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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.
This can lead to disordered eating behaviors, eating disorders, or a condition known as muscle dysmorphia, or bigorexia. Teens with bigorexia, which primarily affects boys and young men, are obsessed with bodybuilding and getting more muscular.
Key Takeaways
New research shows that 17 percent of teen boys struggle with disordered eating.
Eating disorders and body image issues like bigorexia are closely linked to anxiety, depression, and low self-esteem.
Social media images of a supposed “ideal” body type for young men can trigger disordered eating or muscle dysmorphia.
Parents support and mental health treatment can help teens recover from body image issues and related behaviors.
2023 Research on Teen Disordered Eating Behaviors
According to new research published in JAMA Pediatrics, 1 in 5 adolescents globally struggles with disordered eating, which can lead to a full-fledged eating disorder. (Disordered eating includes behaviors such as restricting food intake and types of food, as well as obsession with body weight or shape, distorted self-image, and binge eating and purging.)
And while more teen girls have disordered eating than boys, the number of boys with these issues is rising. The study found that 17 percent of teen boys had disordered eating behaviors, vs. 30 percent of teen girls. That’s a much closer ratio than in recent decades.
What’s the Difference Between Disordered Eating and Eating Disorders?
The term “disordered eating” describes a variety of unhealthy eating behaviors. However, disordered eating is not a diagnosis in itself. In order to receive a diagnosis of an eating disorder, such as anorexia or bulimia, teens must meet a specific set of criteria.
That said, many teens who have disordered eating patterns may fit the criteria for an eating disorder. That’s why assessment and treatment is so important when teens show warning signs.
Watch Newport Academy alum Ryan on the NBC Nightly News, discussing his eating disorder and body image issues and how he found healthy coping skills during treatment.
What Causes Eating Disorders?
Healthcare professionals and researchers point to the impact of media and body image on eating disorders. When a teen has a negative body image, they may strive in unhealthy ways to achieve what the media portrays as the “ideal” body. A report by Common Sense Media founds that kids’ consumption of media puts them at risk of developing unhealthy approaches to their bodies, food, eating, and exercise.
However, mental health experts believe that eating disorders arise from a combination of psychological, genetic, biological, and social factors. Furthermore, many experts agree that, at their root, eating disorders are not really about wanting to be thin. Rather, they are expressions of underlying issues such as depression, trauma, and anxiety. Controlling food intake becomes a form of self-medication—a way to manage emotional pain and distress.
“A teenager cannot simply wake up one morning and choose to have an eating disorder. Rather, there are strong biological and genetic influences that interact with individual differences, personality traits, neurobiological processes, and environmental contexts to result in an eating disorder.”
American Psychiatric Association Special Report, January 2023
Eating Disorders and Mental Health
Eating disorders almost always co-exist with another mental health issue. Here are some findings of a National Institute of Mental Health study of 10,000 teenagers (ages 13 to 18) with eating disorders:
The study showed significant impairment in day-to-day functioning, as well as suicidal ideation and suicide attempts.
About a third of those with bulimia, 15 percent of those with binge eating, and eight percent of those with anorexia had attempted suicide.
In addition, 55 to 88 percent reported such problems as anxiety, depression, or a behavioral disorder.
Teens with eating disorders are also at greater risk for substance abuse and self-harming behavior.
Researchers found that the majority of teens with eating disorders did have contact with mental health care, school services, or general medical services. But, less than a third had talked with a professional about their eating or weight problems.
Moreover, according to a report from the National Center on Addiction and Substance Abuse at Columbia University, as many as 50 percent of those with an eating disorder also abuse drugs.
In addition, a 2023 study of more than 2,700 adolescents and young adults found that teen boys and young men with muscle dysmorphia were more likely to engage in a practice called “dry scooping.” Dry scooping refers to ingesting pre-workout powders without mixing them with water as intended. Experts say this can have serious health effects, including issues with inhalation, cardiac abnormalities, and digestive problems.
How Social Media Influences Male Eating Disorders and 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, eating disorders, 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.
New research by the American Psychological Association found that teens and young adults who reduced their social media use by 50 percent for just a few weeks saw significant improvement in how they felt about their weight and their overall appearance. This was compared with peers who maintained consistent levels of social media use, and saw no significant change in body image. Gender did not appear to make any difference in the effects.
“Social media can expose users to hundreds or even thousands of images and photos every day, including those of celebrities and fashion or fitness models, which we know leads to an internalization of beauty ideals that are unattainable for almost everyone, resulting in greater dissatisfaction with body weight and shape.”
Study author Gary Goldfield, PhD, Children’s Hospital of Eastern Ontario Research Institute
10 Signs of Disordered Eating or Muscle Dysmorphia in Teens
How can a parent distinguish the difference between normal teen boy body dissatisfaction and a disordered obsession with food, eating, or working? According to the International OCD Foundation, warning signs can include the following behaviors:
Preoccupation with body image, body size or shape, a specific part of the body, and weight
Significantly limiting the variety of foods consumed by restricting entire food categories
Performing specific rituals around food intake, and having a rigid eating schedule
Excessively working out or lifting weights, to the point that it disrupts schoolwork and other activities
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
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 more muscular
Using anabolic steroids or other appearance- and performance-enhancing drugs
What Is Bigorexia?
Someone with muscle dysmorphia, or bigorexia, 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. 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.”)
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
Bigorexia is associated with anxiety and depression, substance abuse (specifically the use of anabolic steroids), eating disorders, and problems with school, work, and relationships. 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?
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.
Body Image and Identity Formation 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 eating disorders, 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.
What Parents Can Do to Protect Against Eating Disorders and Dysmorphia
There are many influences outside a parent’s control that contribute to the likelihood that a teen boy will develop eating disorders and/or 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 body image and self-esteem issues, disordered eating or eating disorders, and/or bigorexia. Bullying can also lead to other mental health issues. Learn the signs of bullying to watch for.
Limit social media. Setting boundaries around the use of social media can help prevent eating disorders and 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 their 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 Eating Disorders and Muscle Dysmorphia
If you notice that your teen has developed signs of eating disorders or bigorexia, take care not to dismiss it as vanity, “healthy” eating, or self-consciousness. If their obsession with food, weight, and/or working out is negatively impacting their daily activities, a mental health assessment is in order.
Newport Academy views eating disorders and body images issues as manifestations of underlying mental health conditions, such as anxiety, depression, low self-esteem, and trauma. Our outpatient and residential programs address these underlying issues using tailored treatment plans.
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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