Males account for approximately a third of individuals with eating disorders in the United States, with estimates suggesting as many as 14% of American men experience an eating disorder by age 40. Despite this prevalence, recognition of these conditions remains inadequate, particularly for muscle dysmorphia, which overwhelmingly affects males and involves hyperfixation on muscle development.
Muscle dysmorphia is presently classified under obsessive-compulsive and related disorders in the DSM diagnostic manual, though it frequently co-occurs with extreme dieting behaviors. Jason Nagata, an associate professor of pediatrics at the University of California, San Francisco, proposes reclassifying the condition as an eating disorder in the upcoming sixth edition of the DSM. He argues this change would enhance physician recognition, improve specialist referrals, and strengthen insurance coverage for affected individuals. However, this proposal remains contested within the medical field, with some experts contending the current classification is appropriate and that eating disorder diagnoses can be applied concurrently when necessary.
The current diagnostic criteria for muscle dysmorphia require preoccupation with muscularity or perceived insufficient muscularity, repetitive behaviors such as mirror-checking, and significant functional impairment. A defining feature of the current classification is mutual exclusivity with eating disorder diagnoses—patients cannot simultaneously meet criteria for both conditions. Nagata contends this distinction is problematic because eating and exercise behaviors are intrinsically linked, and many individuals develop disordered eating specifically to achieve muscularity goals, yet lack a specific diagnostic category that captures this combination.
In clinical practice, boys and men presenting with muscularity concerns and disordered eating often receive diagnoses of unspecified feeding and eating disorder rather than a condition-specific label. Treatment access remains limited due to sparse research and few available specialists. Additionally, males frequently experience double stigma when seeking care, as eating disorders carry associations perceived as feminine, creating barriers to identification and treatment engagement.
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