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Body Image Exercise Fitness Competitions Men

Muscle Dysmorphia in Male Bodybuilders

Over the past few decades there has been an increase in the exploitation of male body image insecurities. Thanks to an aesthetics driven media and a $100 billion-dollar global fitness industry, men are now more than ever under pressure to conform to a certain type of physique.1

This means that body dysmorphia is a growing issue amongst men, who compare themselves to society’s idea of the perfect masculine body. Today, men are told that they should be muscular and lean, with a chiselled jaw and six pack abs.

23 years ago, the trend to embody this muscular ideal led to the diagnosis of a new body dysmorphia subtype. This was known as muscle dysmorphia (aka reverse anorexia or bigorexia). Individuals with this condition believe that their body is insufficiently muscular, regardless of actual muscle size and definition.

Male athletes are particularly vulnerable to developing muscle dysmorphia


Male athletes are particularly vulnerable to developing muscle dysmorphia, especially those who take part in aesthetic sports such as competitive bodybuilding.2 Bodybuilding epitomises the social ideal of muscularity: it is a sport judged solely on appearance.

When muscle dysmorphia first entered the literature in 1997, it was introduced as an aspect of what was coined the Adonis Complex by Harvard professors Harrison Pope et al. Their work documented the body dissatisfaction experienced by millions of men worldwide which led to ‘compulsive weightlifting and exercising, steroid abuse, eating disorders, and body dysmorphic disorder.’3

Muscle dysmorphia has also been placed on the obsessive compulsive disorder spectrum. This is because it is characterised by obsessive thoughts of increasing muscularity and reducing body fat, and a compulsive drive to achieve these goals. These compulsions assume the form of camouflaging; and repetitive body checking behaviours, such as measuring the size of muscles, flexing muscles in the mirror and frequent weighing.


CRITERIA


Despite its somewhat confused aetiology, muscle dysmorphia is now included in the DSM V as a form of body dysmorphic disorder. In order to be diagnosed, individuals must meet two of the following four criteria:


1: The individual frequently gives up important social, occupational or recreational activities because of a compulsive need to maintain their workout and diet schedule.

During my own research, all bodybuilders confessed that they are obsessed with training, and frequently turn down or cancel social events because of their weight lifting regime. Training also significantly interferes with their jobs and their relationships. If they are forced to forego a training session, athletes experience depression and anxiety and feel compelled to make up for the missed workout.

2: The individual avoids situations where their body is exposed to others, or endures such situations only with marked distress or intense anxiety.


In Pope’s original research, 88% of men with muscle dysmorphia reported being afraid to take their shirt off in public.4 This is also true of the bodybuilders I interviewed. Despite being able to stand on stage in nothing but the smallest of shiny posing trunks, they otherwise avoid situations or activities, such as swimming, where their bodies would be exposed.

They fear appearance-based rejection


This anxiety may originate from a desire for social acceptance. Meeting sociocultural expectations means that they are rewarded with encouragement in the form of attention and compliments. Conversely, if they do not feel that their bodies are lean enough, or muscular enough then they fear appearance-based rejection.

3: The preoccupation about the inadequacy of body size or musculature causes clinically significant distress or impairment.

Despite other people commenting on their muscle mass, all of the bodybuilders who took part in my research believe that they are insufficiently muscular. They even confessed to hating their bodies and are constantly preoccupied with negative body-image related thoughts. One study found that men with muscle dysmorphia spent more than five hours a day worrying that they are not muscular enough.5

Competitive bodybuilders have high standards of physical perfection that leads to comparison and self criticism

Competitive bodybuilders set themselves such high standards of physical perfection that it leads to relentless comparison and self criticism. The nature of competitive bodybuilding lends itself to this kind of judgement since competitor’s physiques will be compared to determine who goes home with the winning trophy.

The belief that they are insufficiently muscular has a direct effect on bodybuilders’ mental health, leading to lack of confidence, low self-esteem and anxiety.

4: The individual continues to work out, diet or use performance-enhancing substances despite knowledge of adverse physical or psychological consequences.6

Despite being aware of the risks, bodybuilders make conscious decisions to engage in health-compromising practices. These include excessive training, extreme dieting and anabolic steroid use.

Aside from a decrease in physical performance, excessive strength training can cause a wide range of adverse health effects. These include ‘adrenal insufficiency, chronic injuries, gastrointestinal distress, and immune dysfunction.’7 These conditions occur because the human body is not naturally designed to endure such large physical stress.

