Muscle Dysmorphia: The Rising Crisis in Men and Boys Fueled by Social Media
For many young boys and men, the journey through adolescence and into adulthood is marked by evolving perceptions of self, including body image. While societal pressures regarding appearance are often discussed in the context of women, men face their own distinct, and increasingly intense, set of expectations. This is particularly true concerning muscularity and physical size, pressures that are reaching unprecedented levels, significantly fueled by the pervasive influence of social media.
Consider Sam, a 25-year-old man whose struggles with body image began at a tender age. As young as five, he recalls his parents commenting on his size, urging him to eat more, and emphasizing the cultural ideal that “Men need to be big” to fulfill their roles as providers. This early conditioning planted a seed of self-consciousness that would grow over the years.
Sam’s relationship with his body became even more complex in college after he came out as queer. He found himself navigating a subculture within the gay community that, as he described, had a “hyper-fixation on the ‘perfect body.’” This environment often celebrated muscular, chiseled physiques as the epitome of queer masculinity, intensifying his existing anxieties. His time in the gym became less about health and more about scrutinizing his muscles in the mirror, constantly comparing himself to an often unattainable ideal. His diet and overall well-being became inextricably linked to this relentless pursuit of a bigger, stronger-looking body.
“When I start worrying about my body, then my routine and overall health start to deteriorate,” Sam shared, highlighting the profound impact his body image concerns had on his life. His experience is not isolated; it reflects a growing trend among men and boys grappling with a specific and often misunderstood condition: muscle dysmorphia.
The Alarming Rise of Body Dysmorphic Disorder and Muscle Dysmorphia
Research indicates that the United States is currently experiencing an unprecedented rise in body dysmorphic disorder (BDD) among young people across all gender identities. This surge is, in part, attributed to the increasingly stringent and often unrealistic beauty standards that proliferate across social media platforms. While BDD can manifest in various ways, focusing on perceived flaws in any body part, a specific subtype known as muscle dysmorphia is disproportionately affecting men and young boys.
Muscle dysmorphia is characterized by an intense, often debilitating anxiety that one is not muscular enough, regardless of their actual physique. Experts observe that this anxiety is driving a growing number of men and boys toward compulsive behaviors, including excessive exercise, restrictive or highly controlled dieting, and, in alarming cases, the non-medical use of anabolic steroids. This isn't merely a matter of wanting to be fit; it's a compulsive preoccupation that significantly impairs daily functioning and mental health.
This medical consequence is deeply intertwined with a broader cultural shift. Societal expectations for masculine bodies are continuously ratcheting upwards, demanding physiques that are not only large but also lean and highly defined. This escalating ideal fuels a demand for health and fitness advice, much of which is readily available online, often dispensed by individuals with varying levels of expertise to massive audiences.
Online platforms are rife with examples. Sam Sulek, a 22-year-old bodybuilder with a remarkably large physique, commands nearly 10 million followers across YouTube and Instagram. His content, featuring videos like “The Bulk Day 105 – Chest – Heavy Incline and Thought Control” or shirtless photo dumps garnering millions of likes, exemplifies the kind of extreme muscularity being showcased and celebrated. Other influencers, such as Jeremy Ethier and Jeff Nippard, engage in discussions about being “enhanced” (using steroids) versus “natty” (natural). While this transparency might seem informative, it also normalizes steroid use as a viable path to achieving these physiques, even as it highlights potential risks.
As the ideal male body continues to skew towards extreme size and leanness, the psychological toll on young people is becoming increasingly evident. Becca Boswell, a clinical psychologist and director at the Penn Medicine Princeton Center for Eating Disorders, notes that men today face direct pressures regarding their bodies and fitness that were less prevalent two decades ago. “And for many it feels like, ‘If I can’t meet these standards, then who am I to exist in the public arena?” she explains, capturing the profound impact these pressures can have on a man's sense of self-worth and belonging.
