Categories
Body Image Eating Disorders Fitness Competitions Recovery

Mirror, Mirror on the Wall: Body Dysmorphia

BODY IMAGE

Body image is defined as ‘the subjective personal interpretation of an individual’s body.’1 It consists of our thoughts, feelings and perceptions of our own bodies.

More than 75% of us have some kind of body obsession

Most of us are unable to ‘see’ our bodies as they really are. Distortion of body image is a pervasive cultural dysmorphia, with more than 75% of us having some kind of body obsession.

In some cases, body dissatisfaction may develop into Body Dysmorphic Disorder. This occurs in approximately 1% of the adult population2 and is defined as ‘intrusive images, thoughts, or urges centred on body image.’3

Body dysmorphia is the most widely known contributor to the development of disorderly eating behaviours, affecting 39% of inpatients with anorexia nervosa.

WHY WE ARE SO BODY OBSESSED

From a sociocultural perspective, our perception of how we look may become distorted because we are constantly exposed to images of ‘ideal bodies’.

In 2021, value is placed upon the slender, fit bikini body, a physique which is portrayed as the ticket to wealth, success and social approval.

The widespread distribution of this body ideal across print and online media inevitably stimulates comparison: we are socially conditioned to evaluate and measure ourselves against this idea of perfection.

There is often a mismatch between what society dictates we should look like, and how our bodies really appear

This comparison leads to body dissatisfaction since there is often a mismatch between what society dictates we should look like, and how our bodies really appear.

Dissatisfaction with appearance is one of two disturbances in body image that will be addressed in this article.

DISSATISFACTION WITH APPEARANCE

During my research on the subject of body image, I asked 50 women: ‘if it were possible, which part of your body would you change?’

The most common answer was ‘stomach,’ a physical aspect with which I have also had a lifelong fixation. My midsection is where my body tends to store fat; and, having had an eating disorder for 26 years, I also suffer from chronic bloating and distension.

Anorexics can feel relaxed only if the stomach is completely flat

This obsession with my stomach began aged 11 when I first developed anorexia nervosa. This is typical of this form of eating disorder, with many anorexics suffering from ‘persistent anxiety that eating may stretch the stomach or make it bulge; they can feel relaxed only if the stomach is completely flat.’4

The women who I interviewed also expressed a desire to change their legs, particularly their thighs; their breasts that were believed to be either too big or too small; their glutes that needed to be ‘firmer’; and their bingo wings. Three women said that would change everything.

Of the 50 interviewees, only one said that she would not change any part of her body.

BODY CHECKING

For those of us who are unhappy with aspects of our physiques, we may manage our appearance by excessive body checking. This includes measuring, weighing and constantly looking in the mirror.  

Keeping bodies under surveillance through mirrors can develop into a compulsion. For as long as I can remember, I have always checked my appearance (particularly my stomach) every time that I catch my reflection in a mirror or shop window.

The reason why we look in the mirror multiple times a day is to seek reassurance that we are still the same: to check that our bodies have not suddenly gained 10llbs in the last half hour.

If we feel like we are bigger, or more wobbly than we imaged, however, we then take action to ‘correct’ our bodies in the form of dieting and exercise.

Many of us are aware that there is a disjunction between how we perceive our reflected image, and the reality of our appearance

For those who suffer from body image distortion, many of us are aware that there is a disjunction between how we perceive our reflected image, and the reality of appearance. One woman I spoke to admitted: ‘even though I know I’m not overweight, when I look in the mirror I see a much larger person looking back at me.’

APPEARANCE AS IDENTITY

The second aspect of body image distortion is defining our identity in terms of our appearance.

So strong is our desire for social belonging that we alter our bodies to meet the physical ideal

Modern society holds beauty in high regard as a necessary trait; and so strong is our desire for social belonging that we alter our bodies to meet the physical ideal.

This need to be accepted within our social group is driven by a biological urge, and positively reinforced by the encouragement we receive when our bodies conform to cultural standards.

For example, in Western society, weight loss is often praised, with an individual’s ‘after’ pictures often receiving ‘likes’ and compliments. In addition, in the world of fitness competitions, many federations include a transformation category where the prize is awarded to the most drastic physical change. The more weight lost, the better.

This attention served to validate my efforts to emulate the beauty idea, and strengthened my resolve to work even harder

This type of appearance-based approval can be very seductive. In 2015, I was in the best physical shape of my life and became a Pro Bikini Competitor. Subsequently, I received frequent compliments on my physique; and comments praising my willpower and dedication. This attention served to validate my efforts to emulate the beauty ideal, and strengthened my resolve to work even harder.

Being a competitor became my identity.

Basing your identity and self esteem on something as transient as your appearance, however, is a risky business: something that I discovered the hard way.

