The job of Army leaders is to lead the mission and take care of their soldiers. In order to take care of their soldiers, leaders must be aware of soldiers’ ailments, especially those not widely known or represented. When it comes to mental health treatment, the Army largely neglects issues like body dysmorphic disorder and, specifically, muscle dysmorphia.

Body dysmorphic disorder (BDD) is often grouped by psychologists with eating disorders like bulimia nervosa, anorexia nervosa and binge eating. BDD is a mental health condition in which a person can’t stop thinking about one or more perceived defects or flaws in their appearance, to the point that it causes disruption and distress in their life.

What’s familiar in the common narratives about these disorders? Eating disorders and BDD are branded as female issues. And while women remain in the majority of individuals diagnosed with eating disorders, there is a growing and neglected minority of men with eating disorders.

Since the 1980s, with the growing popularity of bodybuilding, there is an increasing population of men whose lives have been dramatically impaired because of an obsession with appearance and performance. A term has been coined to describe the obsession: “bigorexia,” otherwise known as muscular dysmorphic disorder (MDD), a specific type of BDD characterized by the preoccupation that one’s body is not sufficiently muscular.

Several factors can impact a person’s likelihood of developing MDD, including age, sports participation, former obesity—and participation in the military.

The emphasis placed on physical abilities and appearance in the Army is ingrained in every service member’s mind. Because of the service’s historic roots in combat, the culture of the military is institutionally built around physical prowess. This prioritization is evident in Army culture, exemplified right down to the Soldier’s Creed: “I am disciplined, physically and mentally tough, … I always maintain my arms, my equipment and myself.”

Fear of Judgment

This cultural emphasis on self-discipline, on maintaining combat readiness, depends heavily on fear of judgment as a motivational tool. Whether right or wrong, many soldiers judge their fellow soldiers’ competency partly on physical appearance. An impressive physical appearance reflects bearing and discipline, while a soft physique is thought to reflect laziness. A soldier’s judged competency is directly tied to their physical ability in social perception and in standardized requirements.

But these young men’s lives are also influenced by societal pressures outside the military. For younger service members, the second large developing cultural emphasis is the “fitspiration” movement on social media platforms that aims to inspire users to exercise and be healthy. Young males are flooded with videos and images of men with bulging muscles. They read comments that applaud the efforts taken to build those muscles, regardless of whether those broadcasted efforts are honest or healthy.

It’s not new that a muscular aesthetic would increase a man’s sexual desirability, but social media amplifies a message of shame to a magnitude no former generation has contended with during their years of sexual development. 

Tying a service member’s worth and competency to their physical ability in their workplace, coupled with tying their worth and desirability to their physical appearance in their social lives, might be the reason there has been a rise in male eating disorders in recent years, particularly among young service members.

Thirteen percent of male service members meet the criteria for BDD, significantly higher than the general population prevalence rate of 1.7%–2.4%, according to a  survey of 1,150 service members conducted at Joint Base San Antonio-Fort Sam Houston by Army adolescent medicine pediatricians Dr. John Campagna and Dr. Barbara Bowsher. Nearly 22% of female service members meet the criteria for BDD.

Serious Concern

This is not a light diagnosis to be brushed off as an “adolescent phase.” BDD is detrimental to a person’s well-being. Patients with BDD have significantly higher chances of developing eating, substance abuse and personality disorders, as well as major depressive and anxiety disorders, Campagna and Bowsher reported. “The impairment of BDD leads to a much higher rate of suicidal ideations and attempts,” their article in the May 2016 edition of Military Medicine said, adding that about 25% of those with BDD will attempt suicide at least once. Military Medicine is the bimonthly journal of the Association of Military Surgeons of the United States.

There remains insufficient mental health treatment in the military, an issue in itself. Issues like muscle dysmorphia are grossly neglected. At the very least, there should be more of a conversation centered around the real harm and danger of MDD and of partaking in extreme diet, dangerous supplements and exercise to the point of harm.

Having this conversation falls to the leaders of these young men: their commissioned and noncommissioned officers.

Leaders must recognize, confront and mitigate BDD and MDD in young soldiers.

Specifically, look for the signs of BDD and MDD, which include soldiers expressing distress or anxiety about disruptions in strict diets or workout routines; anxious behaviors; constantly comparing themselves; avoiding social activities; and other concerning behaviors.

If a soldier exhibits these symptoms, a leader should approach them, talk to them, support them and, most of all, direct them toward a mental health care professional who will provide effective cognitive behavioral therapies as the soldier navigates their mental health path.  

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Cadet Frankie Henderson is completing her senior year at Colorado State University. She will graduate with a bachelor’s degree in psychology, political science and interdisciplinary liberal arts. She will commission as a second lieutenant in field artillery, then attend the Basic Officer Leaders Course at Fort Sill, Oklahoma, in January.