Understanding Muscle Dysmorphia: More Than Just Vanity
Body dysmorphic disorder (BDD) is a recognized psychiatric condition characterized by a persistent and intrusive preoccupation with a perceived defect in one's physical appearance. This perceived flaw is often minor or even undetectable to others, yet it causes significant distress and can lead to repetitive behaviors or mental acts in response to the appearance concerns. These behaviors might include excessive mirror checking, grooming, skin picking, reassurance seeking, or comparing oneself to others. BDD is associated with obsessive thinking patterns and compulsive behaviors that can severely impact a person's life, leading to social isolation, avoidance of activities, and significant emotional suffering.
Muscle dysmorphia is classified as a specific subtype of BDD. Its central characteristic is a fixation on the idea that one's body is not muscular enough or sufficiently lean, even when the individual is objectively well-muscled. The term was first formally coined by researchers in 1997, though it had been informally recognized within weightlifting and bodybuilding communities for years prior under monikers like “bigorexia” or “reverse anorexia.” The latter term highlights the superficial similarity to anorexia nervosa – both involve a distorted body image and compulsive behaviors – but the direction of the distortion is opposite: individuals with muscle dysmorphia see themselves as small and weak, while those with anorexia see themselves as large or fat.
However, experts emphasize that while disordered eating can be a symptom, muscle dysmorphia encompasses a wider range of compulsive behaviors beyond just diet. Individuals with this condition often develop a compulsive and rigid relationship with exercise, feeling compelled to work out for hours daily, even when injured or ill. Dieting becomes extreme, focused on maximizing muscle gain and minimizing body fat through meticulous tracking of macronutrients and calorie intake, often leading to nutritional deficiencies or imbalances. Furthermore, the intense desire for increased muscularity drives many to consider or actively use anabolic steroids without medical supervision, despite the known health risks.
Muscle dysmorphia also has a high comorbidity rate with other mental health conditions, including obsessive-compulsive disorder (OCD), depression, and anxiety. The relentless preoccupation and compulsive behaviors can consume a person's life, making it difficult or impossible to maintain relationships, hold down a job, or participate in social activities. The overwhelming sense of fear, failure, and shame stemming from their perceived bodily inadequacy can be crippling. Tragically, like other forms of BDD, muscle dysmorphia has a high correlation with suicidal ideation, underscoring the severity of the condition and the profound suffering it causes.
Mair Underwood, an anthropologist at the University of Queensland who studies muscle dysmorphia within bodybuilding communities, points out the common tendency to trivialize the condition. “A lot of people will treat it as a trivial sort of thing like, ‘Why can’t these people just look in the mirror and see that they’re muscular?’ And they treat it like it’s not a real illness,” she says. “But if people knew the level of suffering that comes with these illnesses, they wouldn’t be so quick to trivialize it and dismiss it as an issue of vanity.”
The Hidden Epidemic: Why Men Don't Seek Help
Estimating the exact prevalence of muscle dysmorphia is challenging. While an estimated 0.7–2.4% of the U.S. adult population is affected by BDD overall, getting a precise number for the muscle dysmorphia subtype is difficult for several reasons. Firstly, it's a relatively new area of clinical focus, having only been extensively studied in recent decades. Secondly, and perhaps more significantly, the vast majority of individuals affected by muscle dysmorphia are men, who face substantial barriers to seeking help for mental health issues.
Men are significantly less likely to seek help for mental health concerns compared to women. This reluctance is compounded by the fact that body image and eating disorders are still commonly, and incorrectly, perceived as conditions that primarily affect young white women. This misconception persists despite data showing that BDD affects people of all races and genders, with some studies suggesting that as many as 40% of people with BDD are male.
William Grunewald, a Ph.D. candidate at Auburn University researching mental health risk and male disordered eating, attributes this gender disparity to harmful cultural norms surrounding masculinity. “Men are often explicitly and implicitly discouraged from getting help for these struggles,” he told STAT, pointing to the societal expectation that “real men” are self-reliant, stoic, and capable of handling their emotional difficulties without assistance. Admitting vulnerability or seeking psychological support can be seen as a sign of weakness, directly contradicting these ingrained ideals.
