Many parents today are well aware of mental health issues tied to body image in teenagers, particularly common eating disorders such as anorexia. But doctors are warning about the rise of a lesser-known problem, especially among boys: muscle dysmorphia, also known as “bigorexia.”
“Muscle dysmorphia is a psychological disorder characterized by a distorted self-image focused specifically on muscle mass and physical appearance,” Kara Becker, a therapist specializing in eating disorders at the U.S. health group Newport Healthcare, told HuffPost US. The person becomes obsessed with the idea of becoming more muscular and preoccupied with the feeling that their body is not muscular enough — even when they actually have the physique of a bodybuilder.
“This belief and the preoccupation that follows can lead to unhealthy behaviors, including compulsive exercise, and can drive changes in eating habits,” observed Amy Gooding, a clinical psychologist at the Eating Recovery Center in Baltimore.
Although muscle dysmorphia can affect anyone, it is more common in men, and research suggests the disorder is on the rise. A 2019 study found that in the United States, 22% of adolescent boys and 5% of adolescent girls engaged in “muscularity-oriented disordered eating.” It revealed that supplement use and even steroid use were common among young adult men.
“Eating disorders in boys are often underrecognized and underdiagnosed,” said Jason Nagata, a pediatrician specializing in eating disorders among boys and men and a co-author of the study. He noted that a recent Canadian study found hospitalizations for eating disorders among male patients had increased significantly since 2002.
“Although eating disorders are increasingly well known, muscle dysmorphia can go unnoticed for several reasons, one being that it can lead to behaviors that are often praised in gym culture,” Gooding noted. “Those affected may hesitate to seek help out of shame, a desire for privacy, or because these behaviors are considered normal within the community.”
The Weight of Social Media
The causes of such a disorder can be numerous, Becker noted. “A family history of mental illness, particularly those related to body image or anxiety, can increase the risk of developing bigorexia. Similarly, people with low self-esteem, perfectionism, or obsessive-compulsive tendencies are more vulnerable to this disorder.” Trauma and bullying are also potential risk factors for bigorexia.
“People who practice bodybuilding are at higher risk than the general population,” as are high-level athletes, Nagata pointed out. But one of the main factors contributing to the rise of bigorexia is the weight of social media.
“Not only are young people absorbing the body ideals conveyed by the media, but they also feel pressure to produce content and expose their own bodies on social media,” the researcher continued. “Male bodies are more prominently displayed on social media than ever before, particularly through influencers. Constant comparisons with these idealized bodies can lead to body dissatisfaction and bigorexia.”
“TikTokers and other influencers earn millions of dollars by accumulating likes and followers, which they then invest in professional fitness coaches, full-time chefs, and other experts tasked with maintaining and enhancing their image,” recalled Joseph J. Trunzo, a psychology professor at Bryant University in Rhode Island.
“Most 15-year-olds” do not consider all these factors when they see muscular bodies on social media. These realities are compounded by the deceptive role of filters, camera angles, posing, makeup, and editing. “None of it is real. In short, we are exposed to unrealistic, idealized, and glamorized versions of the human body at a rate we have never experienced before. For a young person of impressionable age, it is a very dangerous dynamic… and a recipe for psychological disaster,” Trunzo added.
What Can Parents Do?
Fortunately, there are many ways for parents to help counter the factors fueling body image problems and psychological disorders such as bigorexia.
“Limit social media use as much as possible,” Trunzo recommended. “Even so, your child will be exposed to these images, so talk with them about what they see. Listen to what they say, how they interpret what they see, and make sure they understand the reality behind it and don’t ‘swallow’ that image.”
He also advocates emphasizing, with teenagers, human values that go beyond physical appearance, stressing qualities such as kindness, creativity, or humor. “It’s important to provide support by creating a safe space for open conversations,” Becker agreed. “Be a positive role model by adopting a healthy attitude toward your own body and self-esteem.” This includes avoiding negative comments about one’s own body and maintaining a balanced relationship with exercise.
When images of sculpted celebrities catch your child’s attention, put them in context. “I’ve had discussions with my 9-year-old son along the lines of, ‘Let’s read what Hugh Jackman had to do to transform into Wolverine and achieve that look,'” recounted therapist Cherie Miller, CEO of a mental health center in Texas. “It’s an opportunity to say, ‘You know, that’s not normal, that’s not realistic, and it’s not something we should try to achieve.'”
She emphasizes “body respect,” stressing to her children that we care about our bodies and want to take care of them, which is why we drink enough water, sleep as much as we need, and eat a variety of foods.
“It’s also important to present body diversity as something positive and natural,” Miller continued. “Life would be boring if we all had the same physique. Isn’t it wonderful that we come in all sizes, shapes, and colors? Look at all the different plants and animals that exist in the world.”
In Cases of Bullying
If parents believe their child is being bullied or mocked because of their appearance, they should obviously act. “Early intervention and treatment are essential to halt the progression of muscle dysmorphia,” Gooding noted. “If a parent notices behavior that may be concerning for the child, they should start a conversation about the reasoning behind their exercise behavior.”
Nagata noted several typical warning signs of muscle dysmorphia. “For example, some boys spend all their time exercising or feel guilty if they are not at the gym,” he explained. “They may no longer eat with family or friends due to rigid concerns about their diet.”
If you suspect your child is beginning to suffer from bigorexia, know that they are not alone and that resources exist to help. Affected teenagers “can address these issues with their pediatrician” or primary care physician.
Optimal care relies on an “interdisciplinary team including mental health professionals, physicians, and nutritionists,” he suggested. The teenager can learn to identify triggers, understand their thought process, and acquire coping strategies. “The earlier it is addressed, the better,” Trunzo concluded.
