Konrad Stoick felt painfully skinny as a teenager growing up in Texas. He started lifting weights at 15, but it wasn’t until he got to college that he got really serious about exercise and nutrition. He was ready for a change—to be perceived as someone desirable and capable of achieving things.

For Stoick, that meant being ripped. And that became his new identity: “I became the person who was known for being in the weight room and for being one of the big Asian guys on campus,” he says. This was a change from the way he’d been perceived before. Stoick, who has a Taiwanese mother and a white father, thinks that Asian American men “have always been depicted as asexual and undesirable. You see that growing up…and you want to buck that stereotype. And one thing in your control is your physique.”

So he worked hard on exerting that control. “It becomes this goal with no end in sight,” he says of the compulsion to keep adding muscle mass. “You want to feel how you look.” The disconnect between the hours he was putting in at the gym and the inevitable plateau was frustrating. It wasn’t until he was out of college, and being exposed to more lifestyles, body types, and life experience in general, that Stoick began to realize that his mental relationship with exercise wasn’t healthy. He was missing out on parts of his life because of the rigid structure he’d built around frequent gym sessions and meals. He was basing his self-worth on his physique and it was beginning to become a problem.

Muscle dysmorphia is an obsession with muscularity and leanness—rather than athletic performance or function—to the point of disrupting social and work life, as it did for Stoick. “[It's] ‘I can never be big enough, I can never be lean enough,’” says Timothy Baghurst, an associate professor of health and human performance at Oklahoma State University. (For Baghurst, his interest in the disorder has personal as well as professional implications.) In its most extreme forms, muscle dysmorphia can lead to heart failure and renal failure, as well as myriad psychological harms.

Sometimes known as bigorexia, muscle dysmorphia still isn’t well understood. “The actual clinical diagnosis is very unclear," Baghurst says, "we’re really in our infancy." Muscle dysmorphic disorder (MDD), as its known clinically, has only been a topic of research for about 20 years. Although it's included in the DSM-5 as a subtype of body dysmorphia disorder, Baghurst says that psychological assessment tools like the Drive for Muscularity Scale and the Muscle Dysmorphia Inventory aren’t universally used. Nor are they designed to diagnose someone, as they’re more for reference.

Furthermore, only in recent years has there been attention paid to intersectional identities, such as ethnicity, sexuality, and immigration status when it comes to muscle dysmorphia, says Brian TaeHyuk Keum, a researcher in counseling psychology at the University of Maryland, College Park. While exact prevalence rates are unknown, Baghurst says that the disorder affects only a minority of the men who are interested in fitness and exercise. In other words, it wouldn’t apply to a casual CrossFit enthusiast or gym-goer.

In the US, the idealized male body type has gotten substantially more muscular over the past 50 years, while the idealized female body type has gotten substantially thinner. This socialization starts young: Six-year-old boys talk about wanting to be muscular. Even action figures are more jacked than they were in the ‘60s.

It would be hard for anyone to meet the superhero fantasy shape. But that body type may be especially out of reach for many Asian American men, who on average are smaller than other races (although there are significant differences within the “Asian American” grouping, including biracial men like Stoick). Compared to white men, Asian American men have been shown to have a larger disparity between their actual body image and their ideal.

American pop culture is full of jokes at the expense of Asian men, frequently stereotyping them as weak and effeminate. And it's clear from psychology research and personal stories that plenty of Asian American men are internalizing these stereotypes.

“It’s not an ideal norm for Asian men, because it’s white men that they’re comparing themselves to,” Keum says. Keum has identified at least two psychological phenomena affecting Asian American men’s body image: social comparison and acculturative stress. Social comparison, or the tendency to compare yourself with the people who are closer to the societal ideal, is difficult for Asian American men because of the inadequacy of media portrayals and the lack of diverse role models.

“They’re looked at as the stereotypical weak link or nerd,” Keum says in pop culture. (In fairness, more recent characters like Glenn Rhee from The Walking Dead have brought some refreshing variety to the table.) Social comparison is powerful: Keum’s research shows that Asian American men who compare themselves more to media images are generally less happy with their bodies. The college students he’s studied are also less satisfied with their muscularity than white men.

Meanwhile, acculturative stress—the psychological burden that comes with navigating different cultural affiliations—has been linked to depression, cultural isolation, and suicidal ideation among Asian Americans. This uniquely affects immigrants and descendants of immigrants, as different masculinity ideals are present in Asia.

The cultural pressures facing Asian American males include the hypercompetitive pressure Asian American families often place on kids, which can extend to the way boys compare their bodies to others’. Keum adds that there are “very high masculinity deals” among certain Asian American groups, such as Hmong Americans. And Baghurst points out that “there is a societal issue with shame” in certain Asian cultures that is likely to affect their ability to seek help.

Keum has seen this as well: “Asian American men have high levels of stigma when it comes to seeking help," he says. That's particularly concerning when it comes to a mental health issue like body dysmorphia, which is already too-little discussed as an issue that affects men. “There’s a lot of saving face norms” in many Asian communities, Keum says, which inhibits the ability to seek help or learn that others might be experiencing the same difficulties.

Baghurst feels that everyone—friend, coach, trainer, therapist—has a responsibility to look out for the warning signs of muscle dysmorphia: a preoccupation with muscularity, a distorted self-image, body dissatisfaction, and an obsession with an idealized body type. Early signs of physical distress include slow-downs in heart rate, blood pressure, and body temperature. However, it can be very hard to actually help, especially if someone is being praised for massive muscle gains and spending time with others who fuel their delusions, particularly in the bodybuilding community.

Keum points out that it’s necessary to address the psychological factors and not merely the physical symptoms. For Asian American men experiencing muscle dysmorphia, he calls for “creating a robust identity for their ethnic and cultural background,” which is so often shamed or denigrated in a majority-white culture. Celebrating the strengths of a specific identity could help to reduce the sense of cultural weakness that contributes to muscle dysmorphia among minorities.

Stoick, who is now nearing 30 and works as an engineer in Chicago, says that his recovery from muscle dysmorphia hasn’t been a quick fix. While he knows that some anxiety related to body image will always be with him, he’s found a more balanced approach to health. He does yoga, indoor rock climbing, and cycling—things that aren’t exclusively about building muscle. He’s also been meditating for seven years, which he finds useful because it “allows you to separate your identity from your thoughts and emotions.” He recognizes that emotions were at the heart of his old obsession with muscularity. “It’s always a spectrum” between healthy and obsessive, he says. “But the spectrum shifts over time.”

If you or some you know shows symptoms of muscle dysmorphia, find help at the International OCD Association.