Grunewald also highlights the unique pressures faced by queer and non-cisgender men. Studies indicate that these groups may feel an added pressure to conform to hyper-masculine body ideals, sometimes as a way to “prove” their masculinity in a culture that often marginalizes or seeks to diminish them. Sam echoed this sentiment, explaining his subconscious feeling that he needed to present his body as the opposite of harmful stereotypes about gay Asian men, striving for a bigger, more muscular physique.
Roberto Olivardia, a clinical psychologist and lecturer at Harvard University, was part of the research team that first coined the term “muscle dysmorphia” in the 1990s. He recalls the difficulty in finding male subjects for early studies, noting how the concept of body image issues was “almost inherently feminized” at the time. He explains that historically, women have been subjected to intense pressures regarding their bodies, making the pursuit of a “right” body almost synonymous with female identity. This historical context contributes to the ongoing difficulty in recognizing and addressing body image issues in men.
The consequences of this gendered perception are severe. As Boswell notes, “When men get treatment for any psychological concern, they’re often sicker because they hold on to that illness for longer.” The delay in seeking help means the disorder has more time to become entrenched, causing greater physical and psychological damage before intervention occurs.
Social Media's Role as an Accelerant
The connection between media and the promotion of unrealistic body standards is not new. However, the advent and widespread adoption of social media have dramatically amplified this phenomenon. For individuals like Will, a 27-year-old in Detroit, the idea of discussing his body image concerns openly felt foreign. “This is maybe one of the longer conversations that I’ve had about this in my life,” he admitted during his interview, highlighting the silence that often surrounds male body image issues. Despite never being formally diagnosed, Will has always been acutely aware of his body's appearance and how it measured up against perceived ideals. As a lanky teenager, he wondered if his physique was a barrier to dating and relationships. Later, a breakup in college triggered what he called a “canon male event” – immersing himself in weightlifting and strict protein consumption, believing that desirability was linked to muscularity. “I just felt like I understood what a man’s chest and abs should look like, and that was very much the center of how male bodies were portrayed on TV,” he recalled, illustrating the long-standing influence of media ideals.
According to Olivardia, there is a clear correlation between the rise of social media and the noticeable increase in young boys, some as young as 9 or 10, seeking help for muscle dysmorphia. Having worked with patients for decades, he sees social media as a “huge accelerant in a bad way in terms of body image.” He finds its negative impact clinically undeniable.
Social media has democratized and mainstreamed aspects of bodybuilding culture that were once confined to niche communities, Underwood observes. Practices like meticulous macronutrient counting and highly structured training regimens, once primarily the domain of competitive bodybuilders, have become commonplace outside these circles. Platforms like TikTok and YouTube are flooded with content related to “building muscle” and “muscle growth,” with millions of tagged posts and videos offering advice on everything from 4,000 calorie diets to macronutrient ratios and targeted exercises for specific body parts, such as a “chiseled lower chest” or “massive lats.”
Dietary supplements, particularly protein powders, are heavily promoted across various online channels, including YouTube videos, Reddit forums, podcasts, and e-commerce articles, all debating their efficacy for muscle gain. This constant barrage of content normalizes extreme dietary focus and supplement use as essential components of achieving the desired physique.
Beyond diet and exercise, social media has also contributed to the normalization and increased accessibility of performance-enhancing drugs. Google search interest in topics like “steroid benefits” and “bulking and cutting” (a bodybuilding strategy involving cycles of gaining muscle and losing fat) has shown a steady rise over several years. Online discourse about steroid use among bodybuilders has become more open, and disturbingly, access to purchasing these substances has become easier. A simple online search for substances like trenbolone (“tren”), a potent cattle steroid popular among some users, can yield numerous purchasing options, including unexpected platforms like SoundCloud. This ease of access, combined with the normalization of discussion, has contributed to steroid usage among young people reaching a new peak in popularity. Globally, an estimated 6.4% of men in countries where steroids are available are reported to use them, a statistic that underscores the scale of the problem.
