Muscle dysmorphia: Recognising a growing problem among young men

Amanda Lyons

6/08/2018 12:26:34 PM

Dr Scott Griffiths, a psychologist and NHMRC Fellow at the University of Melbourne, wants GPs to know that eating and body image disorders are not just women’s issues – or always about keeping thin.

Psychologist Dr Scott Griffiths said the best place to start when trying to understand muscle dysmorphia ‘is to think of it as a reverse form of anorexia’.
Psychologist Dr Scott Griffiths said the best place to start when trying to understand muscle dysmorphia ‘is to think of it as a reverse form of anorexia’.

A teenage boy starts locking himself in his room every evening after dinner to lift weights.
A young man gets stressed when dinner for his girlfriend’s birthday keeps him away for the gym for a night.
A ‘ripped’ guy sits on his towel at the beach, carefully removing a stack of containers from a plastic bag, each containing a component of the classic body builder’s diet: boiled chicken, broccoli and brown rice.
All of these actions might simply show an interest in health and fitness. But they may also be indicators of a growing problem among young men: muscle dysmorphia, colloquially known as ‘bigorexia’.
‘The best way to begin to understand muscle dysmorphia is to think of it as a reverse form of anorexia,’ Dr Scott Griffiths, a psychologist and National Health and Medical Research Council Fellow at the University of Melbourne, told newsGP.
‘Muscle dysmorphia is like that preoccupation with thinness, but taken to the other extreme with muscularity.
‘Instead of abusing laxatives and diuretics to try and lose weight, someone with muscle dysmorphia is likely to abuse anabolic steroids to try and gain weight and muscle.’
There are other key differences between people who experience anorexia and muscle dysmorphia, the level of acute danger chief among them. Dr Griffiths points out that people with muscle dysmorphia can’t starve to death, for example; however, the condition can be psychologically debilitating and, if steroids are involved, it can become more physically and emotionally dangerous.
‘If guys are on steroids, they have a huge amount of testosterone in their system,’ Dr Griffiths said.
‘All that testosterone is being converted into oestrogen as well, so you have massive fluctuations in testosterone that are 20–30 times higher than in a normal person, translating through to levels of oestrogen that can also be 20–30 times higher than that of a normal person. During this time, muscles will lose size and strength.
‘It is a recipe for steroid dependence and all sorts of emotional upheaval, including suicidal ideation and behaviour.’
Steroid use – as detailed by seizures of the drugs by customs agents, and the numbers of users accessing needle and syringe programs – has been steadily increasing within Australia.
Dr Griffiths, who is currently running a longitudinal study called EMAROID to track the mental health of steroid users when they cycle off the drugs, believes these rising numbers reflect a growth in body image issues among men.
‘If we believe that new injection drug users are the canary in the coalmine for where drug use is going, then anabolic steroids is the modern-day, contemporary drug problem,’ he said.
‘We have to ask ourselves, do we really believe that it’s all wannabe amateur athletes, or is there something else driving it?
‘I think many boys just don’t like the way they look and are desperate to do something about it.’
However, the problems of many men with body image issues remain hidden, for two major reasons: an obsession with muscularity is not necessarily perceived as a problem, and gendered notions of behaviour in our culture suggest these types of issues are only experienced by women and girls.
‘When it comes to the domain of eating and body image disorders, men are less likely to recognise those problems in themselves,’ Dr Griffiths said. ‘Also, health professionals are less likely to recognise or ask about them. Plus, the way [muscle dysmorphia] manifests, and the distinction of it from eating and body image disorders like anorexia, compels [people] to think it’s not a problem.
‘Even if men do think it’s a problem, the act of going to see a GP or a psychologist to talk about it is still at odds with traditional understandings of masculinity that are underpinned by self-reliance.
‘In combination, that means that very few men come forward, which contributes to this sense that there’s not many men feeling it, or it’s not a big problem.’
But Dr Griffiths believes muscle dysmorphia can not only be a significant problem, but that it is also an increasingly common one.
‘Eating disorder behaviours are increasing faster in prevalence in men than in women,’ he said.
When looking at what is driving these increases, Dr Griffiths believes the images people absorb through the media and the influence they have on us as children play a strong part.
