“Bigorexia” May Be Rising, Especially Among Boys, and Social Media Is One of the Biggest Factors

A teenager can spend hours in the gym, hear from friends how good he looks, and still leave the mirror convinced he is too small. That is how muscle dysmorphia, better known as “bigorexia,” can play out, even in someone whose build is normal or even muscular. Experts say it is on the rise among boys, and because it can look a lot like dedication, it is easy to overlook.

Kara Becker, national director of eating disorder programs at Newport Healthcare, told HuffPost that bigorexia is a type of body dysmorphic disorder built around a distorted self-image of muscle size and appearance. Amy Gooding, a clinical psychologist at Eating Recovery Center in Baltimore, said people with it may believe they are smaller or less muscular than they are, which can lead to obsessive exercise.

Muscle dysmorphia can affect anyone, though it is more common in males. A 2019 study indicated that 22% of adolescent boys engaged in “muscularity-oriented disordered eating behaviors” while trying to bulk up or gain weight. Jason Nagata, a pediatrician who co-authored the study, also noted that a Canadian study found hospital admissions for eating disorders among male patients have climbed sharply since 2002.

How Bigorexia Came to Light

A 1993 case report on nine “large and muscular” bodybuilders first described the condition. Their focus on working out had grown so intense that they skipped invitations, stayed off the beach or covered up in heavy clothes all summer, afraid they looked too small. Only a few dozen research articles followed, and bigorexia stayed relatively understudied until recently, according to Nagata.

Early on, it went by “reverse anorexia,” a nod to the disorder in which patients can look visibly thin. Bigorexia can be invisible by comparison. Nagata said you often cannot tell from appearance alone, since it can show up across a range of body sizes. He added that boys often face a long delay in referral and diagnosis, and noted that for many people, body image pressure on boys is not on the radar.

Nagata estimated that a third of U.S. teen boys are trying to bulk up, but how many go on to develop bigorexia is harder to pin down. Classification adds to the confusion. It was added to the DSM in 2013 as a body dysmorphic disorder, which means someone showing signs of an eating disorder cannot be diagnosed with it. In a paper, Nagata argued it should be recognized as an eating disorder.

Where Social Media Comes In

NPR reported that several pressures feed the urge to build muscle, including family, peers, and the media. Across multiple studies, the media has been the strongest predictor of muscle dysmorphia. The experts who spoke with HuffPost agreed that social media is one of the biggest reasons bigorexia is rising. Nagata said men’s bodies are on display more than ever, especially through influencers, and constant comparison may lead to body dissatisfaction.

George Mycock, who had bigorexia symptoms in his early 20s and has studied the condition at the University of Worcester, points to how social media is built. More extreme images tend to earn more social and monetary reward, so the ideals keep stretching. Joseph Trunzo, a psychology professor at Bryant University, told HuffPost that influencers may take thousands of photos and pick the best one, and the version people see is carefully curated.

Instagram videos from friends got Dashiell Frederickson, then 16, comparing himself with adult bodybuilders, and he said it cost him a lot of self-confidence. He worked out daily, sometimes up to three hours, and had not been diagnosed with bigorexia. He also credited exercise with making him more confident and less winded, though he said some of his peers had turned to steroids to look better fast.

What Families Can Watch For

Gooding said some of the behaviors involved are often encouraged in the weight room, and those who struggle may hesitate to ask for help out of shame or secrecy. Nagata said parents should take note when a preoccupation with weight, food, exercise, or appearance starts to hurt school, social life, or daily functioning. Some boys feel guilty missing the gym, he said, or stop eating with family and friends.

People with the condition face a higher risk of disordered eating, steroid use, and suicidal ideation, according to NPR. Nagata said boys can start with a primary care pediatrician, and that an interdisciplinary team of mental health, medical, and nutrition providers is best. Trunzo said the earlier it is dealt with, the better, and that, left unchecked, the consequences can be “life-altering.”

If you or someone you know is in crisis, you can call or text 988 in the U.S.

Parents can limit social media as much as possible while accepting it cannot be eliminated, and talk with kids about what they see. Therapist Cherie Miller said she has read up with her 9-year-old son on what Hugh Jackman did to transform into Wolverine. Mycock cautions that too much exercise can become a problem. The feed is not going anywhere, but how kids read it may be something families can help with.