‘Sometimes my son seems full, but he forces himself to eat more’

My 10-year-old son is dressing for school when I notice he has become very thin. He has always been lean, but with his T-shirt off I can see his ribs protruding. Instead of taking two sandwiches for lunch, he wants only one. He starts running to and from school and around the oval at recess. I find his snacks in the bin. Sometimes he reaches for a biscuit and checks himself. I try to squeeze calories into him.

He has seen another boy being teased about his weight and is worried. If he is not skinny, my son says, he will be a nobody. Some of the popular kids have thin arms. He thinks his arms are too fat so he wears long sleeves, even when it is boiling hot. I take him to a hospital eating-disorders unit as an outpatient. He meets the criteria for an Eating Disorder Plan and qualifies for up to 40 sessions of subsidised psychological help.

Four years later, my son starts going to the gym. He wants two sandwiches for lunch and a container of nuts and a supplement drink and cheese. He counts calories and grams of protein. He wants to put on 10 kilos. He starts talking about his wrist-to-forearm ratio, bulking and cutting, sets and reps.

His friends start going to the gym, too. They appraise each other’s bodies and lifting capacity online and in person. One boy tells him his forearms are too thin. YouTube’s algorithms bombard him with videos of oiled-up muscly influencers instructing him on how to improve his physique. He buys grip strengtheners and performs dead hangs from an overhead bar he installs in his bedroom doorway.

He puts on 10 kilos, but still feels skinny and weak. Among the social media accounts run by his classmates is one requesting comments on students’ appearances. Threats of physical violence are constant and made for the flimsiest of reasons. Boys he doesn’t like are bigger than him. They could bash him, and he imagines looking pathetic, lying on the ground. “Hypothetically,” my son asks me, “if someone punched me in the face, how hard would my head have to hit the ground for me to die?”

He wants to be the biggest in his class. He sneaks food. Sometimes he seems full, but he forces himself to eat more. The first time he vomits, it is loud and forceful and the rest of the family rushes to the bathroom at the ­centre of our small home. He says he is such an idiot. He is distressed because he has just lost all those calories.

Going to the gym makes my son feel confident, but he is scared people won’t like him if he loses weight. He goes more often and his workouts get longer. He puts on another 10 kilos, and it is still not enough. He feels like he’s in competition with every male in the world, even though he knows it’s a competition he can’t win. I try to give him smaller dinners.

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Dr Google diagnoses my son with muscle dysmorphia, a form of body dysmorphic disorder (BDD), also known as bigorexia. Both Eating Disorders Victoria and the Butterfly Foundation emphasise this is not an eating disorder, although one article by the Butterfly Foundation (“The Rise of Muscle Dysmorphia”) says, “the causes of muscle dysmorphia may be similar to other eating disorders, such as low self-esteem, perfectionism and the importance of appearance to one’s self-worth.” BDD is a subset of obsessive compulsive disorder, in which people focus on perceived physical flaws generally unseen by others. Suicide rates of BDD sufferers are high.

I tell an actual doctor I am worried my son has put on more than 20 kilos in nine months and is eating and exercising in an unhealthy manner. The doctor tells me he was probably underweight, and now he’s just catching up; his weight is in the healthy range. I tell him I understand that, but I am worried he is damaging his health. I want blood tests. I insist. Surely, his cholesterol will be high, and he will be shocked out of his behaviour. The doctor orders them but acts as if I am overreacting. When the tests come back fine, he is smug.

The doctor is not alone in failing to detect problematic eating and exercising behaviours in boys. The SCOFF test is a widely used five-question screening tool for eating disorders. Two or more yes answers to questions about: purposely vomiting; worrying about losing control over eating; losing more than six kilograms in three months; believing you are fat when others say you are thin; and thoughts about food dominating your life, indicate the possibility of an eating disorder. It is no surprise to me that a review of studies using the SCOFF test across 16 countries found significantly more disordered eating in girls.

Disordered eating in males often differs from the typical presentations in females, upon which almost all assessment and diagnosis tools are based. But an article in the British Journal of Psychiatry argued unhealthy eating and exercising in males “are comparable, in terms of the distress and disability that they engender, to the weight-control behaviours characteristic of ­eating disorders in females”.

Working out is good for you, but my son’s aim is to be big and strong, not fit and healthy. His body is his defence, his only social capital.

