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Bigorexia: How to Recognize Muscle Dysmorphia in Teens

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All adolescents are at risk for some degree of body dissatisfaction. Because the teen physique is changing so quickly, body image consciousness is a natural part of adolescence. But for some teens, the focus on body image becomes all-consuming. Teens with a condition known as bigorexia are obsessed with bodybuilding and getting more muscular.

Bigorexia is a mental health disorder that primarily affects teen boys and young men. It is associated with anxiety and depression, substance abuse (specifically the use of anabolic steroids), eating disorders, and problems with school, work, and relationships.

What Is Bigorexia?

Obsessive bigorexia, more formally known as muscle dysmorphia, is a form of body dysmorphia that focuses on muscle obsession. (The term dysmorphia comes from the Greek word for “misshapenness” or “ugliness.”)

Someone with muscle dysmorphia believes that they are small and skinny, despite being typically or even unusually muscular. They compulsively work out and control their diet to increase their muscularity. Like other forms of behavioral addiction, muscle dysmorphia is regarded as a type of obsessive compulsive disorder.

How big a problem is this form of teen boy body dissatisfaction? Bigorexia statistics are difficult to quantify. The disorder is thought to afflict somewhere around 2 percent of people. However, many more teen boys may suffer from undiagnosed muscle dysmorphia. Research shows that 25 percent of adolescent males are worried about not having enough muscles. One study of 149 boys ages 11–18 found that close to one-third were dissatisfied with their body shape.

Criteria for Obsessive Bigorexia

The most recent edition of the Diagnostic and Statistical Manual of Disorders lists the following criteria for bigorexia:

  • A preoccupation with the idea that one’s body is not lean and muscular enough
  • Long hours spent lifting weights
  • Excessive attention to diet
  • Frequently misses important social, occupational, or recreational activities that would interfere with a workout schedule or dietary plan
  • Avoids or becomes anxious about situations where their body might be exposed to view by others
  • The preoccupation causes a degree of distress that interferes with relationships or responsibilities
  • Continuing to work out, diet, or use performance-enhancing substances even when they know it could cause them harm. (For example, a teen with bigorexia might continue working out even with an injury because the muscle obsession is so strong.)

While bigorexia most often develops in late adolescence, symptoms can emerge with the onset of puberty. The condition typically occurs in teen boys and men. But it does infrequently occur in girls and women, especially among victims of sexual assault.

What causes bigorexia in teens?

What Causes Bigorexia?

Muscle dysmorphia was first recognized as a disorder in a 1993 study of bodybuilders and mental illness. However, there is no evidence that bodybuilding or weightlifting in itself causes muscle dysmorphia. Rather, these activities appeal to individuals who are already vulnerable to having disordered concerns about their muscularity.

What causes that vulnerability? Muscle dysmorphia often occurs together with anxiety and depression. Like those conditions, it is thought to stem from a complex interplay of genetic factors, brain chemistry, and life experiences. A family history of OCD is a genetic risk factor.

Teen boys and young men who struggle with bigorexia commonly report low self-esteem. In addition, many were underweight or overweight during childhood. Victims of bullying may be especially susceptible, as they strive to compensate for those experiences and to make sure they never happen again.

Teen Bigorexia vs. Anorexia

The term “bigorexia” was coined in 1985 by the Barbarian Brothers, a pair of comedian-bodybuilders. But it is no joke. As the twins told People magazine, “It is an obsession like anorexia. We always look at ourselves and ask, ‘Do we look big?’ We get crazy about looking small.”

As the name suggests, muscle dysmorphia shares many features with anorexia nervosa, and in fact was initially called “reverse anorexia.” Both disorders share:

  • High levels of body dissatisfaction
  • Cognitive distortions about body shape reflecting cultural body ideals (never muscular or lean enough for males, or never skinny enough for females)
  • Compulsive dieting and exercise habits
  • Similar underlying psychological features, including sensitivity to distress, low self-esteem, and perfectionism.

Despite these similarities, muscle dysmorphia is categorized as a subtype of body dysmorphic disorder rather than an eating disorder because food restriction is secondary to the compulsive exercise that is the hallmark of bigorexia. While anorexia is the mental illness with the highest fatality rate, bigorexia does not have the same immediate risks to health.

The Link Between Body Image, Identity Formation and Muscle Dysmorphia in Teens

Adolescence is a time when the teen physique is evolving dramatically, thanks to biological changes. And this occurs just when teens’ psychology makes them keenly sensitive to the perceptions of others. Body image is a core component of identity formation, the critical process of adolescence by which an individual develops a clear sense of who they are.

