Going to the gym. Drinking protein shakes. Eating “clean.” These habits can be associated with a healthy lifestyle. 

But for some boys and young men, what begins as a fitness goal can quietly become something much more serious. “Bigorexia,” also called muscle dysmorphia, is a condition in which the pursuit of muscle becomes an obsession. 

Leah Jesse, MD, child and adolescent psychiatrist, explains what it is, why boys are particularly vulnerable and what families should watch for.

What is bigorexia?

Bigorexia is an extreme, obsessive preoccupation with building muscle mass. It has its roots in both eating disorders and body dysmorphic disorder, combining a distorted perception of one’s body with compulsive behaviors around food and exercise.

Like anorexia, bigorexia involves a relentless focus on changing the body. But instead of wanting to be thinner, a person with bigorexia wants to be bigger and more muscular, no matter how much muscle they already have. 

“The amount of time and preoccupation with this takes up extensive periods of their day,” Dr. Jesse says. “It causes functional decline and limits engagement in activities they previously enjoyed.”

While bigorexia can affect anyone, Dr. Jesse says it is mostly seen in boys and young men. 

“It’s driven by ideals of masculine appearance and having muscle mass,” she says. “Women’s beauty standards are not focused on the same things, so I think of this as being a bigger issue for the male community.”

Why it often goes unnoticed

One of the reasons bigorexia can be so easy to miss is that it hides in plain sight. Going to the gym, tracking protein and caring about fitness are all culturally celebrated – especially for young men. 

“It can be covered up because it may look like typical, normative behaviors of gym culture,” Dr. Jesse says. “But when it gets to a more extensive level, it becomes a problem.”

The diet associated with bigorexia often involves extreme restriction, focused almost entirely on high protein intake, which can actually harm overall health. 

“You’re not going to get the balanced nutritional input and vitamins you need,” Dr. Jesse says. “So, you’re putting your health at risk by trying to change the way you look.”

Warning signs to watch for

Because bigorexia can look so much like healthy behavior on the surface, it is important for parents and loved ones to know the signs that something more serious may be going on:

• Workouts that feel mandatory. Skipping the gym causes significant anxiety or distress.
• Highly restrictive eating. Often focused on protein intake, with avoidance of other food groups.
• Frequent body checking. Measuring muscle mass, monitoring weight, taking progress photos or flexing in the mirror repeatedly.
• Withdrawal from social activities. Avoiding events that might interfere with workouts or eating schedules.
• Spending significant money. The cost of gym memberships, fitness gear, supplements and other muscle-building products adds up.
• Use of performance-enhancing drugs. Anabolic steroid use is associated with bigorexia.

The risk of steroids and supplements

The desire to build muscle quickly can make young men with bigorexia particularly vulnerable to steroid use. Dr. Jesse says this is an area of serious concern. 

“Steroids have enormous risks, particularly to mental health,” she says. “We can see extreme mood changes, increases in aggression, anger, outbursts and violence.”

Dr. Jesse also notes that steroids obtained outside of a medical setting carry extra risks. 

“Most of the time, they’re unregulated and not coming from a medical doctor,” she says. “The dose is not monitored, and it’s not clear what’s actually in them.” 

Physical health effects – particularly those affecting hormonal and sexual health – are also significant risks.

The role of loneliness and belonging

Bigorexia does not develop in a vacuum. Dr. Jesse says that loneliness and social isolation are significant underlying factors for many of the young men she sees. 

“Boys can struggle to form deep and meaningful relationships with peers in which they really feel seen and supported,” she says. When those needs go unmet, they can be drawn to online communities – including fitness and bodybuilding spaces – that offer a sense of purpose and belonging, even if those communities promote unhealthy ideals.

“They’re spending a lot more time alone at home, not going through these coming-of-age experiences,” Dr. Jesse says. “It’s led to a lot of feelings of isolation and feeling left behind and misunderstood.”

How bigorexia is treated

Recovery from bigorexia typically involves working with a trained mental health professional. 

Cognitive behavioral therapy, which focuses on identifying and challenging distorted beliefs about the body, has the strongest evidence base. Exposure and response prevention therapy, which helps people resist compulsive behaviors like body checking or rigid eating routines, can also be helpful.

“You can explain those concepts and they sound intuitive,” Dr. Jesse says, “but actually going through the work and replacing those behaviors is really challenging. It requires working closely with someone who can guide you through it.”

Medication, particularly a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), may also be effective. This is especially true if depression or anxiety are present alongside muscle dysmorphia.

For parents trying to encourage a loved one to seek help, Dr. Jesse recommends leading with curiosity and compassion rather than confrontation.

“If we push young people and say, ‘You need to do this’ or ‘You’re hurting yourself,’ that’s not going to resonate,” she says. “Instead, focus on values: What do you really care about? What do you want your life to look like? Is the path you’re on getting you there?”