When I go through the list of psychologists Eating Disorders Victoria sends me, none treats children for BDD. The few that I find myself have year-long waiting lists. I contact researchers and enrol my son in a university study that confirms his diagnosis.

While he spends up to “three hours per day thinking about his appearance and performing appearance-related behaviours” including going to the gym and checking his body in reflective surfaces, he does “not meet criteria for an eating disorder, given his eating behaviours are intended to help him gain weight and vomiting is accidental rather than a compensatory behaviour”. He does not qualify for the 40 sessions of subsidised psychological therapy provided by an Eating Disorder Plan. But given I can’t find an expert to help him within a reasonable time frame, this is a secondary concern.

Sometimes I think, “at least he is not drinking, taking drugs or sitting in front of a screen”. He occasionally meets other kids at the gym and no longer hangs out with boys who criticise his body. But even the kind boys reinforce his behaviour with their own insecurities, encouraging each other to improve their benching records and mindsets. Working out is good for you, but my son’s aim is to be big and strong, not fit and healthy. His body is his defence, his only social capital. He is always tired; he doesn’t socialise, has no time for homework and his concentration and schoolwork suffer.

Talking to my son and other parents, I am stunned at the number of boys we know who are consumed by concerns about their muscularity. Australian research published in 2016 found 60 per cent of males were ­dissatisfied with their bodies. In a survey of 20 US urban high schools, more than 90 per cent of boys said they exercised more to build up their muscles in the past year. Between one quarter and a half of adolescent boys in Australia use protein powder to build muscle; this and other supplements are part of a growing multibillion-dollar industry.

Eventually, I get an appointment with a psychologist. The treatment for BDD is exposure therapy, but my son cannot imagine taking a single small first step towards eating and exercising less. He can’t imagine a time when worrying about his body is not a part of his life.

One night I watch him struggle to finish his plate after he has eaten more than his share of bread. I warn him he will be sick. He says he will not. When I hear choking and a gush of vomit from behind the bathroom door for the sixth or seventh time, I lose my cool.

I tell my son this is ridiculous. From now on, I will control what he eats. When he has brushed his teeth, we sit together on the couch, and he tells me very calmly that if I want to do that and he has a bad day which he links to being skinny, he will kill himself.

I backtrack very quickly, and discuss it with the psychologist. We hope he is just expressing how upsetting the idea of change is. Of course, there is no taking risks. I observe him closely and make him promise he will always talk to me if he feels like hurting himself.

Given his resistance to change, there is no point ­continuing therapy. I decide, in the end, that I can do nothing to stop him overeating and vomiting or spending hours at the gym six days a week. I hope that time, talking with him regularly and moving to a less poisonous school environment will help.

Adolescence is brutal. When I sit on the edge of my son’s bed and tell him it is the person you are that ­matters, that can give you real confidence – if you are kind, generous, a good friend – I know my words will be buried within hours by the relentless, toxic torrents of electronic sludge spewing from his peers and the likes of Andrew Tate.

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But male body image ideals are not created from these extremes alone. My son, now 15, does not look unwell. He looks, in fact, fantastic. He is five foot 10 and 74 kilograms of muscle. In the past year and a half, his body mass index has moved from being in the lightest 20 per cent for his height and age to the heaviest. His regimen is vindicated by positive feedback. People who have not seen him recently comment on how much he’s grown, how good he looks. Men ask if he is working out, slap him on the back, shake his hand firmly and say, “Good on you!” or, “Don’t bash me!”

One day, he comes out of the gym while teenagers are harassing passers-by. He tells me that when he hears one suggest they follow him, another says, “No, look at the size of him.” Even I, hearing this, am secretly glad his body has protected him.

Our kids are suffering, with both eating disorders and muscle dysmorphia on the rise. My son has experienced both, even though the thoughts and behaviours are effectively the same, flipped 180 degrees. Every child deserves timely access to effective treatment and we, as a society, need to question the body image and gender role messages we’re sending boys. I’m so glad Australian of the Year and body image activist, Taryn Brumfitt, has used her platform to raise this issue. So many gorgeous young men are standing before us, needing our help. But when you don’t know what you’re looking for, it’s hard to see them.

* Name has been changed for privacy reasons. Lifeline: 13 11 14; Butterfly Foundation: 1800 33 4673.