Males account for approximately one-third of individuals with eating disorders in the United States, though this population remains underrepresented in clinical recognition and treatment. Some estimates indicate that as many as 14% of American men experience an eating disorder by age 40, and research suggests they may face higher mortality rates from these conditions compared to women.
Muscle dysmorphia, a condition characterized by preoccupation with muscularity and hyperfixation on muscle building, overwhelmingly affects males. The condition is currently classified under obsessive-compulsive and related disorders in the DSM, though it frequently involves extreme dieting practices. Jason Nagata, an associate professor of pediatrics at the University of California, San Francisco and an eating disorders specialist, has advocated for reclassifying muscle dysmorphia as an eating disorder in the upcoming sixth edition of the DSM.
Under the current classification system, muscle dysmorphia diagnostic criteria include preoccupation with insufficient muscularity, repetitive behaviors such as mirror-checking, and clinically significant distress or impairment in functioning. However, a critical limitation exists: individuals cannot simultaneously receive diagnoses for both muscle dysmorphia and eating disorders under existing DSM definitions. Nagata argues this mutual exclusivity creates diagnostic challenges, as eating behaviors related to muscle-building goals—including high-protein diets, carbohydrate or fat restriction, and intermittent fasting—are inseparable from the pursuit of muscularity.
In clinical settings, many males presenting with muscularity concerns and disordered eating patterns receive a diagnosis of “unspecified feeding and eating disorder” rather than a specific muscularity-focused diagnosis. Nagata contends that reclassification would improve physician identification of affected patients, increase specialist referrals, and enhance insurance coverage. However, this proposal remains debated within the medical community, with some experts maintaining that the current classification is appropriate and that dual diagnoses can be applied when clinically indicated.
Treatment access for muscle dysmorphia remains limited due to sparse research and few specialized providers worldwide. Boys and men seeking care often experience stigma related to conditions perceived as feminized and may feel isolated in treatment settings primarily serving patients with other eating disorders.
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