‘Studies of the bodies depicted in traditional media like TV, music, comic books, are all pretty clear that those depictions have become more muscular across recent decades,’ Dr Griffiths said.
‘For example, the action figures of even 30 years ago are notably less muscular and less disproportionate than the ones we currently market to young kids.’
The rise of social media has made these influences even more pervasive.
‘It’s not just the types of bodies that are depicted in media; it’s the access and the omnipresence of it,’ Dr Griffiths said.
‘It is now the case that 99% of young people are on social media, and the images that they put on social media, especially of themselves, are to a large degree curated. Because everyone understands, at least implicitly, that you are under constant evaluation and scrutiny when you are on social media.
‘And the advent of things like “thinspiration” and “fitspiration”, which are, by definition, very glorified images of bodies and dieting and exercise and the holier-than-thou value that these bring to one’s life, are a manifestation of the anxieties people feel around their bodies.
‘This means that the media climate is now generally quite hostile for the wellbeing of both boys and girls with respect to their body image.’
Dr Griffiths believes it is important for healthcare professionals who suspect muscle dysmorphia to tread carefully in order not to pathologise behaviour that is not necessarily problematic, and suggests two important ways to distinguish someone experiencing the condition from a fitness enthusiast.
‘One of the phenomena that comes up is negative emotions following any break in exercise or diet,’ he said.
‘So something comes up unexpectedly and you can’t go to the gym that afternoon. How does it make you feel – a passing disappointment that you’ve broken the routine, or an anxiety or dread that doesn’t go away? Can you not stop thinking about getting back into the gym during the time you’re doing the other thing? Do you find yourself in arguments with people around you about prioritising the gym over these other ostensibly important things?
‘If the answer is yes, those are red flags.
‘The other one is training through injuries. If you or I were in the gym and we tweaked a muscle and it hurt, we might think, “I should stay off of this muscle, or even out of the gym, until it feels better”.
‘But if your self-esteem is entirely wrapped up in the size of your muscles, that is really hard to do. You will almost feel panic and a despondency, “My muscles are going to shrink over the next few days and I’m going to have to do something else to compensate for it”.
‘That type of thinking and constant injuring and re-injuring because you don’t take time to heal is quite characteristic of muscle dysmorphia.’
Dr Griffiths believes it is important for healthcare professionals to set aside notions that eating and body disorders are a female-only domain, and to ask male patients directly if they suspect these concerns are relevant.
‘Ask that question outright, “Do you sometimes feel unhappy with how your body looks?” and then offer a statement in validation of those feelings,’ he said. ‘Because that could be the only, or one of the very few times, a boy has had his concerns about his appearance validated like that.’
Dr Griffiths has found treatment that has already been developed for other eating and body image disorders such as anorexia and bulimia is generally effective for muscle dysmoprhia.
‘GPs don’t have to have the answer right there, they can use the same pathways they were using for people who were worried about wanting to be super-thin, even if most of those were girls. Those avenues will be useful for people who are worried about being muscular, even if the majority of those are guys,’ he said.
‘It doesn’t demand a reinvention of the wheel; those mechanisms and avenues are getting stronger. The Butterfly Foundation is all across muscle dysmorphia now, for example.’
Dr Griffiths believes the growing numbers of men experiencing muscle dysmorphia is an indicator of the way eating and body image disorders change and develop with the society that surrounds them.
‘Eating disorders as a psychiatric illness are not static, they will continue to change as the types of bodies we hold up as the pinnacle of what you can achieve changes, as well,’ he said.
‘That means eating disorders are a moving target and we have to stay on top of them.’

body image disorders eating disorders muscle dysmorphia steroids

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Luke Evans (student RN)   8/08/2018 8:07:47 AM

Excellent article, Amanda. Thank you for providing information on this increasingly common form of body dysmorphia. All too often, body image and eating disorders are still collectively viewed as exclusively the domain of the young, anorexic woman.