Men and Eating Disorders: Bigorexia and the Invisible Group

“This isn’t an eating disorder. It’s just discipline.”

A man of twenty-nine who came to my room because of anxiety and insomnia. We did not talk about food or his body for the entire first month, because it did not seem important to him. Then he mentioned in passing that he had not gone to a friend’s wedding, because he did not know what there would be to eat there or when. He said it as a logistical detail. At that moment it was clear to me that we had been talking about something quite different from what I had assumed.

A man with an eating disorder does not usually arrive with an eating disorder. He arrives with insomnia, anxiety, irritability or a problem in his relationship. And often he does not know – genuinely does not know – that he has what he has.

Men are not rare, they are rarely recognised

For a long time it was believed that eating disorders in men were an exception. When large population studies asked the general public rather than clinics, it turned out that men make up a considerable share of all cases – and with binge eating disorder the ratio between the sexes is close to even. The impression of rarity was largely created by where we were looking, not by reality.

The reason men are not visible in clinics has three parts. They do not come themselves. The people around them do not think of it. And the criteria by which we recognise the disorder were developed with women – questions about body image were framed for decades in a way that a man in distress does not recognise himself in, so he answers no.

Research on self-stigma shows exactly this: being male and feeling shame about seeking treatment together predict a greater likelihood that an eating disorder will go undiagnosed. Not rarer. Undiagnosed.

Bigorexia: what it actually is

Muscle dysmorphia, often called bigorexia in everyday speech, was first described in the 1990s. It is a persistent and tormenting conviction that the body is not muscular enough, which does not budge even when everyone else says the opposite. It is classified among body dysmorphic disorders – a group whose core is a distorted view of one’s own body – rather than among eating disorders in the narrow sense.

But the line between them is not sharp. In many people they overlap: the same inner mechanism, only a different direction. Instead of self-worth being measured by less, it is measured by more. The preoccupation, the rigidity, the withdrawal from company and the self-punishment when the plan is not met are the same.

That is also why diagnosis is not the most interesting question here. The interesting question is how much of a life goes into it and what happens when the plan fails. I have written about what a diagnosis is and is not in the piece on who is allowed to diagnose.

Why in men it looks like a virtue

This is where the difference between the sexes is greatest. A woman whom food has taken over will sooner or later meet someone who becomes concerned. A man whom his body has taken over gets applause. Endurance, order, self-discipline – in the male world these are words of honour. Someone who does not go to a party because he has his own schedule counts as serious. Someone who never gives way counts as solid.

So for men the feedback from the outside is systematically wrong. Every step deeper is rewarded with a little respect. The sign that something is not right does not come from outside – it comes only once a man notices for himself that his world has narrowed to a single subject and that it is making him ill.

Often there is also an inner critic behind it, which in men speaks less about appearance and more about sufficiency: you are not enough, you cannot take enough, others manage more. The body is simply the arena where that sentence is easiest to test.

What a culture of images has done

An interesting detail from the research: at the end of the 1990s a group of researchers compared male action figures from different decades and showed that over time they had shifted markedly in a direction that is unattainable in a real body. The conclusion was not that toys cause disorders. The conclusion was that the cultural ideal of the male body had moved, and had moved faster than our understanding of the consequences.

Today this happens on a screen, every day, without pause, and the comparison is no longer with ten acquaintances but with the curated and edited image of countless strangers. Constant comparison is one of the few risk factors that research confirms fairly consistently – and at the same time the hardest to remove, because it is built into the devices we carry in our pockets.

What stops a man at the door

When I ask such a man why he did not come sooner, I almost always get one of four answers. That he did not know this was even a thing. That it seemed to him a women’s problem and he would feel odd in the waiting room. That it is not bad enough. And the commonest one: that he ought to sort it out himself.

That last answer is in fact the same logic that created the problem. The conviction that a man must manage alone and that asking for help is evidence of weakness is the very conviction driving everything else. I have written about why men come to therapy later, and usually only at a breaking point, in the piece on why men arrive later.

What changes in therapy

The first thing that usually changes is not behaviour but language. As long as the whole thing is “discipline”, there is nothing to discuss – discipline is a good thing, after all. Once a man names for the first time what is actually happening, a space opens that was not there before.

Then we talk about what this thing is for. Almost always it turns out to be doing a job: calming anxiety, providing a sense of predictability, or being the one place where a man can be proud of himself. Until something else does that job, taking it away makes no sense.

The third part is practising flexibility in small things. Not large decisions, but one place where a rule gives way, and then watching what actually happened. As a rule, less than fear predicted. And this is where the hardest thing usually appears for men: self-compassion, which many find alien and superfluous until they try it.

What the people close to him see

It is interesting how often this subject enters the room through a relationship. A partner does not say she is worried about food – she says he has become absent, that he is no longer there for shared evenings, that he is unpredictably irritable, and that at home everything gives way to a schedule she does not understand and cannot negotiate about.

In men this is often the first external signal: not the body, but the narrowing of the world. The plan first displaces spontaneity, then friends, then holidays. Each individual absence has a reasonable explanation and none of them can be argued with. Only when you stack them one on top of another does the pattern show.

I usually advise those close to him the same as with all these subjects. A comment about his body or his food opens a defence and nothing else – and with a man even faster, because it reads as doubt about his self-discipline. A question about room is more useful: does this leave you less time for things that mattered to you? That is a question a man cannot easily explain away, because he already knows the answer.

And one more thing worth knowing: the irritability and insomnia these men often arrive with are not character traits. They are frequently the physiological consequence of prolonged deprivation and continuous tension. Once that settles, a good deal of what looked like personality steps aside on its own.

Where this article does not apply

Now against myself, because it would be dishonest otherwise and could do harm.

Regular physical activity is not a disorder. Ambition is not a disorder. Elite sport demands precision, planning and going without, and all of that is legitimate. A man who takes movement seriously and has a clear structure to his day is most often entirely fine. If this piece were read as saying that anyone who goes to a gym is suspect, it would do more harm than good.

The difference is not how much effort someone puts in. The difference is what happens when he cannot put it in. If the lapse is unpleasant and the day carries on, all is well. If the lapse is a moral event and the day collapses, then we are not talking about fitness but about where a man stores his worth.

And one more honest admission: the research base for men is thinner than for women. Most studies were done on women, the measurement tools were developed on women, and part of what I have written here is transfer rather than direct evidence. That should be said, not hidden.

When a doctor comes first

When the body is affected, therapy is not the first port of call. Heart rhythm disturbances, fainting, rapid deterioration, marked changes in mood – those belong in a surgery.

This holds especially for substances some people take to change their bodies. I will not write about how they are used, because that does not belong here. What I will say is what matters: these are drugs that seriously affect hormonal balance, the heart and mood, and stopping them suddenly is not necessarily safe. If this concerns you, a conversation with a doctor is the first step, not the last, and there is no need to feel ashamed of it. I have written about when the order runs that way in the piece on when a doctor is the first step.

What to remember

Men with eating disorders are not rare, they are unrecognised. The criteria we search with were built around women, men do not come forward themselves, and those around them do not think of it.

Bigorexia, the persistent conviction that the body is not muscular enough, is classified among body dysmorphic disorders, but it shares a mechanism with eating disorders: self-worth measured through the body and through control. Only the direction differs.

With men, the people around them systematically give the wrong feedback, because this direction looks like a virtue. So the signal that something is wrong usually comes from within rather than from outside – and it arrives as tiredness, not as fear.

At the same time, not every commitment to movement is a disorder. The measure is not the amount of effort but what happens when you cannot make the effort. And when the body is at risk, or substances for changing the body are involved, a doctor comes before everything else.