posted January 12, 2000 08:27 PM            

12:02 PM ET 01/09/00 Mental Illness Drives Bodybuilders? Mental Illness
Drives Bodybuilders? WASHINGTON (AP) _ What drives some bodybuilders is a
form of mental illness that can be treated with drugs, a researcher says.
These people have a type of body dysmorphic disorder, a condition which is
characterized by a preoccupation with an imagined or slight defect in
appearance, said Dr. Eric Hollander of Mount Sinai School of Medicine in
New York. ``Body dysmorphic disorder affects probably 1 to 2 percent of the
U.S. population, but among men in particular there is a sort of
subclassification called `bigorexia,' which is sort of the opposite of
anorexia,'' Hollander said. Anorexics think they are too fat, no matter how
thin they are _ and bigorexics think themselves too small, no matter how
big they are, he said. Bigorexia, more properly termed muscle dysmorphia,
is not yet formally recognized as a psychiatric condition, Hollander said.
But the coming revision of the American Psychiatric Association's
Diagnostic and Statistical Manual will describe the condition, he said.
Bodybuilding can be a healthy competition, but these people take muscle
development to the point at which it interferes with ordinary living,
including holding a job or staying healthy, Hollander said. ``They will
continue to exercise even after they have dislocated a shoulder,'' he said.
As an expression of body dysmorphic disorder, muscle dysmorphia is an
obsessive-compulsive spectrum disorder, Hollander said. People with OCD are
driven to do things such as repeatedly check their appearance in mirrors
and perform ritualistic movements. ``An exaggerated sense that something
doesn't look right'' seems to have origins in brain chemistry, Hollander
said. He and his colleagues reported in Archives of General Psychiatry on
the effects of the drug clomipramine on the brain chemical serotonin. One
of serotonin's normal roles seems to be in turning off brain processes that
signal when ``things don't fit our conceived notions,'' Hollander said. If
serotonin levels are abnormally low, however, it can't turn off the mental
alarm bell that rings when things don't seem right, and the bell keeps on
ringing even when things are right, he said. Clomipramine helps the brain
raise serotonin levels by interfering with the body's ability to destroy
the chemical, he said. Hollander and his colleagues wanted to be sure
clomipramine was producing improvements in the behavior of people with body
dysmorphic disorder, and that the patients were not improving simply
because they knew they were getting treatment and therefore expected
themselves to improve. So the researchers compared clomipramine with
another drug, desipramine, which had similar side effects but does not
affect serotonin. Clomipramine treatment was significantly better in
reducing patients' repetitive movements and obsessive preoccupation with
perceived flaws, the study found. But it is not a cure, Hollander said.
``Don't think about symptoms going down to zero,'' he said. ``They were 25
to 35 percent improved.'' There was, however, a significant improvement in
their ability to go back to school or function at work, and a significant
drop in their thoughts of suicide, he said. Although this study did not
focus on muscle dysmorphia, treatment for body dysmorphia has been shown to
work on muscle dysmorphia, Hollander said. And a clinician who was not
involved in the study said she found the drug to work, especially in
combination with psychological therapy. ``I don't feel behavior therapy is
sufficient, and certainly medications are not efficacious alone either,''
said Fugen Neziroglu, senior clinical director of the Bio-Behavioral
Institute in Great Neck, N.Y. Neziroglu has treated a number of people with
muscle dysmorphia. ``I had one who just left, an attractive, nice,
44-year-old man, he's telling me he has flab on his sides,'' she said.
``You look at him and you know he has no flab.'' Medications help to
stabilize patients with muscle dysmorphia, but therapy is needed to retrain
habits and thought patterns needed to make the improvements last, Neziroglu
said. Clomipramine is one of the better drugs, she said. And therapy alone
may be adequate treatment, said James Rosen, a clinical psychologist and
professor at the University of Vermont. The cognitive-behavioral approach
teaches patients to realize when their thoughts are unrealistic, recast
their self-image into more neutral terms, and adapt to situations that
could set off the compulsion, he said. For muscle dysmorphia, this could
include easing away from the idea that the exercisers would lose control of
themselves if they skip a workout, Rosen said. However, one bodybuilding
promoter said he couldn't tell whether bodybuilders have this condition.
High-level bodybuilders are like other athletes in paying extremely close
attention to what they eat, how much they exercise and where they fall
short of their own goals, said James Lorimer of the Arnold Schwarzenegger
Fitness Weekend, Feb. 22-27 in Columbus, Ohio. ``I can't say I place these
particular athletes outside the normal range of people who are trying to be
the best they can be in whatever sport they are in,'' Lorimer said. ``You
can say it's excessive, it's unusual, but (I) can't say whether it is
disordered or not.''

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Yours in sport,

George

George Spellwin
Research Director