Does Your Kid Have Muscle Dysmorphia?
AS A PARENT, caregiver, or coach, seeing a kid get pumped about fitness and strength can feel kind of amazing. Especially when you consider that only between 21 to 28 percent of kids ages six to 17 engage in 60 minutes of physical activity every day, according to the latest data from the Physical Activity Alliance. (Covid didn’t make things any better, either, with childhood rates of inactivity increasing.)
So when your son or daughter says they want to start working out more, the question you may ask yourself is 'How can I help?' Which is great, because active, healthy kids often grow into active, healthy adults. But there’s another important question you may want to ask, too: 'Why?'
Maybe it's because your kid wants to perform better at sports, or they genuinely love how working out makes them feel. But there are other not-so-healthy reasons that may signal something deeper might be at work.
Researchers are beginning to better understand the psychological effects behind conditions called body dysmorphia and muscle dysmorphia – and how these conditions can endanger the physical and mental health of kids. Clinicians, too, are slowly diagnosing and treating more children for body and muscle dysmorphia. And research shows that the disorder is on the rise in kids. The risks are real: over-training that can cause bodily injury, disordered eating, dehydration, and malnutrition. Kids who have body and muscle dysmorphia may also take supplements, which can carry dangerous side effects.
What Are Body Dysmorphia and Muscle Dysmorphia?
Body dysmorphic disorder is a condition where a person becomes obsessive and/or compulsive with a flaw within their physical appearance that others don’t see, according to the National Eating Disorders Association. "Flaws" can include skin and hair appearance, but also specific body parts like the nose. This negative self-perception can result in shame, disgust, anger, anxiety, and depression. About two percent of the population suffers from body dysmorphia, and the disorder is more common in adolescents, according to the Body Dysmorphic Disorder Foundation.
Then there’s muscle dysmorphia, a subset of body dysmorphia, where the person believes that their body is too small or not muscular enough and bulking up becomes an obsession. You may have also heard of the disorder called 'bigorexia' or 'reverse anorexia.' Like with body dysmorphia, the prevalence is rare. Studies estimate that roughly two percent of adolescent boys have muscle dysmorphia, and that percentage increases with age, peaking in later adolescence and early adulthood among men. Experts are also speculating that the condition is rising due to social media use among teens. Boys are more likely to suffer from muscle dysmorphia than girls, and weight lifters and competitive athletes face a higher risk compared to people who are not athletes.
What Are the Signs of Muscle Dysmorphia?
Some are overt; others covert. In general, 'warning signs include when boys develop preoccupations or obsessions with their muscles, appearance, weight, food, or exercise in a way that worsens their quality of life and impairs their social, school, or daily functioning,' says Jason Nagata, M.D, M.Sc., an associate professor of pediatrics in the Division of Adolescent & Young Adult Medicine at University of California, San Francisco. (Nagata is a leading muscle dysmorphia researcher and clinician and is featured in Generation Flex.)
What muscle dysmorphia may look like in a person:
No longer eating with families or friends
Skipping meals
Anxiety/anger when exercise routine disrupted
Obsessive mirror checking
Following diets that are high protein/low fat
Preoccupation with certain body parts (biceps, abs, etc.)
Withdrawal in activity from usual activities and/or friends
Regular use of muscle-building supplements (protein powder, creatine, etc)
Use of anabolic steroids
Excessive exercise duration and/or frequency
Preoccupation with muscle- or fitness-centric social media
What Are the Risks of Muscle Dysmorphia?
They’re serious – which means that parents, caregivers, and coaches can play a huge role in getting kids help.
Development of disordered eating and eating disorders
Dehydration and malnutrition
Frequent nausea and vomiting
Extreme fatigue/lack of focus
Muscle and/or joint injuries
Increased risk of depression, anxiety, obsessive-compulsive disorder, substance use, suicidal ideation
Steroid use, which can lead to extreme aggression, irritability, paranoia as well as kidney, liver, and heart problems
If you’re already seeing the warning signs or – worse still – the risks, it's time to discuss all this with your kids. The Body Dismorphic Disorder Foundation recommends avoiding discussion about your child's appearance, and instead focus on the distress it's causing them or others.
If the problematic behaviour continues, it’s time to call in professional help. 'Parents should raise these issues with a health care provider who may be able to assess for an eating disorder and provide appropriate referrals,' Dr. Nagata says. 'Eating disorders and muscle dysmorphia are best supported by an interdisciplinary team including a mental health, medical, and nutrition provider.'
You can also always reinforce healthy messages around health and fitness at home.
If possible given sports and activity schedules, consider 'family meals, which offer an opportunity to model healthy food choices and foster open communication about eating behaviours,' Dr. Nagata says. 'These shared meals also allow parents to monitor their child’s eating habits and address any concerns early on.' And notice the emphasis on "more." Even if you all never gather for a meal, sharing one meal weekly counts as "more."
He also says to keep discussions about muscles, weight, and appearance to a minimum. 'Conversations that centre around muscularity, body weight, or dieting are linked to unhealthy behaviours and disordered eating. Instead, parents should emphasise healthy eating and physical activity, focusing on well-being rather than appearance.'
That also means discouraging weight-related or appearance-related teasing within the family, Dr. Nagata says. 'Negative comments about weight or appearance can increase the likelihood of children engaging in harmful weight control behaviours. Creating a positive and accepting environment helps foster a healthy relationship with food and fitness.'
And while talking about all this is important, so too is modelling positive behaviours. So if you're big on doing the latest detox or diet – or you find yourself complaining about how your body looks – your kids may notice too.
Visit USADA.org for more information on the risks of steroids, supplements, and other performance-enhancing substances.
Lead animation by Cameron Sherrill.
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