CAUSE

The cause of muscle dysmorphia is multifaceted with various cognitive, biological, psychological and sociocultural factors that influence its expression

The biological model proposes that the condition may be ‘a problem of somatoperception’ (a problem with knowing your own body). This is thought to be ‘related to organic lesions or processing issues in the right parietal lobe of the brain.’8

Other research suggests that some individuals have a genetic predisposition to developing muscle dysmorphia. This biological theory also involves an environmental component since it proposes that the condition only emerges following exposure to certain trauma such as domestic violence, physical assault, bullying or abuse.


Given the correlation between muscle mass and strength, it is understandable how the desire for a strong, muscular body may be a reaction to physical abuse or feelings of vulnerability. Being muscular is a way of safeguarding and defending oneself against future mistreatment.

Several of my interviewees had experienced bullying and even serious trauma, leaving one man I spoke to suffering from complex PTSD. He confessed that his muscular physique makes him feel more able to protect himself, and others: it is his ‘safety blanket.’

Athletes tend to have psychological factors that predispose them to muscle dysmorphia

In addition, athletes tend to have psychological factors that predispose them to muscle dysmorphia, such as perfectionism and high levels of competitiveness.9 These are linked in the world of competitive bodybuilding where success depends upon having a perfect, balanced physique.

TREATMENT

Despite its increasing prevalence and potentially serious consequences, muscle dysmorphia goes largely untreated. This is partly because it is difficult to diagnose.

Identifying the disorder can be problematic since competitive bodybuilders have an outward appearance of health

The characteristics that are associated with muscle dysmorphia, such as exercise and good nutrition, along with the discipline and motivation required to build a muscular physique, are typically viewed as positive traits.

Even if individuals with muscle dysmorphia are aware that they might need some kind of intervention, many are ashamed of their condition. There are social taboos both against men having body image concerns in the first place, and also against expressing their feelings about them.

Current treatment methods are the same as those prescribed for general body dysmorphia. These include cognitive behavioural therapy and antidepressant medications.10 Their efficacy remains controversial, however, and the relapse rate is high.11

Regarding future diagnosis and treatment, it is important that fitness coaches and health care professionals are informed about the signs and symptoms of muscle dysmorphia; and its potential dangers. This will enable them to identify who may be at risk and to prescribe the correct treatment.

There has to be a paradigm shift in how male bodies are portrayed

In order to tackle muscle dysmorphia on a wider sociocultural level, however, ultimately there has to be a paradigm shift in how male bodies are portrayed by media and advertising. It is important for us to remember that while Adonis was a demigod, everyone else is only human.


  1. https://www.businessinsider.com/fitness-has-exploded-into-a-nearly-100-billion-global-industry-2019-9?r=US&IR=T
  2. https://journals.sagepub.com/doi/pdf/10.1177/1557988318786868
  3. https://www.researchgate.net/publication/247715403_The_Adonis_Complex_The_Secret_Crisis_of_Male_Body_Obsession_Looking_Good_Male_Body_Image_in_Modern_America_Making_the_Body_Beautiful_A_Cultural_History_of_Aesthetic_Surgery_Body_Modification
  4. Pope, H.G.; Phillips, K.A.; Olivardia, R, The Adonis Complex: How to Identify, Treat, and Prevent Body Obsession in Men and Boys (Touchstone, New York, 2000)
  5. Pope, H.G.; Phillips, K.A.; Olivardia, R, The Adonis Complex: How to Identify, Treat, and Prevent Body Obsession in Men and Boys (Touchstone, New York, 2000)
  6. https://www.researchgate.net/publication/23225701_Bigorexia_Bodybuilding_and_Muscle_Dysmorphia
  7. http://darwinian-medicine.com/the-dangers-of-excessive-strength-training/
  8. https://ziggibson.wordpress.com/2017/02/05/muscle-dysmorphia-and-the-adonis-complex-mirror-mirror-on-the-wall-why-am-i-not-the-biggest-of-them-all/
  9. https://en.wikipedia.org/wiki/Muscle_dysmorphia
  10. http://eprints.worc.ac.uk/4859/1/Muscle%20Dysmorphia%20Current%20insights.pdf
  11. https://ziggibson.wordpress.com/2017/02/05/muscle-dysmorphia-and-the-adonis-complex-mirror-mirror-on-the-wall-why-am-i-not-the-biggest-of-them-all/
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.