After being starved and dehydrated for show day, returning to a more ‘normal’ diet following a competition causes the body to react by storing water and rapidly gaining weight.

This weight gain can exacerbate a competitor’s body dysmorphia since they compare their now now heavier, softer physique to what they looked like onstage. Many of my fellow competitors told me that during this post-competition period they usually ‘feel fat,’ and some even ‘hate’ their bodies.

They also reported being concerned about other’s people’s judgements of their figures: they fear that they will fail to live up to others’ expectations of how they ‘ought’ to look.

Basing your identity on your appearance makes you incredibly vulnerable

Basing your identity on your appearance, therefore, makes you incredibly vulnerable. In my case, losing my stage physique had a direct effect on my confidence; and triggered my most severe relapse into anorexia nervosa to date.

CONCLUSION

Now, 5 years into my recovery, I would like to share four things that I have learnt during my ongoing journey towards body acceptance:

  1. The way that we perceive our bodies is not necessarily reality.
  2. We tend to fixate on aspects of our bodies that cause us concern. The more we hone in on these aspects, however, the worse they will seem. So take a step back and look at your body as a whole; or, better still, avoid looking at your body at all.
  3. The closer I became to achieving my idea of a perfect body, the more miserable and anxious I felt. Having the ‘ideal’ body does not make you happy: in my case, it had the opposite effect.
  4. Happiness and self-worth need to come from something other than your appearance. For me, this is still a work in progress but I am getting there.  

In conclusion, it all comes down to the way we feel. When we look in the mirror, the reflected image is distorted by how we feel about our appearance.

It is not our bodies that require alteration, but our perceptions of them

While we are waiting for society to shed the beauty ideals that inform these feelings, we can remind ourselves that it is not our bodies that require alteration, but our perceptions of them. And we can change these by done by working on accepting our bodies, just the way they are.


  1. The Journal of Psychology
  2. Phillips, Katherine, ‘Fixing the Broken Mirror: Body Dysmorphic Disorder’, http://www.psychweekly.com/aspx/article/ArticleDetail.aspx?articleid=112
  3. Nussbaum, Abraham, The Pocket Guide to the DSM-5 Diagnostic Exam, American Psychiatric Publishing (Washington; London, 2013)
  4. Bruch, Hilde, The Golden Cage: The Engima of Anorexia Nervosa (Cambridge: Harvard University Press, 1978; 2001)

Categories
Body Image Eating Disorders Exercise Men Recovery

Freddie Flintoff: Men and Eating Disorders

CW: details of purging behaviours.

In the BBC One documentary ‘Living with Bulimia,’ former England Cricket Captain Andrew ‘Freddie’ Flintoff speaks openly for the first time about his 20 year struggle with the eating disorder bulimia nervosa. In the programme, he gives an honest account of his experiences with body dysmorphia, self-induced vomiting and compulsive exercise, which began during his cricketing career when his weight came under scrutiny from the British media.

Today 1.5million people in the UK are reported to have bulimia, 25% of which are men. The actual number of male sufferers, however, is likely to be much higher: a 2007 study suggests that it is closer to 40%.1

Eating disorders are often considered to be female illnesses

The reason why this condition often goes unreported is owing to sex-related stigma. Eating disorders are often considered to be female illnesses, meaning that only 10% of men pursue treatment. Flintoff himself was prevented from disclosing his bulimia owing to his dietician’s discriminatory attitude towards men and eating disorders.

Until being interviewed for this documentary, Flintoff kept his eating disorder secret for 2 decades. Ashamed of his condition, he still finds it difficult to even say the word, ‘bulimia.’ Instead, he refers to it as ‘being sick’.

The secrecy and shame associated with bulimia gave him the sense of having a duel identity. Publicly, Freddie Flintoff is a famous TV presenter and international sportsperson; but privately, he suffers from such low self-esteem that he is compelled to vomit after every meal.

When he began his sporting career age 16, Flintoff had what he describes as a ‘skinny’ physique.2 At this time he became aware of the difference between his own teenage body and those of his teammates, who, in comparison, were more muscular.

The British press christened him ‘The Fat Cricketer’

Over the next few years, Flintoff consequently attempted to increase his size in order to have ‘more presence’.3 Yet, he was not fully aware of how much weight he had gained until his appearance caught the attention of the British press who christened him ‘The Fat Cricketer.’ It was this weight shaming that was the trigger for his 20 year long struggle with bulimia.

By shaming Flintoff for his weight gain, the media reinforced the idea that a professional sportsperson should have a certain type of body, i.e. lean and athletic. Because he did not accord with their aesthetic ideal, Flintoff was publicly humiliated.

