Body image, muscle dysmorphia and eating disorders in boys and men

The vast majority of eating disorders are diagnosed in females, but this is increasingly being seen as a gender bias. Eating disorders in boys and men are likely vastly under reported, diagnosed and treated.

Men experience all types of eating disorders. Recent estimates state that 20 million women and 10 million men will suffer from a clinically significant eating disorder at some time in their life (Wade, Keski-Rahkonen, & Hudson, 2011). A study of 2,822 students on a large university campus found that 3.6% of males had positive screens for ED. The female-to-male ratio was 3-to-1 (Eisenburg, 2011).

One of the reasons males are not seen as having eating disorders is because many times their disorders look strikingly different from that of females. Specifically, while females are socially conditioned to seek the physique of an underweight fashion model, males are socially conditioned to seek the physique of a heavily-muscled superhero.

This key difference in the “ideal body type” is partially responsible for the misunderstanding of male eating disorders. Research from Labre in 2005 showed that most males strive to achieve a lean and muscular physique. This desire has markedly increased since the 1970s. The sexual objectification of men in the media is on the rise and is strongly correlated with a male obsession with muscularity.

• 25% of normal weight males perceive themselves to be underweight (Atlantic, 2014)
• 90% of teenaged boys exercised with the goal of bulking up (Eisenberg, 2012)
• 68% of college-aged men say they have too little muscle (AOL body image survey)

Just as women see a body type that can be achieved naturally by less than 5% of the female population, men are exposed to body types that are similarly difficult to achieve.

Bobby Holland Hanton, body double for Chris Hemsworth’s Thor, said he must eat 35 meals per day and undertake two strenuous training sessions to achieve a physique close to the Australian actor’s size (Mel Magazine).

Researchers believe that muscle dysmorphia, a subtype of body dysmorphic disorder, is directly correlated to increased media attention on highly-muscular male bodies, which connect muscularity with masculinity. The disorder was first described in scientific literature fewer than 25 years ago. Sometimes called ‘Bigorexia,’ it was recently included as an official diagnosis in the DSM-5.

• 2.2% of men in the United States have body dysmorphic disorder (Phillips KA, Wilhelm S, Koran LM, et. al)
• 9-25% of men who have body dysmorphic disorder have muscle dysmorphia (Phillips KA, Wilhelm S, Koran LM, et. al)

Body dysmorphia is often characterized by:

• Preoccupation with body size and shape
• Conviction that body is insufficiently muscular
• Compulsive weight lifting
• Abnormal eating patterns
• Use of over-the-counter herbal or dietary supplements
• Use of anabolic-androgenic steroids (AASs), which includes testosterone and synthetic testosterone derivatives
• Use of appearance- and performance-enhancing substances such as human growth hormone, thyroid hormones, insulin, clenbuterol, etc.

Compulsive weight lifting

It is not uncommon for teenage and young adult men to find belonging and success in the weight room. Whether they are lifelong athletes looking to “bulk up” for a particular sport or newbies trying to build out a “weak” or “skinny” adolescent physique, the gym is full of men seeking to change their body size and shape.

Working out in the gym is not always a sign of an eating disorder or muscle dysmorphia. The vast majority of boys and men will work out for a while and then move onto other pursuits. Or they may find that they love working out, and continue working out for a long time in a measured, healthy manner.

As parents, we want to be aware that our sons can definitely be in a healthy relationship with the gym and their bodies, but we also want to be aware of the signs that he is crossing over into obsession. One sign is a continually increasing the amount of time spent at the gym. While one hour per day may be required by his football coach, he may opt to spend 3 or more hours at the gym, which may be a signal of disordered body image.

The main sign that our son is obsessed with achieving particular results at the gym is an inflexibility with his workout schedule. This means that when you go on vacation, your son requires the same access to and time at the gym as he does at home. It also means that he will sacrifice other activities and opportunities in order to go to the gym. This inflexibility is a sign that the gym is taking up a significant part of his identity, and it may be worthwhile speaking with an expert about whether his preoccupation is healthy.

Herbal and dietary supplements and male eating disorders

One of the most common and obvious signs that your son is becoming obsessed with achieving a lean and muscular body is the use of over-the-counter herbal and dietary supplements. These are unregulated, and often contain illegal AASs and other anabolic compounds.

Dietary supplements (typically shakes) are broadly marketed in stores like the Vitamin Shoppe and GNC, as well as on social media, by thousands of “thought leaders” (salespeople) who sell them directly as part of the #fitspo movement.

If your son is using products such as these, you may want to consider whether he is pursuing an unattainable ideal while simultaneously consuming dangerous products. Aside from the fact that these products are not regulated and therefore may contain dangerous ingredients, they promise an unrealistic result. These products are heavily promoted by peers, coaches and social media, making them extremely appealing to young men.

Anabolic-androgenic steroids (AASs) and male eating disorders

Perhaps the most dangerous aspect of muscle dysmorphia is the use of AASs. Since it is impossible for the majority of men to achieve the size and physique of a man like Chris Hemsworth, they must turn to steroids to pursue the “dream body.”

Studies have estimated that 2.9 million to 4.0 million mostly-male individuals have used AASs at some time in their lives, and that about 1 million of those are or have been dependent on AASs. (Pope HG Jr, Wood RO, Rogol A, Nyberg F, Bowers L, Bhasin S).

The majority of AAS users today are not competitive athletes. Most are nonathlete weightlifters who use AASs to achieve a leaner and more muscular physique. Since the use of AASs, over-the-counter supplements and other appearance- and performance-enhancing supplements have only been broadly used since the 1980s, the research is still preliminary, but long-term health risks include damage to the:

• Cardiovascular system
• Psychiatric health
• Reproductive and sexual performance
• Neurobiology

If you believe your son may be facing muscle dysmorphia and/or an eating disorder, please seek advice from an eating disorder specialist who is certified by the International Association of Eating Disorders Professionals Foundation (IAEDP) and can help you determine whether any treatment is necessary.

See Our Parent’s Guide To The Different Types Of Eating Disorders

---

Additional resources:

Body Image Disorders and Abuse of Anabolic-Androgenic Steroids Among Men (JAMA)

The Adonis Complex: How to Identify, Treat and Prevent Body Obsession in Men and Boys

Research on Males and Eating Disorders (NEDA)