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1002\/eat.23349","article-title":"Muscle dysmorphia: A systematic and meta-analytic review of the literature to assess diagnostic validity","volume":"53","author":"Cooper","year":"2020","journal-title":"Int. J. Eat. Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s40337-021-00375-y","article-title":"Treatment of compulsive exercise in eating disorders and muscle dysmorphia: Protocol for a systematic review","volume":"9","author":"Matenstyn","year":"2021","journal-title":"J. Eat. Disord."},{"key":"ref_30","first-page":"20","article-title":"Features and management of compulsive exercising in eating disorders","volume":"37","year":"2015","journal-title":"Physician Sportsmed."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1002\/eat.22657","article-title":"The assessment and treatment of unhealthy exercise in adolescents with anorexia nervosa: A Delphi study to synthesize clinical knowledge","volume":"50","author":"Noetel","year":"2017","journal-title":"Int. J. Eat. Disord."},{"key":"ref_32","first-page":"322","article-title":"Systematic review of the diagnostic category muscle dysmorphia","volume":"50","author":"Tirico","year":"2015","journal-title":"Austr. N. Zeal. J. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Applewhite, B., Olivola, M., Tweed, C., Wesemann, U., and Himmerich, H. (2022). Body dysmorphic disorder, muscle dysmorphia, weight and shape dissatisfaction and the use of appearance-enhancing drugs in the military: A systematic review. BMJ Mil. Health, e002135.","DOI":"10.1136\/bmjmilitary-2022-002135"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1080\/07448480009596271","article-title":"An exploration of the drive for muscularity in adolescent boys and girls","volume":"48","author":"McCreary","year":"2000","journal-title":"J. Am. Coll. Health."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1002\/eat.20669","article-title":"Development and validation of a male specific Body Checking Questionnaire","volume":"43","author":"Hildebrandt","year":"2010","journal-title":"Int. J. Eat. Disord."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.bodyim.2004.01.001","article-title":"Muscularity concerns among men: Development of attitudinal and perceptual measures","volume":"1","author":"Hildebrandt","year":"2004","journal-title":"Body Image"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1891\/0889-8391.31.4.255","article-title":"Muscle dysmorphia: An overview of clinical features and treatment options","volume":"31","author":"Cunningham","year":"2017","journal-title":"J. Cogn. Psychother."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1002\/eat.23665","article-title":"Reducing eating disorder risk among male athletes: A randomized controlled trial investigating the male athlete body project","volume":"55","author":"Perelman","year":"2022","journal-title":"Int. J. Eat. Disord."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1037\/ccp0000245","article-title":"The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis","volume":"85","author":"Linardon","year":"2017","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.cpr.2013.11.001","article-title":"Cognitive behavioral therapy for anorexia nervosa: A systematic review","volume":"34","author":"Allan","year":"2014","journal-title":"Clin. Psychol. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1177\/1359104514521639","article-title":"Adolescent muscle dysmorphia and family-based treatment: A case report","volume":"20","author":"Murray","year":"2015","journal-title":"Clin. Child. Psychol. Psychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1047280","DOI":"10.3389\/fpsyt.2022.1047280","article-title":"Therapeutic management of buying\/shopping disorder: A systematic literature review and evidence-based recommendations","volume":"13","author":"Vasiliu","year":"2022","journal-title":"Front. Psychiatry"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"210","DOI":"10.3892\/etm.2020.9340","article-title":"Predictive factors in early onset schizophrenia","volume":"20","author":"Budisteanu","year":"2020","journal-title":"Exp. Ther. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"349","DOI":"10.55453\/rjmm.2022.125.3.1","article-title":"Cannabinoids- a new therapeutic strategy in neurology","volume":"125","author":"Manole","year":"2022","journal-title":"RJMM"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"241","DOI":"10.55453\/rjmm.2020.123.4.1","article-title":"Current treatment of posttraumatic stress disorder\u2014A review of therapeutic guidelines and good practice recommendations","volume":"123","author":"Vasiliu","year":"2020","journal-title":"RJMM."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1176\/appi.ajp.2013.12060782","article-title":"DSM-5 criteria for substance use disorders: Recommendations and rationale","volume":"170","author":"Hasin","year":"2013","journal-title":"Am. J. Psychiatry"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e605-11","DOI":"10.4088\/JCP.14r09758","article-title":"Early onset of response with selective serotonin reuptake inhibitors in obsessive-compulsive disorder: A meta-analysis","volume":"77","author":"Issari","year":"2016","journal-title":"J. Clin. Psychiatry"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"127","DOI":"10.9740\/mhc.2018.05.127","article-title":"Role of antidepressants in the treatment of adults with anorexia nervosa","volume":"8","author":"Marvanova","year":"2018","journal-title":"Ment. Health Clin."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.jpsychires.2004.08.001","article-title":"A retrospective study of SSRI treatment in adolescent anorexia nervosa: Insufficient evidence for efficacy","volume":"39","author":"Holtkamp","year":"2005","journal-title":"J. Psychiatr. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S455","DOI":"10.1016\/S0924-977X(14)70729-1","article-title":"SSRI dose escalation versus duloxetine in treatment of major depressive disorder not responding to initial SSRI","volume":"24","author":"Petrescu","year":"2014","journal-title":"Eur. Neuropsychopharmacol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"17m11741","DOI":"10.4088\/JCP.17m11741","article-title":"Efficacy of tianeptine 25\u201350 mg in elderly patients with recurrent major depressive disorder: An 8-week placebo- and escitalopram-controlled study","volume":"79","author":"Emsley","year":"2018","journal-title":"J. Clin. Psychiatry"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"325","DOI":"10.3928\/00485713-20100701-05","article-title":"Pharmacotherapy for body dysmorphic disorder","volume":"40","author":"Phillips","year":"2010","journal-title":"Psychiatr. Ann."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/1748-5908-5-56","article-title":"Expediting systematic reviews: Methods and implications of rapid reviews","volume":"5","author":"Ganann","year":"2010","journal-title":"Implement. Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1186\/s13643-017-0629-x","article-title":"Expediting citation screening using PICo-based title-only screening for identifying studies in scoping searches and rapid reviews","volume":"6","author":"Rathbone","year":"2017","journal-title":"Syst. Rev."},{"key":"ref_55","first-page":"1694","article-title":"How to write a narrative literature review article?","volume":"15","author":"Saracci","year":"2019","journal-title":"Rev. Med. Suisse"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/9\/1234\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:37:54Z","timestamp":1760128674000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/9\/1234"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,24]]},"references-count":55,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["brainsci13091234"],"URL":"https:\/\/doi.org\/10.3390\/brainsci13091234","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,24]]}}}