The bigorexic will stand in front of the mirror and see a lot of areas that need improvement - arms are too thin, legs scrawny, chest needs more muscle, and so on.  They will be constantly looking for ways to get bigger and more muscular, no matter how big they are. 
The bigorexic is not a vain person, but is rather in the grip of a psychiatric disorder that causes its victims to be preoccupied with imaginary defects in their appearance.  They will let their obsession to get bigger drive their exercising to unhealthy extremes and never be satisfied with their appearance.  This is very similar to other eating disorders.

Bigorexia compared to other Eating Disorders

The problems with self-image that muscle dysmorphia are associated with have been compared to anorexia nervosa, but it was only identified much later than anorexia nervosa.  It has been intensively researched since the mid 1990's.  One of the pioneering authors, Dr Roberto Olivardia, described it as a “a pathological preoccupation with their muscularity”.

Dr Olivardia found that men with muscle dysmorphia had a very different experience of weight lifting compared to a control group of men without an eating disorder.  They were more likely to be dissatisfied with their body image and use steroids.  They had a higher lifetime prevalence of developing certain psychological disorders such as mood, anxiety, and eating disorders.  They suffered from a large degree of shame and embarrassment and struggled in social situations.

Bigorexia - obsession and inadequacy

People with muscle dysmorphia become subsumed in their obsession to reach a goal weight, a goal size, or other targets.  They spend hours every day in the gym and restrict their diet to provide only exactly what they need to build more muscle.  They are obsessed with their appearance and never feel acceptable because of their eating disorder. 

The effort that is required for them to maintain this strict routine of diet and exercise often results in them becoming socially reclusive, interferes with their ability to work at a normal job, and causes them to lose friends other than gym partners.

Eating Disorders treatment

Effective treatment for bigorexia is still being researched.  At the moment there is no treatment option that has been clearly identified as being the most effective, but cognitive therapies, behavioural therapies, and combinations of the two are being explored as the most likely to succeed.  There have been treatment successes and it is possible to recover from this eating disorder.