It’s a growing problem that’s long been overlooked.
For decades, body image issues have been pegged as primarily a female struggle, with one study finding that 53% of American girls are “unhappy with their bodies” by age 13.
Now, experts say the epidemic is increasingly reaching boys and young men — and while their female peers usually want to shrink, these guys often want to get bigger, stronger and more jacked, sometimes to the extreme.
In boys, a negative body image often stems from the feeling that they aren’t muscular enough, according to Dr. Jason Nagata, an eating-disorder researcher at UC San Francisco.
For some, that mindset spirals into an obsession with shedding fat and packing on muscle, a fixation known as “bigorexia,” or muscle dysmorphia.
“It occurs when someone is preoccupied or even obsessed with the idea that they don’t have enough muscularity,” Nagata told NPR. “In many cases, an individual’s build is actually normal or even objectively muscular.”
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), lists bigorexia as a type of body dysmorphic disorder (BDD) — a condition where someone obsesses over a perceived “flaw” that isn’t really there.
Dr. Katharine Phillips, a psychiatry professor at Weill Cornell Medicine, has treated muscle dysmorphia patients for more than 30 years and says the obsession can get extreme.
Young men who end up in her care are often in serious distress. They spend three to five hours a day worrying about their bodies, constantly checking their appearance in mirrors and battling major mood problems.
“It can be quite severe,” Phillips told Men’s Health. “Some people wind up housebound. There’s an association with suicide.”
People with bigorexia may also push themselves into compulsive, excessive exercise, especially weightlifting, even when they’re injured or their bodies are clearly worn out, according to the National Alliance for Eating Disorders.
They may also restrict calories or cut out entire food groups while overloading on protein or misusing supplements to bulk up. Some even turn to medications or anabolic steroids to increase their size.
Those habits can take over daily life, causing them to skip work, school or social events because of strict workout schedules, rigid diets or constant worries about their appearance.
And while bigorexia can affect anyone, studies suggest nearly 90% of those struggling with muscle dysmorphia are young men between the ages of 15 and 32.
Bodybuilders and competitive athletes are at higher risk due to their intense focus on physique, strength and perfectionism, as are people with mental health conditions such as OCD, depression or anxiety.
Other risk factors include a personal or family history of BDD, eating disorders or bigorexia, as well as childhood trauma like bullying. Heavy exposure to social media messaging that promotes “ideal” body types may also increase vulnerability.
While getting swole might sound harmless, bigorexia can carry serious mental and physical risks.
In the short term, too much exercise — especially for teens still growing — can cause stress fractures, muscle strains, damaged growth plates, ruptured discs and extreme fatigue, according to The Alliance.
Misuse of supplements or steroids, meanwhile, has been linked to liver damage, kidney failure, immune suppression and mood changes. Obsessing over body shape can also fuel low self-esteem, depression and anxiety.
Yet, despite these real dangers, experts say body dysmorphic disorders in boys often go unnoticed, including when it comes to bigorexia.
“Muscle dysmorphia can be overlooked for several reasons ― one reason being that it can lead to behaviors often encouraged in the weight room,” Dr. Amy Gooding, a clinical psychologist at the Eating Recovery Center in Baltimore, told HuffPost.
“Those who struggle may hesitate to reach out for help due to shame, secrecy or the normalization of the behaviors in the community,” she added.
Nagata also says it can be hard to spot just by looking at someone.
“There may be people who are from a range of body sizes, weights and shapes who experience muscle dysmorphia,” he said.
If you or someone you know is struggling with bigorexia, help is available.
Phillips recommends cognitive behavioral therapy to curb compulsive behaviors, challenge distorted thinking and improve social functioning. Antidepressants like Prozac, Lexapro and Zoloft can reduce obsessive thoughts and avoidant behaviors.
Because muscle dysmorphia can cause serious medical problems, treatment usually requires close supervision and may include support for eating-related issues as well.
If you are struggling with suicidal thoughts or are experiencing a mental health crisis and live in New York City, you can call 1-888-NYC-WELL for free and confidential crisis counseling. If you live outside the five boroughs, you can dial the 24/7 National Suicide Prevention hotline at 988 or go to SuicidePreventionLifeline.org.