This type of discrimination has been documented as posing a significant threat to psychological and physical health; and is also a risk factor for depression, low self-esteem, and body dissatisfaction.4

It is often weight stigma that causes eating disorders

As in Flintoff’s case, it is often weight stigma that causes eating disorders. It was only after the press commented on his appearance that he became concerned about his size. Constantly under the scrutiny of the public eye and known as ‘Fat Flintoff’, Freddie consequently began engaging in destructive behaviours in order to lose weight, making himself sick after every meal.

This behaviour was reinforced by a subsequent improvement in his cricket performance and positive attention from the previously critical British media. This, therefore, confirmed his idea that a trimmer physique was his ticket to increased sporting performance and social approval.

Flintoff also admits that he derived a ‘perverse’ enjoyment from the act of purging itself. He describes it as being addictive, a descriptor commonly used by patients with bulimia since purging activates the opioid (or addictive) part of the brain.5 For many individuals, being sick often provides feelings of comfort, euphoria or instant relief, which makes it difficult to stop.6

Although Flintoff states that he currently has his vomiting under control, he still purges via excessive exercise by carrying out an hour of fasted cardio every morning, becoming anxious if he is unable to train.

Amongst male athletes like Flintoff, purging can lead to serious outcomes that may affect their particular sport. These include ‘increased susceptibility to injury, inconsistent performance, problematic recovery [and] muscle deficiencies.’7

He still experiences guilt and an urge to make himself sick

Although his eating disorder is now functional, in addition to carrying out compulsive exercise, he still experiences guilt and an urge to make himself sick after eating.

Despite these symptoms, however, Flintoff questions whether he is in need of treatment. His claims that he is in control of his eating disorder and can stop whenever he wants, however, are inconsistent with his previous comments that he feels out of control and isn’t able to stop.

Despite bulimia’s medical diagnosis, Flintoff continues to perceive the condition, not as an illness, but part of who he is. It is perhaps owing to his strong identification with his eating disorder that he has not yet made a full recovery. Believing that it is an inherent aspect of his personality means that he will not be open to change.

 ‘Gaining weight would be his worst nightmare’

Flintoff’s reluctance to seek help also seems to be driven by the fear of renouncing his purging behaviours since, as he states, ‘gaining weight would be [his] worst nightmare’.8 Yet, this help can be vital, since ‘almost half of all people with bulimia will not recover without treatment’.9

The importance of Freddie Flintoff sharing his story is that not only is it a stepping stone towards his own recovery; but it will also help to break the stigma surrounding gender stereotypes and eating disorders, and encourage more men to seek the help that they need.


  1. https://www.nationaleatingdisorders.org/blog/males-dont-present-females-eating-disorders [accessed 30 September 2020]
  2. Freddie Flintoff: Living With Bulimia, BBC Television, 28 September 2020
  3. Freddie Flintoff: Living With Bulimia, BBC Television, 28 September 2020
  4.  Andreyeva, T., Puhl, R. M. and Brownell, K. D. (2008), Changes in Perceived Weight Discrimination Among Americans, 1995–1996 Through 2004–2006. Obesity, 16: 1129–1134. doi:10.1038/oby.2008.35
  5. https://eating-disorders.org.uk/information/bulimia-nervosa-a-contemporary-analysis [accessed 30 September 2020]
  6. https://mirror-mirror.org/eating-disorders-2-2/bulimia-nervosa [accessed 30 September 2020]
  7. https://journals.sagepub.com/doi/full/10.1177/1941738120928991 [accessed 30 September 2020]
  8. Freddie Flintoff: Living With Bulimia, BBC Television, 28 September 2020
  9. https://eating-disorders.org.uk/information/bulimia-nervosa-a-contemporary-analysis/ [accessed 30 September 2020]

Categories
Body Image Dieting Eating Disorders Exercise Fitness Competitions Recovery

Hanging Up The Bikini: Why I Quit Competing

CW: details of eating disordered behaviours.

In October 2014, at age 31 I achieved the award that marked the pinnacle of my fitness competition career: the coveted Bikini Athlete Pro Card. Standing onstage in a Hertfordshire theatre, smiling for the winner’s photographs, I appeared the epitome of health and fitness. But, in reality, I was suffering from serious physical and mental damage.

Entering the world of fitness competitions triggered a major relapse

I have had a disordered relationship with food since I developed anorexia at the age of 11. Over the years, I have also suffered from body dysmorphia and bulimia. When I was in my late 20s, entering the world of fitness competitions triggered a major relapse into these destructive patterns of eating.

I am second from the left

Fitness competitions are a misnomer. The irony of these events lies in the very title itself: fitness is not necessarily synonymous with health. I was a fitness model, yet I was far from fit. I ignored my body’s appeals for food and rest, and instead rigidly adhered to punishing diet and training regimes in the hope that they would make me muscular and lean.