Body image is more than what you see when you look in a mirror. Rather, it is an interplay of many elements, including:

  • Thoughts and beliefs about body shape and appearance, which are influenced by family, peers, and the culture at large
  • Perception of body size, shape, and weight, which may not accurately match actual appearance
  • Feelings of satisfaction or dissatisfaction about one’s body in comparison to an internalized ideal body image
  • Behaviors that reinforce those thoughts, perceptions and feelings, such as frequent mirror checking or avoidance of social situations in the case of muscle dysmorphia.

A healthy adolescent may experience episodes of preoccupation with their bodies. But for a teen with bigorexia or other types of body dysmorphia, body image becomes the central feature of their self-esteem, to the exclusion of other interests and values.

How Social Media Can Influence Teen Muscle Dysmorphia

Advertisers and the mainstream media have long played a powerful role in establishing unrealistic standards of the “ideal” body. Until recently, the focus was on how Photoshopped images and toys like Barbie dolls produce a “drive for thinness” in girls and women. Over the last several decades, the muscular male ideal has grown in prominence. A study of the evolution of male action figures over the course of 30 years found that they had grown much more muscular over time. Video game avatars and hyper-realistic CGI animation techniques take muscularity to new extremes that are not humanly possible.

Social media can also heighten a teen boy’s vulnerability to body dissatisfaction and bigorexia. The highly visual nature of Instagram and Snapchat reinforces body image sensitivity. One study found that the most frequently depicted male body type on Instagram is lean and muscular.

The apps also provide near-constant opportunities for teen boys to compare themselves with filtered and curated images of both celebrities and peers. “#Fitspiration” images featuring beautiful people doing exercise are particularly damaging. “Before and after” pictures give the impression that an ideal is attainable through diet or exercise. In fact, the media-driven ideal body is not physiologically possible for most people.

teen bigorexia

Signs of Bigorexia in Teens

How can a parent distinguish the difference between normal teen boy body dissatisfaction and a disordered obsession? According to the International OCD Foundation, signs of muscle dysmorphia can include the following behaviors:

  • Excessively working out or lifting weights
  • Counting calories and tracking nutrient content to achieve a “perfect” formula
  • Avoiding social gatherings or eating out due to perceived lack of control over food content
  • Eating multiple meals throughout the day on a rigid schedule
  • Excessively checking mirrors or other reflective surfaces—or avoiding mirrors
  • Staying away from social situations where bodies may be on display, such as the beach or pool
  • Wearing multiple layers of clothing to appear larger
  • Using anabolic steroids or other appearance- and performance-enhancing drugs
  • Struggling with schoolwork, extracurricular activities, and/or relationships due to their preoccupation with bodybuilding.

What Parents Can Do to Protect Against Bigorexia

There are many influences outside a parent’s control that contribute to the body image dissatisfaction that is at the core of bigorexia. But parents can do a lot to nurture their child’s self-esteem, support a more nuanced concept of masculinity, and model healthy behaviors.

Be on the lookout for signs of bullying. The long-term health risks of bullying can include bigorexia, as well as other mental health issues. Here’s what to watch for.

Limit social media. Setting boundaries around the use of social media can help prevent bigorexia, as well as a wide array of other negative impacts.

Educate your teen about the issue. Let them know that teen boy body dissatisfaction is common, and they are not alone. Explain how media and social media can make body image issues worse.

Stay connected and listen. Get curious about your child’s thoughts and feelings about their appearance and ideas about masculinity. Check out these tips for talking to teens.

Check your own attitudes and behaviors. We all have internalized, often unconscious, beliefs about body image and masculinity. Your child will notice how you talk about your own appearance, or comment on other people’s.

Treatment for Muscle Dysmorphia

If you notice that your child has developed signs of bigorexia, take care not to dismiss it as vanity or self-consciousness. If their obsession is negatively impacting their daily activities, a mental health assessment is in order.

Newport Academy views muscle dysmorphia and other disordered eating and body images issues as manifestations of underlying mental health conditions. Our outpatient and residential programs address these underlying issues using tailored treatment plans.

Rather than focusing on their outer appearance, teens at Newport Academy build self-esteem and positive self-image through authentic connection—with self, others, and a caring community of peers and mentors. Contact us today to learn more.


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