The Unique Challenges of Recognizing and Treating Muscle Dysmorphia
One of the primary obstacles for individuals with muscle dysmorphia is simply recognizing that they have a problem. Society widely promotes exercise and healthy eating as positive lifestyle choices, and deliberately shaping one's body is a common practice. This makes the line between dedicated self-improvement and a mentally and physically debilitating condition incredibly blurry.
”Society tells us to exercise and watch what we eat, and deliberately shaping your body to look its best is common practice,” Underwood states. “So how do you know when it becomes a problem?” This question is particularly difficult to answer in the context of online fitness culture, where increasingly extreme dieting and exercise regimens are not only shared freely but often celebrated.
Grunewald points out that “Oftentimes fitness advice is conflated with what appears to be disordered eating.” Furthermore, much of the fitness content aimed at men is presented as “scientifically proven,” a label that many viewers may accept without critical evaluation, failing to consider individual variables like age, health status, or the potential for bias in the information presented. This can lead individuals down paths of extreme behavior under the guise of pursuing optimal health.
Counselors specializing in muscle dysmorphia note that many patients do not seek professional help until a significant life crisis forces them to confront the reality of their condition. Events such as a relationship breakdown, job loss, or a severe injury that prevents training can serve as painful wake-up calls. Underwood suggests this is because it often takes a dramatic disruption of their environment for individuals to stop normalizing their disordered behaviors. Within insular communities, such as certain online bodybuilding forums, these behaviors can be reinforced and defended. “You can put a post online, for example, saying, ‘My partner’s complaining about the amount of time I spend in the gym,’ and you’ll watch everyone go, ‘Dump them! They don’t understand you.’” she explains. “It’s very hard to get perspective, especially when you’re surrounded by people who also have no perspective.”
To help discern whether someone's focus on their body has crossed the line into a disorder, experts recommend examining the underlying motivations and the cost of their compulsive behaviors. “Even if someone feels like they’re striving for health and wellness, the question becomes at what cost?” Boswell asks. “And if it’s at the cost of their relationships or their time for everything else or for their bodily health, then it’s no longer about wellness.” When the pursuit of a physical ideal begins to damage other essential areas of life, it's a strong indicator of a disordered relationship with one's body.
Paths to Recovery: A Multifaceted Approach
Given that muscle dysmorphia impacts individuals on multiple levels – physiological, psychological, and social – the recovery process is necessarily multifaceted. At centers like the Princeton Center for Eating Disorders, the initial focus is often on ensuring the patient's physical health. This might involve addressing nutritional deficiencies resulting from extreme dieting or managing the health consequences of steroid use. Easing off performance-enhancing drugs is a critical step, as steroids are linked to increased mental health risks, potentially exacerbating the psychological symptoms of muscle dysmorphia.
Psychological treatment is tailored to the individual's specific needs and the severity of their condition, but generally centers on two key objectives: helping the patient understand the root causes and functions of their compulsive behaviors, and fostering acceptance that these behaviors are ultimately unsustainable and harmful. Therapy provides a space for patients to explore the underlying anxieties, fears, and beliefs that drive their preoccupation with muscularity.
Boswell describes her therapeutic approach as guiding patients toward their own insights into the disorder. “What was the function of this pattern of behavior? Was it to create a sense of control?” she probes. “Did it help create a sense of achievement and protection from social judgment?” By understanding the purpose the disorder served, patients can begin to develop healthier coping mechanisms and self-perceptions. This understanding is crucial for implementing strategies like exposure and response prevention (ERP), a form of cognitive behavioral therapy. ERP helps patients confront situations or stimuli that trigger their body image anxiety (e.g., seeing their reflection, being in a gym) without engaging in their usual compulsive behaviors (e.g., excessive mirror checking, rigid adherence to a workout). Over time, this helps break the cycle of obsession and compulsion.