In the fitness world, disordered eating is extremely common

These types of strict routines mean that most competitors become disconnected from their bodies and what they truly need. Unsurprisingly, therefore, in the fitness world disordered eating is extremely common. Female athletes have the same risk factors as women in the general population, supplemented by the additional risk of reducing their body fat to dangerously low levels.

Body fat is decreased during the final stage of competition preparation, which is masochistically known as ‘cutting’. This typically begins eight to twelve weeks prior to a show, depending on the amount of fat that must be lost in order to create a winning physique.

This process increases the female competitor’s susceptibility to three inter-related disorders, known as the Female Athlete Triad. The components of the triad are osteoporosis, amenorrhea and disordered eating.

Osteoporosis occurs because limiting calorie intake leads to a decreased production of the hormone oestrogen. Since oestrogen plays a crucial role in calcium resorption and bone growth, reduced levels can lead to brittle bones.

Even though I was following an extremely restrictive diet, I naively thought that any damage would be offset by my strength training which typically increases bone density. After competing, however, I had a bone density (DEXA) scan, which revealed that my bone density was borderline abnormal.

This was the last time I lost my period before I learned that I was infertile


Not only does a low level of oestrogen lead to brittle bones, it also causes menstrual dysfunction where the cycle can be delayed, or can stop altogether (known as amenorrhea). Owing to my restrictive eating habit, I have lost my period on numerous occasions over the past two decades.

When I experienced amenorrhea during competition preparation, however, this was the last occasion before I learned that I was infertile. Three very costly and emotionally traumatic in vitro fertilization (IVF) cycles later, and I am still waiting for my miracle baby.


While osteoporosis and amenorrhea are widely experienced by female athletes, the most common aspect of the triad is disordered eating. This includes extreme calorie restriction, binge eating, and purging via excessive exercise or self-induced vomiting. These abnormal patterns of behaviour are caused by the strict nutritional regime required during competition prep.

My own insubstantial food plan exacerbated my pre-existing patterns of disorderly eating. I was so hungry that I couldn’t keep any ‘forbidden’ food items in the house since I had moments of ‘weakness’, where I would ‘give in’ and binge. A teaspoon of peanut butter could easily become a whole jar.

I unsuccessfully attempted to alleviate my troublesome appetite by drinking litres of cherry Pepsi max and chewing sugar free gum. The Pepsi, however, gave me headaches and heart palpitations; and I chewed so much gum that I eventually wore away my teeth and had to have most of them filled.

Hunger increases during the final weeks of preparation, when carbohydrates are drastically decreased in order to boost fat loss. Reducing carbohydrates to less than 20g per day releases ketones which the body can then use as fuel. This process produces various side effects, however, including nausea, headaches and fatigue.

This established a pattern of eating which would later turn into a vicious cycle of restriction and binging

In order to avoid these undesirable symptoms, competitors typically cycle carbohydrates. This involves enduring several consecutive low carbohydrate days, followed by a high carbohydrate ‘refeed’ day to aid metabolism and ensure continual fat loss. I didn’t know at the time, but this established a pattern of eating which would later turn into a vicious cycle of restriction and binging.

In the end, all my hard work paid off. I won. And I was awarded my Pro Card. But was it worth it? On show day, the audience admire and applaud your physique. But they don’t see behind the curtain. They don’t see what it takes to be that woman holding the trophy. And they don’t see what happens afterwards.


Stepping off stage was the beginning of a relapse into my most serious and dangerous anorexic phase to date.


Terrified of losing my stage physique, I continued to restrict my calorie intake over the next couple of years. I lost body fat, and I also lost the muscle that I worked so hard to gain. My body literally ate itself. My glutes, the prize aspect of every bikini competitor, became saggy and deflated. My coccyx was so bony that I had to sit on a cushion. I was constantly cold from the inside out and handfuls of my hair fell out in the shower. I couldn’t go to the gym; I couldn’t even walk 10 minutes to the shop without feeling faint.

Eventually, my internal organs began to shut down and my hormones stopped functioning. I developed bradycardia because the muscles in my heart had shrunk.

I lost over 2 stone (12.7kg) before I was admitted into an eating disorders hospital, where I spent 18 months as an outpatient. I was emaciated and mentally broken, a shadow of the woman who triumphantly raised the winning trophy.

In my experience, having your dream body does not make your life better. For me, it did exactly the opposite.

Whether you are preparing for a fitness competition, or just trying to manipulate your body through diet and exercise, I hope this has brought attention to the physical and emotional damage that can be caused by valuing aesthetics over mental health.

I am now working towards food freedom and body acceptance. I still have my competition bikini as a memento, but its time in the spotlight is over and it is resolutely HUNG UP.