‘Bigorexia’ is a type of body dysmorphia afflicting boys and young men : NPR

The gym is constantly on Dashiell Frederickson’s mind. The 16-year-old trains religiously every day, sometimes up to three hours a day.

“The gym is the only thing I can think about during the day,” Frederickson said. “I wake up, I think about the gym. I brush my teeth, I think about the gym…and once I’m finally at the gym, I’m kind of ready and I’m happy.”

Despite all his efforts to perfect his physique, despite his friends telling him how handsome he is, when Frederickson looks in the mirror he thinks he looks “horrible.”

Body dissatisfaction among young people is on the rise, and clinicians like Dr. Jason Nagata say it’s a trend that’s starting to affect more boys. This challenges a long-standing trend in medicine – and society more broadly – ​​to associate body image problems primarily with girls.

Nagata, an eating disorder researcher at the University of California, San Francisco, says negative body image attitudes in boys often stem from feeling like they’re not muscular enough. A small portion of these young men develop an obsession with becoming bigger and more muscular – also called bigorexia.

“This happens when someone is preoccupied or even obsessed with the idea of ​​not having enough muscle,” Nagata said. “In many cases, an individual’s constitution is actually normal, or even objectively muscular.”

Frederickson doesn’t see himself that way and hasn’t been diagnosed with bigorexia. He says he suffers from “body dysmorphia”, although that has never been diagnosed either.

The discovery of bigorexia

Bigorexia was first described in a 1993 report on nine “tall, muscular” bodybuilders who were so preoccupied with training that they “turned down social invitations, refused to be seen at the beach, or wore heavy clothing” during the summer, fearing they would look too small in normal clothing.

A few dozen research articles were published after the original report, but bigorexia remained relatively understudied until recently, according to Nagata. Although it is difficult to measure how many boys suffer from bigorexia, eating disorders among young men are a growing problem.

“For a lot of people, the fact that boys and men face pressure when it comes to body image is completely off their radar,” Nagata said. “When we receive referrals for boys and men with muscle dysmorphia, there is often a long delay in referral and diagnosis.”

Three major pressures – family, peers and the media – contribute to the increase in muscle dysmorphia and men’s desire to build muscle. In several studies, the last variable is the most significant predictor of muscle dysmorphia.

Frederickson’s social media feeds are full of content from bodybuilders whose idealized Greek god bodies remind him of what he would like to look like one day.

“My friends were sending me videos on Instagram and they were like, ‘Oh, this guy looks crazy,'” Frederickson recalls. “I started comparing myself to these adults. It kind of made me lose a lot of self-confidence.”

George Mycock experienced symptoms of bigorexia in his early 20s and now studies the condition as a graduate student at the University of Worcester in England. He points out that the inherent design of social media is a significant driver of these trends.

“You tend to gain more social and monetary capital if the images and content you put out there are more extreme,” he said. “And then a lot more extreme body ideals are put out there.”

Bulking and cutting to sculpt perfect muscles

The obsession with muscularity pushed Mycock over the edge as he became obsessed with working out. During this period, he went through what bodybuilders call “bulking” phases – where he ate more to build muscle – and “cutting” phases, cycles of trying to lose weight to help bring out muscle definition. He weighed every meal to avoid gaining weight, forcing himself to vomit and falling into suicidal thoughts.

If you or someone you know is considering suicide or is in crisis, call or text. 988 to reach the lifeline 988 Suicide & Crisis.

All his training – it wasn’t enough. “I just felt like my body could be a symbol of my manhood,” Mycock said.

Physically, the condition may be invisible, unlike disorders like anorexia, in which patients may have a very low body weight and appear visibly thin. This is why, when bigorexia was first described, it was called “reverse anorexia.”

“It’s really hard to tell if someone has muscle dysmorphia just by looking at them,” Nagata said. “There can be people of different sizes, weights and shapes who experience muscle dysmorphia.”

People with this condition are at greater risk of eating disorders, steroid use, and suicidal ideation. When eating disorders become severe, patients may be hospitalized. And a growing share of these patients are now boys, according to a longitudinal study conducted in Canada. The authors of this study say there is an “urgent need” to educate clinicians about this trend.

Who is affected remains a mystery

Nagata estimates that a third of adolescents in the United States are trying to gain weight. But determining how many people develop bigorexia is more difficult.

This challenge comes from a lack of awareness of the condition, which was first added to the DSM – a manual used by clinicians to diagnose mental health problems – in 2013. Diagnosing young men with bigorexia is also difficult because they are less likely to seek help and experts disagree on how to diagnose it.

When bigorexia was first added to the DSM, it was classified as body dysmorphic disorder – a condition that causes a person to obsess over a perceived flaw in their appearance – which does not account for the disruptive eating seen in bigorexia. This discrepancy complicates the diagnosis.

For example, someone showing signs of an eating disorder may not be diagnosed with bigorexia, because eating disorders and body dysmorphic disorder are considered mutually exclusive. This is why, in a recent article, Nagata advocated for bigorexia to be recognized as an eating disorder.

Although researchers continue to debate this distinction, it is clear that certain groups, such as transgender men, are at greater risk.

“Biologically, they may have more feminine appearance factors, and then they try to change that to feel like they’re in a more masculine body,” Nagata said. “They have to overcome other types of obstacles to get that type of muscle building.”

A dark side to playing sports

Frederickson admitted that he thinks about his physique almost every day, calling it mentally exhausting. “You just tell your brain to shut up,” he said. “But it gets boring to say, ‘You need to look better. You need to cut. You need to bulk up. You need to stay where you are.'”

Despite these pressures, the teen feels supported by his family and medical providers, and has noticed that exercise has positive effects. “I feel a lot more confident with myself. It’s easier to run, easier to do things. I don’t get out of breath as quickly.”

But that doesn’t hold true for all of his peers, some of whom he says began using steroids to “look better as quickly as possible.” “They tell me they hated the way they looked and wanted to look better quickly.”

Although exercise is beneficial — and many children in the United States don’t get enough of it — the dangers of bigorexia can be life-threatening. But public health messages often fail to mention how exercise is too important for children. Mycock is on a mission to change that.

“I always talk about how people refer to exercise as the miracle drug,” Mycock said. “As with all other drugs… there is a tab that talks about side effects and addiction issues.”

“This isn’t to say that exercise and diet are bad for you. It’s just that too much exercise or an over-reliance on it – or when it becomes your whole identity – can become a problem.”

Michal Ruprecht is a media fellow at Stanford Global Health.