Olivardia emphasizes the importance of helping patients transition from a compulsive, all-consuming diet and exercise routine to one that is balanced and sustainable. This can be particularly challenging because, unlike addiction to substances where abstinence is the goal, recovery from muscle dysmorphia involves learning to engage with fitness and nutrition in a healthy, moderate way. “The goal is not to have these men never exercise or lift weights again,” Olivardia clarifies. “It’s about how to engage in that arena in a more regulated fashion, and building the skills and support to make that happen.” This involves redefining their relationship with exercise and food, shifting from a focus on achieving an impossible ideal to one centered on genuine health and well-being.
Pushing Back Against Societal Pressures and Fostering Change
A critical aspect of recovery, acknowledged by all the psychologists and researchers interviewed, is preparing patients for the inevitable reality of encountering triggers in their daily lives. “I can’t immunize my patients from being triggered. We live in a culture where it’s all around us,” Olivardia states. Marketing, media, and everyday conversations are saturated with messages about ideal bodies, making it impossible to completely avoid stimuli that can provoke body self-consciousness or shame.
While individual therapy and support are essential, experts argue that truly addressing the rising tide of muscle dysmorphia requires a fundamental societal shift in how we define and discuss ideal bodies, health, and masculinity. The cultural reality where certain body types receive disproportionate praise and attention needs to be challenged. Reducing the risk of muscle dysmorphia on a larger scale necessitates a critical examination of whether prevailing ideals about bodies, health, and wellness are, paradoxically, making people sicker. “There is a real cultural component to the body image pressures that people are tied to,” Boswell asserts.
Encouragingly, some of this cultural change is beginning to emerge, even within the very platforms that have contributed to the problem. Amidst the vast amount of content promoting extreme muscle growth, a small but growing number of male influencers and individuals are speaking openly about their struggles with body image and the mental health risks associated with the relentless pursuit of an unattainable physique.
Jeff Nippard, a popular bodybuilder and fitness YouTuber, has shared his own experiences with body dysmorphia. He notes that while confidence might initially improve with leanness, there's a point where “A switch flips in their brain and they can no longer see their physique objectively.” He describes how individuals become overly critical, fixating on minor perceived flaws. Mike Israetel, a bodybuilder and former sports physiology professor, has used his platform to advise listeners to recognize and question negative self-talk and constant comparisons to others, suggesting that “Hating yourself as a motivation is the shortest fuse in the world.” These voices, sharing personal vulnerability and promoting healthier mindsets, offer a counter-narrative to the dominant messages of extreme perfection.
Social media also holds the potential to be a force for positive change by showcasing a wider diversity of body types, reminding viewers that there isn't a single, narrow definition of an attractive or valuable body. Will found this exposure particularly helpful in his own journey. “Something that helped me a lot was seeing on TikTok, YouTube — just seeing on social media people recognizing and sharing their attraction to all different types of people,” he shared. “I think seeing that bandwidth and understanding like, everyone is capable of being loved and attractive feels like it takes the weight off. You feel like you don’t feel like you have to earn it.” This exposure to diverse perspectives can help dismantle the rigid belief that only one type of body is worthy of acceptance or desirability.
These gradual cultural shifts, though seemingly subtle, are crucial components of the long-term effort to combat muscle dysmorphia and other forms of BDD. Experts agree that relying solely on affected individuals to recognize their problem and find their own way to recovery is insufficient. “If we’re going to rely on men to identify this themselves and find their own way out of it, that’s not going to happen,” Underwood states emphatically. Society as a whole needs to become more aware of muscle dysmorphia, destigmatize male body image issues, and actively challenge the harmful ideals that fuel this growing crisis. Only through a combination of individual support, increased public awareness, and a fundamental shift in cultural norms can we hope to effectively address the rising prevalence of muscle dysmorphia in men and boys.