For several decades, much of the focus on body image disorders has focused on females. In American society, the feminine ideal is to appear thin. Males, however, are encouraged to be muscular. Lately, we are witnessing a shift in how males perceive their bodies.

Many of today’s young males want a strong body; specifically, they want more muscles. With action figures such as Batman, Captain America, and Superman to magazine covers boasting “Double your muscle!” and “Bigger arms now!,” it’s no wonder that teens view being chiseled and ripped as the ideal male body image.

It’s one thing to play with an action figure or peruse a magazine, but it’s quite another to think obsessively about becoming muscle-bound and to diet and exercise compulsively to look this way. Sound like obsessive compulsive disorder (OCD)? Yes. Sound like an eating disorder? Yes.

What I have just described is a psychiatric disorder known as muscle dysmorphic disorder (MDD). According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the authoritative guide to the diagnosis of mental disorders used by medical care providers, MDD is actually a type of body dysmorphic disorder (BDD), which is a type of OCD. (How confusing is that?) Individuals with BDD:

  • Have a preoccupation with one or more nonexistent or slight defects or flaws in their physical appearance.
  • Perform repetitive, compulsive behaviors in response to their concerns about appearance.
  • Experience significant distress or impairment in social, occupational, or other important areas of functioning due to the preoccupation.

For individuals with MDD, popularly known as reverse anorexia or bigorexia, the body type desired is not thinner as we see in anorexia nervosa, but bigger and more muscular. Driven by the fear of not being muscular enough, individuals with MDD exercise compulsively, restrict their diets, take protein and other supplements, and even use performance-enhancing drugs such as steroids.

Some researchers believe that MDD is really a male eating disorder. It should be noted that MDD can also be seen in females, it’s just less common. Athletes are particularly at risk because of the societal pressures surrounding sport performance and appearance.

Despite actually having high levels of muscle development, individuals with MDD are preoccupied by irrational thoughts that their muscles are too small. This can cause significant psychological distress, even mood, social, and anxiety disorders. They may also be preoccupied with other body areas, focusing on hair, skin, or penis size.

Some health risks associated with MDD include muscle and joint injuries from overtraining, heart disease, kidney failure, and infections. Individuals with MDD are at higher risk of suicide and substance abuse.

Since people with MDD usually start off in good health, their condition may go unrecognized and untreated for a long time. So how do you know whether your teen has crossed the line and might have MDD? Here are some things to be on the lookout for:

  • Excessive time spent at the gym or weightlifting.
  • Panicking if they cannot workout.
  • Working out even when injured.
  • A change in eating behavior including special diets or protein supplements.
  • Compulsive comparing and checking of one’s physique.

Exercise, exercise, exercise. That’s what we’ve all been hearing is good for our children (and the rest of us, too) … unless they’re being obsessive and compulsive about it. If you are worried about your child having MDD, start the conversation about what you are noticing while making an appointment with your child’s primary-care provider. The consequences of MDD should not be taken lightly.

Rima Himelstein is a pediatrician and adolescent-medicine specialist at Nemours/Alfred I. duPont Hospital for Children.